Mark Peyrot, PhD
About 5% of cancers are the histological diagnosis by either of these methods is associated with progressive destruction of neurons made on the basis that morphological features of benign throughout the nervous system without evidence of tumours resemble those of normal tissue and that they are metastasis in the brain and spinal cord symptoms zollinger ellison syndrome order 500 mg glucophage sr fast delivery. This is probably medi unable to invade and metastasise symptoms ms order glucophage sr overnight delivery, while malignant tumours ated by immunologic mechanisms medications zetia buy generic glucophage sr. The changes in the are identified by lack of differentiation in cancer cells termed neurons may affect the muscles as well symptoms 9 weeks pregnancy glucophage sr 500 mg line. 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. 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 paraffin subjective 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. These methods, argentaffin granules therefore, lack sensitivity as well as specificity and can only be employed for the following: 7. 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. 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. 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. 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 implemen that 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. 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. It is estimated Lanka is chewing of tabacco alone or mixed with slaked lime that a person who smokes 2 packs of cigarettes daily at the as a bolus of paan kept in mouth for long hours which is the age of 30 years reduces his life by 8 years than a non-smoker. Hookah smoking, in which tobacco smoke passes and the beneficial effect reaches the level of non-smokers after through a water-filled chamber which cools the smoke before 20 or more of smoke-free years. In view of serious Tobacco contains numerous toxic chemicals having adverse health hazards of tobacco, India has recently succeeded in effects varying from minor throat irritation to carcinogenesis. If implemen the major diseases accounting for higher mortality in tation of this ban is effective, it is likely to have a favourable tobacco smokers include the following (in descending order impact in coming years on the public health in this populous of frequency): country. Besides the harmful effects of smoking on active smokers Besides above, smokers suffer higher risk of development themselves, involuntary exposure of smoke to bystanders of a few other cancers and non-neoplastic conditions as (passive smoking) is also injurious to health, particularly to illustrated in Fig. There is more severe, extensive and accelerated athero sclerosis of coronary arteries and aorta in smokers, possibly due to increased platelet aggregation and impaired lung function that causes reduced myocardial oxygen supply. This is the most common cancer in men (Source: National Council of Applied Economic Research, New Delhi). In general, the risk of adverse drug reaction increases with increasing number of drugs administered. Adverse effects of drugs may appear due to: overdose; genetic predisposition; exaggerated pharmacologic response; interaction with other drugs; and unknown factors. It is beyond the scope of this book to delve into the list of drugs with their harmful effects. However, some of the common forms of iatrogenic drug injury and the offending drugs are listed in Table 9. Right side Chronic alcoholism is defined as the regular imbibing of an shows smoking-related neoplastic diseases while left side indicates non amount of ethyl alcohol (ethanol) that is sufficient to harm neoplastic diseases associated with smoking, numbered serially in order an individual socially, psychologically or physically. Cigarette smoking is strongly as well as chronic, are related to the quantity of alcohol implicated in evolution of lung cancer as described in content imbibed and duration of consumption. Besides lung cancer, smokers have a can of beer (or half a bottle of beer); higher risk of development of cancer of upper aerodigestive 120 ml of neat wine; or tract (lips, oral cavity, larynx, oesophagus), pancreas, urinary 30 ml of 43% liquor (small peg). Syndromes
I further declare that I have not withheld any relevant information or made any misleading statements symptoms in spanish glucophage sr 500 mg visa. I understand that if I have made any false or misleading statement in connection with this application symptoms 24 hour flu order glucophage sr 500mg otc, or if I do not consent to release the supporting medical information treatment lower back pain generic glucophage sr 500mg with amex, the Authority may refuse to grant me a Medical Assessment or may withdraw any Medical Assessment granted treatment 32 for bad breath discount glucophage sr 500mg otc, without prejudice to any other legal action applicable pursuant to [insert relevant national law]. The Applicant must personally complete in full all questions (boxes) on the Application Form. The following numbered instructions apply to the numbered headings on the application form. State date (day/month/year) and place (city/town and country) of last aviation medical examination. The following instructions apply to the same numbered headings on the Medical Examination Report Form. First without correction, then with spectacles (if used) and lastly with contact lenses, if used. If worn, state type from the following list; hard, soft, gas-permeable or disposable. The full range of frequencies has diagnostic value and is useful for provision of advice concerning hearing conservation. If the test has been performed (whether required or on indication) complete the normal or abnormal box, as appropriate. In the case of question 72, the number of other accompanying reports must be stated. If a fit assessment is recommended, indicate whether a Medical Certificate has been issued or not. An applicant may be recommended as Fit for Class 2 but also deferred or recommended as Unfit for Class 1. The number of air carrier accidents per year will increase if industry growth continues and accident rates remain unchanged. It is, therefore, essential to continue to examine all areas which have an impact on flight safety. One such area is that of in-flight pilot incapacitation, which can be defined as any reduction in medical fitness to a degree or of a nature that is likely to jeopardize flight safety. However, when abnormal conditions or an emergency occurs, flight crew may have to perform complex physical and mental tasks under time constraints, and in such circumstances even a minor deficiency in performance could be operationally significant. From the operational standpoint, it is irrelevant whether degraded performance is caused by a petit mal episode, preoccupation with a serious personal problem, fatigue, problematic use of psychoactive substances or a disordered cardiac function. One of the most important things is that the risk to aviation safety in situations where a pilot is physically incapacitated can be virtually eliminated in air transport (multi-crew) operations by training the pilots to cope with such events. Based on the 6 assumptions stated above, a pilot flying a two-pilot aircraft can have an incapacitation risk of no more than one in 10 hours, 9 and the operation will achieve the target medical cause fatal accident rate of no more than one in 10 hours, since the presence of a second pilot reduces the risk by a factor of 1 000. However, other limits of acceptable incapacitation risk, such as 2 per cent per annum, or even greater, have been suggested. The important point is that States should endeavour to define objective fitness criteria to encourage consistency in decision-making and to assist in improving global harmonization of medical standards. A survey (1993-1998) of flight crew incapacitation on United States scheduled airlines recorded five deaths in the cockpit, all owing to cardiovascular diseases. In two studies of airline pilots, in 1968 and again in 1988, more than 3 000 airline pilots completed an anonymous questionnaire survey including questions about whether they had ever experienced an incapacitation during a flight. After some medication I felt wonderfully relieved and was released from the hospital. Subtle incapacitations are frequently partial in nature and can be insidious because the affected pilot may look well and continue to operate but at a less than optimum level of performance. It was learned that all pilot incapacitations create three basic problems for the remaining crew. This is true whether the incapacitation is obvious or subtle and whether there is a two (or more) member crew. Although this study was carried out many years ago, its recommendations are still valid. For this reason, responsibility for the incapacitated pilot, who should preferably be removed from the flight deck, should be given to the cabin crew. These three steps became the organized plan for handling in-flight incapacitation. Retrospectively, there often seems to have been ample warning of an impending problem. In most cases of cognitive incapacitation, the pilot demonstrates manifestly inappropriate behaviour involving action or inaction, and the inappropriate behaviour is associated with failures of comprehension, perception, or judgement. Captain reacted almost catatonically to his altitude call-outs and the additional call-outs that they were descending through the cleared altitudes. Remainder of month with Captain has had same pattern with many cases of very poor performance. Has to be reminded of things several times, even including getting his signature on required papers. The following paragraph is taken from his paper given at an aeromedical examiner symposium in the 1980s: Psychiatric disturbances giving rise to unusual behaviour are. It is often very difficult to define the boundaries between normality, eccentricity, and psychiatric disorder, and individuals, not uncommonly, cross over these boundaries from day to day. A basic requirement for that monitoring is that all flight crew members must know what should be happening with and to the aeroplane at all times. This was dramatically demonstrated in the United Kingdom in 1989 when a flight crew shut down the wrong engine of a Boeing 737. Interpersonal relationships are not particularly amenable to measurement, and there is much suspicion among pilots about any process which attempts, or seems to attempt, to measure personality. Figures for the risk of a future cardiac event in an individual recovering from a common cardiac problem such as myocardial infarction are available. Figures may also be available for certain other relatively common diseases, such as the risk of a cerebral metastasis from a recurrence of a surgically removed malignant melanoma, or the recurrence of an epileptic seizure after a first fit. It should be remembered that a medical condition in a pilot that might potentially result in only a loss of efficiency or a moderate decrease in safety in a multi-pilot aircraft might incur great risk in single-pilot operations. At the same time, it seems reasonable to assume that uneventful flying experience may breed complacency and also that experience, obtained many years ago in aircraft types no longer flown and with navigational systems and other equipment no longer in use, may be of little value today. Unfortunately, the data relating pilot experience to risk of accident are sparse, although there is little evidence to suggest that the risk changes much between 60 and 65 years of age, and in 2006, 65 years became the upper age limit for professional pilots in multi-crew aircraft (increased from 60 years).
Marcus Nashelsky and Morris Dailey of the University of Iowa medications you cannot eat grapefruit with cheap glucophage sr 500mg otc, Department of Pathology symptoms to diagnosis buy on line glucophage sr, for assistance with can have a profound effect symptoms acid reflux order glucophage sr toronto. UploadedFiles/research/ClinicalResearch/ Glycemic regulation and insulin secretion 3 symptoms knee sprain glucophage sr 500 mg low cost. Curr fants with cystic fibrosis diagnosed fol man cystic fibrosis airway epithelia have Opin Immunol 2001;13:89-95. Am J Physiol Lung old infants with cystic fibrosis diagnosed from the sweat gland. Assessing mucociliary transport of produces abnormalities in tracheal devel model of cystic fibrosis. Science 2014;345: single particles in vivo shows variable opment in neonatal pigs and young chil 818-22. Proc Natl Acad Sci U S A tional anatomic defect of the cystic fibro Air trapping and airflow obstruction in 2003;100:16083-8. Hyposecretion of fluid from tracheal ation of the development of tracheal sub fibrosis. The majority of these lesions are usually a radiological fnding and are capable of quite large before being diagnosed. The standard treatment for these cysts is the enucleation and the extraction of the affected tooth. However, if the patient is a child and the affected tooth is not developed, a more conservative attitude should be considered. Material and Methods: (Clinical case): A 7-year-old patient is presented with an eruptive backlog of the lower per manent frst molars. Radiological examination reveals two radiolucid lesions in relation to them, which are compa tible with a dentigerous cyst, and in relation to the inferior aveolar nerve and various germs. A partial enucleation is carried out, maintaining all the dental germs related to the cyst in mouth and monitoring the patient until the case study is over. Results and Discussion: Diagnosis and early treatment of these lesions in children is of great importance, especially in cases where the lesions enclose permanent teeth. Conclusions: Whenever possible, a conservative attitude should be taken, one that allows for the maintenance of the dentition and treatment of the associated cyst in order to not compromise either the occlusion or the mental state of these patients. Introduction Dentigerous cysts derive from a change in the develo Dentigerous cysts are the second most common cystic pment of the reduced epithelium enamel organ, which lesion to affect the mandibular. They account for 14 results in an accumulation of fuid between this and the 20% of mandibular cysts and between 15. The frequency with which explain the association of these cysts with the lower pri dentigerous cysts develop has been calculated at 1. The second is that the germ men than in women and are more frequent in Caucasians of the primary second molar is closer to the permanent than in individuals with darker skin (1). Dentigerous cysts in children Dentigerous cysts are typically asymptomatic and are an incidental fnding on routine radiographs. They are rarely painful and any pain suffered is associated with infection in the lesion (4). In some instances, these cysts can grow to very large size and can trigger the infamma tion, expansion and erosion of the cortical bone. In such a case, they can generate a differential diagnosis to an ameloblastoma or an odontogenic keratocystic tumour. On radiographs, dentigerous cysts appear as a radio transparent, round, well-defned image that is in close relation to the crown of an enclosed tooth (5). With respect to the above approach, different treatment options exist for these lesions. The classic approach is the removal of the cyst together with the affected tooth, to allow the regeneration of healthy bone. At times, this approach is too aggressive and more conservative ones (such as decompression, marsupialization, etc. At all times, cases studies should be assessed on an in dividual basis when deciding on the treatment method that is most appropriate for the size and location of the Fig. Intraoral examination revealed that the patient presented a mixed dentition with an eruptive backlog (Fig. On the orthopantomograph, two compatible radiolucid second permanent molars and second permanent pre areas with cystic cavities are clearly visible, in close molars. Careful dissection of the inferior alveolar nerve proximity to the lower permanent frst molars, which is should be carried out. It rejects the in For this reason, more conservative and less traditional ferior alveolar nerve all the way to the mandibular basal options should be explored. The success of these tech bone and affects the germ of the second molar, displa niques is put down to maintaining eruptive potential of cing it distally. It also affects germ of treated was located on tooth 36, where a partial removal tooth 47. In both situations, it is possible that the germ (and subsequent anatomapathologial study) of its capsu of the permanent second molar is affected. In all cases stu procedure was repeated on the lesion located on tooth dies, anatompatholigal study is necessary to arrive at the 46 (Fig. When looking at clinical fndings, presumptions are Three months after the procedure, the frst permanent mo made about dentigerous cysts. In the routine follow ups, it was prise the removal of both lesions, which would entail noted that the permanent frst molar occupied its position in the removal of both frst permanent molars, possibly the the arch and that the cystic cavity disappeared completely. Dentigerous cysts in children pression either with or without traction of the tooth to its correct position in the arch. Now that the problems relating to cystic enucleation have been discussed, it is believed that, in these instan ces, other, more conservative that minimise the harm to the patient should be considered. In this case, after administering antibiotics and carrying out exodontia of the canine and the deciduous primary molar, marsupia lization was conducted to try and save the implicated permanent teeth and after 12 months, a complete reduc Fig. A to D: Follow up, three months after the frst surgical inter tion of the lesion and the eruption of the canine and frst vention. E to H: Sight should also not be lost of those case studies where Follow up, two years after the frst surgical intervention. Only faces of the frst molars were located very close to the a slight misalignment, caused by the appearance of both oral mucosa. For this reason, it is believed that partial cysts, of the permanent second molars was noted. This removal of the cystic capsule together with a non-water could be resolved by your orthodontist. Molars are es tight suture of the wound could give the opportunity to sential and their development completely normal. Dentigerous cysts are odontogenic cysts that typically For Hyomoto, (10) the key factors in the eruption of the affect impacted teeth, in the majority of cases mandibular tooth in the arch are bone development, the angle and third molars and maxillary canines (7,8). The impacted case study in question refers to a primary frst molar at a teeth together with incomplete root development show stage of formation, which is an uncommon situation. It has also been proven that those teeth ted, as well as the possibility of pathologic fracture if a that present an axial angle less than 80fi and a depth in radical approach is carried out, etc. The size of the cyst and the existing pect to the management of dentigerous cysts in children, space between adjacent teeth appear to have no infuen which include the complete enucleation of these lesions ce on the eruption of these teeth. Dentigerous cysts in children cyst increases in patients over the age of 10, in those 11. Such factures, indicated by Hyomoto and Fujii et after marsupialization of an infected dentigerous cyst. Evolution and involution of periapical le Yahara (9) and Hyomoto (10) establish that the average sions correlated between radiographic and histopathological aspects. Panoramic to a period of some hundred days after the more conser fndings for predicting eruption of mandibular premolars associated with dentigerous cyst after marsupialization. Conclusion the diagnosis and early treatment of lesions in children, such as those presented in this article, is of great impor tance above all in case studies where lesions that enclose permanent teeth in order to minimize the associated da mages to what is done. We should always study, and where possible opt for, a conservative attitude that allows for the maintenance of the dentition and treatment of the associated cyst in or der to not compromise either the occlusion or the mental state of these patients. Interesting eruption of 4 teeth associated with a large dentigerous cyst in mandible by only marsupialization.
Though described here under viral usual seasonal flu vaccine does not provide protection against infections medicine x 2016 order discount glucophage sr online, chlamydia are no more considered as filterable H1N1 treatment plan for anxiety effective glucophage sr 500mg, personal hygiene and prophylaxis remain the mainstay viruses as was previously thought but are instead of further spread of disease medications list template order genuine glucophage sr online. The condition begins as a painless medications related to the lymphatic system discount glucophage sr 500mg without a prescription, herpes-like lesion on Varicella zoster virus is a member of herpes virus family and the cervix, vagina, or penis. The organisms are carried via causes chickenpox (varicella) in non-immune individuals and lymphatics to regional lymph nodes. The involved lymph herpes zoster (shingles) in those who had chickenpox in the nodes are tender, fluctuant and may ulcerate and drain pus. Microscopically, the lymph nodes have characteristic Varicella or chickenpox is an acute vesicular exanthem stellate-shaped abscesses surrounded by a zone of occurring in non-immune persons, especially children. On lesion takes place by fibrosis and permanent destruction entering the blood stream, viraemia is accompanied by onset of lymphoid structure. A few cases may develop caused by Bartonella henselae, an organism linked to rickettsiae complications which include pneumonia, hepatitis, but unlike rickettsiae this organism can be grown in culture. The condition occurs more commonly in children (under 18 Herpes zoster or shingles is a recurrent, painful, vesicular years of age). There is regional nodal enlargement which appears about 2 weeks after cat-scratch, and sometimes after eruption caused by reactivation of dormant varicella zoster thorn injury. The lymphadenopathy is self-limited and virus in an individual who had chickenpox in the earlier regresses in 2-4 months. The virus during the latent period resides in the dorsal root Microscopically the changes in lymph node are spinal ganglia or in the cranial nerve ganglia. On reactivation, characteristics: the virus spreads from the ganglia to the sensory nerves and i) Initially, there is formation of non-caseating sarcoid to peripheral nerves. The lesions are particularly surrounded by pallisaded histiocytes and fibroblasts, an painful as compared with painless eruptions in chickenpox. The condition is particularly severe in immunodeficient the virus spreads from the contaminated saliva of these patients and neonates while milder attacks of infection cause animals. The organism enters a peripheral nerve and then fever-blisters on lips, oral mucosa and skin. A latent period of 10 develop complications such as meningoencephalitis and days to 3 months may elapse between the bite and onset of keratoconjunctivitis. Since the virus localises at the brainstem, it respiratory infection reactivate latent virus lying in the produces classical symptoms of difficulty in swallowing and ganglia and result in recurrent attacks of blisters. Parasites may cause disease due to their presence in the lumen of the intestine, due to infiltration into the blood stream, or due to their presence inside the cells. These diseases form a distinct subject of study called Parasitology; only a few conditions are briefly considered below. The condition is particularly more common in tropical and subtropical areas with poor sanitation. The parasite occurs in 2 forms: a trophozoite form which is active adult form seen in the tissues and diarrhoeal stools, and a cystic form seen in formed stools but not in the tissues. The cysts are the infective stage of the parasite and are found in contaminated water or food. The trophozoites are formed from the cyst stage in the intestine and colonise in the caecum and large bowel. The trophozoites as well as cysts are passed in stools but the trophozoites fail to survive outside or are destroyed by gastric secretions. Cysticercosis* Taenia solium *Diseases discussed in this chapter 188 action of the trophozoite and have necrotic bed. Such chronic amoebic ulcers are described as flask-shaped ulcers due to their shape. The margin of the ulcer shows inflammatory response consisting of admixture of poly morphonuclear as well as mononuclear cells besides the presence of trophozoites of Entamoeba histolytica (Fig. Amoeboma is the inflammatory thickening of the wall of large bowel resembling carcinoma of the colon. Microscopically, the lesion consists of inflammatory granulation tissue, fibrosis and clusters of trophozoites at the margin of necrotic with viable tissue. Amoebic liver abscess may be formed by invasion of the radicle of the portal vein by trophozoites. The amoebic abscess contains yellowish-grey amorphous liquid material in which trophozoites are identified at the junction of the viable and necrotic tissue. Section from margin of amoebic ulcer occur are peritonitis by perforation of amoebic ulcer of shows necrotic debris, acute inflammatory infiltrate and a few trophozoites of Entamoeba histolytica (arrow). While Plasmodium falciparum causes malignant amoebic carditis and cerebral lesions, cutaneous malaria, the other three species produce benign form of amoebiasis via spread of rectal amoebiasis or from anal illness. Malaria is a protozoal disease caused by any one or the life cycle of plasmodia is complex and is diagram combination of four species of plasmodia: Plasmodium vivax, matically depicted in Fig. In falciparum malaria, there is massive absorption of ii) Erythrocytes of any age are parasitised while other haemoglobin by the renal tubules producing blackwater plasmodia parasitise juvenile red cells. At autopsy, cerebral malaria is characterised by iv) the parasitised red cells are sticky causing obstruction congestion and petechiae on the white matter. Parasitised erythrocytes in falciparum malaria are responsible for extraordinary virulence of P. These eggs then develop into larval stages in the host, spread by blood to any site in the body and form cystic larvae termed cysticercus cellulosae. The cysticercus may be single or there may be multiple cysticerci in the different tissues of the body. The cysts may occur virtually anywhere in body and accordingly produce symptoms; most common sites are the brain, skeletal muscle and skin. Cysticercus consists of a round to oval white cyst, about 1 cm in diameter, contains milky fluid and invaginated scolex with birefringent hooklets. The lymphatic vessels inhabit the adult Others, Rubella, Cytomegalovirus, and Herpes simplex virus; worm, especially in the lymph nodes, testis and epididymis. Majority of infected patients remain be acquired by the foetus during intrauterine life, or asymptomatic. Symptomatic cases may have two forms of perinatally and damage the foetus or infant. Chronic form of filariasis is characterised by lymphadeno pathy, lymphoedema, hydrocele and elephantiasis. The most significant histologic changes are due to the presence of adult worms in the lymphatic vessels causing lymphatic obstruction and lymphoedema. The tissues surrounding the blocked lymphatics are infiltrated by chronic inflammatory cell infiltrate consisting of lymphocytes, histiocytes, plasma cells and eosinophils. Chronicity of the process causes enormous thickening and induration of the skin of legs and scrotum resembling the hide of an elephant and hence the name elephantiasis. Chylous ascites and chyluria may occur due to rupture of the abdominal lymphatics. The eggs are passed in human faeces which the cyst while the cyst wall shows palisade layer of histiocytes. Herpes and cytomegalovirus infections are common intrapartum infections acquired venereally. Cytomegalovirus and herpesvirus infection are generally transmitted to foetus by chronic carrier mothers. An infectious mononucleosis-like disease is present in about 10% of mothers whose infants have Toxoplasma infection. Genital herpes infection is present in 20% of mothers whose newborn babies suffer from herpes infection. Rubella infection during acute stage in the first 10 weeks of pregnancy is more harmful to the foetus than at later stage of gestation. Symptoms of cytomegalovirus infection are present in less than 1% of mothers who display antibodies to it. Malignant tumours of which some cells proliferate throughout life (labile cells), of epithelial origin are called carcinomas, while malignant some have limited proliferation (stable cells), while others mesenchymal tumours are named sarcomas (sarcos = fleshy) do not replicate (permanent cells). 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