Padraig S. J. Malone, MCh, FRCSI, FRCS, FEAPU

• Consultant Paediatric Urologist,
• Southampton University Hospitals, NHS Trust,
• Southampton, United Kingdom

Contaminant are absorbed and accumulated by roots cheap erectile dysfunction pills uk cheap malegra dxt 130 mg on line, adsorbed onto the roots erectile dysfunction treatment abu dhabi cheap 130mg malegra dxt otc, or precipitated in the rhizosphere b12 injections erectile dysfunction purchase malegra dxt 130mg free shipping. This reduces or even prevents the mobility of the contaminants preventing migration into the groundwater or air and also reduces the bioavailability of the contaminant thus preventing spread through the food chain benadryl causes erectile dysfunction cheap malegra dxt 130 mg fast delivery. Plants for use in phytostabilization should be able to (i) decrease the amount of water percolating through the soil matrix, which may result in the formation of a hazardous leachate, (ii) act as barrier to prevent direct contact with the contaminated soil, and (iii) prevent soil erosion and the distribution of the toxic metal to other areas [46]. Phytostabilization can occur through the process of sorption, precipitation, complexation, or metal valence reduction. It can also be used to reestablish a plant community on sites that have been denuded due to the high levels of metal contamination. Once a community of tolerant species has been established, the potential for wind erosion (and thus spread of the pollutant) is reduced, and leaching of the soil contaminants is also reduced. Phytostabilization is advantageous because disposal of hazardous material/biomass is not required, and it is very effective when rapid immobilization is needed to preserve ground and surface waters [147, 148]. Phytofiltration is the use of plant roots (rhizofiltration) or seedlings (blastofiltration), is similar in concept to phytoextraction, but is used to absorb or adsorb pollutants, mainly metals, from groundwater and aqueouswaste streams rather than the remediation of polluted soils [3, 123]. Rhizosphere is the soil area immediately surrounding the plant root surface, typically up to a few millimetres 16 from the root surface. The contaminants are either adsorbed onto the root surface or are absorbed by the plant roots. Plants used for rhizofiltration are not planted directly in situ but are acclimated to the pollutant first. Plants are hydroponically grown in clean water rather than soil, until a large root system has developed. Once a large root system is in place, the water supply is substituted for a polluted water supply to acclimatize the plant. After the plants become acclimatized, they are planted in the polluted area where the roots uptake the polluted water and the contaminants along with it. Repeated treatments of the site can reduce pollution to suitable levels as was exemplified in Chernobyl where sunflowers were grown in radioactively contaminated pools [21]. Cook, "Soil testing for heavy metals," Communications in Soil Science and Plant Analysis, vol. Rogers, "Review: a bioavailability-based rationale for controlling metal and metalloid contamination of agricultural land in Australia and New Zealand," Australian Journal of Soil Research, vol. Yang, "Use of bentonite to control the release of copper from contaminated soils," Australian Journal of Soil Research, vol. Kaluarachchi, "Risk assessment at hazardous waste-contaminated sites with variability of population characteristics," Environment International, vol. Vogeler, "Solute interactions in soils in relation to bioavailability and remediation of the environment," in Proceedings of the 5th International Symposium of Interactions of Soil Minerals ґ with Organic Components and Microorganisms, Pucon, Chile, November 2008. Ryan, "Methods for speciation of metals in soils: a review," Journal of Environmental Quality, vol. Gerzabek, "Determination of mobile heavy metal fraction in soil: results of a pot experiment with sewage sludge," Communications in Soil Science and Plant Analysis, vol. Page, "Cycling of metal ions in the soil environment," in Metal Ions in Biological Systems, H. Baker, "Distribution and forms of copper, zinc, cadmium, iron, and manganese in soils near a copper smelter," Soil Science, vol. Yli-Halla, "Use of sequential extraction to assess metal partitioning in soils," Environmental Pollution, vol. Chaney, "Trace element chemistry in residual-treated soil: key concepts and metal bioavailability," Journal of Environmental Quality, vol. Lasat, "Phytoextraction of metals from contaminated soil: a review of plant/soil/metal interaction and assessment of pertinent agronomic issues," Journal of Hazardous Substances Research, vol. Conclusion Background knowledge of the sources, chemistry, and potential risks of toxic heavy metals in contaminated soils is necessary for the selection of appropriate remedial options. Remediation of soil contaminated by heavy metals is necessary in order to reduce the associated risks, make the land resource available for agricultural production, enhance food security, and scale down land tenure problems. Immobilization, soil washing, and phytoremediation are frequently listed among the best available technologies for cleaning up heavy metal contaminated soils but have been mostly demonstrated in developed countries. These technologies are recommended for field applicability and commercialization in the developing countries also where agriculture, urbanization, and industrialization are leaving a legacy of environmental degradation. Zhu, "Health risks of heavy metals in contaminated soils and food crops irrigated with wastewater in Beijing, China," Environmental Pollution, vol. Wang, "Use of single extraction methods to predict bioavailability of heavy metals in polluted soils to rice," Communications in Soil Science and Plant Analysis, vol. Maier, "Rhamnolipid-enhanced mineralization of phenanthrene in organic-metal co-contaminated soils," Bioremediation Journal, vol. Sumner, "Beneficial use of effluents, wastes, and biosolids," Communications in Soil Science and Plant Analysis, vol. Oliver, "Sources, potential adverse effects and remediation of agricultural soil contaminants," in Contaminants and the Soil Environments in the AustraliaPacific Region, R. Graham, "Effect of Chloride in Soil Solution on the Plant Availability of Biosolid-Borne Cadmium," Journal of Environmental Quality, vol. Estela, "Sequential fractionation and plant availability of heavy metals as affected by sewage sludge applications to soil," Communications in Soil Science and Plant Analysis, vol. Page, "Assessment of metal pollution in soil," in Applied Environmental Geochemistry, pp. Taylor, "Leaching of macronutrients and metals from undisturbed soils treated with metal-spiked sewage sludge. Dunham, "Trace metal leaching through a soil-grassland system after sewage sludge application," Journal of Environmental Quality, vol. Hendry, "Leaching of macronutrients and metals from undisturbed soils treated with metal-spiked sewage sludge. Pandya, "Metal bioavailability and speciation in a wetland tailings repository amended with biosolids compost, wood ash, and sulfate," Journal of Environmental Quality, vol. Gradwohl, "Remediation of heavy metalcontaminated soil using rock phosphate," Better Crops, vol. Environmental Protection 17 Agency, Office of Solid Waste and Emergency Response, 1996. Samphao, "Fractionation of arsenic in soil by a continuousflow sequential extraction method," Journal of Environmental Quality, vol. Buekers, Fixation of cadmium, copper, nickel and zinc in soil: kinetics, mechanisms and its effect on metal bioavailability, Ph. Sommers, "Distribution and partitioning of trace metals in contaminated soils near Leadville, Colorado," Journal of Environmental Quality, vol. Marshall, "Heavy metal poisoning and its laboratory investigation," Annals of Clinical Biochemistry, vol. Rosen, Lead in the home garden and urban soil environment, Communication and Educational Technology Services, University of Minnesota Extension, 2002. Edelmann, "The use of natural processes for the control of chromium migration," Remediation, vol. Greany, An assessment of heavy metal contamination in the marine sediments of Las Perlas Archipelago, Gulf of Panama, M. Motto, "Solubility of lead, zinc and i copper added to mineral soils," Environmental Pollution, vol. Maturi, "Removal of nickel and phenanthrene from kaolin soil using different extractants," Environmental Engineering Science, vol. Blsson, "Sequential extraction procedure for the speciation of particulate trace metals," Analytical Chemistry, vol. Ankley, "Acid volatile sulfide predicts the acute toxicity of cadmium and nickel in sediments," Environmental Science and Technology, vol. Ruby, "Review of in situ remediation technologies for lead, zinc and cadmium in soil," Remediation, vol. Hari, "In situ gentle remediation measures for heavy metal-polluted soils," in Phytoremediation of Contaminated Soil and Water, N. Sato, "Impacts of chemical amendment and plant growth on lead speciation and enzyme activities in a shooting range soil: an X-ray absorption fine structure investigation," Journal of Environmental Quality, vol. Letan, "Bioavailability and z s mobility of Pb after soil treatment with different remediation methods," Plant, Soil and Environment, vol. De Koe, "Immobilization of trace metals and arsenic by different soil additives: evaluation by means of chemical extractions," Communications in Soil Science and Plant Analysis, vol.

The blood supply of the gingiva is derived primarily from supraperiosteal vessels which represent terminal afferent branches of the following arteries: 1) sublingual; 2) mental; 3) buccal; 4) facial; 5) greater palatine; 6) infraorbital; and 7) the posterior superior dental erectile dysfunction va disability buy generic malegra dxt 130mg line. These vessels anastomose with those supplying the alveolar bone and periodontal ligament erectile dysfunction injection dosage 130 mg malegra dxt overnight delivery. Prior to entering the apical foramina respective dental arteries (branches of superior or inferior alveolar dental artery) are the originating sites of the intraseptal arteries erectile dysfunction drugs research buy discount malegra dxt 130mg. A plexus of vessels with numerous venules (dento-gingival plexus) is located beneath the junctional epithelium; in health erectile dysfunction at 30 discount malegra dxt 130mg on line, capillary loops are not found in this plexus. In contrast, the subepithelial plexus of the free and attached gingiva manifest capillary loops (7 (im) which supply individual connective tissue papilla. Elimination of pockets by removal and/or recontouring of soft or osseous tissues; 3. Removal of diseased periodontal tissues creating a favorable environment for new attachment and/or readaptation of soft and/or osseous tissues; 4. Establishment of esthetics by reducing soft tissue sites of enlargement-overgrowth or by augmenting sites with soft and/or hard tissue deficiencies; 7. Determining or improving treatment prognosis (including exploratory procedures; 10. The maxillary sinus occupies the entire body of the maxilla and may extend into the zygomatic and alveolar processes. General Principles actually represents a functional vascular syncytium which significantly impacts the technical provision of periodontal therapy (Klaus et al. The sensory portion supplies the skin of the face, oral mucous membranes, and the teeth. The motor portion supplies the 4 paired muscles of mastication, and the mylohyoid and digastric muscles. The maxillary (second) division of the trigeminal nerve sends anterior, middle, and posterior superior branches to the maxillary teeth. The infraorbital, nasopalatine and the greater palatine nerves supply sensation to areas of skin and mucous membrane. The mandibular (third) division branches are the buccal, lingual, inferior alveolar, and mylohyoid nerves. The terminal branches of the inferior alveolar nerve are the mental and incisive nerves (Clarke and Bueltman, 1971). Musculature the four primary muscles of mastication are innervated by the mandibular division of the trigeminal nerve. The primary function of the temporalis, medial pterygoid, and masseter muscles is elevation of the mandible, while the lateral pterygoids are mainly responsible for protrusion. These muscles work in concert with the accessory muscles of mastication allowing coordinated, functional mandibular movements. The geniohyoid has a similar function as the mylohyoid and is innervated by the cervical plexus (DuBrul, 1980). Anatomic Spaces Potential anatomic spaces of the oral cavity are found within subcutaneous or submucosal connective tissues and sites delineated by fascial membranes which may allow communication with the orbit, the neck, and the mediastinum. These spaces are the canine, buccal, masticator (pterygomandibular), mental, submandibular (made up of the submental, sublingual, and submaxillary spaces), lateral pharyngeal, and retropharyngeal (parapharyngeal) spaces (Clarke and Bueltman, 1971). Surgical Anatomy A detailed understanding of surgical anatomy is essential if complications during periodontal surgery are to be avoided. The depth of the vestibule in the mandibular anterior region may be limited by the attachment of the mentalis muscle and prominence of the mental tuberosity. An unusually high or large genial tubercle may impede osseous recontouring in the area. The extent of the external oblique ridge may also limit the surgical treatment of intrabony defects, or make apical positioning of flaps difficult. The vertical bony prominence of the mandibular ramus may limit treatment possibilities for the distal aspect of terminal mandibular molars. On the lingual aspect of the mandible, incision of the lingual nerve and/or lingual artery must be avoided. Surgical manipulation of the tissues in this area can generally be safely accomplished by careful reflection of a full thickness flap. Perforation of the periosteum and damage to structures within the flap can be avoided by following the lateral flare of the mandible in this region maintaining bony contact during tissue retraction and elevation (Clarke and Bueltman, 1971). The maxillary sinus closely approximates the roots of the maxillary molar teeth and should be noted radiographically when considering extensive osseous recontouring, regenerative procedures or placement of implants. The greater palatine artery must be avoided during flap reflection or graft (hard or soft tissue) harvesting in this region. Prominent palatal exostosis or a flat palate may render osseous interproximal ramping difficult (Clarke and Bueltman, 1971). Vertical incisions have limited use, but when used judiciously may be helpful; they are best avoided on the posterior palate and mandibular lingual areas (Clarke and Bueltman, 1971; Hunt, 1976). Excessive hemorrhage may be controlled by direct pressure, vasoconstriction from the local anesthetic solution, suture ties, and burnishing the offending vessel against bone. Damage to the inferior alveolar nerve may occur during preparation for implant placement or during placement of the implant itself. General safety factors include a thorough understanding by the surgeon of the bony and soft tissue anatomy in the surgical area and periphery. Soft tissues should be protected with metal retractors when using rotary instruments. Stable fingers are also fundamental to good surgical technique (Clarke and Bueltman, 1971; Hunt, 1976). The postoperative infection rate following periodontal surgery is about 1% (Pack and Haber, 1983). It is imperative that affected sites be adequately debrided and proper drainage established. A decision to prescribe antibiotics should be based on the systemic health of the patient and presence of objective clinical indicators. Infections in the area of the maxillary anterior teeth may involve the canine space and can spread to the orbit and/or the buccal space. Infections of the buccal space may spread to the masticator space with potential communication with the parotid and the lateral pharyngeal spaces. Infections in the area of mandibular anterior teeth can involve the mental space and may spread to the buccal space. Infections on the lingual aspect of the mandible may affect the submandibular space which is composed of the sublingual, submaxillary and submental spaces. Route of extension is via the submaxillary space through the lateral pharyngeal space into the retropharyngeal space. Infections in the retropharyngeal space may drain into the mediastinum if the alar fascia ruptures. The patient may be febrile with a protruding tongue, "board-like" swelling of the floor of the mouth and dyspnea. This is a life-threatening situation due to the possibility of asphyxiation and requires immediate hospitalization and aggressive therapy (Hunt, 1976). Proceedings from the State of the Art Workshop on Surgical Therapy for Periodontitis. While it has been used for nearly a century, it became more popular in the late 1960s when improved technology afforded better control of the electrical current. In contrast to this electrosective current, partially rectified current (damped) provides good electrocoagulative properties. The active electrode consists of a small wire which is used at the operative site while the passive electrode is a conductive plate placed at a distant site. The 3 classes of active electrodes include: 1) single wire electrodes for incising tissue; 2) loop electrodes for planing tissue; and 3) heavy, bulkier electrodes for coagulation procedures. The 4 electrosurgical techniques are electrosection, electrocoagulation, electrofulguration, and electrodesiccation. Electrosection and electrocoagulation are biterminal techniques and are the electrosurgical procedures most commonly used in dentistry. Three types of electrosection applications have been described and include incisions, excisions, and planing. Incisions and excisions are performed with a single-wire active electrode that can be bent or adapted to the type of cutting procedure.

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Trypticase Soy Agar with Penicillinase and Trypticase Soy Agar with Lecithin erectile dysfunction pills in pakistan generic malegra dxt 130mg line, Polysorbate 80 and Penicillinase contain 50 mL/L of penicillinase erectile dysfunction causes and remedies buy malegra dxt 130 mg on-line, which inactivates antibiotics such as penicillins and cephalosporins erectile dysfunction rap buy cheap malegra dxt 130mg line. With the Sterile Pack and Isolator Pack plates erectile dysfunction drugs covered by medicare cheap malegra dxt 130mg visa, the entire double-wrapped (Sterile Pack) or triple-wrapped (Isolator Pack) product is subjected to a sterilizing dose of gamma radiation, so that the contents inside the outer package(s) are sterile. Isolator Pack plates have been validated to protect the medium from vaporized hydrogen peroxide when used in an Isolator System. Summary and Explanation these media may be employed to establish and monitor cleaning techniques and schedules. Tryptic (Trypticase) Soy Agar with Lecithin and Polysorbate 80 is recommended for the Aerobic Plate Count (Microbial Limit Test) for water-miscible cosmetic products containing preservatives. The 100 Ч 15 mm and the 150 Ч 15 mm style plates can be used for active and passive air sampling. These plates are also designed for personnel monitoring of finger tips (Finger Dab). Lecithin and polysorbate 80, two commonly used neutralizers, are reported to inactivate residual disinfectants when the sample is being collected. When hot, solution is medium amber, slightly opalescent with a resuspendable precipitate. Apply disks impregnated with varying dilutions of a quaternary ammonium compound to the medium surface. If specimen is being cultured from a swab, roll the swab directly on the medium surface. Hold the plate with thumb and second finger and use index finger to press plate bottom firmly against surface. Subdivide surface (floor or wall) into 36 equal squares per 100 square feet of area by striking five equidistant dividing lines from each of the two adjacent sides. Sample odd points at one sampling period, even points at the next sampling period. Incubate exposed plates at 35-37°C for 48 hours, and 25°C for 7 days or as required. Spreading colonies should be counted as one but care should be taken to observe other distinct colonies intermingled in the growth around the plate periphery or along a hair line. These should also be counted as one colony, as should bi-colored colonies and halo type spreaders. It is generally agreed that 200 colonies is the approximate maximum that can be counted on contact plates. Limitation of the Procedure the effectiveness of preservative neutralization with this medium depends on both the type and concentration of the preservative(s). Defibrinated sheep blood is the most widely used blood for enriching agar base media. Additionally, the increased blood content can make hemolytic reactions less distinct and more difficult to read. With 5 or 10% sheep blood, it is extensively used for the recovery and cultivation of fastidious microbial species and for the determination of hemolytic reactions that are important differentiating characteristics for bacteria, especially Streptococcus species. Some investigators prefer the use of rabbit or horse blood, but Trypticase Soy Agar with 5% Horse Blood is not recommended for use with throat cultures. These formulations utilize the peptones Tryptone H and Tryptone H Plus to enhance hemolysin production while minimizing antagonism or loss in activity of streptococcal hemolysins. If a hemolytic reaction is obtained, the organisms should be tested with a Taxo A disc and grouped serologically or tested by the fluorescent method. However, rabbit blood does not inhibit Haemophilus haemolyticus, a bacterium inhibited by sheep blood that produces colonies indistinguishable from those of beta-hemolytic streptococci. The inoculum may be taken from an overnight broth culture or from colonies picked from a blood agar plate. If a loop is used, do not use it parallel to the agar surface, since the streak will be too wide and the results will not be satisfactory. The streptococcal isolates to be tested are inoculated by making a simple streak perpendicular to the S. The procedure should be practiced with known cultures before using it to identify unknown isolates. For preparation of blood plates, add 5-10% sterile, defibrinated blood to sterile agar which has been cooled to 45-50°C. Expected Results Hemolytic streptococci may appear translucent or opaque, grayish, small (1 mm), or large matt and mucoid (2-4 mm) colonies, encircled by a zone of hemolysis. They may be distinguished by their rod shape in stains, and by motility at room temperature. After streaking, stab the agar several times to deposit beta-hemolytic streptococci beneath the agar surface. The streptococcal growth must be within the wide zone of partial hemolysis that surrounds the S. A negative reaction may appear as a bullet-shaped zone of slightly increased hemolysis or as no increased hemolysis. Group B streptococci tend to produce larger colonies and have less pronounced zones of beta hemolysis than other beta-hemolytic strains, and some group B strains are nonhemolytic. Incubate the plates in an inverted position (agar side up) at 35 ± 2°C in an aerobic atmosphere for 18-48 hours. Gram staining, biochemical tests and other procedures should be performed to confirm findings. Consult appropriate references for detailed information and recommended procedures. Defibrinated sheep blood supplies nutrients and, simultaneously, it allows detection of hemolytic reactions. Ampicillin is active against gram-negative as well as gram-positive organisms, although most Aeromonas spp. Intended Use secretions by inhibiting the growth of bacteria that masked the presence of pneumococcal colonies. Summary and Explanation Streptococcus pneumoniae is the leading cause of bacterial pneumonia and a cause of meningitis, endocarditis, otitis media and sinusitis. Defibrinated sheep blood supplies nutrients necessary to support the growth of fastidious organisms and to detect hemolytic reactions while also inhibiting the growth of Haemophilus haemolyticus, a bacterium commonly found in nose and throat specimens that is indistinguishable from beta-hemolytic streptococci. Circular, flat, translucent colonies surrounded by zones of alpha hemolysis may be presumptively identified as Streptococcus pneumoniae. Trypticase Soy Broth with 5% Fildes Enrichment is used for the cultivation of fastidious organisms;. Tryptic Soy Broth without Dextrose, a low carbohydrate formulation of Tryptic Soy Broth, is used for cultivating fastidious and nonfastidious microorganisms. Principles of the Procedure Enzymatic digests of casein and soybean provide amino acids and other complex nitrogenous substances. At this concentration, the sodium chloride is a selective agent that interferes with membrane permeability and osmotic and electrokinetic equilibria. Dextrose is omitted from the formula for Tryptic Soy Broth without Dextrose to permit use of the medium in fermentation studies. The carbohydrate concentration used most frequently in fermentation reactions is 0. Tryptic Soy Broth and Trypticase Soy Broth are provided as prepared media in a variety of bottle styles. Extract from a paper presented at the Canadian Society of Microbiology Annual Meeting, June 12-15. Microbiology of food and animal feeding stuffs ­ Horizontal method for the detection and enumeration of Listeria monocytogenes ­ Part 1: Detection method. Approved Standard M2-A9: Performance standards for antimicrobial disk susceptibility tests, 9th ed. Approved Standard M7-A7: Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically, 7th ed. For liquid specimens, use a sterile inoculating loop to transfer a loopful of the specimen to the broth medium.

This biopsy specimen reveals secretory endometrium otc erectile dysfunction pills walgreens discount 130mg malegra dxt mastercard, but there is a significant difference (asynchrony) between the estimated chronologic menstrual date and the estimated histologic menstrual date erectile dysfunction facts buy malegra dxt 130 mg fast delivery. Based on this information zopiclone impotence 130 mg malegra dxt visa, what is the correct diagnosis for this biopsy specimen? Anovulatory cycle (no corpus luteum formed) Inadequate luteal phase (decreased functioning of the corpus luteum) Irregular shedding (prolonged functioning of the corpus luteum) Normal endometrium during the follicular phase of the cycle (no corpus luteum formed) erectile dysfunction kya hai 130 mg malegra dxt otc. Normal endometrium during the luteal phase of the cycle (normal corpus luteum) 390 Pathology 374. Which one of the listed endometrial abnormalities has the greatest risk of developing into endometrial cancer? Simple hyperplasia Complex hyperplasia Atypical hyperplasia Cystic hyperplasia Polyp 375. Prolonged unopposed estrogen stimulation in an adult female increases the risk of development of endometrial hyperplasia and subsequent carcinoma. Adenocarcinoma Clear cell carcinoma Small cell carcinoma Squamous cell carcinoma Transitional cell carcinoma 376. Which of the following criteria will be used by the pathologist in determining benignancy versus malignancy in permanent sections? Mitotic rate Cell pleomorphism Cell necrosis Nucleus-to-cytoplasm ratio Tumor size 377. A 25-year-old female presents with lower abdominal pain, fever, and a vaginal discharge. Pelvic examination reveals bilateral adnexal (ovarian) tenderness and pain when the cervix is manipulated. Adenomatoid tumor Ectopic pregnancy Endometriosis Luteoma of pregnancy Pelvic inflammatory disease Reproductive Systems 391 378. Physical examination reveals an obese young female with acne and increased facial hair. A pelvic examination is essentially within normal limits, excluding the adnexal regions, which could not be palpated secondary to obesity. Ultrasound examination reveals bilateral enlargement of the ovaries with multiple subcortical cysts. Which one of the listed sets of serum laboratory values is most likely to be present in this individual? A 23-year-old female presents with pelvic pain and is found to have an ovarian mass of the left ovary that measures 3 cm in diameter. Histologically, these cysts are lined by tall columnar epithelium, with some of the cells being ciliated. What is your diagnosis of this ovarian tumor, which histologically recapitulates the histology of the fallopian tubes? Serous tumor Mucinous tumor Endometrioid tumor Clear cell tumor Brenner tumor 380. Clear cell tumor of the kidney Cystic tumor of the gallbladder Mucinous tumor of the ovary Serous tumor of the ovary Smooth-muscle tumor of the uterus 392 Pathology 381. Chronic salpingitis An ectopic pregnancy A granulosa cell tumor A cystic teratoma Metastatic squamous cell carcinoma 382. A 32-year-old female presents with the recent onset of oligomenorrhea followed by amenorrhea, and then the loss of female secondary characteristics. Which one of the following ovarian tumors would most likely produce these symptoms? Epithelial tumor Stromal tumor Germ cell tumor Surface tumor Metastasis Reproductive Systems 393 383. An 18-year-old female presents with amenorrhea and is found to have normal secondary sex characteristics and normal-appearing external genitalia. Her first menstrual period was at age 13, and her cycle has been unremarkable until now. Examination had revealed the placenta to be located normally, but following delivery the woman fails to deliver the placenta and subsequently develops massive postpartum hemorrhage and shock. An abruptio placenta A placenta previa A placenta accreta A hydatidiform mole An invasive mole 385. While in the bathroom she passes a cast of tissue composed of clot material and then collapses. She is brought to the hospital, where a physical examination reveals a soft, tender mass in right adnexa and pouch of Douglas. Histologic examination of the tissue passed in the bathroom reveals blood clots and decidualized tissue. Aborted intrauterine pregnancy Complete hydatidiform mole Ectopic pregnancy Endometrial hyperplasia Partial hydatidiform mole 394 Pathology 386. A 26-year-old female in the third trimester of her first pregnancy develops persistent headaches and swelling of her legs and face. Early during her pregnancy a physical examination was unremarkable; however, now her blood pressure is 170/105 mmHg and urinalysis reveals slight proteinuria. Eclampsia Gestational trophoblastic disease Nephritic syndrome Nephrotic syndrome Preeclampsia 387. A 25-year-old woman in her fifteenth week of pregnancy presents with uterine bleeding and passage of a small amount of watery fluid and tissue. She is found to have a uterus that is much larger than estimated by her gestational dates. Her uterus is found to be filled with cystic, avascular, grapelike structures that do not penetrate the uterine wall. Partial hydatidiform mole Complete hydatidiform mole Invasive mole Placental site trophoblastic tumor Choriocarcinoma 388. A 50-year-old woman presents with fatigue, insomnia, hot flashes, night sweats, and absence of menses for the last 5 months (secondary amenorrhea). A 27-year-old female who is actively training for a marathon presents with the new onset of a painful lump in the upper outer quadrant of her right breast. An excisional biopsy reveals a localized area of granulation tissue and numerous lipid-laden macrophages surrounding necrotic adipocytes. Acute mastitis Ectasia Enzymatic fat necrosis Foreign-body reaction Traumatic fat necrosis 390. During a routine breast self-examination, a 35-year-old female is concerned because her breasts feel "lumpy. After performing an examination, you reassure her that no masses are present and that the "lumpiness" is due to fibrocystic changes. Considering this clinical opinion, a pathologic finding that is consistent with the nonproliferative form of fibrocystic change is a. A blue-domed cyst A radial scar Atypical hyperplasia Papillomatosis Sclerosing adenosis 391. A 23-year-old woman presents with a rubbery, freely movable 2-cm mass in the upper outer quadrant of the left breast. Large numbers of neutrophils Large numbers of plasma cells Duct ectasia with inspissation of breast secretions Necrotic fat surrounded by lipid-laden macrophages A mixture of fibrous tissue and ducts 396 Pathology 392. A 39-year-old female presents with the new onset of a bloody discharge from her right nipple. Physical examination reveals a 1-cm freely movable mass that is located directly beneath the nipple. Sections from this mass reveal multiple fibrovascular cores lined by several layers of epithelial cells. The lesion is completely contained within the duct and no invasion into underlying tissue is seen. The mass is excised, and histologic sections reveal a tumor composed of a mixture of ducts and cells, as seen in the photomicrograph below. There is a marked increase in the stromal cellularity, but the stromal cells are not atypical in appearance and mitoses are not found. Atypical epithelial hyperplasia Benign phyllodes tumor Fibroadenoma Malignant phyllodes tumor Medullary carcinoma Reproductive Systems 397 394. The presence of activated oncogenes the histologic type and grade the size of the tumor the status of axillary lymph nodes the presence of estrogen receptors 395. A biopsy from this mass reveals many of the ducts to be filled with atypical cells. Colloid carcinoma Comedocarcinoma Infiltrating ductal carcinoma Infiltrating lobular carcinoma Lobular carcinoma in situ 396.