Redonda Gail Miller, M.B.A., M.D.
- President, The Johns Hopkins Hospital
- Associate Professor of Medicine
https://www.hopkinsmedicine.org/profiles/results/directory/profile/0005712/redonda-miller
Early in its evolution medicine rash generic 250mg chloromycetin with visa, the lesion may be noted as a tender swelling medications list form generic 250mg chloromycetin free shipping, often with a dusky erythema of the overlying mucosa denivit intensive treatment buy chloromycetin 500mg without a prescription. Subsequently medications jamaica discount 500mg chloromycetin fast delivery, the mucosa breaks down, and there is a sharply demarcated deep ulcer with a yellowish gray lobular base. In the palate, the lesion may be unilateral or bilateral, with individual lesions ranging from 1 to 3 cm in diameter. There is necrosis of salivary glands and squamous metaplasia of salivary duct epithelium at the base of an ulcer (Figure 8-10). The lobular architecture of salivary glands is preserved and this feature helps to distinguish this process from neoplasia. The squamous metaplasia may be misinterpreted as squamous cell carcinoma, but unlike cancer, there is no cytologic atypia. Likewise, when this metaplasia is seen in the Histopathology Clinically, squamous cell carcinoma and malignant minor salivary gland neoplasms must be ruled out, usually by a biopsy. Syphilitic gummas and deep fungal infections likewise must be ruled out because they may present as punched-out lesions of the palate. Findings from serology, biopsy, and/or culture are usually needed to exclude these entities. In medically compromised patients, such as those with poorly controlled diabetes, opportunistic fungal infections such as mucormycosis may cause a similar clinical picture. The entity of subacute necrotizing sialadenitis has been described as a nonspecific, inflammatory condition of minor salivary glands of unknown origin. It is characterized by abrupt onset of pain and localized swelling, usually of the hard or soft palate, but, unlike necrotizing sialometaplasia, it is self-limiting and has no ulcerative or metaplastic components. This is a benign, self-limiting process that, apart from a biopsy to establish the diagnosis, does not require surgical intervention. Patient reassurance, wound irrigation using a bland baking soda-and-water mouth rinse, and occasional use of analgesics are the only management steps necessary. Adenomatoid hyperplasia is a non-neoplastic enlargement of the minor salivary glands of the hard palate. Treatment and Prognosis Adenomatoid Hyperplasia Clinical Features · Figure 8-9 Necrotizing sialometaplasia of the hard palate. The palate is the principal site of involvement of this salivary gland hyperplasia. The clinical presentation is a unilateral, A · Figure 8-10 B Necrotizing sialometaplasia. Histopathology tissues in the body, including the liver, pancreas, kidney, and nervous system. Treatment and Prognosis There are lobules of hypertrophic otherwise normalappearing mucous glands. The cytologic and morphologic features of acinar and ductal elements are within normal limits. The clinical differential diagnosis would include salivary neoplasm, lymphoma, and extension of nasopharyngeal or sinonasal disease into the oral cavity. Subsequent to diagnosis by incisional biopsy, no treatment is necessary, given the purely benign nature of this process. Differential Diagnosis Treatment and Prognosis Treatment is symptomatic and includes bed rest. Complete recovery is generally the rule, although viral encephalitis, myocarditis, and nephritis may lead to rare fatalities. Antibody conversion occurs in approximately 80% to 90% of individuals, and immunity is lifelong. Although mumps is the most common form of viral sialadenitis, parotitis may be caused by other viral agents, including Coxsackie A virus, echovirus, choriomeningitis virus, cytomegalovirus, and parainfluenza virus types 1 and 2. Cytomegaloviral infection of the salivary glands, or cytomegalic inclusion disease, is a rare condition that affects neonates as a result of transplacental infection. Systemic disease may cause debilitation, developmental retardation, and premature birth. Cytomegalovirus can be demonstrated in biopsy material; with the use of in situ hybridization methods, its presence can be easily confirmed in tissue sections.
Both sensitivity and specificity decrease Ans (2) [Nirmal medicine and technology chloromycetin 250mg overnight delivery, Med College Thrissur] Aiims answer Contribute to aippg symptoms kidney failure dogs cheap chloromycetin 500mg mastercard. Ans 2 Park 17th [all goals to be acieved by 2010] 135) As per the World Health Organisation guidelines medications cause erectile dysfunction buy cheap chloromycetin 250 mg on line, iodine deficiency disorders are endemic in a community if the precalence of goiter in school age children is more than: 1 medicine nobel prize 2016 discount chloromycetin 250 mg online. Ans 2 137) the drug of choice for chemoprophylaxis in contacts of a patient of pneumonic plague is: 1. The control should come from a population that has the same potential for breast cancer as the cases. Ans 4 143) the number of patients required in a clinical trial to treat a specify disease increases as: 1. Ans 2 146) the visual acuity used as cut off for differentiating "normal" from "abnormal" children in the School Vision Screening Programme in India is: 1. Ans 3 148) Scabies, an infection of the skin caused by Sarcoptes scabiei, is an example of: 1. He must preserve viscrea and send for toxicology examination in case of poisoning. Ans 1 157) Following cranial neve is most commonly involved in patients with sarcoidosis: 1. Ans 2 160) All of the following murmurs may be heard in patients with aortic regurgitation except: 1. It is generally heard best at the lower left sternal border and radiates well to the base of the heart. It is most frequently the result of the audible opening of the mitral valve due to stiffening. During inspiration the opening snap of mitral origin is softer due to the decreased blood return to the left ventricle. Ans 3 163) A thirty-year man presented with nausea, fevcer and jaundice of 5-days duration. Within 5 minutes, he developed generalized urticaria, swelling of lips, hypotension and bronchospasm. Ans 2 166) A patient ingested some unknown substance and presented with myoclonic jerks, seizures. Ans 3 167) Significant loss of vision in a patient with a hypertension can occur due to all of the following except: 1. Retinal hemorrhage Ans 3 168) A 33 years old lady presents with polydypsia and polyuria. Her hemoglobin was 92 g/l and fetal hemoglobin level was 65 % She has not received any blood transfusion till date. Answer: - (2) [Dr Vipul, Banglore] [In Thasassemia Intermedia Blood transfusion is not generally required and mild hepatosplenomegaly is seen; in heriditary persistant fetal Hb homozygous state microcytosis is seen] 172) All of the following cause high anion gap metabolic acidosis except: 1. Which of the following medium will be ideal for the culture of the throat swab for a rapid identification of the pathogen: 1. Answer: - (3) 178) A 56 year old man has painful rashes over his right upper eyelid and forehead for the last 48 hours. His temperature is 98 Degree F, blood pressure 138/76 mm Hg and pulse is 80/ minute. Answer: - (2) 179) A 24-years-old cook in a hostel mess suffered from enteric fever 2 year back. Answer: - (1) 183) A 17 yrs old girl with keratitis and severe pain in the eye came to the hospital and Acanthameaba keratitis was suspected. The culture shows growth of bacteria only on chocolate agar and not on blood agar. Eight out of them develop severe gastroenteritis within 4-6 hrs of consumption of the sandwiches. Ans 3 194) Differential diagnosis of pre-menstrual tension included all of the following except: 1.
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Melanocytic nevi of the skin are common acquired papular lesions that usually appear shortly after birth and throughout childhood medicine with codeine buy generic chloromycetin 250mg on line. Less common sites are the buccal mucosa medications may be administered in which of the following ways purchase 500mg chloromycetin with amex, labial Treatment and Prognosis Clinical Features Nevus cells Epithelium Basement membrane Junctional nevus Compound nevus Intramucosal nevus Melanocytic nevus subtypes symptoms nausea dizziness discount chloromycetin 250mg with visa. Must differentiate from melanoma (biopsy) Types (in order of frequency): Intramucosal nevus Blue nevus Compound nevus Junctional nevus Probably has no malignant potential mucosa medications rights effective 250mg chloromycetin, gingiva, alveolar ridge, and vermilion (Box 5-5; Figures 5-14 and 5-15). Histopathology A Microscopically, several subtypes are recognized (Figures 5-16 and 5-17). When cells are located in the epitheliumconnective tissue junction, the lesion is called a junctional nevus; when B · Figure 5-16 Intramucosal nevus. A fourth type of nevus, in which cells are spindle shaped and are found deep in the connective tissue, is known as blue nevus. Malignant transformation of an oral benign melanocytic nevus is highly improbable. Various observations support this statement, including (1) malignant features are never seen in oral nevi, (2) oral melanomas rarely, if ever, contain preexisting nevi histologically, and (3) almost no cases of the malignant counterpart of the relatively common oral blue nevus have been reported. Because oral melanocytic nevi can mimic melanoma clinically, all undiagnosed pigmented lesions should undergo a biopsy. In the oral cavity, intramucosal nevi are the most commonly seen variety, and blue nevi are the second most common. The so-called dysplastic nevus that is commonly seen in skin has not been observed in oral mucous membranes. Other clinical considerations that should be included with any type of oral melanocytic nevus are melanotic macule, amalgam tattoo, and melanoma. Palatal lesions may offer a challenge in terms of a clinical diagnosis, as both pigmented nevi and mucosal melanoma most commonly are noted at Diascopy (compression under glass) could be used to rule out the last two lesions, in which the blood is contained within a well-defined vascular system. Treatment Because of the infrequency with which oral nevi occur, and because of their ability to clinically mimic melanoma, all suspected oral nevi should be excised. Because they generally measure less than 1 cm, excisional biopsy is usually indicated. Typically, these hyperpigmented lesions are macular to minimally elevated with a tendency for rapid growth, thus raising concern over the possibility of a malignant process. Lesions are typically focal and are generally found in the buccal mucosa, but may also occur in the palate or gingiva. Melanoacanthoma On the skin are several melanoma subtypes, including nodular melanoma, superficial spreading melanoma, acral lentiginous melanoma, and lentigo maligna melanoma, each having distinctive microscopic, clinical, and behavioral features. Differences in clinical progression and histology are related, in large part, to recognition that all melanomas have two distinct phases of variable duration: (1) a radial or horizontal growth phase, during which malignant melanocytes spread laterally along the epidermal-dermal interface, and (2) a vertical growth phase, characterized by penetration of the dermis and subcutaneous tissues by malignant melanocytes. In nodular melanoma, the radial growth phase is generally very short compared with a longer radial growth phase in other forms of melanoma. Surgery is the primary form of treatment, although chemotherapy, immunotherapy, and/or radiation are utilized for patients with advanced disease. For patients with regional disease it is 60%, and for patients with advanced disease it is 15%. Newer therapies are emerging, including targeted biological immmunotherapy with the monoclonal antibody ipilimumab. Oral Melanoma Melanoma Cutaneous Melanoma Melanomas of the skin have been increasing in frequency during the past several decades and now represent approximately 2% of all cancers (excluding carcinomas of the skin). The average age at the time of diagnosis is 60 years, and is rare before 20 years of age. Predisposing factors for skin lesions include extensive sun exposure, particularly in childhood, fair natural pigmentation, tanning bed abuse, and precursor lesions, such as congenital melanocytic nevi and dysplastic nevi. It should be noted that in Japan the incidence of oral melanoma is relatively high when compared to the incidence of cutaneous melanoma, which is very low in this population. Intraorally, preexisting melanosis was reported to appear before the development of some melanomas. This pigmentary defect, however, very likely represents an early radial growth phase of these lesions, and not benign melanosis.
A stochastic branching model with formation of subunits applied to the growth of intestinal crypts medicine 20th century order chloromycetin 250 mg online. Intraductal papillarymucinous tumors of the pancreas: clinicopathologic features symptoms of hiv buy chloromycetin 500 mg with amex, outcome medications ok during pregnancy generic chloromycetin 250 mg online, and nomenclature symptoms estrogen dominance 250mg chloromycetin sale. Case report: Krukenberg tumours arising from a primary duodenojejunal adenocarcinoma. Paracrine growth stimulation by hepatocyte-derived insulin-like growth factor-1: a regulatory mechanism for carcinoma cells metastatic to the liver. Observations on the etiology and pathogenesis of intraductal papillary-mucinous neoplasms of the pancreas. Lorimier G, Binelli C, Burtin P, Maillart P, Bertrand G, Verriele V, Fondrinier E (1992). Metastatic gastric cancer arising from breast carcinoma: endoscopic ultrasonographic aspects. Genomic instability in colorectal cancer: relationship to clinicopathological variables and family history. Cancer of esophagus and esophagogastric junction: analysis of results of 1,025 resections after 5 to 20 years. Prognostic value of Ki-67 expression, ploidy and S-phase fraction in patients with pancreatic cancer. Intraepidermal cytokeratin 7 expression is not restricted to Paget cells but is also seen in Toker cells and Merkel cells. Evidence for regional specialization and extrathymic T cell maturation in the human gut epithelium. A study of the histopathogenesis of carcinoid tumors of the small intestine and appendix. Solitary fibrous tumour of the pancreas: a new member of the small group of mesenchymal pancreatic tumours. The grade of pancreatic ductal carcinomas is an independent prognostic factor and is superior to the immunohistochemical assessment of proliferation. The Kras mutation pattern in pancreatic ductal adenocarcinoma usually is identical to that in associated normal, hyperplastic, and metaplastic ductal epithelium. The retroperitoneal resection margin and vessel involvement are important factors determining survival after pancreaticoduodenectomy for ductal adenocarcinoma of the head of the pancreas. Multifocal neoplasia involving the colon and appendix in ulcerative colitis: pathological and molecular features. Genetics, natural history, tumor spectrum, and pathology of hereditary nonpolyposis colorectal cancer: an updated review. Distant metastasis from a carcinoid tumor of the appendix less than one centimeter in size. E-cadherin expression is correlated with the isolated cell/diffuse histotype and with the features of biological aggressiveness of gastric carcinoma. E-cadherin gene mutations provide a genetic basis for the phenotypic divergence of mixed gastric carcinomas. Mucin-hypersecreting intraductal neoplasms of the pancreas: a precursor to cystic pancreatic malignancies. The expression of cytokeratins 7, 19, and 20 in primary and metastatic carcinomas of the liver. Diagnosis of mucin-producing tumor of the pancreas by balloon-catheter endoscopic retrograde pancreatography - compression study. Epithelioid hemangioendothelioma of the liver: a clinicopathologic study of 137 cases. Germ line p53 mutations in a familial syndrome of breast cancer, sarcomas, and other neoplasms. Cancer of the esophagus and associated lesions: detailed pathologic study of 100 esophagectomy specimens. Dietary iron overload as a risk factor for hepatocellular carcinoma in Black Africans.
References
- Winter GD: Formation of scab and the rate of epithelialization of superficial wounds in the skin of the young domestic pig. Nature 193:293, 1962.
- Deprest J, Jani J, Gratacos E, et al.; FETO Task Group. Fetal intervention for congenital diaphragmatic hernia: the European experience. Semin Perinatol 2005;29:94-103.
- Redonnet-Vernhet I, Cjatelut M, Basile JP, et al. Cholesteryl ester storage disease: relationship between molecular defects and in situ activity of lysosomal acid lipase. Biochem Mol Med 1997;62:42.
- Bennett DL, Woods CG. Painful and painless channelopathies. Lancet Neurol. 2014;13(6):587-599.
- Albert ML, Bachman DL, Morgan A, et al. Pharmacotherapy for aphasia. Neurology 1988;38:877.
- Jelenko C, III: Chemicals that burn. J Trauma 14:65-72, 1974.
