A. Abe. University of Texas at Arlington.
If an ex posure of 70 kVp and 200 mAs is desired 100mg kamagra soft overnight delivery erectile dysfunction psychological causes treatment, � 600 this x-ray tube could be operated at 70 f 500 kVp generic kamagra soft 100mg without prescription erectile dysfunction protocol free ebook, 200 rA order kamagra soft 100mg amex erectile dysfunction after radiation treatment prostate cancer, and 1. Notice that any � 400 � attempt to get a shorter exposure would ::: 300 _ fail, because the tube is limited to 0. Operating the tube at Automatic Exposure Control high rA causes maximum focal spot (Phototimer) blooming. Heating the anode to its maxi Mechanical and electronic timers are mum capacity with each exposure shortens subject to human error. Manufacturers generally set lects the exposure time that he believes will the tube to operate at somewhat lower than produce a film of the desired density. They measure the They find their greatest use with automatic amount of radiation required to produce exposure generators where simple opera the correct exposure for a radiographic ex tor controls are desired. Once the kV p is selected, either the tech A variety of ways to control the length nologist or a phototimer must select the of an x-ray exposure have been developed. We will mention these briefy, and consider The goal is to produce a satisfactory radi only phototimers in any detail. Automatic exposure control (photo response to this radiation, produce a small timers) electric current. The length of the x-ray exposure Phototimers can be located in front of the is determined by the time required to cassette, and are called entrance types, or charge a capacitor through a selected re behind the cassette as exit types. This is posure and also starts charging the capac the most common type of automatic ex itor. The detector is capacitor is charged to a value necessary to made of lucite, which is a material that can turn on associated electronic circuits. The lucite is coated with one exposure time is therefore determined by or more (commonly three) areas of a phos the length of time for the capacitor to phor that will emit light when irradiated charge, and this time can be varied by vary with x rays (these lucite detectors are usu ing the value of the resistance in the charg- ally called lucite paddles). Sensors detect the kVp being used, and the phototimer detector will be decreased in sensitivity if low kVp is being used. When light strikes the pho Figure 3-29 Photomultiplier automatic ex toemissive layer on the photocathode, the posure control (phototimer) photoemissive material emits photoelec trons in numbers proportional to the in area is about 100 square centimeters (100 tensity of the light. When a phosphor generates trodes are coated with a material that emits light, the intensity of the light is obviously secondary electrons when struck by an proportional to the intensity of x rays that other electron. The lucite transmits ated by a positive potential from one dy this light to an output region called a "light node to the next, with each dynode giving gate. Photomultiplier photocathode of a photomultiplier tube, tubes come in many sizes and shapes, and where the light is converted to an electric are used extensively in nuclear medicine current that is amplifed to produce an and physics laboratories. The electric current gen of electrons collected at the anode repre erated by the photomultiplier tube may be sents the output current, and this output used to charge a capacitor. When the ca current is proportional to the intensity of pacitor reaches a predetermined charge it the light that struck the photocathode. In can be used to bias the gate of a thyrister herent in the operation of a photomulti in the x-ray circuit and cause the exposure plier tube is the requirement for a stable to terminate. Ioni lucent, so it will not produce a detectable zation chambers are almost always used as image if placed in front of a cassette. An ionization lucite serves two functions: it is the support chamber is very slightly imaged on flm, but that holds the fuorescent screen or the image is so faint it is lost in the images screens, and it transmits light to the pho of anatomic parts. Gas (usually room a function of kVp because low energy pho air) is present between the plates. The gas tons are absorbed more readily in the phos becomes ionized when struck by radiation, ppor. At lower and ionization is in direct proportion to the peak kilovoltage (about 60 kVp) the phos- amount of radiation. In fact, the have a rectangular-shaped detector in its structure we have described is a parallel center (in the region of the mediastinum) plate capacitor. When the gas is ionized by and two more laterally placed square de radiation, the negative ion (electron) moves tectors. The technologist can choose to use toward the positive plate and the positive one, two, or all three detectors. Use of the ion (ionized gas atom) moves toward the central feld may permit a good view of the negative plate. When the ions arrive at the thoracic spine but overexpose the lung plates they neutralize part of the charge felds. This lung felds well unless one lung happens to reduction in charge reduces the residual be opaque. A variety of solid-state ra that the phototimer be adjusted for the diation detectors are on the market today film, intensifying screen, and cassette being that operate on the basis of radiation-pro used. Our Health and Human Services requires that mention of these two types is an indication a phototimer show variation of no more of how fuid solid-state technology is. An informal to terminate an exposure in case of equip poll of several of our local equipment sup ment failure. The Department of Health pliers indicated that photomultiplier tubes and Human Services regulations state that and ionization chambers are still in the ma the generator must automatically termi jority at this time. Miscellaneous Autotimer Topics Use of automatic timer devices requires Pulse-Counting Timers attention to a number of details; we will A technique used extensively in meas use this section to discuss some of these. There curate clock, the atomic clock, counts the may be one, two, or three detectors; the very stable frequency of atomic oscillation. In the electronic world, timing is accom A single detector positioned in the center plished by counting pulses of a regular pe of the flm is commonly used in fuoro riodic voltage. The time would be to count voltage pulses of cathode-anode circuit, called the high-volt high frequency. Obviously, the higher the age circuit, contains an autotransformer frequency, the more pulses that are and a step-up transformer. Pulse-counting timers use this technique Rectifiers are devices (usually silicon di of voltage pulse counting to control the odes) that transmit a current in only one time of short exposure techniques. Single-phase generators may frequencies can be generated by the oscil have half-wave rectifcation (60 pulses per lation in a quartz crystal whose frequency second). Three-phase generators may be of oscillation is determined by the size, ori six-pulse (360 pulses per second) with a entation of the cut of the crystal, and the theoretical ripple factor of 13. Special types of however, discuss piezoelectric oscillation in generators include capacitor-discharge Chapter 20 on ultrasound). With a quartz generators, battery-powered generators, crystal it is quite easy to obtain megahertz medium-frequency generators, and falling frequencies that are extremely stable. A 1O-ms time could be meas dicates the maximum safe output of the ured by counting 10,000 pulses. Such ratings are ex number of pulses accounts for the accu pressed as the kilowatt rating. The ers (obsolete), electronic timers, automatic x-ray tube requires two sources of energy, exposure controls (phototimers), and one to heat the flament and the other to pulse-counting timers. Automatic expo accelerate electrons between the cathode sure control may be achieved with photo and anode.
Since in the given question purchase cheapest kamagra soft erectile dysfunction icd 9 code wiki, both (less than 2 years as well as testicular involvement) are mentioned we would go for testicular involvement as the better answer here buy kamagra soft 100 mg line erectile dysfunction doctor singapore. In tumors with monocytic differentiation M4 and M5 (more commonly) order kamagra soft cheap erectile dysfunction funny images, infltration of the skin (leukemia cutis) and the gingiva leading to gum hypertrophy can be observed, likely refecting the normal tendency of non-neoplastic monocytes to extravasate into tissues. Bone marrow shows marked erythroid hyperplasia with polychromatophilic and orthochromatophilic erythroblasts. There is distinct dissociation of nuclear and cytoplasmic maturation with immature megaloblastoid nuclei and mature cytoplasm. Recurrent or persistent mild jaundice, hepatosplenomegaly and anemia are the presenting features. Blood smear shows anisocytosis, poikilocytosis, tear drop cells and basophilic stippling Bone marrow shows erythroid hyperplasia with binucleated or multinucleated mature blasts. Data shows its increased levels are associated with colon/breast and pancreatic cancer. Chronic myeloid leukemia is a stem cell disease that is characterized by leukocytosis with granulocytic immaturities, basophilia, splenomegaly and distinct chromosomal abnormality Philadelphia chromosome. These are actually group of protein markers present on the surface of white blood cell. These markers are used to classify the lineage of the leukocytes and are detected by immunophenotyping. Singh 1st/186-190, Harrison 17th/683 – 84) • An old man having fatigue and weight loss (due to anemia and cancer) and heaviness in left hypochondrium (most likely due to splenomegaly). For the diagnosis of acute leukemia, the number of blasts in the blood should be >20%. Good prognosis t (8; 21), inv (16) or t (15; 17) Moderately favorable outcome No cytogenetic abnormality Poor prognosis inv (3), monosomy 7 For all Prognostic factors in acute myeloid leukemia, see text. Disease conditions: Hay fever, Asthma, Eczema, Serum sickness, Allergic vasculitis, Pemphigus, All types of parasitic infections. It can progress to – – Paroxysmal Nocturnal hemoglobinuria – Myelodysplastic anemia – Rarely acute leukemia Pure red cell aplasia is a selective disease of absence of erythrocyte progenitor cells. It is characterized by: Anemia, Neutropenia, Thrombocytopenia, and Reticulocytopenia. Splenomegaly is characteristically absent; if present, the diagnosis of aplastic anemia is almost ruled out. Bone marrow shows hypocellular marrow largely devoid of hematopoietic cells, often only fat cells, fbrous stroma, and scattered or clustered foci of lymphocytes and plasma cells. These cells are fragile and are frequently disrupted in the process of making smears, producing so-called smudge cells. Markedly elevated transco- balmin I level are seen in chronic myelocytic leukemia and myeloid metaplasia whereas low levels are seen in chronic leucopenia and aplastic anemia’. Williams hematology 8th/adds that ‘the increase is proportional to the total leukocyte count in untreated patients and falls with treatment’. Conditions having elevated levels of cobalamin Hematological conditions Non-hematological conditions • Chronic myelogenous leukemia • Acute hepatitis • Promyelocytic leukemia • Cirrhosis • Polycythemia vera • Hepatocellular carcinoma • Hypereosinophilic syndrome • Metastatic liver disease 48. The staining of the blasts suggests presence of monoblasts (peroxidase negative and nonspecifc esterase positive). So, the likely diagnosis for her is M5 leukemia, which is characterized by increased chances of tissue infltration and organomegaly. Other options; • Acute lymphoblastic leukemia is typically seen in children and young adults. Poor prognostic markers for acute lymphoblastic leukemia/lymphoma are • Count >100,000 • Presence of t(9;22) • Presentation in adolescents, and adulthood 60. Conditions associated with Dohle bodies • Burns • Infections • Physical trauma • Neoplastic diseases • Wissler’s disease • May-Hegglin anomaly (seen in neutrophil, monocyte, lymphocyte) • Chédiak-Steinbrinck-Higashi’s syndrome 62. Ans (d) More than 5000 cells/microliter (Ref: Washington Manual 2013, table 11-4) 62. Hodgkin’s Lymphoma, nodular sclerosis (Ref: Loachim’s lymph node pathology/186) Direct quote. It is also associated with nodular sclerosis and lymphocyte predominant Hodgkin’s lymphoma’. It involves subcutaneous tissues and lymph nodes predominantly in the head and neck region and is characterized by angiolymphoid proliferation and eosinophilia. Histopathology • Lymphoid infltrates with formation of follicles and germinal centers accompanied by plasma cells, mast cells and particularly large amount of eosinophils are present in subcutis. Diseases Associated with Massive Splenomegaly Chronic myelogenous leukemia Gaucher’s disease Lymphomas Chronic lymphocytic leukemia Hairy cell leukemia Sarcoidosis Myelofbrosis with myeloid metaplasia Autoimmune hemolytic anemia Polycythemia vera Diffuse splenic hemangiomatosis 66. Common cytogenetic abnormalities include t(8;21), inv (16) and t(9;11)Q Additionally, the percentage of these molecules can be derived from the data given in Neoplastic Hematology. About other options, the relevant points: Eosinophils are not a part of this neoplasm differentiating it from eosinophilic leukemia. While non-Hodg- kin lymphomas frequently occur at extranodal sites and spreads in an unpredictable fashion, Hodgkin’s lym- phoma arises in a single node or chain of nodes and spreads frst to anatomically contiguous nodes. The prognosis of non Hodgkin’s lymphoma varies markedly with various histological types of non Hodgkin’s lymphoma, “In general lymphomas with a follicular histological pattern are of lower grade (longer survival) than those of diffuse pattern”. A common cause of congestive splenomegaly is portal hypertension resulting from cirrhosis. The common variant t(8;14)(q24;q32), involving the oncogene myc on chromosome 8, and the heavy immunoglobulin chain on chromosome 14. The other two variants are: t(8;22)(q24;q11), involving myc and the lambda light chain immunoglobulin site, and t(2;8)(p12;q24), involving the kappa light chain and myc. Although B lymphocytes are in- fected by the virus, the characteristic atypical cells are activated suppresser T cells explaining the paracortical location (normally a T cell zone) in the lymph node. Lymph nodes in viral infections show expansion of germinal centers without loss of normal architecture. All lymphomas, including Burkitt’s, Hodgkin’s and non-Hodgkin’s lymphomas, destroy the normal architecture of the lymph node. They have the following exceptional characteristics: • Often arise within tissues involved by chronic infammatory disorders of autoimmune or infectious etiology • Remain localized for prolonged periods, spreading systemically only late in their course • May regress if the inciting agent (e. Eyelid, Conjunc- tival, and Orbital Tumors 345345 Review of Pathology Also know: for a future question • The most frequently encountered primary neoplasms of the orbit are vascular in origin like the capillary hemangioma, the lymphangioma and the encapsulated cavernous hemangioma. These phagocytes have abundant clear cytoplasm, creating a charac- teristic “starry sky” pattern. This tumor is typically composed of large anaplastic cells, some containing horseshoe-shaped nuclei and voluminous cy- toplasm (so-called hallmark cells). Gene rearrangement studies, therefore, can be used for diagnostic purposes to determine whether a lymphoid population is monoclonal (ie, neoplastic) or polyclonal (i.
In this disorder kamagra soft 100mg overnight delivery erectile dysfunction pump implant video, the (b) Its defciency can cause factor 8 defect also low platelet count is due to which of the following? Pancreatic insuffciency and cyclic neutropenia is a part (d) Gray platelet syndrome of which syndrome 150 order kamagra soft 100mg online erectile dysfunction virgin. All the following statements are correct about treatment (a) Young syndrome in chronic immune thrombocytopenic purpura except (b) Colts syndrome (a) Most of the patients respond to immunosuppressive (c) Shwachman syndrome doses of glucocorticoids (d) Roots syndrome 331331 Review of Pathology explanations 1 100mg kamagra soft overnight delivery erectile dysfunction treatment injection therapy. Flow cytometry has also proved useful in the identifcation and classifcation of tumors arising from T and B lymphocytes and from mononuclear-phagocytic cells. When symptoms appear, they are nonspecifc and include easy fatigability, weight loss, and anorexia. Hepatosplenomegaly and generalized lymphadenopathy are present in 50% to 60% of symptomatic patients. For unclear reasons, the tumor cells are exceptionally sensitive to particular chemotherapeutic regimens, 332 White Blood Cells and Platelets which produce long-lasting remissions. So, the condition is not having additional increase in improvement with age less than 50 years. It is an autoimmune haemolytic anemia due to IgG autoantibod- ies which bind to P blood group antigen and cause intravascular hemolysis and hemoglobinuria. As is suggested by the name, there are 2 populations of cells which are morphologically and immunophenotypically distinct from each other. So, the answer is Mixed phenotypic leukemia A word about the last option ‘d’, please note that in un-differentiated acute leukemia, blasts usually lack any evidence of lineage differentiation. The translocation results in the increased expression of c-MyC resulting in development of neoplasia. This is a typical example of question where the changed data may lead to the question being repeated in the future exam friends. Direct quote from Williams Hematology 8th/edn “The most common abnormalities are 5q–, -7/7q–, +8, –18/18q–, and 20q–. Monosomy 7 is the second most frequent cytogenetic abnormality in the marrow cells of patients with myelodys- plasia. It is also the receptor for the cytokine Flt3 ligand (Flt3L) and has the presence of tyrosine kinase activity. Two thirds of these lymphomas come to clinical attention with nontender nodal enlargement involving one or more lymph nodes. The remaining one third of cases present with extranodal involvement of skin, brain, and gastrointestinal tract, for example. In contrast, virtually all cases of Hodgkin lymphoma present with lymph node enlargement. Abnormal plasma cells (choice A) would be a feature of multiple myeloma or some B-cell leukemias and lymphomas. Giant platelets (choice B) are a feature seen in several myeloproliferative disorders (notably essential thrombocytopenia), which do not cause lymphadenopathy. Immature neutrophil precursors (choice C) would most likely be a feature of a myeloid leukemia, which would not cause a lymphadenopathy. Involved lymph nodes are diffusely effaced by a heterogeneous cellular infltrate, which includes T cells, eosinophils, plasma cells, and benign macrophages admixed with Reed-Sternberg cells 99. This condition is diagnosed with the demonstration of a very high proliferative fraction and the presence of any of the following cytogenetic abnormalities on the surface of the cells • t (8;14) (most commonly) • t (2;8) or • t (8;22) 101. It is a stem cell disorder, in which neo- plastic megakaryocytes secrete fbrogenic factors leading to marrow fbrosis. The neoplastic clone goes to spleen where it shows trilineage hematopoietic proliferation (extramedullary hematopoiesis) with prominent megakaryocytes. These causes also can give rise to a leukoerythroblastic picture but splenic enlargement with trilineage proliferation usually is not seen. The other options Hodgkin lymphoma and portal hypertension can cause splenic enlargement but not marrow fbrosis. It is divided into three categories: Letterer-Siwe syndrome, Hand-Schuller-Christian disease, and eosinophilic granuloma. Letterer-Siwe disease • Also known as Multifocal multisystem Langerhans cell histiocytosis • Occurs most frequently before 2 years of age but occasionally affects adults. Polycythemia is not to be confused with the polycythemia vera for which the following information is asked repeatedly. Singh 1/e p198) Leukoerythroblastosis is a term used for “an anemia characterized by the presence in the peripheral blood of immature red cells and a few immature white cells of the myeloid series” that is erythroblasts and leukoblasts. The common pathogenic feature is the presence of mutated, constitutively activated tyrosine kinases or other acquired mutations result- ing in growth factor independence. The examples include: • Chronic myelogenous leukemia • Chronic neutrophilic leukemia • Polycythemia vera • Primary myelofbrosis • Essential thrombocythemia • Chronic eosinophilic leukemia • Mastocytosis 103. The patient in question has 14% plasma blasts in the peripheral blood and thus does not ft into category of plasma cell leukemia. Plasma cell leukemia • More than 20% plasma cells in the peripheral blood • Absolute plasma cell count of more than 2 X 109/L 2. IgD Myeloma • Presence of Monoclonal IgD in the serum usually indicates IgD myeloma • No evident M– spike on serum protein electrophoresis • Higher incidence of renal insuffciency, amyloidosis and proteinuria than IgG/IgA myeloma. Langerhans cell is a special type of dendritic cell in the skin functioning as antigen presenting cell. In the past, these disorders were called histiocytosis X and were subdivided into three categories: • Letterer-Siwe syndrome • Hand-Schüller-Christian disease, • Eosinophilic granuloma. Under the electron microscope, Birbeck’s granules have a tennis-racket appearance. His bone marrow is infltrated with plasmacytoid lymphocytes having immunoglobulins in the cytoplasm (Russell bodies). These fndings are suggestive of the patient suffering from lymphoplasmacytic lymphoma/ Waldenstrom’s macroglobulinemia. This disorder is characterized by neoplastic B cells producing IgM leading to a mono- clonal IgM spike in the serum. Hypercalcemia occurs with myeloma because of bone destruction, and punched out lytic lesions are typical of multiple myeloma. Light chain in urine (Bence Jones proteins) is also a feature of multiple myeloma. This patient is making a monoclonal population of kappa light chains and excreting them in the urine as Bence-Jones proteins. These patients make decreased levels of normal im- munoglobulins of all isotypes, thus making them susceptible to infections (also the commonest cause of death). Such variants include: • Flame cells: with fery red cytoplasm, • Mott cells: with multiple grapelike cytoplasmic droplets The globular inclusions are referred to as Russell bodies (if cytoplasmic) or Dutcher bodies (if nuclear).