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By: Bertram G. Katzung MD, PhD

  • Professor Emeritus, Department of Cellular & Molecular Pharmacology, University of California, San Francisco


They comprise about 10% of all the salient features of various types of gallstones are gallstones minocycline 50mg for sale bacterial cell diagram. They constitute about 10% of all (cholesterol purchase minocycline 50 mg fast delivery infection after dc, bile pigment or calcium carbonate) and outer gallstones order minocycline 50 mg overnight delivery 51 antimicrobial effectiveness testing. They are further divided into 3 types according shell of mixed gallstone; or a mixed gallstone nucleus with pure to the component of bile forming them purchase minocycline 50 mg with amex antibiotic resistance frontline. It may result in deposition of cholesterol and may be diagnosed by chance during investigations for within the mucosal macrophages of the gallbladder some other condition (silent gallstones. The future course in producing cholesterolosis which is an asymptomatic condition such asymptomatic silent cases is controversial, most (Fig. Pure cholesterol stones are radiolucent but 10surgeons advocating cholecystectomy while physicians 20% of them have calcium carbonate in them which renders advising watchful waiting. They have mulberry like cholecystitis is well known but it is not certain which of the external surface. Calcium colic precipitated by fatty meal, nausea, vomiting, fever carbonate gallstones are usually multiple, grey-white, small alongwith leucocytosis and high serum bilirubin. They, too, do not produce any change in extrahepatic biliary passages and the small bowel, or less the gallbladder wall. Mixed gallstones are the most common gallstone in the common bile duct frequently develop pain (80%) and contain more than 50% cholesterol monohydarate and obstructive jaundice. Fever may develop due to bacterial plus an admixture of calcium salts, bile pigments and fatty ascending cholangitis. The condition usually begins with obstruction, passed in the faeces without causing symptoms. Based on the initiating mechanisms, intestinal obstruction called gallstone ileus. Obstruction results in distension of the gallbladder followed by acute inflammation which is initially due to chemical irritation. In such cases, a variety of causes have been assigned such as previous nonbiliary surgery, multiple injuries, burns, 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.

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Once it becomes too thick buy minocycline 50mg cheap virus movies list, then the Phosphorus should be stopped to let the blood become thin and flow better purchase 50 mg minocycline free shipping antibiotic long term side effects. In the patients of Ferrum Phos cheap 50mg minocycline mastercard antibiotics gram negative, muscles on the back can get strained easily and result in permanent discomfort on lifting even a light Ferrum Phos 331 weight generic minocycline 50 mg line infection nail bed. The patient of Ferrum Phos likes to remain alone and does not want to face other people. The headache is more severe while going up the stairs, and sometimes the patient experiences temporary loss of vision due to the lack of blood (anaemia. When the patient tries to sit up suddenly or when he is climbing the stairs, the headache becomes worse due to lack of flow of blood to the brain. This symptom is also found in the remedies associated with excessive blood accumulation such as Gelsemium. In Gelsemium it is not due to the lack of blood but due to the localised increase of blood pressure (congestion. But in Ferrum Phos, it is due to a deficiency of blood, and not enough blood reaching the head. This is similar to the remedies causing vascular congestion leading to the loss of vision. The catarrhal secretions are mixed with blood, which is due to the bleeding tendency in the Ferrum Phos patients. If the patient of Ferrum Phos has bleeding from the lining of the mouth and the gums, it is red in colour as in Millefolium. The tonsils swell and there is irritation in the throat due to bleeding, burning and inflammation, causing difficulty in swallowing. These symptoms are common in many other remedies, so the diagnosis for Ferrum Phos cannot be based on these findings alone. For this purpose, the combination of Ferrum Phos, Calcarea Phos, and Kali Phos is very useful. In the first few months of pregnancy, the tendency of abortion is stopped and in the last two to three months of pregnancy, it helps in the development of the baby. These, however, should not be used continuously but should be resumed after an interval. In Ferrum Phos, the appetite sometimes decreases a lot and at other times increases to the extent that it knows no bounds. The pregnant women like to take harmful things, and dislike those that are useful for their body. There are many other remedies for nausea, particularly related to pregnancy of which one should have full knowledge. I have tried a new remedy called Pipli, which is prepared from the leaves and the burnt ashes of the tree called Pipal. The Holy Quran has mentioned this saying: We have placed the embryo in a safe and secure place under the three protective coverings (Chapter 39, Sura Al-Zumar: 7. If the defensive mechanism around the foetus is weaker than the attacking power, the pregnancy would certainly be lost. In some institutions, the scientists have discovered ways to balance the internal and the external defence systems. However, a great majority of women who were able to receive this treatment delivered their babies successfully. Ferrum Phos 333 I have found Pipli to be very useful in controlling nausea during pregnancy. However, this needs further research and experimentation on a wider scale by homoeopaths all over the world. I would like Pipli to be tried in different potencies and carefully observed to see what kind of patients it works on, and on what kinds of patients it does not. Potency: Biochemic 3x to 12x Homoeopathic 30 or Higher Ferrum Phos 334 Fluoricum Acidum (Hydrofluoric Acid) Fluoric Acid is a deeply rooted and vastly effective remedy. It is indicated in deep, slowly progressive ailments, which ultimately become part of ones life. Some patients are labelled as Sulphur or Natrum Mur but do not respond to either of them. In Natrum Mur, the nails become unsightly, loose and grow rapidly, while their ends crack, shrivell and become lifeless. These symptoms lead ones attention towards Natrum Mur, whereas the feeling of warmth, burning and sweating remind one of Sulphur. All these signs are found together in Fluoric Acid, which is a very effective remedy. If Fluoric Acid is ignored in this set of symptoms, the patient may be severely harmed. In those patients in whom the diseases progress to a stage where other remedies do not work, then certainly one has to look for profoundly acting remedies, Fluoric Acid is one of them. The deep illnesses, which pass on from one generation to another such as syphilis, gonorrhoea and leprosy, have been divided into three basic categories by many homoeopaths. Tuberculosis of the lung is also passed from one generation to another, but it would need to be treated separately, as a fourth category. At night, the patient feels intense heat while in bed and asks for cold water to be sprinkled on him as in Pulsatilla. In contrast to Natrum Mur and Sulphur, patients of Fluoric Acid react badly to coffee and tea. Silicea, which would ordinarily work on boils, will not be effective in Fluoric Acid patients unless Fluoric Acid is also used after the Silicea.

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Diabetes insipidus levels of electrolytes are maintained in the body by a careful ii buy 50 mg minocycline with visa antimicrobial vs antibiotics. Induced water deprivation (non-availability of water minocycline 50mg visa antibiotics for uti during breastfeeding, total fasting) balance of 4 processes: their intake minocycline 50mg without prescription antimicrobial ointment brands, absorption generic 50mg minocycline visa infection 3 weeks after wisdom teeth removal, distribution iii. Disturbance in any of these processes in diverse in conditions causing combined salt and water deficiency pathophysiologic states may cause electrolyte imbalance. Decreased potassium intake imbalance, abnormalities in serum levels of sodium (hypoi. Diet low in potassium beyond the scope of this book to delve into this subject in B. Electrolyte imbalance in a given case may result from one syndrome) or more conditions. For example, of fistula, gastric suction) abnormality in serum levels of sodium and potassium; C. Excessive mobilisation from extracellular into intracellular calcium and phosphate. Alkalosis levels is in the form of metabolic syndrome and clinical features rather than morphological findings in organs. Excessive potassium intake imbalance are related to its pathophysiologic role in that organ i. Decreased potassium excretion A list of important clinical conditions producing i. Oliguric phase of acute renal failure abnormalities in sodium and potassium are given in ii. Use of drugs such as beta-blockers, cytotoxic drugs During metabolism of cells, carbon dioxide and metabolic iv. The role of bicarbonate buffering system in the extracelluar compartment has already been stated above. The arterial Accordingly, the disorders of the pH of the blood, termed Pco2 level is raised. Alterations in the blood bicarbonate levels: these are A rise in the blood pH occurring due to lowered Pco 2 metabolic acidosis and alkalosis. This is encountered in 2 function of the lungs): these are respiratory acidosis and the following conditions: alkalosis. Hysterical overbreathing Thus, abnormalities in acid-base homeostasis produce Working at high temperature following 4 principal metabolic syndromes which have At high altitude diverse clinical manifestations due to pathophysiologic Meningitis, encephalitis derangements: Salicylate intoxication Clinically, the patients with respiratory alkalosis are Metabolic Acidosis characterised by peripheral vasoconstriction and consequent pallor, lightheadedness and tetany. The arterial Pco2 is A fall in the blood pH due to metabolic component is brought lowered. Normal circulatory function requires uninterrupted flow of Uncontrolled diabetes mellitus (diabetic ketoacidosis. Derangements of blood flow or haemodynamic disturbances are considered under 2 broad headings: Metabolic Alkalosis I. These A rise in the blood pH due to rise in the bicarbonate levels of include: hyperaemia and congestion, haemorrhage and plasma and loss of H+ ions is called metabolic alkalosis. Clinically, metabolic alkalosis is characterised by depression of respiration, depressed renal function with uraemia and increased bicarbonate excretion in the urine. This can occur in the following circumstances: Air obstruction as occurs in chronic bronchitis, emphysema, asthma. The affected tissue or organ is bluish arteriolar dilatation being referred to as hyperaemia or active in colour due to accumulation of venous blood (cyanosis. If the condition Accordingly, venous congestion is of 2 types: develops rapidly it is called acute, while more prolonged and Local venous congestion results from obstruction to the gradual response is known as chronic. Systemic (General) venous congestion is engorgement of the examples of active hyperaemia are seen in the systemic veins. Usually in pneumonia the fluid accumulates upstream to the specific chamber of Blushing i. For emotions example, in left-sided heart failure (such as due to mechanical Menopausal flush overload in aortic stenosis, or due to weakened left Muscular exercise ventricular wall as in myocardial infarction) pulmonary High grade fever congestion results, whereas in right-sided heart failure (such Goitre as due to pulmonary stenosis or pulmonary hypertension) Arteriovenous malformations systemic venous congestion results. The alveolar septa are widened and thickened due to congestion, oedema and mild fibrosis. The alveolar lumina contain heart failure cells (alveolar macrophages containing haemosiderin pigment. The central veins as well as Chronic venous congestion of the lung occurs in left heart the adjacent sinusoids are distended and filled with blood. Long-standing cases may show fine centrilobular fibrosis and regeneration of hepatocytes, Grossly, the lungs are heavy and firm in consistency. The peripheral sectioned surface is dark the sectioned surface is rusty zone of the lobule is less severely affected by chronic brown in colour referred to as brown induration of the hypoxia and shows some fatty change in the hepatocytes lungs. The septa are mildly thickened due to slight increase in fibrous connective tissue. Rupture Chronic venous congestion of the spleen occurs in right heart of dilated and congested capillaries may result in minute failure and in portal hypertension from cirrhosis of liver. The breakdown of erythrocytes liberates haemosiderin pigment which is Grossly, the spleen in early stage is slightly to moderately taken up by alveolar macrophages, so called heart failure enlarged (up to 250 g as compared to normal 150 g), while cells, seen in the alveolar lumina. The brown induration in long-standing cases there is progressive enlargement observed on the cut surface of the lungs is due to the and may weigh up to 500 to 1000 g. Grossly, the liver is enlarged and tender and the capsule ii) There is hyperplasia of reticuloendothelial cells in the is tense. Cut surface shows characteristic nutmeg* red pulp of the spleen (splenic macrophages. The cut surface shows mottled appearance—alternate pattern of dark congestion and pale fatty change.

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Tuberculoma is an intracranial mass occurring secondary to dissemination of tuberculosis Viral Encephalitis elsewhere in the body cheap minocycline 50mg line infection 2 tips. A zone of gliosis generally surrounds the viral replication before involvement of the nervous system tuberculoma generic minocycline 50mg online bacterial vagainal infection. Herpes zoster-varicella is a distinct primary disease Disease Incidence (chickenpox) but the virus remains latent for a long time before it gets reactivated to cause severe hyperalgesia and 1 buy minocycline 50 mg cheap antibiotics you can't drink on. All these viral i) Toxoplasmosis 15% infections enumerated so far cause acute viral encephalitis minocycline 50mg visa infection 2 months after surgery. One major the group of viral encephalitis but is caused by accumulation clinical feature of this entity is the occurrence of dementia i. Majority of cases occur sporadically though familial predisposition with autosomal dominant inheritance has also Histologically, the changes are more in subcortical area been reported in 5-15% cases. Other methods of transmission of the brain and consist of gliosis, multinucleate giant cell are by iatrogenic route (e. Intracranial haemorrhage: 879 a) Haemorrhage in the brain parenchyma (intracerebral haemorrhage) b) Haemorrhage in the subarachnoid space (subarachnoid haemorrhage. The term stroke is used for sudden and dramatic development of focal neurologic deficit, varying from trivial neurologic disorder to hemiplegia and coma. The sliced surface of the cerebral Ischaemic necrosis in the brain results from ischaemia caused hemisphere of the brain shows may tiny whitish nodules and cysts about 1 cm in diameter. The brain requires sufficient quantities of but brain atrophy may be seen in long-standing cases. These Moreover, neural tissue has limited stores of energy reserves changes are predominantly seen in the cortex and other so that cessation of continuous supply of oxygen and glucose grey matter areas. Spongiform changes result in neuronal for more than 3-4 minutes results in permanent damage to loss and glial cell proliferation but significantly without neurons and neuroglial cells. Deprivation of oxygen (anoxia) to the brain may occur in 4 different ways: Fungal and Protozoal Encephalitis 1. Anaemic anoxia, in which the oxygen-carrying haemofrom systemic deep mycoses elsewhere in the body. These fungal infections may produce In all these different forms of anoxia, the end-result is one of the three patterns: fungal chronic meningitis, vasculitis ischaemic brain damage which may have one of the following and encephalitis. Global hypoxic-ischaemic encephalopathy, resulting from amoebiasis, trypanosomiasis and cysticerosis (Fig. Cerebrovascular diseases are all those diseases in which one Global Hypoxic-Ischaemic Encephalopathy or more of the blood vessels of the brain are involved in the pathologic processes. Various pathologic processes commonly the brain receives 20% of cardiac output for maintaining its implicated in cerebrovascular diseases are: thrombosis, vital aerobic metabolism. However, 880 fall of systemic arterial systolic pressure below this critical cortex; the loss of pyramidal cell layer is more severe than value results in rapid fall in cerebral perfusion pressure and that of granular cell layer producing laminar necrosis. Such types of medical Longer duration: Use of modern ventilators has led emergencies occur at the time of cardiac arrest followed by to maintenance of cardiorespiratory function in the relatively delayed resuscitation, severe episode of hypopresence of total brain necrosis unassociated with vital tension, carbon monoxide intoxication and status epilepticus. Hypoxic encephalopathy may be followed by a postischaemic confusional state and complete recovery or a state Cerebral Infarction of coma and even a persistent vegetative life and brain death. Depending upon the proneness of different cells of the Cerebral infarction is a localised area of tissue necrosis caused brain to the effects of ischaemia-hypoxia, three types of lesion by local vascular occlusion—arterial or venous. Selective neuronal damage: Neurons are most vulnerable compression on the cerebral arteries from outside and from to damaging effect of ischaemia-hypoxia and irreversible hypoxic encephalopathy. In particular, oligodendroglial cells are most associated with cerebral infarction depend upon the region susceptible, followed by astrocytes while microglial cells and infarcted. In general, the focal neurologic deficit termed vascular endothelium survive the longest. Occlusion of the cerebral arteries by ii) Presence of acidic excitatory neurotransmitters called either thrombi or emboli is the most common cause of excitotoxins. Thrombotic occlusion of the cerebral iii) Excessive metabolic requirement of these neurons. Laminar necrosis: Global ischaemia of cerebral cortex occlusion is commonly derived from the heart, most often results in uneven damage because of different cerebral from mural thrombosis complicating myocardial infarction, vasculature which is termed laminar or pseudolaminar from atrial fibrillation and endocarditis. In this, superficial areas of cortical layers escape of an infarct are determined by the extent of anastomotic damage while deeper layers are necrosed. Watershed infarcts: Circulatory flow in the brain by Circle of Willis provides a complete collateral flow for anterior, middle and posterior cerebral arteries has internal carotid and vertebral arteries. In ischaemia-hypoxia, perfusion of Middle and anterior cerebral arteries have partial overlapping zones, being farthest from the blood supply, anastomosis of their distal branches. Particularly vulnerable is the border zone of the arteries and have no anastomosis. Hence, occlusion of these cerebral cortex between the anterior and middle cerebral branches will invariably lead to an infarct. The pathologic appearinfrequent phenomenon due to good communications of the ance of the brain in hypoxic encephalopathy varies cerebral venous drainage. However in cancer, due to depending upon the duration and severity of hypoxic increased predisposition to thrombosis, superior sagittal episode and the length of survival. Compression of the cerebral arteSurvival 12-24 hours: No macroscopic change is ries from outside such as occurs during herniation may cause discernible but microscopic examination reveals early cerebral infarction. Mechanism of watershed (border zone) neuronal damage in the form of eosinophilic cytoplasm cerebral infarction in hypoxic encephalopathy has already and pyknotic nuclei, so called red neurons. The In any case, the extent of damage produced by any of the area supplied by distal branches of the cerebral arteries above causes depends upon: suffers from the most severe ischaemic damage and may i) rate of reduction of blood flow; develop border zone or watershed infarcts in the junctional ii) type of blood vessel involved; and zones between the territories supplied by major arteries.

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