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Depending on the type of white blood cell that is involved treatment for strep throat buy discount lamictal 25 mg online, chronic leukemia can be classified as chronic lymphocytic leukemia or chronic myelogenous leukemia symptoms 5 months pregnant purchase lamictal 100 mg with visa. The two types of chronic leukemias can be easily distinguished under the microscope medicine zoloft purchase 50mg lamictal with amex. Acute leukemias In acute leukemia medicine journals impact factor buy 25 mg lamictal fast delivery, the maturation process of the white blood cells is interrupted. The immature cells (or "blasts") proliferate rapidly and begin to accumulate in various organs and tissues, thereby affecting their normal function. This uncontrolled proliferation of the immature cells in the bone marrow affects the production of the normal red blood cells and platelets as well. Acute leukemias are of two types: acute lymphocytic leukemia and acute myelogenous leukemia. Because leukemia is the most common form of childhood cancer, it is often regarded as a disease of childhood. International1205 Leukemia ly, leukemia is the fourth most common cancer among people age 15 to 19 years old. If the doctor has reason to suspect leukemia, he or she will conduct a thorough physical examination to look for enlarged lymph nodes in the neck, underarm, and pelvic region. Swollen gums, enlarged liver or spleen, bruises, or pinpoint red rashes all over the body are some of the signs of leukemia. Urine and blood tests may be ordered to check for microscopic amounts of blood in the urine and to obtain a complete differential blood count. This count will give the numbers and percentages of the different cells found in the blood. An abnormal blood test might suggest leukemia, however, the diagnosis has to be confirmed by more specific tests. During the biopsy, a cylindrical piece of bone and marrow is removed, generally from the hip bone. In addition to diagnosis, the biopsy is also repeated during the treatment phase of the disease to see if the leukemia is responding to therapy. A spinal tap (lumbar puncture) is another procedure that the doctor may order to diagnose leukemia. In this procedure, a small needle is inserted into the spinal cavity in the lower back to withdraw some cerebrospinal fluid and to look for leukemic cells. A gallium scan or bone scan is a test in which a radioactive chemical is injected into the body. This chemical accumulates in the areas of cancer or infection, allowing them to be viewed with a special camera. Causes & symptoms Leukemia strikes both sexes and all ages and its cause is mostly unknown. However, chronic leukemia has been linked to genetic abnormalities and environmental factors. For example, exposure to ionizing radiation and to certain organic chemicals, such as benzene, is believed to increase the risk for getting leukemia. A 2003 study from the Electric Power Research Institute showed possible links between metallic drainpipes and childhood baths. A higher incidence of leukemia has also been observed among persons with Down syndrome and some other genetic abnormalities. A history of diseases that damage the bone marrow, such as aplastic anemia, or a history of cancers of the lymphatic system puts people at a high risk for developing acute leukemias. Similarly, the use of anticancer medications, immunosuppressants, and the antibiotic chloramphenicol also are considered risk factors for developing acute leukemias. Before participating in any alternative treatment programs, patients should consult their doctors concerning the appropriateness and the role of such programs in the overall cancer treatment plan. The effectiveness of most anti-cancer drugs used to treat leukemia can be reduced when patients take mega doses of antioxidants. However, taken during chemotherapy, these antioxidants protect the cancer cells from being killed by treatment. Vitamins that are of particular benefit to cancer patients include beta-carotene, Bcomplex vitamins, (especially vitamin B 6, vitamins A, C, D, E and K. The most important minerals are calcium, chromium, copper, iodine, molybdenum, germanium, selenium, tellurium, and zinc. However, patients should not take mega doses of these supplements without first consulting their doctor. Significant adverse or toxic effects may occur at high dosage, which is especially true for minerals. It is prudent to avoid use of antioxidants when undergoing chemotherapy or radiation therapy since these treatments kill the cancer by producing oxidants. It is best to check with a nutritional physician or other licensed provider when adding these supplements. Patients should consult an experienced herbalist who will prescribe remedies to treat specific symptoms that are caused by conventional cancer treatments. Therefore, patients should wait until after chemotherapy to try this relatively safe alternative treatment. Acupuncture Acupuncture is the use of needles on the body to stimulate or direct the meridians (channels) of energy flow in the body. However, it is an effective treatment for nausea, a common side effect of chemotherapy and radiation. The main aim of 1207 Leukemia the treatment is to reduce the number of leukemic cells as far as possible and induce a remission in the patient. Once the patient shows no obvious signs of leukemia (no leukemic cells are detected in blood tests and bone marrow biopsies), the patient is said to be in remission. This is called continuation or maintenance therapy; the aim in this case is to kill any remaining cells and to maintain remission for as long as possible. It is usually the treatment of choice and is used to relieve symptoms and achieve long-term remission of the disease. Generally, combination chemotherapy, in which multiple drugs are used, is more efficient than using a single drug for treatment. In 2002, scientists announced the discovery of a gene that triggers the death of leukemia cells. Further study was needed on both new discoveries, but they were thought important to improving treatment of two forms of leukemia. Later in 2002, Gleevec, a new antileukemia drug that even proved successful at treating chronic myeloid leukemia, was heralded in clinical trials. Because leukemia cells can spread to all the organs via the blood stream and lymph vessels, surgery is not considered an option for treating leukemias. Radiation therapy, which involves the use of x rays or other high-energy rays to kill cancer cells and shrink tumors, may be used in some cases. For acute leukemias, the source of radiation is usually outside the body (external radiation therapy). If the leukemic cells have spread to the brain, radiation therapy can be given to the brain. Healthy marrow from the donor is then given to the patient through a needle in a vein to replace the destroyed marrow. The marrow that was frozen is then thawed and given back to the patient through a needle in a vein. This mode of bone marrow transplant is currently being investigated in clinical trials. This treatment mode is also being investigated in clinical trials all over the country at major cancer centers. According to statistics, more than 60% of leukemia patients survive for at least one year after diagnosis. This is because chemotherapeutic drugs are most effective against actively growing cells. According to statistics, in chronic lymphoid leukemia, the overall survival for all stages of the disease is nine years. Prevention Most cancers can be prevented by changes in lifestyle or diet, which will reduce risk factors.
Getting adequate amounts of this carotenoid may also decrease the risk of developing colon cancer and heart disease symptoms 2 dpo 25 mg lamictal overnight delivery. Lutein and other carotenoids are considered important because of their antioxidant properties treatment of hemorrhoids discount lamictal 200mg without prescription. Antioxidants help to protect cells from damage caused by free radicals withdrawal symptoms generic 50 mg lamictal otc, the destructive fragments of oxygen produced as a byproduct during normal metabolic processes treatment scabies buy 50 mg lamictal visa. As free radicals travel through the body, they cause damage to cells and genes by stealing electrons from other molecules-a process referred to as oxidation. Concentrated mainly in the lens and retina of the eye, lutein may help to protect vision by neutralizing free radicals and by increasing the density of eye pigment. In late 2001, a British study reported that risk of cortical cataract was lowest with high concentrations of lutein. The carotenoid may accomplish this by protecting eye tissue from free radical damage and shielding the eyes from potentially destructive sunlight. Research also indicates that getting adequate amounts of lutein may decrease the risk of colon cancer and heart disease. Lutein may offer protection against the latter two diseases by acting as an antioxidant, since free radical damage is believed to contribute to the development of cardiovascular disease as well as certain cancers. The results of an earlier study, published in the British Medical Journal in 1992, shed light on the possible link between lutein and cataracts. Odle Lupus see Systemic lupus erythematoses Lutein Description Found in certain fruits and vegetables as well as egg yolks, lutein is a nutrient with a number of potentially beneficial effects. It is a member of the carotenoid family, a group of chemicals related to vitamin A. While betacarotene, the precursor of vitamin A, may be the most fa1244 Lutein cataracts and intake of carotenoids, vitamins C and E, and riboflavin. Researchers studied the dietary habits via questionnaires of over 50,000 registered nurses aged 45 years and over for a period of eight years and found that those who reported consuming the most vitamin A and carotenoids were found to have a lower risk of developing cataracts. Spinach, which is a rich source of lutein, appeared to offer the most protection against the disease. The researchers concluded that the carotenoids present in food may decrease the risk of developing severe cataracts. Lutein may also help to prevent the development of colon cancer, according to a study published in the American Journal of Clinical Nutrition in 2000. This study examined the risk of colon cancer and dietary intake of lutein and other carotenoids such as alphacarotene, beta-carotene, lycopene, zeaxanthin, and betacryptoxanthin. Roughly half the participants were between the ages of 30 and 79 and already had colon cancer, while the remainder made up the cancer-free control group. The results indicated that men and women who had consumed large amounts of lutein were less likely to develop the disease. Interestingly, lutein was the only carotenoid identified by the study that seemed to offer any protection. A study reported in 2001 found that carotid arteries in those with higher lutein levels were clearer than average. A human study also provides some indirect evidence that higher levels of lutein and other carotenoids may play a role in preventing the development of cardiovascular disease. The study, conducted by researchers from Cambridge University and published in 1996, examined blood levels of antioxidant vitamins and carotenoids in people from two regions of the world with very different rates of heart disease: Toulouse, France, and Belfast, Ireland. The results showed that residents of Toulouse, who have a much lower rate of heart disease, had lutein levels about twice as high as those from Belfast, where the incidence of cardiovascular disease is much greater. Other sources of lutein include corn, red seedless grapes, kiwi fruit, squash, and green vegetables such as zucchini, spinach, collard greens, kale, leaf lettuce, celery, peas, broccoli, and leeks. Oranges and orange juice, tomatoes, and carrots also prove good sources of lutein. In 2001, researchers reported that concentrations of lutein are higher in the peels of fruits than in the pulp. Getting too much lutein through food and drink is not considered a significant risk because the nutrient is only present in relatively small amounts in plants and animals. Precautions Lutein is not known to be harmful when taken in recommended dosages, though it is worth remembering that the long-term effects of taking lutein supplements are unknown. Due to lack of sufficient medical study, lutein should be used with caution in children, women who are pregnant or breast-feeding, and people with liver or kidney disease. Side effects When taken in recommended dosages, lutein is not associated with any bothersome or significant side effects. Interactions Lutein is not known to interact adversely with any drugs or dietary supplements. Antioxidant-An organic substance that is able to counteract the damaging effects of oxidation in human and animal tissue. Carotenoid-Any of a group of red and yellow pigments that are chemically similar to carotene. Cataracts-The clouding of the eye lens, which under normal circumstances is clear. General use the first recorded use of lycium fruit as a medicinal herb is from the first century A. For thousands of years it has been used in China to promote a long, vigorous, and happy life. Ill health occurs when the energies and elements of the body are out of balance or in disharmony. Lycium fruit is traditionally believed to have many different effects upon the body. In addition to being a general longevity herb, it is said to raise the spirits, fight depression, and increase cheerfulness. Lycium berries are used as a liver tonic to brighten the eyes, improve poor eyesight, treat blurred vision, sensitivity to light, and other general eye weaknesses. Some herbalists use a tea made of lycium root and Scutellaria (skullcap or Huang Qin) to treat morning sickness in pregnant women. There is some scientific basis for this treatment, since extracts from the root have been shown in laboratory experiments to relax the involuntary muscles, including artery muscles. Other modern scientific studies have shown that extracts of lycium root can reduce fever, including fever associated with malaria. One Korean study published in 1999 looked at the effect extracts from the berries and roots had on the blood of mice that were exposed to whole body x rays. Greg Annussek Teresa Norris Lycium fruit Description Lycium fruit is used extensively in Chinese herbalism. However, it is also grown as a cultivated plant in almost all parts of China and in some other regions of Asia. The fruit also contains amino acids (the building blocks of proteins), iron, and trace elements essential to the body, including zinc, copper, selenium, calcium, and phosphorus. The 1246 Lycopene cytes, and thrombocytes faster than those that did not receive the extract. Combinations Lycium is regularly used in tonics and herbal formulas that treat blood deficiencies, poor kidney function, and liver depletion. Among these are lycium formula, a blood tonic that is intended to strengthen the entire body and brain. Lycium is an ingredient in rhemannia eight combination, a common jing tonic for older men and women that is said to regulate blood sugar and control diabetes, and a vision formula with the Chinese name of Qi Ju Di Huang Wan is made of lycium, chrysanthemum, and rhemannia. Decoction-Decoctions are made by boiling an herb, then straining the solid material out. Erythrocytes-Known as red blood cells, erythrocytes carry oxygen to every part of the body. Leukocytes-Also called white blood cells, leukocytes fight infection and boost the immune system. Thrombocytes-Thrombocytes, also called platelets, help the blood to clot so that wounds can heal. Yin aspects-Yin aspects are the opposite of yang aspects and are represented by qualities such as cold, stillness, darkness, and passiveness.
A classification of polyps symptoms bladder cancer order lamictal 25 mg, along with benign tumours and malignant tumours medications safe in pregnancy generic lamictal 50mg online, is presented below symptoms hypothyroidism cheap lamictal 200 mg overnight delivery. Hamartomatous polyps (i) Peutz-Jeghers polyps and polyposis (ii) Juvenile (Retention) polyps and polyposis B medicine you can overdose on generic lamictal 100mg. Tubulovillous adenoma (Papillary adenoma, villoglandular adenoma) Familial polyposis syndromes 1. Polyps are much more common in the large intestine than in the small intestine and are more common in the rectosigmoid colon than the proximal colon. G/A Hyperplastic polyps are generally multiple, sessile, smooth-surfaced and small (less than 0. M/E They are composed of long and cystically dilated glands and crypts lined by normal epithelial cells. Hyperplastic polyps are usually symptomless and have no malignant potential unless there is a coexistent adenoma. The polyps may be located in the stomach, small intestine or colon but are most common in the jejunum and ileum. M/E the most characteristic feature is the tree-like branching of muscularis mucosae. Peutz-Jeghers polyps do not undergo malignant transformation unless a coexistent adenoma is present. Solitary juvenile polyps occur more often in the rectum, while juvenile polyposis may be present anywhere in the large bowel. G/A Juvenile polyps are spherical, smooth-surfaced, about 2 cm in diameter and are often pedunculated. M/E the classical appearance is of cystically dilated glands containing mucus and lined by normal mucus-secreting epithelium. G/A They are usually multiple, cylindrical to rounded overgrowths of mucosa and may vary from minute nodules to several centimeters in size. M/E the centre of inflammatory polyp consists of connective tissue core that shows some inflammatory cell infiltrate and is covered superficially by regenerating epithelial cells and some cystically-dilated glands. These lesions have no malignant potential; carcinomas seen in longstanding cases of ulcerative colitis arise in the region of epithelial dysplasia and not from the polyps. M/E They are composed of prominent lymphoid follicles with germinal centres located in the submucosa and mucosa. They may be found singly as sporadic cases, or multiple tubular adenomas as part of familial polyposis syndrome with autosomal dominant inheritance pattern. G/A Adenomatous polyps may be single or multiple, sessile or pedunculated, vary in size from less than 1 cm to large, spherical masses with an irregular surface. M/E the usual appearance is of benign tumour overlying muscularis mucosa and is composed of branching tubules which are embedded in the lamina propria. The lining epithelial cells are of large intestinal type with diminished mucus secreting capacity, large nuclei and increased mitotic activity. Malignant transformation is present in about 5% of tubular adenomas; the incidence being higher in larger adenomas. The mean age at which they appear is 6th decade of life with approximatey equal sex incidence. G/A Villous adenomas are round to oval exophytic masses, usually sessile, varying in size from 1 to 10 cm or more in diameter. M/E the characteristic histologic feature is the presence of many slender, finger-like villi, which appear to arise directly from the area of muscularis mucosae. Each of the papillae has fibrovascular stromal core that is covered by epithelial cells varying from apparently benign to anaplastic cells. Villous adenomas are invariably symptomatic; rectal bleeding, diarrhoea and mucus being the common features. The presence of severe atypia, carcinoma in situ and invasive carcinoma are seen more frequently. G/A Tubulovillous adenomas may be sessile or pedunculated and range in size from 0. M/E They show intermediate or mixed pattern, characteristic vertical villi and deeper part showing tubular pattern. The behaviour of tubulovillous adenoma is intermediate between tubular and villous adenomas. Adenomatosis can be distinguished from multiple adenomas in which the number of adenomas is fewer, not exceeding 100. The average age at diagnosis is 2nd and 3rd decades of life with equal incidence in both the sexes. G/A & M/E the commonest pattern is that of adenomatous polyps (tubular adenomas) discussed above. Colorectal cancer develops virtually in 100% of cases by age of 50 years if not treated with colectomy. Family history in some cases may show autosomal dominant inheritance pattern, while it may be negative in others. They resemble the typical juvenile polyps as regards their age (under 5 years), sex distribution and morphology. It is the commonest form of visceral cancer accounting for deaths from cancer in the United States, next only to lung cancer. The incidence of carcinoma of the large intestine rises with age; average age of patients is about 60 years. Geographic variations It is much more common in North America and Northern Europe than in South America, Africa and Asia. Colorectal cancer is generally thought to be a disease of affluent societies because its incidence is directly correlated with the socioeconomic status of the countries. Dietary factors Diet plays a significant part in the causation of colorectal cancer: i) A low intake of vegetable fibre-diet ii) Consumption of large amounts of fatty foods iii) Excessive consumption of refined carbohydrates 3. Adenoma-carcinoma sequence There is strong evidence to suggest that colonic adenocarcinoma evolves from pre-existing adenomas, referred to as adenoma-carcinoma sequence. The following evidences are cited to support this hypothesis: i) In a case with early invasive cancer, the surrounding tissue often shows preceding changes of evolution from adenoma hyperplasia dysplasia carcinoma in situ invasive carcinoma. Other factors Presence of certain pre-existing diseases and some other factors. G/A There are distinct differences between the growth on the right and left half of the colon. Right-sided colonic growths tend to be large, cauliflower-like, soft and friable masses projecting into the lumen (fungating polypoid carcinoma). About 95% of colorectal carcinomas are adenocarcinomas of varying grades of differentiation, out of which approximately 10% are mucin-secreting colloid carcinomas. Direct spread the tumour spreads most commonly by direct extension in both ways-circumferentially into the bowel wall as well as directly into the depth of the bowel wall. Lymphatic spread Spread via lymphatics occurs rather commonly and involves, firstly the regional lymph nodes in the vicinity of the tumour, and then into other groups of lymph nodes. Haematogenous spread Blood spread of large bowel cancer occurs relatively late and involves the liver, lungs, brain, bones and ovary. The most common complications are obstruction and haemorrhage; less often perforation and secondary infection may occur. Amongst the benign tumours of the anal canal, multiple viral warts called as condyloma acuminata are the only tumours of note. Other structures topographically related to peritoneum are retroperitoneum, omentum, mesentery and umbilicus. These structures are involved in a variety of pathologic states but a few important conditions as follows. Chemical peritonitis can be caused by the following: Bile extravasated due to trauma or diseases of the gallbladder. Secondary bacterial peritonitis may occur from the following disorders: i) Appendicitis ii) Cholecystitis iii) Salpingitis iv) Rupture of peptic ulcer v) Gangrene of bowel vi) Tuberculosis (specific inflammation). The condition is, therefore, more like inflammatory rather than neoplastic in origin. Though idiopathic, the etiologic role of ergot derivative drugs and autoimmune reaction has been suggested. Mesenteric Cysts Mesenteric cysts of unknown etiology and varying sizes may be found in the peritoneal cavity. Neoplastic cysts Tumours Peritoneum may be involved in malignant tumours-primary and metastatic. Mesothelioma is an example of primary peritoneal tumour (benign and malignant) and is similar in morphology as in pleural cavity.
Syndromes
The most common location is the cerebellum in the region of root of fourth ventricle treatment yeast uti buy generic lamictal 25 mg on line, in the midline of cerebellum treatment centers for drug addiction buy cheap lamictal 200 mg, in the vermis medications nurses generic lamictal 25 mg free shipping, and in the cerebellar hemispheres medications not to mix discount 200 mg lamictal with mastercard. Medulloblastoma is a highly malignant tumour and spreads to local as well as to distant sites. G/A the tumour typically protrudes into the fourth ventricle as a soft, greywhite mass or invades the surface of the cerebellum. M/E Medulloblastoma is composed of small, poorly-differentiated cells with illdefined cytoplasmic processes and has a tendency to be arranged around blood vessels and occasionally forms pseudorosettes (Homer-Wright rosettes). Another characteristic of the tumour is differentiation into glial or neuronal elements. It may occur sporadically or be a part of von HippelLindau syndrome (along with cysts in the liver, kidney, and benign/malignant renal tumour). Thus, about a quarter haemangioblastomas secrete erythropoietin and cause polycythaemia. M/E the features are as under: i) Large number of thin-walled blood vessels lined by plump endothelium. G/A the tumour is frequently periventricular in location and may appear nodular or diffuse. M/E the features are as under: i) Characteristically, the tumour grows around blood vessels i. Some common examples of such tumours are germinoma (seminoma/dysgerminoma), teratoma and embryonal carcinoma. Their most common sites are in the front half of the head and include: lateral cerebral convexities, midline along the falx cerebri adjacent to the major venous sinuses parasagittally, and olfactory groove. Less frequent sites are: within the cerebral ventricles, foramen magnum, cerebellopontine angle and the spinal cord. They have an increased frequency in patients with neurofibromatosis 2 and are often multiple in these cases. They are usually found in 2nd to 6th decades of life, with slight female preponderance. G/A Meningioma is well-circumscribed, solid, spherical or hemispherical mass of varying size (110 cm in diameter). The tumour is generally firmly attached to the dura and indents the surface of the brain but rarely ever invades it. Cut surface of the tumour is firm and fibrous, sometimes with foci of calcification. Meningotheliomatous (syncytial) meningioma this pattern of meningioma resembles the normal arachnoid cap cells. The tumour consists of solid masses of polygonal cells with poorlydefined cell membranes. The cells have round to oval, central nuclei with abundant, finely granular cytoplasm. Fibrous (fibroblastic) meningioma A less frequent pattern is of a spindleshaped fibroblastic tumour in which the tumour cells form parallel or interlacing bundles. Transitional (mixed) meningioma this pattern is characterised by a combination of cells with syncytial and fibroblastic features with conspicuous whorled pattern of tumour cells, often around central capillary-sized blood vessels. Some of the whorls contain psammoma bodies due to calcification of the central core of whorls. Angioblastic meningioma An angioblastic meningioma includes 2 patterns: haemangioblastic pattern resembling haemangioblastoma of the cerebellum, and haemangiopericytic pattern which is indistinguishable from haemangiopericytoma elsewhere in the body. Anaplastic (malignant) meningioma Rarely, a meningioma may display features of anaplasia and invade the underlying brain or spinal cord. This pattern of meningioma is associated with extraneural metastases, mainly to the lungs. Most common primary tumours metastasising to the brain are: carcinomas of the lung, breast, skin (malignant melanoma), kidney and the gastrointestinal tract and choriocarcinoma. G/A the metastatic deposits in the brain are usually multiple, sharplydefined masses at the junction of grey and white matter. A less frequent pattern is carcinomatous meningitis or meningeal carcinomatosis in which there is presence of carcinomatous nodules on the surface of the brain and spinal cord, particularly encountered in carcinomas of the lung and breast. M/E Metastatic tumours in the brain recapitulate the appearance of the primary tumour of origin with sharp line of demarcation from adjoining brain tissue. A peripheral nerve is surrounded by an outer layer of fibrous tissue, the epineurium. Each nerve is made of several fascicles enclosed in multilayered membrane of flattened cells, the perineurium. Nodes of Ranvier on myelinated fibres are the boundaries between each Schwann cell surrounding the fibre. Following transection, initially there is accumulation of organelles in the proximal and distal ends of the transection sites. Subsequently, the axon and myelin sheath distal to the transection site undergo disintegration upto the next node of Ranvier, followed by phagocytosis. Segmental demyelination is loss of myelin of 617 Chapter 28 the Nervous System 618 the segment between two consecutive nodes of Ranvier, leaving a denuded axon segment. However, if the process of regeneration is hampered due to an interposed haematoma or fibrous scar, the axonal sprouts together with Schwann cells and fibroblasts form a peripheral mass called as traumatic or stump neuroma. Motor features in the form of muscle weakness and loss of tendon reflexes may be present. M/E Polyneuropathy may be the result of axonal degeneration (axonopathy) or segmental demyelination (demyelinating polyneuropathy). Multifocal neuropathy represents part of spectrum of chronic acquired demyelinating neuropathy. It is generally the result of local causes such as direct trauma, compression and entrapment. An acoustic schwannoma or acoustic neuroma is an intracranial schwannoma located within the internal auditory canal originating from vestibular portion of the acoustic nerve. In the peripheral nerves, they occur as solitary nodule on any sheathed sensory, motor, or autonomic nerve. G/A A schwannoma is an encapsulated, solid, sometimes cystic, tumour that produces eccentric enlargement of the nerve root from where it arises. There are areas of dense and compact cellularity (Antoni A pattern) alternating with loose acellular areas (Antoni B pattern). Nerve fibres are usually found stretched over the capsule but not within the tumour. Solitary neurofibroma is a tumour of adults but multiple neurofibromas or neurofibromatosis is a hereditary disorder with autosomal dominant inheritance. Neurofibromatosis type 1 is a genetic disorder having mutation in chromosome 17 while type 2 has mutation in chromosome 22. G/A Neurofibroma is an unencapsulated tumour producing fusiform enlarge ment of the affected nerve. Neurofibromatosis may involve a group of nerves or may occur as multiple, oval and irregular swellings along the length of a nerve (plexiform neurofibroma). M/E A neurofibroma is composed of bundles and interlacing fascicles of delicate and elongated spindle-shaped cells having wavy nuclei. Histologic appearance of Antoni B pattern of schwannoma may be seen in neurofibroma and cause diagnostic difficulty. Neurilemmoma virtually never turns malignant, while sarcomatous transformation in neurofibroma, particularly in neurofibromatosis, is not unusual. The tumour may arise de novo or from malignant transformation of a preexisting neurofibroma than a schwannoma, generally at an early age (2040 years). M/E the tumour has the general appearance of tumour cells resembling a fibrosarcoma. Lengthening and herniation of cerebellar vermix Secondary hydrocephalus has the following features except: A. Common causes are cerebral atrophy and infarction 619 Chapter 28 the Nervous System 2. Tuberculous meningitis the following viral infection of the brain produces intracytoplasmic inclusions: A. Zoster-varicella virus the lowest limit of critical level of systolic pressure upto which the brain continues to be perfused is: A. Glioblastoma multiforme Small foci of calcification are frequently seen on X-ray of the following glioma: A.
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