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Malaise anxiety cures buy on line hydroxyzine, weakness anxiety 2 days before menses buy cheap hydroxyzine online, fatigability and liver transaminase elevations often improve during the first several weeks of treatment anxiety groups 10 mg hydroxyzine overnight delivery, but joint symptoms may initially worsen before eventually improving (if at all) anxiety verses 25 mg hydroxyzine sale. The risk of hepatocellular carcinoma correlates strongly with cirrhosis and persists despite iron depletion. In situations where therapeutic phlebotomy is contradicted, iron chelation can be used as an alternative treatment, although it is costly and has side effects. The mean number of procedures and treatment duration to achieve ferritin of 50 ng/mL were 9 and 20 weeks for the erythrocytapheresis group versus 27 and 34 weeks (p < 0. No difference in adverse events and no significant difference in total treatment costs were observed (the higher cost of erythrocytapheresis was offset by a significant reduction in lost work productivity due to phlebotomy visits) (Rombout-Sestrienkova, 2012). Time to normalization (50ng/mL) of ferritin was equivalent; cost for apheresis was 3x higher in this study (Sundic, 2014). In this study, mean number of procedures per treatment year was significantly higher using phlebotomy versus erythrocytapheresis (3. Eighty percent of the patients expressed preference for the erythrocytapheresis over phlebotomy. The reduction in the number of required procedures per year to maintain a goal ferritin level may give a cost benefit of erythrocytapheresis over phlebotomy. Maintenance treatment can follow with less frequent therapeu tic phlebotomy or erythrocytapheresis. Erythrocytapheresis with recombi nant human erythropoietin in hereditary hemochromatosis therapy: a new alternative. References cytapheresis plus erythropoietin: an alternative therapy for selected patients of the identified articles were searched for additional cases and trials. Interventions for hereditary haemochromatosis: an cell apheresis removes excess iron twice as fast as manual whole blood attempted network meta-analysis. Central nervous system manifestations include confusion, somno lence, dizziness, headache, coma, and parenchymal hemorrhage. Pulmonary complications include hypoxemia, diffuse alveolar hemorrhage, and respiratory failure. Thepathogenesisisunclear,but may relate to cell rigidity, size, rheological properties, high metabolic activity causing local hypoxia, cytoadhesive interactions, and endothelial damage. Compared to lymphoid blasts, myeloid blasts are larger, less deformable, and their cyto kine products are more prone to activate inflammation and endothelial cell adhesion molecule expression. Other studies have reported no benefit and raised con cerns that leukocytapheresis might delay start of induction chemotherapy. Limita tions to these studies include the retrospective, observational nature of the publications, and having moderate to high risk of confounding bias. Thus, leukocytapheresis may still have a therapeutic role in patients presenting with leukostasis. However, chemotherapy should not be postponed and is required to prevent rapid re-accumulation of circulating blasts. Platelet, cryoprecipitate and/or plasma transfusion, however, may be given if the patient has thrombocytopenia and/or coagulopathy prior to the procedure. In patients <10 kg, manual whole blood exchange may be performed instead of using the automated cell separators. The effect of initial manage ment of hyperleukocytosis on early complications and outcome of chil dren with acute lymphoblastic leukemia. Leukapheresis reduces 4-week mortal kemia for reports published in the English language. References of the ity in acute myeloid leukemia patients with hyperleukocytosis a retro identified articles were searched for additional cases and trials. The effect of therapeutic leukapheresis erleukocytosis: a systematic review and meta-analysis. Hyperleukocytosis and loid leukemia in the setting of pregnancy: when is leukocytapheresis appro leukostasis: management of a medical emergency. Apheresis principles in a patient with myeloid leukaemia the challenge of white blood cell counts above chronic myeloid leukemia during pregnancy: challenges in cell separation 200 x 109/l. Extracorpo real elimination of large lipoproteins is hypothesized to stop further organ damage. However, these systems are optimized for the elimination of small to mid-sized apoB100-positive lipoproteins and efficacy can be reduced with chylomicronemia. Therapeutic plasma exchange in patients with chylomicronemia syndrome complicated by acute pancreatitis. Plasma exchange exchange, plasmapheresis, hypertriglyceridemia, chylomicronemia, pancreati treatment for acute hyperlipidemic pancreatitis with falsely low levels of this for articles published in the English language. Plasmapheresis for Preventing Com exchange in patients with severe hypertriglyceridemia: a multicenter plication of Hypertriglyceridemia: A Case Report and Review of Litera study. Extracorporeal treatment in hypertriglyceridemia-induced acute pancreatitis during pregnancy: a ret severe hypertriglyceridemia-induced pancreatitis. As blood viscosity rises, a nonlinear increase in shear stress in small blood vessels, particularly at low initial shear rates, produces damage to fragile venular endothelium such as that of the eye and other mucosal surfaces. Other manifesta tions include congestive heart failure (related to plasma volume overexpansion), respiratory compromise, coagulation abnormalities, anemia, fatigue, peripheral polyneuropathy, and anorexia. Serum viscosity measurement does not consistently cor relate with clinical symptoms among individual patients, however, the viscosity level at which the syndrome appears is generally reproducible within the same patient (symptomatic threshold). Early diagnosis, which can usually be made from the funduscopic exam, is crucial to prevent further progression. Patients with constitutional symptoms, hematological compromise, and bulky disease should be considered for chemotherapy +/ immunotherapy. A combination of bendamustine and rituximab has been recommended as first line therapy for bulky disease, while dexamethasone-rituximab-cyclophosphamide has been suggested as an alternative, especially in the setting of non-bulky dis ease. Other regimens include proteasome inhibitors (bortezomib and carfilzomib), nucleoside analogs (fludarabine and cladribine), and ibrutinib. IgM is 80% intravascular and serum viscosity rises steeply with increasing IgM levels. Thus, a relatively small reduction in IgM concentration has a significant effect on lowering serum viscosity. A transient increase in IgM level after rituximab therapy (flares), has been reported in 30-70% of patients within 4 weeks of treatment initiation. Technical notes Conventional calculations of plasma volume based on weight and hematocrit are inaccurate in M-protein disorders because of plasma volume expan sion. Cascade filtration and membrane filtration techniques have been described and may have similar efficacy in removing M-protein. The reduction in IgM may be less than the theoretical reduc tion of an ideal solute (Miyamoto, 2018). When patients are maintained at a level under their symptomatic threshold, clinical manifestations of the syndrome usually are prevented. Indian J Hematol Blood Miyamoto Y, Hamasaki Y, Matsumoto A, Doi K, Noiri E, Nangaku M. Efficacyofdiscontin impact of disease unrelated mortality and of rituximab-based primary uous flow centrifugation compared with cascade filtration in Waldenstrom’s therapy. Roughly >10% of patients can present as rapidly progressive crescentic glomerulo nephritis. When there are symptoms, the classic presentation for the disease is gross hematuria occurring shortly after an upper respiratory infection (synpharyngitic) or, when asymptomatic, discovery of microscopic hematuria with or without proteinuria. Factors associated with disease progres sion are hypertension, persistent proteinuria >1000 mg/day, and elevations in serum creatinine. Numerous authors have found that improvement only occurred in the presence of cellular crescents, and not in sclerotic, scarred glomeruli. Coexistence of atypical hemolytic uremic syndrome and crescentic IgA nephropathy treated with eculizumab: a case report. References of the identified articles were searched for Atypical hemolytic uremic syndrome associated with complement Fac additional cases and trials. Targeted-release budesonide versus Nicholls K, Becker G, Walker R, Wright C, Kincaid-Smith P. The pathogenesis of IgA nephropathy: What is new and how does it change therapeutic approaches At platelet counts <30 109/L, in patients younger than 40, 40-60, and >60 years old, this risk is 0.
However anxiety 5 steps cheap generic hydroxyzine canada, many ex appreciation of the senses: vision anxiety symptoms grief cheap hydroxyzine 10 mg visa, hearing anxiety symptoms 8 months cheap hydroxyzine 10 mg amex, taste anxiety symptoms causes 25 mg hydroxyzine sale, pain perienced clinicians select signs to be examined to and touch. The spinal cord acts a conduit for informa con rm or rule out differential diagnoses generated tion passing to and from the brain. The progression from clinical ventral grey horns of the spinal chord are located signs to differential diagnosis may go through an in lower motor neurons which are involved in involun termediate step which is the localisation of the lesion tary spinal re exes as well as voluntary actions. The differential diagno peripheral nerves are composed of sensory nerves sis may therefore be based either on the constellation carrying information to the spinal cord and motor of clinical signs that are detected or on the conditions nerves carrying information to the muscle. Neurological conditions of cattle are common and Important questions to consider during the clinical important. Milk fever and bovine spongiform en examination are the following: cephalopathy are two examples. Examination of the nervous system can be dif cult due to the lack of fa • Is the condition a neuropathological disorder. In many cortical necrosis) or a consequence of disease in cases a de nitive diagnosis may not be necessary if another organ system. Incorrect feeding during the dry period in dairy cattle may Many neurological conditions are speci c or more result in a high incidence of milk fever. The sig nesium supplementation may cause hypomagne nalment alone may enable the initial list of differen saemia which may become apparent following tial diagnoses to be small. Age – septicaemia with meningitis and encephalitis Protocols for navel dressing and the possibility of or cerebellar hypoplasia is more commonly seen failure of passive transfer of protective antibodies in calves, whereas clinical bovine spongiform en should be checked if there is a high incidence of cephalopathy is con ned to cattle over 2 years of neonatal calf mortality due to meningitis. For example, a dairy herd that has Class – cerebrocortical necrosis and ruminal acidosis an incorrect mineral content during the dry period are more common in intensively fed beef cattle. The morbidity rate is likely to be high but with a low mortality rate, assuming treat ment is given promptly. The prevalence will be low History but the annual incidence will be high, even with sea sonally calving herds as the disease has a short dura the time of onset, the signs observed and the clinical tion and the cows do not calve concurrently. Congenital conditions are likely to have been present since birth, whereas traumatic lesions such as trau Examination of the environment matic spinal injuries are usually acute in onset with the animal’s condition either stabalising or improv the environment in which the animals are currently ing. The sequence of water supplies contaminated with the blue green events is important to establish; for example, did a algae Microcystis aeruginosa. Examination of silage recumbent animal show any signs of paresis before quality may indicate excessive soil contamination going down Some important neurological conditions are asso ciated with feeding practices and changes in nutri tion. A sudden increase in concentrate feeding may the examination be related to an outbreak of ruminal acidosis or cere brocortical necrosis. Animals with lesions of the spinal chord or periph Forcing the affected animal or group to move at a slow eral nerves usually have a normal mental status walkwill enable the clinician to detect incoordination and are bright and alert, at least in the early stages of. Abnormalities of social interactions, ketosis) may be observed in the con ned space of the such as separation or aggression. Aversion of the head is a lateral, upward or downward deviation and may be seen with cerebral lesions such as cerebrocortical necrosis. With cerebellar involve ment there is a wide-based stance and ataxia, but without muscle weakness. Visual or auditory de cits may become apparent when the animal is approached, although depression or dullness may also produce a delayed response. Dropped ear, recumbent animal will attempt to rise on approach eyelid and jaw, accid lip,head aversion and tongue paralysis. It can be detected by ob so they bump into the walls, although spatial adapta serving the symmetry of the head. An obstacle course can be side, there is bulging of the cheek due to retention of helpful, although sighted animals may knock objects food, and drooping of the ear and eyelid. The xation, menace response and photomotor re exes may be helpful in assessing Nystagmus the presence or absence of vision. These re ex tests re consists of a slow movement in one direction with a quire restraint. An the movement relative to the head may be horizontal, abnormality in the re ex may be due to a lesion any vertical or rotatory. Repeated attempts are often not diagnostic as orbit and may be ventrolateral due to damage to cra cattle fail to respond due to adaptation. To ensure it is the mov ing hand and not the blast of air preceding it, a piece Vestibular eye drop response of rigid transparent plastic should be interposed be In cattle, the eye remains in the original position if the tween the hand and the eye before the test. Palpebral re ex When the periocular skin is touched the normal animal will close the eyelids. When forced to do cates a lesion to one or both of these nerves or their Figure 14. To rule out damage to the Ophthalmoscopy trigeminal nerve (V), facial skin sensation can be Ophthalmoscopy of the lens may reveal cataracts in a tested using a pair of haemostats. Examination of the retina may reveal thrombosis and haemorrhage of the retinal vessels Photomotor re ex Closure of the eyelids when a. Pupillary light re ex the animal should be placed Clinical signs associated with cranial in a darkened environment for several minutes nerve lesions before performing the test. The direct and indirect the clinical signs that may be observed with the dys responses of both eyes should be tested. Care Cornea re ex If the cornea is touched, the eyeball is should be taken to avoid damage to the tongue by retracted and the nictitating membrane comes across the incisor teeth. A limp tongue Examination of the neck that remains exteriorised once released is a sign of hypoglossal paralysis or (if more general signs the symmetry of the neck and pain on manipulation of paresis are present) botulism. The presence of muscle atro dif culty swallowing may present with saliva and phy, peripheral sensation or sweating should be food material around the muzzle. Clinical signs associated with lesions of the cerebrum Manipulation of the head and opisthotonos Manipulation of the head in cattle with cerebellar Signs may be caused by diffuse. Head Opisthotonos is also seen in tetanus, cerebral disease pressing and compulsive behaviour such as self lick and hypomagnesaemia. There may be blindness with normal Hyperextension of the head and neck Extensor rigidity of the limbs Figure 14. There may be abnormal movements, head tremor, intention tremor, head vocalisation. With generalised seizures the the menace response and nystagmus is occasionally animal is recumbent with exaggerated paddling seen. Opisthotonos may movements of the limbs or, in more severe cases, occur or be induced by raising the head. Lesions affecting only one cerebral hemisphere may cause aimless circling or leaning to Clinical signs associated with lesions of wards the affected side with contralateral proprio vestibular disease ceptive de cits. The most common condition causing vestibular dis ease (and brain-stem lesions) is listeriosis. Otitis in Clinical signs associated with lesions of terna and/or otitis media may result in vestibular the cerebellum damage. Manifestations of vestibular disease in the cerebellum coordinates all skeletal muscle activ clude ipsilateral head tilt, circling, nystagmus and a ity. This results in the loss of proprioception (spatial awareness of limb position), weakness or paralysis, Depressed re ex this indicates the lesion is in the increase in extensor tone (hypertonia) causing spas region of the re ex arc. Muscle accidity, decreased or absent re exes, weakness damage may be the result of ischaemic muscle necro and paralysis, with rapid and severe muscle atrophy sis caused by ischaemia in downer cows or white speci c to the skeletal musculature affected. Conscious perception of skin sensitivity Panniculus re ex Apinprick over the body results this can be tested by applying forceps to the skin and in contraction of the panniculus muscle which is ob observing a behavioural response that indicates the served as a inching or twitching of the skin at the integrity of the peripheral sensory nerve and spinal test site. A transition from hyperaesthesia to hypoaes thesia or analgesia when moving in a caudal direc Patellar re ex With the animal in lateral recum tion indicates of the site of the lesion. This causes a have normal forelegs but weakness or paralysis in rapid extension of the sti e in the normal animal. These animals may adopt a dog-sitting position, sup Triceps re ex With the animal in lateral recumben porting weight on their forelegs (Fig. In addition, there may be reduced anal tone, bladder paralysis and decreased perineal Crossed extensor re ex Flexion of one limb causes sensation.
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Ischemia of the gastric mucosa with breakdown of the normal protective barriers of the stomach is a key factor in the syndrome anxiety symptoms arm pain order hydroxyzine 10 mg with mastercard. Gastritis is classified based on the time course of the (acute or chronic) anxiety pathophysiology purchase 25mg hydroxyzine with visa, histologic features anxiety or depression order hydroxyzine with paypal, and anatomical distribution anxietyzone symptoms buy hydroxyzine overnight delivery. Chronic gastritis is classified based on anatomic site of involvement, Type B is an antral predominant form (H pylori related) and Type A refers to body predominant form (autoimmune). It becomes more common with advancing age and is uniformly associated with H pylori infection. Antibodies to parietal cells and to intrinsic factor are frequently seen in the sera, suggesting an immune or autoimmune pathogenesis. It is characterized by large, tortuous gastric mucosal folds, and usually presents with abdominal pain. Protein-losing enteropathy often develops, resulting in hypoalbuminemia and edema. However, some patients develop bile reflux gastritis with symptoms of pain, nausea, and vomiting. A 65-year-old man presents to the clinic for assessment of numerous symptoms which are worse in the winter months. He notices diffuse red patches which are not raised or painful and occasionally purple fingertips. On physical examination, the vital signs are normal, the heart sounds are normal, and the lungs clear. The joints are normal with no active inflammation, and the muscle strength is 4+/5. On his thighs and knees there are fine “lace”-like appearing skin changes that are consistent with livedo reticularis. A 34-year-old man presents to the emergency department with symptoms of fatigue, weakness, nose bleeds, and palpitations with exertion. On examination, he is pale, blood pressure 110/70 mm Hg, pulse 100/min, heart sounds are normal, lungs are clear, and he has multiple petechiae and bruises on his legs. On physical examination, he appears pale, the vital signs are normal, and the pertinent findings are a large spleen, absence of lymph nodes, and normal heart and lungs. Which of the following cytogenetic changes is most characteristic of his condition He reports no active symptoms, there is no past medical history and he is not taking any medications. He mentions that his brother has a “low blood count” that is hereditary but does not recall the name of the disorder. A 57-year-old man is seen in the clinic for symptoms of fatigue and shortness of breath on exertion. The physical examination is normal but a complete blood count reveals pancytopenia. He is referred to a hematologist and a bone marrow aspirate and biopsy confirm the diagnosis of aplastic anemia. Which of the following is the most likely complication of allogenic bone marrow transplantation A 19-year-old man is having recurrent bleeding occur in his knee when playing contact sports. Questions 7 and 8: For each patient with a hematologic abnormality, select the most likely diagnosis. A 19-year-old college student develops a severe sore throat, cervical lymphadenopathy, and atypical lymphocytes on blood film. Questions 9 and 10: For each patient with anemia, select the corresponding clinical and laboratory findings. Questions 11 through 13: For each patient with a blood-count anomaly, select the corresponding clinical situation and/or laboratory finding. A 49-year-old woman feels unwell because of fatigue and shortness of breath on exertion. A 69-year-old man presents with increasing symptoms of chest pain on exertion, but never at rest. Repeat evaluation now reveals a hypochromic microcytic anemia as the cause for his increased chest pain symptoms. A 7-year-old boy has severe microcytic anemia due to beta-thalassemia major (homozygous). He requires frequent blood transfusions (once every 6 weeks) to prevent the skeletal and developmental complications of thalassemia. Which of the following medications is also indicated in the treatment of patients requiring frequent blood transfusions A 45-year-old woman develops symptoms of shortness of breath on exertion, easy fatigue, and jaundice. On examination she is pale, and there is a palpable spleen, but no lymphadenopathy. Which of the following bone marrow findings is most likely to be seen in this patient A 23-year-old woman of Italian extraction is found to have a hypochromic microcytic anemia of 10 g/dL. In addition, there is a fair degree of anisocytosis, poikilocytosis, and targeting on the blood film. Which of the following characteristics is most likely to be helpful in differentiating essential (primary) from reactive (secondary) thrombocytosis He has had multiple blood transfusions in the past, but with the last transfusion, he developed fever and chills after the transfusion was started. Repeat cross-matching and testing at the time ruled out an acute hemolytic transfusion reaction. The next transfusion is ordered through a “filter” to prevent or minimize the febrile reaction. Which of the following mechanisms is most likely to explain the effect of the filter He feels well at the present time, but in the past he has had two presentations to the hospital for severe abdominal and back pain that resolved on its own with no specific diagnosis. Which of the following is the most likely explanation for his previous episodes of abdominal pain She appears well and the physical examination is normal, but her hemoglobin is low at 9. Which of the following would be most helpful in distinguishing thalassemia from one of pure iron deficiency anemia A 21-year-old woman is suspected of having mycoplasma pneumonia based on symptoms of a dry cough, fever, normal lung examination but abnormal chest x-ray with bilateral infiltrates. A 59-year-old man presents to the emergency room with left face and arm weakness that lasts for 3 hours. He is started on clopidogrel, and referred for further evaluation as an outpatient. Which of the following is the most likely mechanism of action on platelet function from this medication A 23-year-old woman has symptoms of leg swelling and discomfort, but no chest pain or shortness of breath. The baby looks well, the height and weight growth parameters are normal, and she is breast-feeding well. A 63-year-old man is involved in a motor vehicle accident and is brought to the hospital. On examination, his blood pressure is 90/60 mm Hg, pulse 110/min, and his abdomen is distended and rigid. The pain is made worse with breathing, but he reports no fever, cough, or sputum production. A 36-year-old woman with sickle cell disease presents with increasing pain in her right hip. She has no fever, chills, back or other bone pain, and there is no history of any trauma. On examination, the conjunctivae are pale, her sclera are icteric, the blood pressure 110/70 mm Hg, pulse 110/min, lungs clear, and heart sounds normal.
The line of demarcation between gangrenous segment and viable bowel is generally not clear-cut (Fig anxiety symptoms out of the blue purchase hydroxyzine in india. It is a special form of wet gangrene caused by gas-forming clostridia (gram-positive anaerobic bacteria) which gain entry into the tissues through open contaminated wounds anxiety hot flashes discount hydroxyzine 10mg visa, especially in the muscles anxiety symptoms scale buy hydroxyzine 10 mg, or as a complication of operation on colon which normally contains clostridia anxiety levels discount hydroxyzine amex. Clostridia produce various toxins which produce necrosis and oedema locally and are also absorbed producing profound systemic manifestations. Grossly, the affected area is swollen, oedematous, painful and crepitant due to Figure 3. Line of demarcation between gangrenous segment and the viable bowel is not clear-cut. Subsequently, the affected tissue becomes dark black and Metastatic calcification, on the other hand, occurs in foul smelling. Microscopically, the muscle fibres undergo coagulative Etiology and pathogenesis of the two are different but necrosis with liquefaction. Large number of gram-positive morphologically the deposits in both resemble normal bacilli can be identified. Histologically, in routine H and E stained sections, calcium salts appear as deeply basophilic, irregular and granular clumps. Occasionally, hetero Deposition of calcium salts in tissues other than osteoid or topic bone formation (ossification) may occur. Two deposits can be confirmed by special stains like silver distinct types of pathologic calcification are recognised: impregnation method of von-Kossa producing black colour, Dystrophic calcification, which is characterised by and alizarin red S that produces red staining. Pathologic deposition of calcium salts in dead or degenerated tissues calcification is often accompanied by diffuse or granular with normal calcium metabolism and normal serum calcium deposits of iron giving positive Prussian blue reaction in levels. Mechanisms Arterial occlusion More commonly venous obstruction, less often arterial occlusion 3. Macroscopy Organ dry, shrunken and black Part moist, soft, swollen, rotten and dark 4. Putrefaction Limited due to very little blood Marked due to stuffing of organ with blood supply 5. Line of demarcation Present at the junction between No clear line of demarcation healthy and gangrenous part 6. Prognosis Generally better due to little septicaemia Generally poor due to profound toxaemia 52 Figure 3. Microscopy shows coagulative necrosis of the affected bowel wall and thrombosed vessels while the junction with normal intestine is indistinct and shows an inflammatory infiltrate. Stroma of tumours such as uterine fibroids, breast cancer, different etiologies and mechanisms. Some tumours show characteristic spherules of calci definition, dystrophic calcification may occur due to 2 types fication called psammoma bodies or calcospherites such as in of causes: meningioma, papillary serous cystadenocarcinoma of the Calcification in dead tissue ovary and papillary carcinoma of the thyroid. Cysts which have been present for a long time may show Calcification in dead tissue calcification of their walls. Calcinosis cutis is a condition of unknown cause in which for dystrophic calcification. Living bacilli may be present there are irregular nodular deposits of calcium salts in the even in calcified tuberculous lesions, lymph nodes, lungs, skin and subcutaneous tissue. Fat necrosis following acute pancreatitis or traumatic fat or bronchial cartilages, and pineal gland in the brain etc. Dead parasites like in hydatid cyst, Schistosoma eggs, and cysticercosis are some of the examples showing dystrophic calcification. Congenital toxoplasmosis involving the central nervous system visualised by calcification in the infant brain. Monckeberg’s sclerosis shows calcification in the tunica while the periphery shows healed granulomas. Milk-alkali syndrome caused by excessive oral intake of as to how dystrophic calcification takes place. Since serum calcium in the form of milk and administration of calcium calcium levels are within normal limits, the denatured carbonate in the treatment of peptic ulcer. Hypercalcaemia of infancy is another condition in which ions, which react with calcium ions to form precipitates of metastatic calcification may occur. Metastatic calcification may the process of dystrophic calcification has been likened occur in any normal tissue of the body but affects the to the formation of normal hydroxyapatite in the bone following organs more commonly: involving 2 phases: initiation and propagation. Kidneys, especially at the basement membrane of tubular Initiation is the phase in which precipitates of calcium epithelium and in the tubular lumina causing nephro phosphate begin to accumulate intracellularly in the calcinosis (Fig. Metasatic causes would include one of the following two conditions: calcification at the above-mentioned sites occurs due to Excessive mobilisation of calcium from the bone. This leads to formation of precipitates of Excessive mobilisation of calcium from the bone. Metastatic causes are more common and include the following: calcification is reversible upon correction of underlying 1. Prolonged immobilisation of a patient results in disuse For the sake of survival on exposure to stress, the cells make atrophy of the bones and hypercalcaemia. Less often, adapt) to the physiologic needs (physiologic adaptation) and excess calcium may be absorbed from the gut causing to non-lethal pathologic injury (pathologic adaptation). These causes are speaking, such physiologic and pathologic adaptations occur as under: by following processes (Fig. Hypervitaminosis D results in increased calcium Decreasing or increasing their size i. Definition Deposits of calcium salts in dead and Deposits of calcium salts in normal tissues degenerated tissues 2. Reversibility Generally irreversible Reversible upon correction of metabolic disorder 5. Pathogenesis Increased binding of phosphates with Increased precipitates of calcium phosphate due to necrotic and degenerative tissue, which hypercalcaemia at certain sites. Various mechanisms which may be involved in adaptive Changing the pathway of phenotypic differentiation of cellular responses include the following: cells i. In general, the adaptive responses are reversible on withdrawal Synthesis of new proteins by the target cell such as heat of stimulus. Atrophy is a normal process of aging in some tissues, which could be due to loss of endocrine stimulation or arteriosclerosis. In starvation, there is first depletion of carbohydrate and fat stores followed by protein Figure 3. There is general weakness, emaciation and hyalinisation, peritubular fibrosis and diminished number and size of anaemia referred to as cachexia seen in cancer and severely spermatogenic elements. Gradual diminution of blood supply due to atherosclerosis may result in shrinkage of the affected similar. Prolonged diminished functional activity There is often increase in the number of autophagic is associated with disuse atrophy of the organ. Hypertrophy without ii) Hypothyroidism may cause atrophy of the skin and its accompanying hyperplasia affects mainly muscles. Enlarged size of the uterus in tumours or cyst or aneurysm may cause compression and pregnancy is an excellent example of physiologic atrophy of the tissues. Examples of certain diseases ii) Erosion of skull by meningioma arising from pia associated with hypertrophy are as under: arachnoid. Hypertrophy of cardiac muscle may occur in a number of iii) Erosion of sternum by aneurysm of arch of aorta. There are some examples of atrophy ventricular hypertrophy are as under: where no obvious cause is present. Irrespective of the i) Cardiac achalasia (in oesophagus) underlying cause for atrophy, the pathologic changes are ii) Pyloric stenosis (in stomach) 56 hyperplastic growth. Neoplasia differs from hyperplasia in having hyperplastic growth with loss of growth-regulatory mechanism due to change in genetic composition of the cell. As with other non-neoplastic adaptive disorders of growth, hyperplasia has also been divided into physiologic and pathologic. For example, a hypertrophied heart of a patient with systemic hypertension may weigh 700-800 g as compared to average normal adult weight of 350 g. Hyperplasia occurs due to increased recruitment of cells from G0 (resting) phase of the cell cycle to undergo mitosis, when stimulated. The liver, pancreas, kidney, adrenal, and thyroid) can undergo epidermis shows an increase in the number of layers of the squamous hyperplasia, while permanent cells.