Mark Corson

By N. Olivier. Central Connecticut State University.

TxA2 generic 500mg hydrea free shipping, a product of the cyclooxygenase path- way of arachidonic acid metabolism buy 500 mg hydrea with amex, is synthesized in platelets and is a powerful platelet aggregator and vasoconstrictor order hydrea 500 mg visa. Fibrinogen, which is produced by the liver and not endothelial cells, is cleaved by thrombin to form fibrin. When formed within the heart or the arteries, thrombi may have laminations, called the lines of Zahn, formed by alternating layers of platelets admixed with fibrin, separated by layers with more cells. Mural thrombi within the heart are associated with myocardial infarcts and arrhythmias, while thrombi in the aorta are associated with General Pathology Answers 111 atherosclerosis or aneurysmal dilatations. Arterial thrombi are usually occlusive; however, in the larger vessels they are not. Venous thrombi, which are almost invariably occlusive, are found most often in the legs, in superficial varicose veins or deep veins. The postmortem clot is usually rubbery, gelatinous, and lacks fibrin strands and attachments to the vessel wall. Large post- mortem clots may have a “chicken fat” appearance overlying a dark “cur- rant jelly” base. These thromboemboli, most of which origi- nate in the deep veins of the lower extremities, may embolize to the lungs. The majority of small pulmonary emboli do no harm, but, if they are large enough, they may occlude the bifurcation of the pulmonary arteries (sad- dle embolus), causing sudden death. Arterial emboli most commonly orig- inate within the heart on abnormal valves (vegetations) or mural thrombi following myocardial infarctions. If there is a patent foramen ovale, a venous embolus may cross over through the heart to the arterial circula- tion, producing an arterial (paradoxical) embolus. Types of nonthrombotic emboli include fat emboli, air emboli, and amniotic fluid emboli. Fat emboli, which result from severe trauma and fractures of long bones, can be fatal as they can damage the endothelial cells and pneumocytes within the lungs. Air emboli are seen in decom- pression sickness, called caisson disease or the bends, while amniotic fluid emboli are related to the rupture of uterine venous sinuses as a complica- tion of childbirth. They can be classified on the basis of their color into either red or white infarcts, or by the presence or absence of bacterial contamination into either septic or bland infarcts. White infarcts, also referred to as pale or anemic infarcts, are usually the 112 Pathology result of arterial occlusion. Red or hemorrhagic infarcts, in contrast, may result from either arterial or venous occlusion. They occur in organs with a dual blood supply, such as the lung, or in organs with extensive collateral circulation, such as the small intestine and brain. These infarcts are hem- orrhagic because there is bleeding into the necrotic area from the adjacent arteries and veins that remain patent. Hemorrhagic infarcts also occur in organs in which the venous outflow is obstructed (venous occlusion). In the latter, twist- ing of the spermatic cord occludes the venous outflow, but the arterial inflow remains patent because these arterial blood vessels have much thicker walls. Testicular torsion is usually the result of physical trauma in an individual with a predisposing abnor- mality, such as abnormal development of the gubernaculum testis. A defi- ciency of either of these two enzymes leads to a disorder called orotic aciduria, which is characterized by orotate in the urine, abnormal growth, and megaloblastic anemia. An association is a pattern of nonrandom General Pathology Answers 113 anomalies with an unknown mechanism (e. A deformation is an alteration of a normally formed body part by mechan- ical forces (e. A disruption is a defect that results from interference in a normally developing process. A malformation is a morphologic defect that results from an intrinsically abnormal developmental process (e. A sequence is a recognized pattern that results from a single pre- existing abnormality (e. Syndrome refers to multiple anomalies having a recognizable pattern and known pathogenesis (e. Autosomal dominant inheritance character- izes both myotonic dystrophy and the facioscapulohumeral type, while limb-girdle dystrophy is autosomal recessive. In Duchenne muscular dys- trophy, males are affected and symptoms begin before the age of 4. Pelvic girdle muscles are affected, with resultant difficulty in walking, and this is followed by shoulder girdle weakness and eventual involvement of respira- tory and cardiac muscles with death from respiratory failure before age 20. Histologic changes include rounded, atrophic fibers; hypertrophied fibers; degenerative and regenerative changes in adjacent myocytes; and necrotic fibers invaded by histiocytes. To calculate the probability that two or more events that are independent of each other will all occur, you must multiply the probabilities for each of these events together. The principle, which assumes random mating, states that given gene frequen- cies p (for an allele A) and q (for another allele a), then the aa genotype (homozygous) = q × q and the Aa genotype (heterozygous carriers) = 2pq. Diagnosis requires General Pathology Answers 115 biopsy demonstration of excess liver glycogen plus either absent or low liver glucose-6-phosphatase activity, or a diabetic glucose tolerance curve, or hyperuricemia. The major myopathic form, McArdle’s disease (type V), is due to lack of muscle phosphorylase. Division of this disease into five categories is generally accepted: type A, the acute neurono- pathic form, is the one that has the highest incidence. The lack of sphin- gomyelinase in type A is the metabolic defect that prevents the hydrolytic cleavage of sphingomyelin, which then accumulates in the brain. Patients who have the type A form usually show hepatosplenomegaly at 6 months of age, progressively lose motor functions and mental capabilities, and die dur- ing the third year of life. These patients have a much milder disease than Hurler’s syndrome patients, but they also secrete dermatan sulfate and heparan sulfate in the urine.

Struc- tures used for orientation include: a) lung b) ostium of the cranial thoracic air sac c) adrenal gland d) gonad e) kidney f) ureter discount 500 mg hydrea visa, oviduct buy hydrea 500mg line, vas deferens area g) abdominal air sac h) caudal thoracic air sac i) liver j) proventriculus k) heart and l) cranial thoracic air sac buy cheap hydrea 500mg online. Other visible structures include lung Gross view from the end of the sternum in nial thoracic air sac (arrow). This represents how a site should ap- was used to take a picture of a second en- 13. The confluent wall of the right cra- pear if the original entry was performed doscope guided into the intestinal perito- nial thoracic air sac and right ventral he- under aseptic conditions. The (lu), cranial pole of the left kidney (k), normal endoscopic anatomy of the ventral right liver lobe (rl) and left liver lobes (ll) transverse abdominal muscle (m), ilium (i) hepatic peritoneal cavity of a pigeon. For reference purposes, in- caudal thoracic and abdominal air sac is include the sternum (s), deep pectoral mus- clearly visible (arrow). Equipment used for sertion point 2 would provide a similar view cle (m), proventriculus (p) and heart (h). Easily identifiable structures include ribs (r), proventriculus originally clear and now are considered A small tear (arrow) has been created in the cloudy, and there is an increase in vascu- caudal thoracic air sac to enter the under- (p), medial intercostal muscle (m), heart (h), attachment of pericardial sac (arrow), larization. When viewed from insertion lying left ventral hepatic peritoneal cavity point 8, a granuloma is evident in the air of a normal pigeon. Liver (li), proventricu- lung (lu), ostium of cranial thoracic air sac (open arrow) and liver (li). Other structures that are visible lus (p), lung (lu), ostium of caudal thoracic include lung (lu), ilium (i), cranial pole of air sac (o), contiguous wall of the caudal Color 13. Other structures that can be visualized include dal thoracic and abdominal air sac (arrow) the liver. Other visible structures include showing the path of the endoscope when the lung (lu) and proventriculus (p). The confluent wall of the caudal An endoscope has been placed in the oral Caudal view of the choanal area in an Afri- thoracic air sac and left ventral hepatic cavity of a Great Horned Owl showing the can Grey Parrot. The visible structures in- peritoneal cavity membrane are clearly vis- infundibular cleft (arrow), sphenopterygoid clude the choanal slit (c), infundibular cleft ible (arrow). Endoscopic view of the cranial margin of lung as viewed from within the left caudal Note the dark pigmentation and uniform the choanal slit in a Moluccan Cockatoo. The nasal septum (n), left middle nasal Well formed papillae (arrow) are noted on concha (arrow) and nasal mucous mem- Color 13. Liver of an Amazon parrot showing severe ible are the lateral commissures of the biliverdin accumulation secondary to mouth (open arrows) and the tongue (t). Histopathology indi- base of the tongue (t), and blunting and feeding catheter (t) has been introduced into the crop and is just ventral to the cated bile duct carcinoma in an Amazon abscessation of the choanal papillae (ar- parrot. Note the smooth, thin texture and an Amazon parrot showing several white, cavity of a normal Amazon parrot. The choanal (arrow) and lingual papillae An endoscope has been passed into the fluid-filled proventriculus of a pigeon. Other struc- tures that can be visualized include the the openings of the proventricular glands (Insertion point 6, postion B-4 see Figure (arrow) and a pelleted food particle (open 13. Note that the choanal slit ear canal (arrow) and caudal wall of the ear pionus parrot. The substantial vascularity does not contain papillae, but that papillae canal (open arrow). Reading small sur- gical biopsies from exotic avian species is a relatively Preparation of Small Biopsies specialized area of pathology. Best results are likely The biopsies obtained with the types of forceps pre- to be obtained by working with a consultant patholo- viously mentioned are small and must be handled gist who has a real interest and expertise in this field. Vari- Timely reporting of results is essential to enable the ous techniques have been recommended in the past clinician to make optimal use of the biopsy information. Wrapping tiny pieces of tissue in filter paper or a very fine cloth Products Mentioned in the Text before immersion in the fixative is one method. J Am Vet Med Assoc (eds): Clinical Avian Medicine and avian tuberculosis by laparoscopy 5. Utrecht, PhD Thesis, 1987, pp the endoscopic determination of sex body cavities and air sacs of Gallus male and male. Necropsy examination often is C H A P T E R N performed to determine the cause of an unexpected death. However, a thorough and system- atic postmortem examination also may be used to confirm a clinical diagnosis, identify the etiology of a disease process, explain apparent unresponsiveness to treatment or reveal unrecognized disease proc- esses. Integration of necropsy findings with clinical 14 signs and laboratory data ultimately will enhance the clinician’s understanding of disease processes and sharpen clinical diagnostic skills. In addition, necropsy will confirm radiographic interpretations and reinforce applied anatomy, which enhances sur- gical skills. This chapter emphasizes the ne- cropsy of psittacine and passerine birds; anatomic variations of other avian species such as ratites may be found by consulting appropriate chapters in this textbook and published articles in the veterinary literature. Rakich by following a systematic approach and using ancil- lary support services as needed to establish a defini- tive diagnosis. Ancillary support services include his- topathology, clinical pathology, microbiology, parasitology and toxicology. Several excellent sources of information, in addition to this textbook, are available to help the clinician The body size of most birds encountered in practice verify questionable anatomic structures, identify will range from a finch to a duck. While recognition in tissue incision, dissection and specimen procure- and interpretation of gross lesions may allow con- ment. Such instruments should be dedicated for ne- struction of a differential diagnosis as to the cause of cropsy use only and be thoroughly cleaned and disin- death, few gross lesions are pathognomonic.

Such condi- Spirochaetaceae Undifferentiated: A non-classified tions may occur in large bodies of water hydrea 500mg on line, and in these spirochete from choanal and tracheal mucus of a situations Pasteurella spp discount 500 mg hydrea fast delivery. Two other cockatiels have in tropical climates peak with seasonal highs in am- been found to harbor similar organisms in the respi- bient temperature and humidity generic 500mg hydrea. Histopathology showed a mild in- flammatory reaction in the nasal sinus, but not in the P. In the lower parts of the respiratory tract, species is divided into strains based on 16 serologi- the organisms could not be demonstrated using ar- cally distinct endotoxins and 4 capsular polysaccha- gentation. Interference with the ciliary activity of the are most commonly isolated from birds. If the organism ing in tissue smears or from first culture passages is able to colonize the respiratory mucosa, it can when fixed in methanol and stained with methylene induce conjunctivitis and respiratory signs including blue. Aspergillosis is one of the The latter is usually considered a secondary patho- triggering factors that allows this secondary patho- gen. Postmortem findings waterfowl, pigeons and Psittaciformes have not been associated with P. Diseases by less virulent strains usually occur in stressed or immunocom- promised hosts. Clinical Disease and Pathology Acute forms are characterized by cyanosis, dyspnea and diarrhea followed by death. Birds that survive acute disease often develop respiratory rales, sinusitis, conjunctivitis or swelling of the sinus in- fraorbitalis. Postmortem findings with acute disease may be ab- sent or limited to petechiae or ecchymoses of the parenchymal organs. Catarrhal to fibri- ately after the injury occurs, and become rapidly depressed and die 12 to 24 hours later. Any carnivore-related injury in a bird is a nous rhinitis, necrotic pneumonia, sinusitis, ble- critical emergency. Following bacteremia, Pasteurella may colonize numerous tissues, resulting in arthri- fibrinous inflammation of the upper respiratory tis, osteomyelitis, otitis media and granulomatous tract, pneumonia and air sacculitis. Some strains will colonize the air Transmission cells of the cranial bones causing fibrinous exudate. Pasteurella infections in birds principally occur in In waterfowl, a diphtheroid enteritis may be ob- the respiratory tract. Transmission can occur through direct contact Diagnosis with contaminated aerosols or through mechanical The isolation of the causative agent is necessary. Septicemic birds rarely survive, even when treated multocida, and any bird that has been mouthed by a intensively. Parenteral administration of broad-spec- cat should be treated with antibiotics immediately trum, long-acting sulfonamides can be tried. Treating birds with Pathogenesis chronic forms is very difficult because of the irre- Virulent strains of P. Less virulent strains result in bac- teriemia and colonization of the lungs, liver, kidneys, Control spleen and heart. Weakly virulent strains generally Preventing rodents and free-ranging birds from en- cause a chronic respiratory disease. Failures liver necrosis, salpingitis, peritonitis, endocarditis associated with the vaccine occur because of the nu- valvularis and fibrinous arthritis are typical lesions. The production of vaccines from strains that persist in an aviary may provide successful long- Diagnosis and Treatment term control. The taxonomic reclassification of the Pas- Tetracyclines and chloramphenicol are indicated for teurellaceae is intertwined with the genus Actino- initial therapy. Because of these classification revisions, difficult to interpret because of oversized inhibition even the actinobacilli that are pathogenic in birds zones. The situation has been compli- during the first week of life or lesions become too cated in recent years because many new strains have extensive to be reversed. However, this classification is not The haemophilus strains that infect companion birds valid. They probably serve as secondary in- Some strains are considered to be primary patho- vaders that sustain upper and sometimes lower res- gens, but the majority of this genus is comprised of piratory tract disease. There are no simple labora- tory tests for differentiation between primary and Pathogenesis secondary invaders. Incubation pe- duce a number of cellular toxins, including neu- riods in the avian host are not known. Birds do not appear to develop an immune response following Clinical Disease and Pathology infection, and relapses are common. Spe- Clinical Disease and Pathology cies-specific strains that infect geese morphologically Haemophilus infections generally cause a rhinitis resemble P. This organism has been ref- that results in a serous-to-mucoid or even fibrinous erenced as a cause of chronic disease in the gosling,26 exudate. Mortality rates in this age group can Blue Crane Pneumonia (together with staphylococci) reach 75% of exposed young. Acute disease develops and necrosis of liver tissue in older birds and is characterized by sinusitis, con- Pigeon Rhinitis junctivitis, coughing and diarrhea, followed in two African Grey Parrot Pneumonia, air sacculitis days by tremors, ataxia and convulsions. Survivors Plum-headed Parakeet Sinusitis, swelling of the liver together are stunted and fail to grow. Cytophaga-induced spondylitis with compression Muscovy Duck Rhinitis, sinusitis of the spinal cord was reported in turkeys. There was exudate forma- the beak cavity tion within the ventricles as well as proliferation of Siamese Fireback Necrosis of the lung tissue. Isolation and identification of the causa- tive agent is necessary in all other cases.

Walking compared with vigorous exercise for the prevention of cardiovascular events in women generic hydrea 500mg line. Recreational physical activity and the risk of breast cancer in postmenopausal women: the Women’s Health Initiative Cohort Study purchase 500mg hydrea amex. The Erlangen Fitness Osteoporosis Prevention Study: a controlled exercise trial in early postmenopausal women with low bone density-first year results cheap hydrea 500 mg mastercard. Efficacy of soy foods and soybean isoflavone supplements for alleviating menopausal symptoms is positively related to initial hot flush frequency. Vasomotor symptom relief by soy isoflavone extract tablets in postmenopausal women: a multicenter, double-blind, randomized, placebo-controlled study. Effect of intestinal production of equol on menopausal symptoms in women treated with soy isoflavones. Effect of flaxseed consumption on urinary estrogen metabolites in postmenopausal women. The effect of flaxseed and wheat bran consumption on urinary estrogen metabolites in premenopausal women. Effects of ethyl-eicosapentaenoic acid omega-3 fatty acid supplementation on hot flashes and quality of life among middle-aged women: a double-blind, placebo-controlled, randomized clinical trial. A randomised, double-blind, placebo-controlled trial on the effect of Pycnogenol on the climacteric syndrome in peri-menopausal women. Clinical studies of oral administration of gamma-oryzanol on climacteric complaints and its syndrome. Effect of gamma-oryzanol on serum lipid peroxide levels and climacteric disturbances. Efficacy on menopausal neurovegetative symptoms and some plasma lipids blood levels of an herbal product containing isoflavones and other plant extracts. Hormone-balancing effect of pre-gelatinized organic maca (Lepidium peruvianum Chacon). Clinical response of early-postmenopausal women to maca in a double blind, randomized, placebo- controlled, crossover configuration, outpatient study. Chemical profiling and standardization of Lepidium meyenii (maca) by reversed phase high performance liquid chromatography. Beneficial effects of Lepidium meyenii (maca) on psychological symptoms and measures of sexual dysfunction in postmenopausal women are not related to estrogen or androgen content. Trifolium pretense isoflavones in the treatment of menopausal hot flushes: a systematic review and meta-analysis. Randomized placebo-controlled trial of an isoflavone supplement and menopausal symptoms in women. The effect of isoflavone phytoestrogens in relieving hot flushes in Peruvian post-menopausal women. Proceedings of the 9th International Menopause Society World Congress on the Menopause, Yokohama, Japan, 1999. The effects of isoflavones derived from red clover on vasomotor symptoms and endometrial thickness. Proceedings of the 9th International Menopause Society World Congress on the Menopause, Yokohama, Japan, 1999. Isoflavones from red clover (Promensil) significantly reduce menopausal hot flush symptoms compared with placebo. John’s wort on severity, frequency, and duration of hot flashes in premenopausal, perimenopausal and postmenopausal women: a randomized, double-blind, placebo-controlled study. John’s wort) on hot flashes and quality of life in perimenopausal women: a randomized pilot trial. The effect of herbal extract (EstroG-100) on pre-, peri- and post-menopausal women: a randomized double-blind, placebo-controlled study. Relation between measured blood loss and patients’ subjective assessment of loss, duration of bleeding, number of sanitary towels used, uterine weight and endometrial surface area. The relationship between menstrual blood loss and prostaglandin production in the human: evidence for increased availability of arachidonic acid in women suffering from menorrhagia. Menstrual disorders and mild thyroid insufficiency: intriguing cases suggesting an association. Nutritional deficiency in the etiology of menorrhagia, metrorrhagia, cystic mastitis and premenstrual tension: treatment with vitamin B complex. Food allergy and adult migraine: double-blind and mediator confirmation of an allergic etiology. Migraine: a diagnostic test for etiology of food sensitivity by a nutritionally supported fast and confirmed by long-term report. Platelet serotonin release in rheumatoid arthritis: a study in food-intolerant patients. Histamine free diet: treatment of choice for histamine-induced food intolerance and supporting treatment for chronic headaches. Vitamin B-6 nutriture and plasma diamine oxidase activity in pregnant Hispanic teenagers. Milk protein-free diet for nonseasonal asthma and migraine in lactase-deficient patients. Labile aggregation stimulating substance, free fatty acids and platelet aggregation. The influence of different types of omega–3 polyunsaturated fatty acids on blood lipids and platelet function in healthy volunteers. Amelioration of severe migraine with omega-3 fatty acids: a double-blind, placebo-controlled clinical trial. Supplementation with omega-3 polyunsaturated fatty acids in the management of recurrent migraines in adolescents.