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Seeding of body cavities and surfaces (transcoelomic spread) this seeding may occur wherever a malignant neoplasm penetrates into a natural "open field" are erectile dysfunction drugs tax deductible buy viagra with dapoxetine 100/60mg on-line. Most often involved is the peritoneal cavity enlarged prostate erectile dysfunction treatment order viagra with dapoxetine 100/60mg line, but any other cavities such as pleural impotence pump buy cheap viagra with dapoxetine 100/60mg, pericardial erectile dysfunction treatment in kenya purchase 100/60 mg viagra with dapoxetine with amex, sub-arachnoid and joint spaces-may be affected. Particular examples are krukenberg tumour that is a classical example of mucin producing signet ring adenocarcinomas arising from gastrointestinal tract, pancreas, breast, and gall bladder may spread to one or both ovaries and the peritoneal cavities. The other example is pseudomyxoma peritoni which are mucus secreting adrocarcinoma arising either from ovary or appendix. These carcinomas fill the peritoneal cavity with a 194 gelatinous soft, translucent neoplastic mass. Lymphatic spread Lymphatic route is the most common pathway for the initial dissemination of carcinomas the pattern of lymph node involvement follows the natural routes of drainage. Lymph nodes involvement in cancers is in direct proportion to the number of tumour cell reaching the nodes. Due to numerous inter connections between vascular and lymphatic channels the emphasis that used to be given, lymphatic spread for carcinomas and vascular spread for sarcomas is misreading. Metastasis to lymph nodes first lodge in the marginal sinus and then extends throughout the node. The cut surface of this enlarged lymph node usually resembles that of the primary tumour in colour and consistency. The best examples of lymphatic spread of malignant neoplasm can be exemplified by breast carcinoma. Skip metastasis happen to occur because of venous lymphatic anastomoses or because inflammation or radiation has obliterated the lymphatic channels for example abdominal cancer (gastric cancer) may be initially signaled by supra clavicular (sentinel node). A clinical presence of enlarged lymph node is not necessarily synonymous with a metastasis. Conversely, the absence of tumour cells in reseated lymph nodes does not guarantee that there is no underlying cancer. Hematogenous spread Typical for all sarcomas and certain carcinomas- the spread appears to be selective with seed and soil phenomenon. Lung & liver are common sites of metastasis because they receive the systemic and venous out flow respectively. In the circulation, tumour cells form emboli by aggregation and by adhering to circulating leukocytes particularly platelets. The site where tumour cell emboli lodge and produce secondary growth is influenced by · · · Vascular (and lymphatic) drainage from the site of the primary tumour Interaction of tumour cells with organ specific receptors the microenvironment of the organ or site, example a tissue rich in protease inhibitors might be resistant to penetration by tumour cells. Cancer Epidemiology the only certain way to avoid cancer is not to be born, to live is to incur the risk. Over the years cancer incidence increased in males while it slightly decreased in females (due to largely screening Procedures-cervical, breast etc. In the studied populations the most common cancer in males is broncogenic carcinoma while breast carcinoma in females. Acute leukemias and neoplasms of the central nervous system accounts for about 60% of the deaths. Geographic factors (geographic pathology): Specific differences in incidence rates of cancers are seen worldwide. Inherited cancer syndromes (Autosomal dominant) with strong familial history include Familial retinoblastomas usually bilateral, and a second cancer risk particularly osteogenic sarcoma. Oncosupressor gene is the basis for this carcinogenesis 196 - Familial adenomatous polyps of the colon. Endometrial hyperplasia Cervical dysplasia Bronchial dysplasia Regenerative nodules - endometrial carcinoma - cervical cancer - bronchogenic carcinoma - liver cancer Certain non-neoplastic disorders may predispose to cancers. Chronic atrophic gastritis Solar keratosis of skin Chronic ulcerative colitis Leukoplakia of the oral cavity, vulva and penis - squamous cell carcinoma - gastric cancer - skin cancer - colonic cancer Certain types of benign neoplasms Large cumulative experiences indicate that most benign neoplasms do not become malignant. Molecular Basis of Cancer (Carcinogenesis) Basic principles of carcinogenesis: the fundamental principles in carcinogenesis include 1) Non-lethal genetic damage lies at the heart of carcinogenesis. Such genetic damage (mutation) may be acquired by the action of environmental agents such as chemicals, radiation or viruses or it may be inherited in the germ line. However, initiation alone is not sufficient for tumour formation and thus, promoters can induce tumours in initiated cells, but they are non-tumourogenic by themselves.

Sylvatic cycles may remain restricted to natural foci without spreading to domestic pigs or other domestic animals impotence gandhi buy viagra with dapoxetine 50/30 mg mastercard. They are generally killed by deep-freezing to ­25 8C within 10­20 days impotence 19 year old purchase viagra with dapoxetine 100/60mg line, although muscle larvae of the cold-resistant species T erectile dysfunction medication injection 100/60mg viagra with dapoxetine amex. The sources of human infection are raw and insufficiently cooked or frozen meat products from domestic pigs and wild boars erectile dysfunction dr. hornsby effective 50/30 mg viagra with dapoxetine, horses, and less frequently from bears, dogs, and other animal species. The severity and duration of clinical manifestations depend on the infective dose and the rate of reproduction of the trichinellae. Infections run a two-phase course: 10 Kayser, Medical Microbiology © 2005 Thieme All rights reserved. With capsule Domestic pig, rat, horse, wild boar, R: low camel, dog, red fox, bear, humans Mainly sylvatic, also synanthropic. Red fox, wolf, jackal, raccoon dog, wildcat, bears, badger, marten, rodents, domestic pig, wild boar, horse, humans Sylvatic, also synanthropic. Bear, raccoon, red fox, coyote, bobcat (Felis rufus), horse, humans Mainly sylvatic, also synanthropic. Polar fox, red fox, polar bear, wolf, raccoon dog, jackal, dog, wild boar, humans With capsule R: moderate T. Quoll (Dasyuridae), raccoon, korsak (steppe fox), rodents, bird species, (birds of prey and others), humans Sylvatic. Wild boar, domestic pig, humans Cycle in farmed crocodiles Experimental hosts: pig, rat, monkey With capsule R: none Without capsule R: none 10 Trichinella papuae Papua New Guinea Trichinella zimbabwensis Zimbabwe 1 Without capsule R:? Animals involved: synanthropic cycle: animals living in proximity to human dwellings (domestic animals, rats etc. Nematoda (Roundworms) 601 & Intestinal phase: incubation period of one to seven days. Symptoms: nau- sea, vomiting, gastrointestinal disorders with diarrhea, mild fever, and other symptoms. Symp- toms caused by invasion of body tissues by Trichinella larvae: myositis with muscle pain and stiffness, respiratory and swallowing difficulties, fever, edemas on eyelids and face, cutaneous exanthema. Further characteristic features are blood eosinophilia, raised activity of serum lactate dehydrogenase, myokinase and creatine phosphokinase, and creatinuria. It is frequently followed by recovery, but rheumatoid and other symptoms can also persist. Diagnosis during the intestinal phase is difficult and only rarely trichinellae can be found in stool or duodenal fluid. The safest methods are to boil or fry the meat sufficiently (deep-freezing may be unreliable, see above! Important disease control measures include prophylactic inspection of domestic and wild animal meat for Trichinella infection and not feeding raw meat wastes to pig livestock and other susceptible domestic animals. Infections Caused by Nematodal Larvae & Larva migrans externa and Larva migrans interna are diseases caused by 10 migrating nematode larvae. The first (externa) is a skin disease, usually caused by zoonotic hookworms or Strongyloides species. In toxocarosis the infection results from peroral ingestion of infective eggs of roundworms of the genus Toxocara that are released to the environment in the feces of dogs, foxes, and cats (infection risk for children on contaminated playgrounds! Additional diseases caused by nematode larvae & include anisakiosis, angiostrongylosis, and dirofilariosis. Other potential causative organisms include insect larvae (Hypoderma, Gasterophilus, etc. The infective larvae of the above-mentioned hookworm species can penetrate human skin (feet, hands, other body regions) upon contact with contaminated soil. These larvae rarely penetrate further into the body and normally do not reach sexual maturity in the host (however, see also p. The larvae persist in the skin for several weeks to months, and then they die (see p. The clinical presentation with many 1­2 mm wide and centimeter-long worm burrows usually suffices for a diagnosis. Recommended treatments include topical application of thiabendazole ointment (15 %), wetting with ivermectin solution, spray-freezing with ethyl chloride and peroral therapy with albendazole or ivermectin. The main causative agents of this disease are the larvae of various roundworm species from domestic and wild animals, for instance Toxocara canis from dogs and foxes, T. Angiostrongyliosis and dirofilariosis can also be included in this disease category.

If someone drinks during the day less liquid than is passed out of the body in urine and sweat erectile dysfunction causes nhs generic viagra with dapoxetine 100/60 mg on-line, he or she begins to dehydrate erectile dysfunction age generic viagra with dapoxetine 100/60 mg otc. Also called hepatitis delta delirious delirium delirium tremens delivery delivery bed delivery room delta delta hepatitis ous leishmaniasis delicate / delIkt/ adjective 1 erectile dysfunction doctors fort lauderdale cheap 100/60 mg viagra with dapoxetine with visa. Also called dendron dendritic /den drItIk/ adjective referring to a dendrite dendritic ulcer /den drItIk ls/ noun a branching ulcer on the cornea erectile dysfunction zyrtec viagra with dapoxetine 100/60 mg on line, caused by a herpesvirus dendron / dendrn/ noun same as dendrite denervation / di n veI()n/ noun the stopping or cutting of the nerve supply to a part of the body dengue / de i/ noun a tropical disease caused by an arbovirus transmitted by mosquitoes, characterised by high fever, pains in the joints, headache and rash. Also called breakdendritic dendritic ulcer dendron denervation dengue accept that he or she has a serious medical problem Denis Browne splint / denIs bran splInt/ noun a metal splint used to correct a club foot [Described 1934. Also called dental decay dental cyst / dent()l sIst/ noun a cyst near the root of a tooth dental decay / dent()l dI keI/ noun same as dental caries dental floss / dent()l fls/ noun a soft thread which can be pulled between the teeth to help keep them clean dental hygiene / dent()l haId i n/ noun procedures to keep the teeth clean and healthy dental impaction / dent()l Im p k()n/ noun a condition in which a tooth is closely pressed against other teeth and cannot grow normally dental plaque / dent()l pl k/ noun a hard smooth bacterial deposit on teeth, which is the probable cause of caries dental plate / dent()l pleIt/ noun a prosthesis made to the shape of the mouth, which holds artificial teeth dental prosthesis / dent()l prs i sIs/ noun one or more false teeth dental pulp / dent()l p lp/ noun soft tissue inside a tooth dental surgeon / dent()l s d n/ noun a person who is qualified to practise surgery on teeth dental dental care dental caries dental cyst dental decay dental floss dental hygiene dental impaction dental plaque dental plate dental prosthesis dental pulp dental surgeon tooth denture / dent/ noun a set of false teeth, fixed to a device which fits inside the mouth deodorant /di d()rnt/ noun a substance which hides or prevents unpleasant smells н adjective hiding or preventing odours deontology / di n tld i/ noun the ethics of duty and of what is morally right or wrong deoxygenate /di ksId neIt/ verb to remove oxygen from something deoxygenated blood /di ksId neIt bl d/ noun blood from which most of the oxygen has been removed by the tissues. Also called coridermatitis herpetiformis dermatodermatochalasis dermatographia dermatological dermatologist dermatology dermatome dermatomycosis dermatomyositis dermatophyte dermatophytosis dermatoplasty dermatosis dermis `. Also contact dermatitis caused by cosmetics such as toothpaste, soap, shaving creams. Compare ascending aorta descending colon /dI sendI kln/ noun the third section of the colon which goes down the left side of the body. Also called retinal detachment descending colon descending tract desensitisation desensitise designer drug desogestrel desquamate desquamation detach detached retina (1732­1810), French physician; Professor of Anatomy and Surgery in Paris. Symptoms of diabetes mellitus are tiredness, unusual thirst, frequent passing of water and sweet-smelling urine. Full form Dual EnerDexa scan dextro- /dekstr/ prefix referring to the right, or the right side of the body dextrocardia / dekstr k di/ noun a congenital condition in which the apex of the heart is towards the right of the body instead of the left. They diabetic cataract diabetic coma diabetic diet diabetic retinopathy diabetogenic diabetologist diaclasia diadochokinesis diagnose diagnosis diagnostic 108 diaphragmatic pleurisy / daIfr m tIk plrIsi/ noun inflammation of the pleura which covers the diaphragm diaphyseal / daI fIzil/ adjective referring to a diaphysis diaphysis /daI fsIs/ noun the long central part of a long bone. Compare ring to diagnosis diagnostic and treatment centre / daI nstIk n tri tmnt sent/ noun a facility mainly for day surgery or short-term stay, where a range of planned operations such as joint replacements, hernia repair and cataract removal can be undertaken. Two large electrodes will give a warming effect over a large area (medical diathermy); if one of the electrodes is small, the heat will be concentrated enough to coagulate tissue (surgical diathermy). Foods with the highest proportion of fibre include wholemeal bread, beans and dried apricots. Fibre is thought to be necessary to help digestion and avoid developing constipation, obesity and appendicitis. Abbr D & C dilate /daI leIt, dI leIt/ verb to become wider or larger, or make something become wider or larger the veins in the left leg have become dilated. The disease is also highly infectious, and all contacts of the patient must be tested. The Schick test is used to test if a person is immune or susceptible to diphtheria. Compare hemiplegia diplegic /daI pli d Ik/ adjective referring to diplegia diplacusis diplegia diplegic 111 diplo- /dIpl/ prefix double diplococcus / dIpl kks/ noun a bacterium which usually occurs in pairs as a result of incomplete cell division. Also called double vision dipsomania / dIps meIni/ noun an uncontrollable desire to drink alcohol direct contact /dI rekt knt kt/ noun a situation where someone or something physically touches an infected person or object directions /daI reknz/ noun directions for use (on a bottle of medicine, etc. If the skin on the lips is discoloured it may indicate that the person has swallowed a poison. Cardiac dissection takes about 20 minutes and lung dissection takes 60 to 90 minutes. Opposite disturb disturbed disulfiram dithranol diuresis diuretic diurnal divarication divergence divergent strabismus convergent strabismus diverticula / daIv tIkjl/ plural of diverticulum diverticular disease / daIv tIkjl dI zi z/ noun a disease of the large intestine, diverticula diverticular disease where the colon thickens and diverticula form in the walls, causing pain in the lower abdomen diverticulitis / daIvtIkj laItIs/ noun inflammation of diverticula formed in the wall of the colon diverticulosis / daIvtIkj lsIs/ noun a condition in which diverticula form in the intestine but are not inflamed. Compare recessive dolor dolorimetry dolorosa domiciliary domiciliary care domiciliary midwife domiciliary services domiciliary visit dominance dominant dizygotic / daIzaI tIk/ adjective developed from two separately fertilised eggs dizygotic twins / daIzaI tIk twInz/ plural noun twins who are not identical and not always of the same sex because they come from two different ova fertilised at the same time. Also called fraternal twins dizziness / dIzins/ noun the feeling that everything is going round because the sense of balance has been affected dizzy / dIzi/ adjective feeling that everything is going round because the sense of balance has been affected the ear infection made her feel dizzy for some time afterwards. Compare plantar flexdopaminergic Doppler transducer Doppler ultrasound Doppler ultrasound flowmeter dormant dorsa dorsal dorsal vertebrae dorsidorsiflexion Dr traIl/ noun a trial used to test new treatments in which patients are randomly placed in either the treatment or the control group without either the patient or doctor knowing which group any particular patient is in double blind study / d b()l blaInd st di/ noun an investigation to test an intervention in which neither the patient nor the doctor knows if the patient is receiving active medication or a placebo double-jointed / d b()l d IntId/ adjective able to bend joints to an unusual degree double blind study double-jointed (informal) ion dorso- /d s/ prefix same as dorsidorsoventral / d s ventrl/ adjective 1. Also called Drinker respirator drachm /dr m/ noun a measure used in pharmacy, equal to 3. Also called guinea worm dragee /dr eI/ noun a sugar-coated tablet or pill drain /dreIn/ noun a tube to remove liquid from the body н verb to remove liquid from the body an operation to drain the sinus They drained the pus from the abscess. Also called drug dependence drug allergy / dr ld i/ noun a reaction to a particular drug drug dependence / dr dI pendns/ noun same as drug addiction drug-related / dr rI leItId/ adjective associated with the taking of drugs drug tolerance / dr tlrns/ noun a condition in which a drug has been given to someone for so long that his or her body no longer reacts to it, and the dosage has to be increased drunk /dr k/ adjective intoxicated with too much alcohol dry /draI/ adjective 1. Schedule 2: drugs which can be used medicinally such as heroin, morphine, cocaine, and amphetamines: these are fully controlled as regards prescriptions by doctors, safe custody in pharmacies, registering of sales, etc.

Single gene disorders with nonclassic inheritance are rare & are briefly mentioned here venogenic erectile dysfunction treatment buy 100/60mg viagra with dapoxetine amex. Diseases associated with gonadal mosaicism Gonadal mosaicism can explain unusual pedigrees seen in some autosomal dominant disorders such as osteogenesis imperfecta in which phenotypically normal parents have more than one affected children erectile dysfunction doctor edmonton viagra with dapoxetine 50/30mg with visa. Fragile X syndrome - is the second most frequent cause of hereditary mental retardation next to Down syndrome doctor who cures erectile dysfunction buy viagra with dapoxetine 100/60mg with mastercard. List the various types of mutations & discuss their effects by giving examples for each type erectile dysfunction treatment viagra order 50/30mg viagra with dapoxetine with mastercard. Explain the criteria, the pathogenesis, & give clinical examples for the 3 main mendelian patterns of inheritance. Explain the general pathogenesis of mendelian disorders associated with enzyme defects. Describe the karyotypes & the clinical features of Turner syndrome Hypofunction of which organ can explain these clinical features? Describe the cause, the karyotypes, & the clinical features of Klinefelter syndrome. Tesfaye is married to an unrelated woman called Tenagne, & has a 2 year old daughter, Mimi. Hypersensitivity Reactions the purpose of the immune response is to protect against invasion by foreign organisms, but they often lead to host tissue damage. An exaggerated immune response that results in tissue injury is broadly referred to as a hypersensitivity reaction. This bridging of IgE molecules activates signal transduction pathways from cytoplasmic portion of IgE fc receptors. One leading to mast cell degranulation with discharge of preformed (primary) mediators and the other involving denovo synthesis and release of secondary mediators. Initial phase (response): Characterized by vasodilatation, vascular leakage, and depending on the location, smooth muscle spasm or glandular secretions. Mast cells are bone marrow driven cells widely distributed in tissues around blood vessels, and sub epithelial sites where type I reaction occurs. Morphology: Histamine and leukotriens are released rapidly from sensitized mast cells and are responsible for intense immediate reaction characterized by edema, mucous secretions and smooth muscles spasms. Three different antibody-dependent mechanisms are involved in this type of reaction these cells secrete other waves of 141 (i) Complement-dependent reaction i. Direct lysis: a) It is effected by complements activation, formation of membrane attack complex (C5 ­ 9). This membrane attack complex then disrupts cell membrane integrity by drilling a hole. In anucleated cells once and in nucleated cells many attacks of the complex are needed for cell lysis, because the latter ones have abilities to repair cell membrane injuries rapidly. Examples include red blood cells, leukocytes and platelets disorders: Transfusion reaction; haemolytic anemia; Agranuloytosis; Thrombocytopenia; Certain drug reaction ii. The target cells coated with IgG antibodies are killed by a variety of nonsensitized cells that have Fc receptors. Antibody-mediated cellular dysfunction In some cases, antibodies directed against cell surface receptors impair or dysregulated function without causing cell injury or inflammation. For example: In Myasthenia Gravis, antibodies reactive with acetylcholine receptors in the motor end plates of skeletal muscles impair neuromuscular transmission and cause muscle weakness. The converse is noted in Graves disease where antibodies against the thyroidstimulating hormone receptor on thyroid epithelial cells stimulate the cells to produce more thyroid hormones. Endogeneous origin Nuclear components (systemic lupus erythematosis) Immunoglobulins (rheumatoid arthritis) Tumour antigen (glomerulonephritis) Therefore, autoimmune diseases are hypersensitivity diseases in which the exaggerated immune response is directed against the self antigens as exemplified by the above three diseases. Formation of Ag-Ab complex Introduction of an antigen into the circulation, then Production of specific antibodies by immuno-competent cells and subsequent antigen antibody formation b. Deposition of immune complexes the mere formation of antigen-antibody complex in the circulation does not imply presence of disease. Other factors for immune deposition include charge of immune complexes, valence of antigen, avidity of the antibody, affinity of the antigen to various tissue components, three-dimenstional /lattice/ structure of the complex, hemodynamic factors, etc. Sites of immune complex deposition include: Renal glomeruli, joints, skin, heart, serosal surfaces, & small blood vessels 143 c. Inflammatory reaction After immune complexes are deposited in tissues acute inflammatory reactions ensues and the damage is similar despite the nature and location of tissues.

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