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By: Neal H Cohen, MD, MS, MPH

  • Professor, Department of Anesthesia and Perioperative Care, University of California, San Francisco, School of Medicine, San Francisco, California

https://profiles.ucsf.edu/neal.cohen

Extrinsic (allergic) asthma may be related to fungus nutrition purchase diflucan 200 mg without prescription IgE (type I) immune reactions; intrinsic (nonallergic) asthma may be triggered by infections or drugs anti fungal wash b&q purchase 200mg diflucan overnight delivery. Chronic bronchitis is characterized by a productive cough that is present for at least 3 months in at least two consecutive years antifungal genital cream order 50mg diflucan visa. There is hyperplasia of mucous glands with hypersecretion fungus under toenail diflucan 150 mg free shipping, due in large part to tobacco smoke. Emphysema is abnormal dilation of the alveoli due to destruction of the alveolar walls. Steatosis refers to the accumulation of triglyceride within the cytoplasm of hepatocytes. Bacterial infections generally result in a polymorphonuclear (neutrophil) response. Bacterial infection of the lung (pneumonia) results in consolidation of the lung, which may be patchy or diffuse. Patchy consolidation of the lung is seen in bronchopneumonia (lobular pneumonia), while diffuse involvement of an entire lobe is seen in lobar pneumonia. Histologically, bronchopneumonia is characterized by multiple, suppurative neutrophil-rich exudates that fill the bronchi and bronchioles and spill over into the adjacent alveolar spaces. In contrast, lobar pneumonia is characterized by four distinct stages: congestion, red hepatization, gray hepatization, and resolution. Possible causes of a lung abscess include aerobic and anaerobic streptococci, Staphylococcus aureus, and many gram-negative organisms. Aspiration more often gives a 282 Pathology right-sided single abscess, as the airways on the right side are more vertical. The abscess cavity is filled with necrotic suppurative debris unless it communicates with an air passage. Clinically an individual with a lung abscess will have a prominent cough producing copious amounts of foul-smelling, purulent sputum. Complications of a lung abscess include pleural involvement (empyema) and bacteremia, which could result in brain abscesses or meningitis. This type of pneumonia is called primary atypical pneumonia because it is atypical when compared to the "typical" bacterial pneumonia, such as produced by S. These bacterial pneumonias are characterized by acute inflammation (neutrophils) within the alveoli. In contrast, acute interstitial pneumonia is characterized by lymphocytes and plasma cells within the interstitium, that is, the alveolar septal walls. Viral cytopathic effects, such as inclusion bodies or multinucleated giant cells, may be seen histologically with certain viral infections. Since most adult red cells have I antigens, blood from a patient with mycoplasma pneumonia will hemagglutinate when cooled. This type of reaction is not seen with infection by either P pneumoniae or Mycobacterium tuberculosis. This organism, although it has low virulence, is opportunistic; it is often seen to attack severely ill, immunologically depressed patients. Early in the disease there are multiple, very small nodules in the upper zones of the lung, which produces a fine nodularity on x-ray. The fibrotic lesions may also be found in the hilar lymph nodes, which can become calcified and have an "eggshell" pattern on x-ray examination. Asbestos results in larger areas of fibrosis, and histologically asbestos (ferruginous) bodies are found. In the chronic state, beryllium elicits a cellmediated immunity response, seen histologically as noncaseating granulomas. Noncaseating granulomas are also seen in patients with sarcoidosis, a disease that may cause enlargement of the hilar lymph nodes ("potato nodes"). The term ferruginous body is applied to other inhaled fibers that become ironcoated; however, in a patient with interstitial lung fibrosis or pleural plaques, ferruginous bodies are probably asbestos bodies. The type of asbestos mainly used in America is chrysotile, mined in Canada, and it is much less likely to cause mesothelioma or lung cancer than is crocidolite (blue asbestos), which has limited use and is mined in South Africa. Cigarette smoking potentiates the relatively mild carcinogenic effect of asbestos. Laminated spherical (Schaumann) bodies are found in granulomas of sarcoid and chronic berylliosis.

The junction between the calcified and radial zones appears fungus on mulch discount diflucan 50mg mastercard, in sections antifungal pills side effects cheap diflucan 50 mg otc, as a basophilic "tide line" that represents the advancing front of the calcification process antifungal green smoothie cheap diflucan 200mg fast delivery. The tangential zone contains several layers of flattened anti fungal house spray diflucan 150mg, fibroblast-like cells whose long axes, like those of the collagen fibers, are parallel to the surface. Their oval or elongated nuclei usually have smooth outlines, but some are irregular and show a variety of undulations, deep indentations, or clefts; the patchy, clumped chromatin stains deeply. Inclusions such as lipids and glycogen are rare, but pinocytotic vesicles are plentiful. In the transitional zone, the cells are rounded and show many long cytoplasmic processes that often bifurcate at their tips. The round, usually eccentric nuclei contain finely granular chromatin and frequently show one or more nucleoli. Granular endoplasmic reticulum is abundant, the Golgi apparatus is well developed, and secretory granules are prominent. The cells of the radial zone also are rounded but tend to form short columns or isogenous groups. The endoplasmic reticulum is less developed, the Golgi complex is sparse, and mitochondria are small and dense. Intracellular filaments are increased in number, and lipid droplets and glycogen granules are common. The calcified zone is characterized by short columns of enlarged, pale staining cells that are in the advanced state of degeneration. The nuclei are dense and pyknotic, the nuclear envelope is fragmented, and cytoplasmic organelles are lacking. The organization of the chondrocytes of articular cartilage into successive zones is reminiscent of the arrangement of cells in an epiphyseal plate during endochondral bone formation. Indeed, during growth, articular cartilage does serve as a growth zone for the subchondral bone. When epiphyseal growth is complete, the deep zones of chondrocytes in the articular cartilage are converted to compact bone and incorporated into the subchondral bone layer. The central regions of the cartilage receive their nutrition by diffusion from the synovial fluid, which bathes the cartilages, and, to a lesser extent, from vessels in the subchondral bone. At their edges, the articular cartilages are well nourished from blood vessels in the nearby synovial membrane. It is a loose-textured, highly vascular connective tissue that lines the fibrous capsule and extends onto all intraarticular surfaces except those subjected to compression during movement of a joint. Thus, articular cartilages, articular discs, and menisci are not covered by synovial membranes. Occasional fingerlike projections, the synovial villi, and coarser folds of the synovial membrane project into the joint cavity. The free surface (synovial intima) of the synovial membrane consists of one to three layers of flattened synovial cells embedded in a granular, fiber-free matrix. The surface cells do not form a continuous layer, and in places, neighboring cells are separated by gaps through which the synovial cavity communicates with tissue spaces in the synovial membrane. Where the cells do make contact, their surfaces may be complex and interdigitated. Desmosomal junctions have been described in rat synovial membranes, but their presence in humans has not been confirmed. A-cells are predominant and resemble macrophages (hence their alternate name, M-cells). The subintimal tissue varies from place to place within the same joint, and based on the structure of this tissue, the synovial membrane is classified as areolar, adipose, or fibrous. In areolar synovial membranes, the underlying tissue is a loose connective tissue with relatively few collagen fibers and an abundant matrix. Adipose synovial membranes line the articular fat pads, and the subintimal tissue mainly consists of fat cells. In fibrous synovial membranes, the underlying tissue is a dense irregular connective tissue and is found in regions subjected to tension; where such forces are extremely high, fibrous cartilage may be present.

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In reproductive age: complications of pregnancy yogurt antifungal purchase diflucan 50mg on-line, endometrial hyperplasia fungus gnats mycetophilidae discount diflucan 150 mg on line, carcinoma fungus human body buy diflucan 50mg visa, polyps fungus gnats neem oil discount diflucan 200 mg otc, leiomyomas and adenomyosis. At premenopause: anovulatory cycles, irregular shedding, endometrial hyperplasia, carcinoma and polyps. M/E In acute endometritis and myometritis, there is progressive infiltration of the endometrium, myometrium and parametrium by polymorphs and marked oedema. Chronic nonspecific endometritis and myometritis are characterised by infiltration of plasma cells alongwith lymphocytes and macrophages. Tuberculous endometritis is almost always associated with tuberculous salpingitis and shows small caseating granulomas. The term adenomyoma is used for actually circumscribed mass made up of endometrium and smooth muscle tissue. The possible underlying cause of the invasiveness and increased proliferation of the endometrium into the myometrium appears to be either a metaplasia or oestrogenic stimulation due to endocrine dysfunction of the ovary. On cut section, there is diffuse thickness of the uterine wall with presence of coarsely trabecular, ill-defined areas of haemorrhages. M/E the diagnosis is based on the finding of normal, benign endometrial islands composed of glands as well as stroma deep within the muscular layer. The minimum distance between the endometrial islands within the myometrium and the basal endometrium should be one low-power microscopic field (2-3 mm) for making the diagnosis. The chief locations where the abnormal endometrial development may occur are as follows (in descending order of frequency): ovaries, uterine ligaments, rectovaginal septum, pelvic peritoneum, laparotomy scars, and infrequently in the umbilicus, vagina, vulva, appendix and hernial sacs. Transplantation or regurgitation theory is based on the assumption that ectopic endometrial tissue is transplanted from the uterus to an abnormal location by way of fallopian tubes. Metaplastic theory suggests that ectopic endometrium develops in situ from local tissues by metaplasia of the coelomic epithelium. Vascular or lymphatic dissemination explains the development of endometrial tissue at extrapelvic sites by these routes. G/A Typically, the foci of endometriosis appear as blue or brownish-black underneath the surface of the sites mentioned. M/E the diagnosis is simple and rests on identification of foci of endometrial glands and stroma, old or new haemorrhages, haemosiderinladen macrophages and surrounding zone of inflammation and fibrosis. It is commonly associated with prolonged, profuse and irregular uterine bleeding in a menopausal or postmenopausal woman. Hyperplasia results from prolonged oestrogenic stimulation unopposed with any progestational activity. Endometrial hyperplasia is clinically significant due to the presence of cellular atypia which is closely linked to endometrial carcinoma. The following classification of endometrial hyperplasias is widely employed by most gynaecologic pathologists: 1. The glands are increased in number, exhibit variation in size and are irregular in shape. The glands are lined by multiple layers of tall columnar epithelial cells with large nuclei which have not lost basal polarity and there is no significant atypia. The glandular epithelium at places is thrown into papillary infolds or out-pouchings into adjacent stroma i. The malignant potential of complex hyperplasia in the absence of cytologic atypia is 3%. The cytologic features present in these cells include loss of polarity, large size, irregular and hyperchromatic nuclei, prominent nucleoli, and altered nucleocytoplasmic ratio. The most common variety, however, is the one having the structure like that of endometrium and is termed endometrial or mucus polyp. The histologic pattern of the endometrial tissue in the polyp may resemble either functioning endometrium or hyperplastic endometrium of cystic hyperplasia type, the latter being more common. The most important presenting complaint is abnormal bleeding in postmenopausal woman or excessive flow in the premenopausal years.

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M/E Salient features are: i) the oedema fluid of the preceding stage is replaced by strands of fibrin anti fungal anti bacterial shampoo buy discount diflucan 50 mg line. The cut surface is dry anti fungal tea cheap 150 mg diflucan visa, granular and grey in appearance with liver-like consistency fungus gnats bacillus thuringiensis buy generic diflucan 50 mg on line. G/A the previously solid fibrinous constituent is liquefied by enzymatic action antifungal hair shampoo purchase diflucan 50mg without a prescription, eventually restoring the normal aeration in the affected lobe. The cut surface is grey-red or dirty brown and frothy, yellow, creamy fluid can be expressed on pressing. M/E Salient features are: i) Macrophages are the predominant cells in the alveolar spaces, while neutrophils diminish in number. However, they may develop in neglected cases and in patients with impaired immunologic defenses. The major symptoms are: shaking chills, fever, malaise with pleuritic chest pain, dyspnoea and cough with expectoration which may be mucoid, purulent or even bloody. The common physical findings are fever, tachycardia, and tachypnoea, and sometimes cyanosis if the patient is severely hypoxaemic. G/A Bronchopneumonia is identified by patchy areas of red or grey consolidation affecting one or more lobes, frequently found bilaterally and more often involving the lower zones of the lungs due to gravitation of the secretions. On cut surface, these patchy consolidated lesions are dry, granular, firm, red or grey in colour, 3 to 4 cm in diameter, slightly elevated over the surface and are often centred around a bronchiole. There may be history of preceding bed-ridden illness, chronic debility, aspiration of gastric contents or upper respiratory infection. For initial 2 to 3 days, there are features of acute bronchitis but subsequently signs and symptoms similar to those of lobar pneumonia appear. Chest radiograph shows mottled, focal opacities in both the lungs, chiefly in the lower zones. The epidemic occurs in summer months by spread of organisms through contaminated drinking water or in air-conditioning cooling towers. Impaired host defenses in the form of immunodeficiency, corticosteroid therapy, old age and cigarette smoking play important roles. Systemic manifestations unrelated to pathologic changes in the lungs are seen due to bacteraemia and include abdominal pain, watery diarrhoea, proteinuria and mild hepatic dysfunction. Other terms used for these respiratory tract infections are interstitial pneumonitis, reflecting the interstitial location of the inflammation, and primary atypical pneumonia, atypicality being the absence of alveolar exudate commonly present in other pneumonias. Occasionally, psittacosis (Chlamydia) and Q fever (Coxiella) are associated with interstitial pneumonitis. G/A Depending upon the severity of infection, the involvement may be patchy to massive and widespread consolidation of one or both the lungs. M/E Main changes are as under: i) Interstitial inflammation There is thickening of alveolar walls due to congestion, oedema and mononuclear inflammatory infiltrate. A few days later, dry, hacking, non-productive cough with retrosternal burning appears due to tracheitis and bronchitis. M/E Salient features are: i) Interstitial pneumonitis with thickening and mononuclear infiltration of the alveolar walls. Aspergillosis Aspergillosis is the most common fungal infection of the lung caused by Aspergillus fumigatus that grows best in cool, wet climate. The infection may result in allergic bronchopulmonary aspergillosis, aspergilloma and necrotising bronchitis. G/A Pulmonary aspergillosis may occur within pre-existing pulmonary cavities or in bronchiectasis as fungal ball. Mucor is distinguished by its broad, non-parallel, nonseptate hyphae which branch at an obtuse angle. Mucormycosis is more often angioinvasive, and disseminates; hence it is more destructive than aspergillosis. Candidiasis Candidiasis or moniliasis caused by Candida albicans is a normal commensal in oral cavity, gut and vagina but attains pathologic form in immunocompromised host. Histoplasmosis It is caused by oval organism, Histoplasma capsulatum, by inhalation of infected dust or bird droppings.

References:

  • https://www.health.ny.gov/publications/1174_8.5x11.pdf
  • https://biomarkerres.biomedcentral.com/track/pdf/10.1186/s40364-020-0182-y.pdf
  • https://www.meddra.org/sites/default/files/guidance/file/000354_intguide_22.1.pdf
  • http://www.childrenshospitaloakland.org/Uploads/Public/Documents/MedProfessionals/NICU.pdf
  • https://med.stanford.edu/content/dam/sm/depressiongenetics/documents/Levinson_GeneticsDepression.pdf