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We are in receipt of a booklet entitled buy alendronate 35 mg mastercard xanthelasma menopause, The Traction Couch for Disease Treatment alendronate 70mg line menstrual 2 days late. These words are as different in meaning and application 35mg alendronate with mastercard women's health clinic toledo ohio, as antipodal as a fish and a pipe organ alendronate 35 mg overnight delivery womens health first. There were hundreds of machines designed and manufactured hundreds of years ago that, in principle, as the many above verify, are today in use, in any orthopedical hospital or supply house, for the purpose of Disease Treatment. The head is engaged by padded straps over the forehead and at the base of the occiput. Shoulders rest upon strap support and are engaged by the curved crutch-like fastenings, passing under the armpits. The feet are secured by hooks and straps, giving a direct pull down the long bones of the leg. Machines sold are to pseudo- Chiros and not to those who have studied specific, pure and unadulterated Chiropractic at the parent school. I have yet to see the orthopedical machine or apparatus made, using for its principle traction, or gradual pressure, that is one cents value to a Chiropractor who is thorough in his knowledge. The honest Chiropractor knows that subluxation is a thing accidentally received, as such, sympathy and practical assistance should be extended instead of conjuring some machine that will make the intruder flee. The following letter is one of many on this subject received at this school: I am suffering with a growing out of the spine, 8th, 9th 10th dorsal vertebrae, which was brought on by heavy straining work, the weight falling about this part of the back. Have been suffering about three years; have worn different forms of braces, including the Philo Burt brace, but all with but little or no permanent benefit. To make this or any other person well you must find the cause and then correct it, a thing all P. True, there is more temporary money to invent a machine where the patient can be treated from two to five years. The school that gives permanent results is the one that continues to increase its business. These little points of honor to a science are carefully figured by prospective students. All the mechanical laws are employed in the workings of the body, and the hands can set them at work to correct mechanical derangements. It is impossible to teach Chiropractic Orthopedy without the use of an immense osteological collection. Chiropractic adjustment has for its application a quick, energetic, piano, or typewriter movement. Orthopedic books advise the use of steady, gradually increasing, mechanical force. Chiropractic is eminently successful in adjusting the cause of these deformities, which was not, nor is today, thought of by medical men. Orthopedical appliances and all its principles aim only to treat the effects, thereby making continual dismal failures. Orthopedic surgery is cruel, inhuman, torture, savage, barbarous, pitiless, unrelenting, hard-hearted, inexorable, harsh. Chiropractic assists Innate by adjusting the cause, thus is humane, forbearing, merciful, benevolent and beneficent. Orthopedic surgery appliances of this counterfeit type are traceable to Hippocrates, time (460 B. Conclusion�Chiropractic Orthopedy, from a Modernized Chiropractic viewpoint, would be like asking a German band to play pipe organ music; get lake white fish from a muddy river; a typesetter to build a boat; for butter and get oleomargarine; for lard and get cottolene. To an Indian camp for musical instruction, asking for Chiropractic, but getting a crude counterfeit, Chiropractic Modernized. In Bishops Deformities of the Human Body we have another authority who denounces the brutal treatment of machinery for deformities of the body. In considering the entire body and its mechanical treatment, he says: Hence we have a multitude of machines invented for the purpose of doing what they have never accomplished, in cases in which the mechanism needed might have been found in the body itself. If an examination be made into the effects of extending the body in the axis of its length with the view of correcting distortions of the spine, it will not be very difficult to demonstrate, in the first place, that it can never effect the object sought; and secondly, that the practice is not merely insufficient, but absolutely injurious. It is clear that the extending principle must be altogether useless, to say nothing of the confinement, torment, and loss of health occasioned by this plan of treatment. Practitioners who pursue the extension system are probably little aware of the great amount of force necessary to accomplish its end, and the injurious consequences of force when applied to the soft parts. There are, however, practitioners in the present day who make use of powerful machines, capable of overcoming ankylosed union of the diseased parts of the vertebral column; and it is reported that life has been sometimes sacrificed in the attempt. When we take a survey of the vile machines that have been invented, and considered the amount of torture inflicted by them for no useful end, that patients have been subjected, often for years, to painful restraint, have incurred expense, and lost much precious time, all which has been borne with fortitude by the young and delicate, buoyed up by the fallacious hope of a happy result; and that muscles and tendons have been cut, and various mutilations inflicted on a mechanism so beautiful and so perfect as that of the human body in order to attain objects which such means could never accomplish,�it must be acknowledged that this branch of surgery is in a most deplorable state. Almost every orthopedic practitioner has hitherto employed some favorite machine for the treatment of distortions. The author does not intend to propose any new machinery, either for stretching, pulling, pushing or propping the body; his aim being to dispel the illusion that such machines possess any value, but demonstrating their inefficiency in the majority of cases. The above is an authority and broadly quoted for the reliableness and thoroughness of decision. Their knowledge of the latter is minus and largely constricted, thus swindling people, making them think they are getting Chiropractic. The Innate mind represents the addition of generation after generation of thoughts stored away. Our educated brain is capable of expressing a portion of Innate in voluntary form; that is, at the command of our external man, and is the expansion that takes place from birth to death. You look upon him as a person who uses good, clear judgment, who goes to the bottom of any investigation or matter presented.

Sometimes buy alendronate 70 mg low cost women's health exercises at home, there is severe pain in the stomach alendronate 70mg cheap pregnancy reveal ideas, so much so that the patient may not even be able to talk 70mg alendronate for sale pregnancy fitness. Small swellings form at the nails of the fingers and toes (clubbing of the fingers related to cyanotic diseases of the heart buy 35 mg alendronate amex women's health clinic columbia mo. The stools are watery, greenish in colour and associated with severe griping pain. In traditional medicine, the extract of the plant is used in the treatment of headache, heart attack and for expulsion of phlegm from the lungs. In homoeopathic form, it has been found very useful in the treatment of insect bites and joint pains. Like Lachesis, its ailments begin on the left side, are more intense in the upper part of the body than the lower, start mostly at the feet or the leg and then spread from below upwards. Particularly, when used along with Arnica and Hypericum it proves to be much more effective. Ledum is of special use in the treatment of old injuries, leaving deep residual effect, or in the treatment of injuries caused by pointed objects like nails and thorns, etc. Ledumsusceptible wounds emit a lightning type of pain, even after having apparently been healed for years. In this situation, if the patient happens to get convulsions or severe muscular spasms, Ledum proves to be the best remedy. However, if the horse itself should step on a sharp rusty nail, and sustain a deep wound in the hoof which then happens to dig into the bone, the convulsions of tetanus can rapidly be cured with Ledum 200. Ledum has the capability of curing tetanus resulting, even after many years, from wounds inflicted with sharp weapons. Ledum is also very useful in the treatment of injuries penetrating through the surface linings of the bone (periosteum. However, for the associated damage to the nerve fibres around the bone, Hypericum is much more effective. Similarly, if the nerves are damaged following surgery and the pain continues then Hypericum is found to be more useful than Ledum. Arnica in a high potency is useful in treating the sprain at the heel, but not for the residual pain due to injury to the nerve fibres. Persistent swelling and chronic pain of the ankle resulting from repeated Ledum 473 ligamentous sprains responds better to Equisetum. Ledum may also be very beneficial if the chronic swelling is due to the involvement of the joints. Chronic ill effects of repeated ankle injuries are better treated with Ruta, Bellis and Equisetum. Some homoeopathic remedies have been found useful on clinical evidence, though they have not been described in literature. At one time, proving had been the standard for establishing the efficacy of homoeopathic substances, which obviously is the best method. However, in view of the scarcity of conscientious and impartial volunteers, clinical evidence has definitely played an important role in the advancement of homoeopathic knowledge. It may also result in the cramping of the legs, which becomes worse on walking or excessive movement, causing severe discomfort. Only, on specific treatment, will the discomfort start receding towards the original site, where it will become localised. The appropriate analogous therapy will prevent the spread of discomfort from here. The swelling of Ledum originates from the joints of the feet, like the onset of gout. Phantom pains in which a diseased or injured part has been amputated and yet the patient feels the original part of the limb existing and continuing to hurt, is an extremely troubling condition. For example, a persons leg has been surgically removed (amputated) for some incurable condition, but he feels as if the big toe (that does not exist any more) is hurting. If the treating physician comes to know of the existing condition that required the amputation in the first place, then he should treat that very condition. The phantom pain is the pain along the nerve fibres that have been sensitized by the sickness. In case the analogous treatment of the sickness is administered, the Ledum 474 affected nerve fibres will receive the message of reverting to their normal state. The Ledum patient is cold and feels very cold both inside and out, yet his joint pains feel better with cold applications. Ledum may also be useful in the treatment of chronic pain of the knee joints, in addition to the ankles, provided the pain seems to be relieved with cold applications. In female patients of Ledum, periods are frequent, excessive and of deep red colour. One symptom is common to Pulsatilla and Ledum yet it is not difficult to differentiate between the two. In Ledum the limbs that become the seat of chronic pain, gradually become weak, contracted and shrivelled, in comparison to the non-affected side. The clear distinction is that a Pulsatilla patient feels hot and gets relief with cold, while the patient of Ledum feels cold yet gets relief with cold. Injury to the eye, blood shots, and simultaneous onset of gout and cataract respond beautifully to treatment with Ledum. In Ledum, tiny red pimples form on the forehead and cheeks, which are painful to touch. The innate body temperature of a Ledum patient is low (sub-normal), yet Ledum 475 he cannot tolerate the warmth of the bed. It is particularly very useful in the treatment of women of hysterical and impulsive nature who chronically suffer from uterine and heart conditions.

In such cases safe 70 mg alendronate breast cancer vector, a variety of causes have been assigned such as previous nonbiliary surgery order alendronate 35mg overnight delivery women's health clinic overland park regional, multiple injuries cheap alendronate 70 mg on-line womens health pavilion, burns discount alendronate 35mg otc womens health 2014, recent childbirth, severe sepsis, dehydration, torsion of the gallbladder and diabetes mellitus. Rare causes include primary bacterial infection like salmonellosis and cholera and parasitic infestations. Except for the presence or absence of calculi, the two forms of acute cholecystitis are morphologically similar. The serosal surface is coated with fibrinous exudate with congestion and haemorrhages. The wall of the gallbladder is thickened and the lumen is packed with well-fitting, multiple, multi-faceted, mixed gallstones. Grossly, the gallbladder exudate and the condition is known as empyema of the is generally contracted but may be normal or enlarged gallbladder. The wall of the gallbladder is thickened which Microscopically, wall of the gallbladder shows marked on cut section is grey-white due to dense fibrosis or may inflammatory oedema, congestion and neutrophilic be even calcified. There may be frank abscesses in the wall and thickened, or flattened and atrophied. The lumen gangrenous necrosis with rupture into the peritoneal commonly contains multiple mixed stones or a combined cavity (gangrenous cholecystitis. Thickened and congested mucosa but occasionally of either type have similar clinical features. Penetration of the mucosa deep into the wall of the irritation such as guarding and hyperaesthesia. The gallbladder up to muscularis layer to form Rokitanskygallbladder is tender and may be palpable. Early cholecystectomy within the first consisting of lymphocytes, plasma cells and macrophages, three days has a mortality of less than 0. Variable degree of fibrosis in the subserosal and attacks and adhesions is avoided. There is almost constant association of Porcelain gallbladder is the pattern when the chronic cholecystitis with cholelithiasis. The association of chronic Acute on chronic cholecystitis is the term used for cholecystitis with mixed and combined gallstones is virtually the morphologic changes of acute cholecystitis always present. However, it is not known what initiates the superimposed on changes of chronic cholecystitis. Generally, the patient�a fat, fertile, repeated attacks of mild acute cholecystitis result in chronic female of forty or fifty, presents with abdominal distension or cholecystitis. There is penetration of epithelium-lined spaces into the gallbladder wall (RokitanskyAschoff sinus) in an area. Mononuclear inflammatory cell infiltrate is present in subepithelial and perimuscular layers. Biliary colic may and cholecystitis, though there is no definite evidence of occasionally occur due to passage of stone into the bile ducts. Cholelithiasis and cholecystitis are Cholecystography usually allows radiologic visualisation of present in about 75% cases of gallbladder cancer. A number of chemical carcinogens structurally similar to naturally-occurring bile Benign tumours such as papilloma, adenoma, adenomyoma, acids have been considered to induce gallbladder cancer. Adenomyoma is more common benign tumour than the higher incidence of gallbladder cancer. All these tumours resemble their counterparts in morphology elsewhere in the body. Japanese immigrants and Native Americans Carcinoma of the gallbladder and carcinoma of the bile ducts of the South-Western America have increased frequency and ampulla of Vater are among the more frequent malignant while American Indians and Mexicans have lower incidence. Patients who have undergone previous surgery on the biliary tract have higher incidence of Carcinoma of the Gallbladder subsequent gallbladder cancer. Patients with inflammatory Primary carcinoma of the gallbladder is more prevalent than bowel disease (ulcerative colitis and Crohns disease) have other cancers of the extrahepatic biliary tract. It may remain undetected until the time it is widely fundus, followed next in frequency by the neck of the spread and rendered inoperable. They may be papillary or infiltrative, well-differentiated or poorly-differentiated. About 5% of gallbladder cancers are squamous cell carcinomas arising from squamous metaplastic epithelium. A few cases show both squamous and adenocarcinoma pattern of growth called adenosquamous carcinoma. Carcinoma of the gallbadder is slow-growing and causes symptoms late in the course of disease. Quite often, the diagnosis is made when gallbladder is removed for cholelithiasis. The symptomatic cases have pain, jaundice, noticeable mass, anorexia and weight loss. In such case, the growth has usually invaded the liver and other adjacent organs and has metastasised to regional lymph nodes and more distant sites such as the lung, peritoneum and gastrointestinal tract. This is an infrequent neoplasm but is more common than the rare benign tumours of the biliary tract. Infiltrating type appears as an irregular area of diffuse diseases of the biliary passages, it is more common in males thickening and induration of the gallbladder wall. Fungating type grows like an irregular, friable, with a number of other conditions such as ulcerative colitis, papillary or cauliflower-like growth into the lumen as well sclerosing cholangitis, parasitic infestations of the bile ducts as into the wall of the gallbladder and beyond. Extrahepatic bile duct carcinoma may arise anywhere in the biliary tree but the most frequent sites, in descending order of frequency, are: the ampulla of Vater, lower end of common bile duct, hepatic ducts, and the junction of hepatic ducts to form common bile duct (see Fig.

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This is probably mediunable to invade and metastasise buy alendronate 35mg without a prescription womens health 15 minute workouts, while malignant tumours ated by immunologic mechanisms buy 70 mg alendronate otc menstrual ovulation cycle calculator. The changes in the are identified by lack of differentiation in cancer cells termed neurons may affect the muscles as well generic alendronate 70mg line women's health uk forum. The changes are: anaplasia or cellular atypia and may invade as well as peripheral neuropathy generic 70mg alendronate with amex women's health clinic edmonton abortion, cortical cerebellar degeneration, metastasise. The light microscopic and ultrastructural myasthenia gravis syndrome, polymyositis. Pap smear) method was initially employed for detecting v) Gastrointestinal syndromes. Malabsorption of various dysplasia, carcinoma in situ and invasive carcinoma of the dietary components as well as hypoalbuminaemia may be uterine cervix. However, its use has now been widely associated with a variety of cancers which do not directly extended to include examination of sputum and bronchial involve small bowel. The method is based on amyloidosis may produce nephrotic syndrome in patients microscopic identification of the characteristics of malignant with cancer. However, a negative diagnosis terised by the appearance of black warty lesions in the axillae does not altogether rule out malignancy due to possibility of and the groins may appear in the course of adenocarcinoma sampling error. Currently, include seborrheric dermatitis in advanced malignant cytopathology includes not only study of exfoliated cells but tumours and exfoliative dermatitis in lymphomas and also materials obtained from superficial and deep-seated Hodgkins disease. The complex 233 can be aspirated under direct vision while deep-seated of antigen-antibody on slide is made visible for light masses such as intra-abdominal, pelvic organs and microscopic identification by either fluorescent dyes (fluororetroperitoneum are frequently investigated by ultrasound chromes) or by enzyme system (chromogens. The smears are fixed in 95% ethanol by wet hybridoma technique for monoclonal antibody production. While Papanicolaou these monoclonal antibodies, besides being specific against method of staining is routinely employed in most laboratories antigen, are highly sensitive in detection of antigenic for wet fixed smears, others prefer H and E due to similarity component, and, therefore, impart objectivity to the in staining characteristics in the sections obtained by paraffinsubjective tumour diagnosis made by the surgical embedding. Histochemistry and Cytochemistry already in Chapter 2 and an abbreviated list of antibody stains in some common cancers of unknown origin is given in Histochemistry and cytochemistry are additional diagnostic Table 2. Though immunohistochemical techniques are more Ultrastructural examination of tumour cells offers selective useful for tumour diagnosis (see below), histochemical and role in diagnostic pathology. This is an immunological method of recognising a cell by iii) Cell shape and cytoplasmic extensions. Tumour Markers (Biochemical Assays) � Massons trichrome In order to distinguish from the preceding techniques of 2. Acid mucin � Alcian blue to keep in mind that many of these products are produced (mesenchymal origin) by normal body cells too, and thus the biochemical estimation 5. These methods, argentaffin granules therefore, lack sensitivity as well as specificity and can only be employed for the following: 7. Enzymes � Myeloperoxidase at by other methods and not for primary diagnosis of cancer. Diagnosis of Tumours Intermediate Tumour In addition to the methods described above, some other Filament modern diagnostic techniques have emerged for tumour 1. Keratins Carcinomas, mesotheliomas, diagnostic pathology but their availability as well as some germ cells tumours applicability are limited. Since for flow cytometry, single cell suspensions are required to flow through the hormones and cancer antigens; these are listed in Table 8. Their serum levels are high in cancers microdeletions, subtelomere deletions and to look for of the gastrointestinal tract, pancreas and breast. These techniques behaviour of tumour, detection of minimal residual disease are highly sensitive, specific and rapid and have and for hereditary predisposition of other family members revolutionised diagnostic pathology in neoplastic as well as to develop a particular cancer. Antigen receptor gene rearrangement fi 236 Environmental and Chapter 9Chapter 9 Nutritional Diseases Non-therapeutic toxic agents (e. Injury by physical agents: discipline of tropical medicine was of interest to the Thermal and electrical injury physician, largely due to contamination of air, food and water Injury by ionising radiation by infectious and parasitic organisms. Nutritional diseases: interest got focussed on geographic pathology due to Overnutrition (obesity) occurrence of certain environment-related diseases confined Undernutrition (starvation, protein energy malnutrition, to geographic boundaries. In addition, is the related problem of composition of environment is called pollutant. Population explosion abundance by day-to-day activities on our planet earth due 2. Urbanisation of rural and forest land to accommodate to industrial effluent and automobile exhausts. A vast variety of pollutants are inhaled daily, some of which But the above atmospheric pollutants appear relatively may cause trivial irritation to the upper respiratory pathminor compared with voluntary intake of three pollutants�use ways, while others may lead to acute or chronic injury to the of tobacco, consumption of alcohol and intoxicant drugs. Infant mortality related to and free radicals capable of oxidant cell injury to respiratory environmental factors in developing countries is 12 times passages. In highly polluted cities where coal consumption higher than in the developed countries. It has been reported have not been quite effective due to difficulty in implementhat 6 out of 10 largest cities in India have such severe air tation. The present discussion on environmental and nutritional the adverse effects of air pollutants on lung depend upon diseases is covered under the following groups: a few variables that include: 1. Environmental pollution: longer duration of exposure; Air pollution total dose of exposure; Tobacco smoking impaired ability of the host to clear inhaled particles; and 2. Chemical and drug injury: particle size of 1-5 fim capable of getting impacted in the Therapeutic (iatrogenic) drug injury distal airways to produce tissue injury. Irritation and toxicity � Formaldehyde tipped cigarettes appear to have 30-50% lower risk of to respiratory mucosa Nitrogen oxide development of cancer due to reduced inhalation of tobacco 4. Dose and Duration Smoking bidis and chewing pan masala, zarda and gutka are Tobacco contains several harmful constituents which include more widely practiced than cigarettes. Habit of smoking nicotine, many carcinogens, carbon monoxide and other chutta (a kind of indigenous cigar) in which the lighted end toxins (Table 9. For example, one pack of Indian states of Uttar Pradesh and Bihar and in parts of Sri cigarettes daily for 5 years means 5 pack years.

The location of vegetations on mitral valve (left upper diagram) is shown as viewed from the left atrium alendronate 70mg sale women's health specialists, while the vegetations on aortic valve (left lower diagram) are shown as seen from the left ventricular surface order 70 mg alendronate women's health center pueblo co. B alendronate 35mg fast delivery menstruation food, Opened up chambers and valves of the left heart show irregularly scarred mitral valve leaving a fish-mouth or buttonhole opening between its two cusps (black arrow discount alendronate 70 mg free shipping womens health katy. The free surface and margin of the mitral valve shows tiny firm granular vegetations (white arrow. Vegetations the mitral (in 98% cases alone or along with other valves) present at the free margins of cusps appear as eosinophilic, and aortic. The approximate frequency of deformity of tiny structures mainly consisting of fibrin with various valves is as under: superimposed platelet-thrombi and do not contain Mitral alone = 37% cases. Vascularisation of the valve cusps may still be evident in the form of thick-walled blood Mitral + aortic + tricuspid + pulmonary = less than vessels with narrowed lumina (Fig. Thickening, shortening and fusion of the appears as a map-like area of thickened, roughened and chordae tendineae further contribute to the chronic wrinkled part of the endocardium (see Fig. Microscopically, the appearance of MacCallums patch Microscopically, the inflammatory changes begin in the is similar to that seen in rheumatic valvulitis. The affected region of the valve rings (where the leaflets are attached area shows oedema, fibrinoid change in the collagen, and to the fibrous annulus) and then extend throughout the cellular infiltrate of lymphocytes, plasma cells and entire leaflet, whereas vegetations are usually located on macrophages with many Anitschkow cells. Grossly, in the early of capillaries and infiltration with lymphocytes, plasma (acute) stage, the myocardium, especially of the left cells, histiocytes with many Anitschkow cells and a few ventricle, is soft and flabby. A, Microscopic structure of the rheumatic valvulitis and a vegetation on the cusp of mitral valve in sagittal section. B, Section of the myocardium shows healed Aschoff nodules in the interstitium having collagen, sparse cellularity, a multinucleate giant cell and Anitschkow cells. The Microscopically, the most characteristic feature of subserosal connective tissue is infiltrated by lymphocytes, rheumatic myocarditis is the presence of distinctive plasma cells, histiocytes and a few neutrophils. These diagnostic nodules are scattered Characteristic Aschoff bodies may be seen which later throughout the interstitial tissue of the myocardium and undergo organisation and fibrosis. Organisation of the are most frequent in the interventricular septum, left exudate causes fibrous adhesions between the visceral and ventricle and left atrium. Derangements of the conduction parietal surfaces of the pericardial sac and obliterates the system may, thus, be present. Extracardiac Lesions surrounded by palisade of Anitschkow cells and Patients of the syndrome of acute rheumatism develop multinucleate Aschoff cells. There is infiltration by lesions in connective tissue elsewhere in the body, chiefly lymphocytes, plasma cells and some neutrophils. As pain and swelling subside in one joint, others tend to get involved, producing 3. Inflammatory the characteristic migratory polyarthritis involving two or involvement of the pericardium commonly accompanies more joints at a time. Grossly, the usual finding is fibrinous pericarditis in Histologically, the changes are transitory. The synovial which there is loss of normal shiny pericardial surface due membrane and the periarticular connective tissue show to deposition of fibrin on its surface and accumulation of hyperaemia, oedema, fibrinoid change and neutrophilic slight amount of fibrinous exudate in the pericardial sac. Sometimes, focal lesions resembling Aschoff If the parietal pericardium is pulled off from the visceral bodies are observed. A serous effusion into the joint cavity pericardium, the two separated surfaces are shaggy due is commonly present. They are attached to deeper structures like tendons, ligaments, fascia or periosteum and therefore 443 Histologically, the changes are oedema, capillary often remain unnoticed by the patient. Characteristic haemorrhages and focal areas of fibrinous exudate in the locations are extensor surfaces of the wrists, elbows, ankles alveoli. With subsequent fibroblasts forming a palisade arrangement, and the streptococcal pharyngitis, there is reactivation of the disease outermost zone of connective tissue which is infiltrated and similar clinical manifestations appear with each recurrent by non-specific chronic inflammatory cells and attack. Supportive evidence of preceding group A streptococcal fibrinoid necrosis or ill-formed Aschoff bodies may be infection include: positive throat culture for group A present close to the vessel wall. The antecedent laboratory evidence of streptococcal throat condition is characterised by disordered and involuntary infection in the presence of any two of the major criteria, or jerky movements of the trunk and the extremities occurrence of one major and two minor criteria. Myocarditis, in Histologically, the lesions are located in the cerebral particular, is the most life-threatening due to involvement hemispheres, brainstem and the basal ganglia. They of the conduction system of the heart and results in serious consist of small haemorrhages, oedema and perivascular arrhythmias. There may be endarteritis chronic valvular deformities, especially the mitral stenosis, obliterans and thrombosis of cortical and meningeal as already explained on page 441. In bacterial endocarditis and embolism: rheumatic pneumonitis, the lungs are large, firm and 1. Bacterial endocarditis of both acute and subacute type may valves, in the valve pockets and on the adjoining supervene due to inadequate use of antibiotics. The organs most frequently affected are Libman-Sacks endocarditis do not produce any significant the brain, kidneys, spleen and lungs. Similar inflammatory endocarditis on the basis of anatomic area of the involved changes may be found in the interstitial connective tissue endocardium such as: valvular for valvular endocardium, of the myocardium. The Aschoff bodies are never found mural for inner lining of the lumina of cardiac chambers, in the endocardium or myocardium. Most types of endocarditis are Non-bacterial thrombotic, cachectic, marantic or terminal characterised by the presence of vegetations or verrucae endocarditis or endocarditis simplex is an involvement of which have distinct features. The Libman and Sacks, two American physicians, described a following diseases and conditions are frequently associated form of endocarditis in 1924 that is characterised by sterile with their presence: endocardial vegetations which are distinguishable from the 1. Rheumatic endocarditis (page 440) brownish and occur along the line of closure of the leaflets 2.