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If the results of the H alothane study are accurate order 75 mg effexor xr visa anxiety love, many patients are rolling dice with their lives when they seek care effexor xr 75 mg low cost anxiety symptoms jelly legs. In general effexor xr 75mg free shipping anxiety 4 days after drinking, the research shows that the quality of medical care varies greatly; many instances of poor care can be found effexor xr 150mg for sale anxiety symptoms for months. T he data are also remarkable in light of the presuppositions most consumers hold about the quality and reliability o f medical care. Most of the studies in the report judge the quality of care by examining the “processes” of care rather than “outcomes” of care. In other words, the “m anner” in which care was provided is the focus of most o f the studies, rather than the actual “outcomes” o f care. Initially, only 94 of the 141 patients com pleted the battery of studies based on diagnostic X-rays; 77 (or 55 percent) re ceived an adequate work-up based on the intern’s diagnostic impression; but only 37 o f 98 patients, having received diagnostic X-ray examinations, were inform ed whether the findings were normal or abnormal; and only 14 of the 38 patients with abnorm al X-ray results (or 37 percent) ap peared to have received adequate therapy for the conditions indicated. Thus, the study resulted in effective medical care for only 38 patients (or 27 percent). N either effective nor ineffective care was given to 19 patients, or the rem aining 13 percent. T he study was not conducted in a small rural hospital, nor in the inadequate and shabby facilities often found in m ajor public hospitals. It was conducted in the Baltimore City The Impact of Medical Care on Patients 11 Hospital emergency room, where it was assumed that the competence and efficiency of the house staff would be optimal. Although few doubts were expressed by his superiors about his m ethodol ogy, the uncritical assum ption was that the findings of the study were characteristic of City Hospital, a less prestigious institution than Johns Hopkins. T he challenge proved too much for Brook; his next target was the em ergency room at Johns Hopkins. Using essentially the same methodology, Brook’s work revealed that only 28 percent o f 166 patients with gastrointestinal symptoms were given acceptable care, 2 percent less than in the City Hospital. And, although he has refrained from generalizing about his re sults, that is, from drawing inferences about medical care in general from treatm ent of the “tracer” condition, generaliza tion seems w arranted. Less 12 1‘he Impact of Medicine understandable is medicine’s persistent refusal to examine what it does for the patient in relation to the result to the patient. T here are a num ber of reasons why this occurs, but a principal one is that the physicians need to keep busy. Tonsillectomy is the most common surgi cal procedure perform ed in W estern civilization. Nevertheless, recent data reflect that, in most communities, approxim ately 20 to 30 percent have their tonsils rem oved. Nonetheless, because of the volume of cases, tonsillectomies account for 100 to 300 deaths annually in the United States. Finally, there is some evidence that removal of the tonsils results in the loss to the patient o f an invaluable “im munity” mechanism, possibly linked to increased risk o f H odgkin’s disease and bulbar poliomyelitis. T he young tonsillectomy candidate, perhaps five or six years of age, is made captive in a hospital, separated from his or The Impact of Medical Care on Patients 13 her parents, and surrounded by mysterious figures in white coats. T he emotional harm is dem onstrable, and the pallia tive ice cream at the end of surgery hardly compensates. The psychiatric literature contains evidence that childhood tonsillectomy often has profound irreversible and lifelong repercussions. T here is an extensive literature on this subject, most of which has been ignored by practitioners. T he subtitle o f the first speaks for itself: “A Study Based on Removal o f 704 Normal Ovaries from 546 Patients. Classic examples of calamities in medicine have been the loss or im paired hearing o f some patients given chloramphenicol, and the w renching results of the use of thalidom ide. They include post operative pulm onary infections, wound infections, burn in fections, and tracheotom y infections, to nam e a few. Some re cently concluded research links the death o f thousands of asthmatics to the inhalation of isoproterm ol, a medication for the treatm ent of asthma, which can be purchased either with a prescription or over the counter. Paul Stolley of the School of Hygiene and Public Health at Johns Hopkins University, in reviewing research on the question, rem arked, “It’s the most tragic drug disaster on record. In En gland, the deaths of approxim ately 3500 asthmatics have been traced to its use. Adverse results from tonsillectomies and hysterectomies, and infections are the most common iatrogenic phenom ena, but there are others. Charlotte Mul ler, a professor of urban studies at City University of New York, has extensively studied drug prescribing and use pat terns. She docum ents the staggering degree o f overmedica tion, and concludes that it is “one source of reduced hum an welfare. Damage arising both from faulty diagnostic and therapeutic procedures is another example. H andler also spotlights a new and fascinat ing problem, psychosemantics, a congeries o f anxieties in duced in patients by what a physician says or implies. New drugs are introduced to the m arket with an advertising barrage focused on the physician. T heir journals, even the more popular ones like Medical Economics and Medi cal World News, are filled with them. Doctors’ offices and probably their homes are well stocked with drugs, many proffered free by pharmaceutical companies. And then there are the grinning drug pushers—the detailers of the major pharmaceuticals. Since doctors do not have the time to educate themselves about most drugs, they frequently look to the detailer for their inform ation. Pekkanen puts it this way: Contrary to their accepted image and contrary to what the public rightly expects, doctors often know very little about the drugs they are prescribing. T here are drugs that dull, like tranquilizers, and others that speed up, like the friendly am phetam ine family. Doctors who seek to calm the frenzied 16 The Impact of Medicine patient with tranquilizers and to bolster the will of the over weight patient with am phetam ines are not necessarily harm ing the patients. But physicians who maintain a patient on drugs because they are unwilling to consider alternatives may be. A study completed in 1973 shows that, conserva tively, 7 percent of all patients suffer compensable injuries while hospitalized, but few of these patients do anything about it. Infections, overmedication, removal of healthy organs are all included, but a more penetrating example is the diagnosis and treatm ent of “non disease. T he assumption is that the error arises from a false diagnosis, or from a failure to diagnose. H eart m urm urs can be “detected” in up to one-half of a given sample of children. O f the rem ainder —those who did not have any heart abnormality—40 per cent or 30 children were “restricted” in their activities. Most of the restrictions were imposed by physicians, but parental zeal was a contributing factor. In this case, therefore, the am ount of disability resulting from nondisease exceeded the disability due to actual heart disease. T he medical care system is subject to the same foibles, imperfections, and inefficiencies that plague all large institutions.
Therefore generic effexor xr 37.5 mg amex anxiety symptoms for hiv, resources should be attributed to high blood pressure order effexor xr in india anxiety natural treatment, dyslipidemia order effexor xr pills in toronto anxiety symptoms joint pain, not be allocated disproportionately to emerging novel smoking and diabetes buy 37.5mg effexor xr fast delivery anxiety 60 mg cymbalta 90 mg prozac, and also to atrial fibrillation risk factors that may account for up to only 20% of all and valvular heart disease (cardiogenic and embolic strokes at the expense of researching the determinants ischemic stroke) . A recent review indicated that of the relatively few established causal factors that about 10% to 20% of atherosclerotic ischemic strokes account for up to 80% of all strokes. The evidence is can probably be attributed to recently established, strong to suggest that the control of the established probably causal risk factors for ischemic heart disease: risk factors for stroke will result in prevention of a raised apoB/apoA1 ratio, obesity, physical inactivity, very large number of stroke events and premature psychosocial stress and low fruit and vegetable intake deaths. While the importance of genes predisposing to stroke cannot be denied , the contribution of any single Chapter Summary gene towards ischemic stroke is likely to be modest and to apply in selected patients only and in combin- On a global scale, stroke is the second most frequent ation with environmental factors or via other epistatic cause of mortality world-wide and a leading cause (gene–gene or gene–environmental) effects. It is especially prevalent in low- and Hankey proposed, based on the well-known middle-income countries. Global and regional burden of disease and be in part due to genetic differences or due to diff- risk factors, 2001: systematic analysis of population erences in risk-factor profiles. Preventing stroke: changes in case fatality rather than changes in event saving lives around the world. Definitions by clinical means alone can be Prevention of chronic diseases: a call to action. Lancet Neurol 2003; putative and confirmed risk factors have been listed 2(1):43–53. Among non-modifiable risk factors old age, racial or ethnic factors, low birth weight, and genetic suscep- 7. In individuals with non-modifiable International trends in mortality from stroke, 1968 to 1994. Sivenius J, Tuomilehto J, Immonen-Raiha P, and prevention rely on risk profiles in a population. Continuous The Framingham Stroke Profile is widely used but 15-year decrease in incidence and mortality of stroke hitherto has not been validated in many populations. Changes in stroke attributed to more recently established, probably incidence and case-fatality in Auckland, New Zealand, causal risk factors for ischemic heart disease: raised 1981–91. However, their causal role remains to be stroke classification, and risk factors in southeastern proven. While the importance of genes predisposing New England, 1980 to 1991: data from the Pawtucket to stroke cannot be denied, the contribution of any Heart Health Program. Truelsen T, Prescott E, Gronbaek M, Schnohr P, modest and apply in selected patients only and Boysen G. Changed incidence and trol of the established risk factors for stroke will result case-fatality rates of first-ever stroke between 1970 and in prevention of a very large number of stroke events 1993 in Tartu, Estonia. Stroke incidence and mortality in rural and urban Shanghai from 1984 through 1991. Sarti C, Stegmayr B, Tolonen H, Mahonen M, 86 2: Stroke event registration data component. Are changes in mortality Cardiovascular Diseases, World Health Organization; from stroke caused by changes in stroke event rates Chapter 5: Basic epidemiology of stroke and risk assessment or case fatality? Jousilahti P, Rastenyte D, Tuomilehto J, Sarti C, Group; Cardiovascular Nursing Council; Clinical Vartiainen E. Parental history of cardiovascular disease Cardiology Council; Nutrition, Physical Activity, and and risk of stroke. A prospective follow-up of 14371 Metabolism Council; and the Quality of Care and middle-aged men and women in Finland. Prenatal influences on survival: secular trends in Rochester, Minnesota, stroke mortality in England and Wales. Neuroepidemiology 2003; of risk factors for stroke and transient ischemic attack 22(3):196–203. Broderick J, Brott T, Kothari R, Miller R, Khoury J, J Neurol 2007; 254(3):315–21. Cerebrovascular disease in African cohorts of young adult and middle-aged men and Americans. Do trends in mortality between non-Hispanic whites, Hispanic population levels of blood pressure and other whites, and blacks. The National Longitudinal cardiovascular risk factors explain trends in stroke Mortality Study. Stroke World Health Organization Monitoring of Trends and incidence and survival among middle-aged adults: Determinants in Cardiovascular Disease. J Clin Epidemiol 2005; study of early risk of stroke after transient ischaemic 58(9):951–8. Neurology 2004; evaluation of the Finnish Diabetes Risk Score: a tool to 62(11):2015–20. Transient prediction of dementia risk in 20 years among middle ischaemic attacks: which patients are at high (and low) aged people: a longitudinal, population-based study. Lancet 2005; Meta-analysis of genetic studies in ischemic stroke: 366(9479):29–36. The strategy in primary preven- Lifestyle modifications have a high potential to tion is to lower stroke risk attributed to these factors prevent at low cost and low risk the development of through education, lifestyle changes and medication. Thus, they should be an such as atrial fibrillation or diabetes mellitus can be important issue in stroke prevention. Targets of primary stroke prevention can Five low-risk lifestyle factors with a high potential to prevent stroke: be the entire population or high-risk – but stroke- non-smoking free – individuals partly suffering from disorders moderate activity! Lifestyle factors Stroke prevalence has been associated with individual lifestyle factors (e. Healthy lifestyle in general was considered in one Projections estimate the mortality attributed to large prospective cohort study of healthy women. Nearly one-third from smoking, low-normal body mass index, moder- of these deaths are caused by cardiovascular diseases ate alcohol consumption, regular exercise and healthy and 8% by cerebrovascular diseases . Large observational studies have the data of two large cohort studies, the Nurses’ shown cigarette smoking to be an independent risk Health Study (71 243 women) and the Health Profes- factor for stroke in both men and women [e. Smoking is a well-established risk factor for ischemic Smoking may have additive effects and potentiate stroke . This may suggest a lower middle-aged patients (18–49 years) and with the risk tolerance for high blood pressure in smokers . Another between fatal stroke cases and other men were only population-based case-controlled study including 432 found for non-smokers . In the Non-smokers exposed to tobacco smoke were Nurses’ Health Study total and ischemic stroke excess estimated to absorb only the equivalent of 0. Nevertheless passive for former smokers compared to never smokers was smoking was associated with a greater progression 1. Only ever, due to its addictive effect the success in smoking a few studies investigated stroke risk due to environ- cessation is only modest. A meta-analysis of pharmacological therapies are available to assist 16 studies of variable design and quality suggests that smokers in quitting and their effects are the subject Chapter 6: Common risk factors and prevention of a number of Cochrane reviews (e. All Beneficial effects on lipids and hemostatic factors forms of nicotine replacement therapy (nicotine gum, have been reported .
Results: Result buy generic effexor xr 75mg line anxiety symptoms heavy arms, in about one third (31%) of cases was rial and Methods: A 3-year-old girl sustained multiple fexor and normal generic 37.5mg effexor xr overnight delivery anxiety symptoms for years. The most common roots involved in lumbosacral and cer- extensor tendon rupture and median nerve injury of left hand in a vical radiculopathies were L5 (49 effexor xr 37.5 mg without a prescription anxiety symptoms 6 days. All the muscle strength buy effexor xr 150 mg anxiety symptoms eye pressure, and sensory), and how to do gentle stretching and doctors were general duty doctors or residents in their respective massage. The areas covered were Rahim Yar Khan, Rojan, Dera the instructions for therapy and supervision were done by text mes- Ghazi Khan, MuzaffarGarh, Rajanpur, Nowshehra, Charsadda and sage and messenger applications with mobile phone. The Doctors reached the food area between instructions how to make hand orthoses from local materials. Re- 1–4 weeks and spent an average of 30 days in the food affected sults: After 16 weeks of the telerehabilitation, there was improve- areas. Gastrointestinal, respiratory and skin Conclusion: Telerehabilitation programs can be delivered even if infections were the commonest ailments followed by conjuncti- there was no sophisticated technology. Hasnan1 rehabilitation services are required in initial days of foods, general 1University of Malaya, Rehabilitation Medicine, Kuala Lumpur, duty doctors trained in common food related ailments are suff- Malaysia cient, however evacuation of previously disabled person residing in the area should be catered for. Conclusion: Higher self-effcacy and independence level evacuees living in temporary housing, and to identify whether the are associated with higher ftness level. It is therefore important amount of physical activity was related to physical ftness and qual- that rehabilitation interventions include strategies to promote and ity of life. Material and Methods: Sixty-four residents of temporary improve self-effcacy and independence. These measures may lead housing in Minamisoma city, aged ≥65 years participated in the to higher physical activity and ftness level. The average daily steps of each participant were measured using a triaxial accelerometer to be representative of the daily phys- ical activity. No relationship was observed between the amount of Aqil, Pakistan physical activity and physical ftness and health-related quality of life except for “physical function”. Conclusion: Physical activity of Introduction/Background: Floods are one of the most frequent nat- the elderly residents of temporary housing complexes was shown ural disasters in recent history. The aim of this study was to analyze to be less compared with the national average of age-matched in- the spectrum of medical issues during foods and to document the dividuals. This decrease in their activity level puts them at risk for needs for medical rehabilitation expertise during foods in Paki- developing lifestyle diseases. Material and Methods: A questionnaire based cross-sectional facilitating the performance of activities of daily living (i. Doctors who provided services in the food ing, laundry, bathing) for the residents in temporary housing may affected areas in the acute phase were interviewed. Orpilla 1 cast for immobilizing the unaffected hand for 5 hour/day and com- Philippine Academy of Rehabilitation Medicine, Manila, Philip- pleted unimanual practice with the hemiplegic hand. Participants were doctors and allied health professionals involved in stroke rehabilitation in the rehabilitation training hospitals in Metro Manila. There were variations in outcomes in the other practices descriptors and auditing guidelines in line with the key 1The University of Hong Kong, Institute of Human Performance, recommendations from the contextualized stroke guidelines. The Hong Kong, Hong Kong- China, 2The Hong Kong Polytechnic Uni- health professionals perceived and valued the guideline implemen- versity, Department of Rehabilitation Sciences, Hong Kong, Hong tation as practical and collaborative. It provided summary of ef- Kong- China, 3The Sixth Affliated Hospital of Sun Yat-sen Univer- fective strategies in stroke rehabilitation and standardized practice. Conclusion: Introduction/Background: This novel study aimed to (1) compare Improvements in some descriptors and quality indicators were seen neuromuscular performance, postural control and motor skills pro- one-year post implementation of recommended guidelines. Three of the six variables for positive reward were toys, snacks, and tablet games and the remaining three for negative were the parents, room and soft pool of balls. Simple percentage was used 1The University of Hong Kong, Institute of Human Performance, to determine the profle of the subjects and mean was used to analyze Hong Kong, Hong Kong- China, 2The University of Hong Kong, the response time on compliance in the reward system. Motor clumsiness is related to sensorimotor defcits and possibly mental 188 attention problems. A multiple regression analysis long-term complications including musculoskeletal disability. Treatment: decrease weight bearing, Ca tion index remained signifcantly associated with the total impair- and vitamin D supplementation. These complications can impair tive Sciences- Department of Physical Therapy, Cebu City, Philip- the survivors’ health-related quality of life. Chen of research, the goal of this study is to determine the effect of positive 1Chang Gung Memorial Hospital- Chiayi, Physical Medicine and and negative reward reinforcements’ response time on compliance to Rehabilitation, Puzih, Taiwan, 2Chang Gung University, School of J Rehabil Med Suppl 55 Short Oral Abstracts 61 Medicine- College of Medicine, Taoyuan, Taiwan, 3Chang Gung be desirable to base forecasts concerning the need for health ser- Memorial Hospital- Chiayi, Traditional Chinese Medicine, Puzih, vices in the future on the model developed during the project. However, com- Hospital Sultan Ismail, Rehabilitation Medicine, Johor Bahru, prehensive information regarding the costs and utilization of reha- Malaysia bilitation for such patients remains scarce. This population-based Introduction/Background: Based on recent data from Malaysian study used a nationwide database to examine the characteristics and Registry of Intensive Care, the incidence of PrU in Hospital Sul- trends of rehabilitation costs and use in Taiwanese patients with tan Ismail, Johor Bharu increased from 8. Material and Methods: Primary ob- hemophilia A who were registered in the National Health Insur- jective: to investigate and analyze the cost of PrU management ance Research Database between 1998 and 2008 were analyzed. Secondary objectives: to Results: The total costs for physical, occupational, and speech/ compare the cost of PrU management between paraplegics and swallowing therapy among patients with hemophilia A during the tetraplegics. Although the rehabilitation costs have increased had their inpatient records reviewed over seven consecutive days since 2004, these values have fuctuated without additional year- based on the most eventful week. They collectively had 55 PrU with an average of 3 PrU per rates for outpatient rehabilitation among all patients with hemo- patient. Conclusion: Higher and encourage these patients to utilize rehabilitation resources to stage of PrU resulted in higher management cost. Bitenc1 ing, thereby increasing patients’ self-reliance and consequently her 1University Rehabilitation Institute Soča, Development centre for dependence on healthcare services. Persons analysis we use data from the Norwegian Patient Registry, Registry with disabilities in Slovenia are mainly employed on the open la- for Individual-based Nursing and Care Statistics, and the Register bour market (80%), social economy represents approximately 20% for Control and Payment of Primary Care Reimbursement Scheme. Work in employment centres is the di- Connecting multiple data records from these sources creates a rect outcome of Slovenian employment rehabilitation services. It allows the analyst to follow an individual’s use of Slovenian thematic study was prepared in 2013 by Development various healthcare services over time. The grounds for the study basis of this formal model combining concepts from micro-eco- are based on the Slovenian Court of Audit Report recommenda- nomic theory, mathematics and statistics, state-of-the-art statistical tions. Material and Methods: Cohort study-retrospective and case- techniques will be used (i) to explain existing data, (ii) to estimate study. Results: State-aids for enterprises for PwD were reimbursed the current effects attributed to home-based reablement and (iii) to through the state with taxes from 95–114% from 2008–2012. A years of economic crises taxes paid by enterprises were lower, multidisciplinary approach combining an economic, medical and whilst in economic prosperity were higher (114%) than state-aids. Conclusion: In- For employment centre different methodology was used due to the formation concerning the quality enhancing and cost reducing po- specifcs, but it turned out that 1 € (100%) invested in employment tential of alternative care approaches is necessary for a meaningful centre produced 152% benefts. Ismal 1 of a hundred consecutive cancer inpatients referred to Rehabilita- Hospital Sungai Buloh, Rehabilitation Medicine, Sungai Buloh, tion physician. Majority of patients had tho- traumatic spinal cord injury are of poor quality with distinguish- racic lesion (n=36), followed by cervical lesion (n=15) and lumbar ing characters of abnormal sperm quantity and viability. Four patients had lesions in the spine but no neurologi- ever, there is a dearth of evidence involving men with complete cal defcit.
Accumulation of fibrillary substances in the interstitium: scarring purchase effexor xr without a prescription anxiety symptoms 50, fibrosis (sclerosis) and cirrhosis order effexor xr 150 mg otc anxiety attack symptoms. Necrosis: definition purchase effexor xr 150mg overnight delivery anxiety symptoms 4dp3dt, types (coagulation and kaseous; liquefactive) 150mg effexor xr with visa anxiety icd 9, nuclear and cytoplasmic morphological changes. Clinical and anatomical forms of necrosis (infarction, gangrene, decubitus, sequesters, mutilation, steatonecrosis, fibrinoid necrosis, ‘noma’). Types of embolism by the way of their distribution: venous and arterial, orthograde, retrograde and paradoxical embolism. Types of embolism, according to the substrate: air, gas, fat, amnial, bacterial, parasitic, tumor cell. Productive inflammation: forms and morphological characteristics of diffuse productive inflammation. Morphology of foreign body granuloma, tubercle, luetic ‘gumma’, granulomas in leprosy and sarcoidosis, cat- scratch disease, toxoplasmosis, rhinoscleroma. Adaptivey processes: hypertrophy and hyperplasia, atrophy - definition, types, morphological characteristics. Biology of tumor growth ( irreversibility, relative autonomy, tumor impact on the whole body). Tumors of the central nervous system - general features, classification, basic representatives. Morphogenesis of vascular lesions in benign and malignant hypertension, organ damage. Rheumatic valvular defects: morphological characteristics, hemodynamic disorders and organ complications. Infective endocarditis - acute and subacute: etiology, pathogenesis, morphology and complications. Non-infectious endocarditis: Libman-Sachs endocarditis, mitral valve prolapse, degenerative calcification of aortic valve endocarditis, marantic type. Congenital heart defects: septal defects and inter - ventricular septa, persistent ductus Botali, coarctation of the aorta Congenital transposition of the trunk vessels. Systemic lupus erythematodes: definition, etiology and pathogenesis, morphological amendments. Rheumatoid arthritis: definition, pathogenesis, Morphogenesis of articular lesions skin and vascular changes, clinical course. Local vasculitis: infectious arteritis, Raynaud (trombangiitis obliterans) syndrome. Inflammatory diseases of the trachea and bronchi: acute tracheitis, bronchitis and bronchiolitis. Lobar pneumonia: definition etiology, Morphogenesis, morphological stages, complications and outcomes. Diseases of teeth and soft tissue apparatus: caries, pulpitis, periodontitis, radicular cyst, periodontal disease. Tumors of the jaw bone and tumor-like processes of the soft tissues of oral cavity. Acute viral hepatitis: etiology, pathogenesis, morphological and biological features of hepatitis A, B and C. Chronic hepatitis: etiology, classification, clinical and morphological forms of evolution. Hyperplastic and inflammatory processes in the lymph nodes: chronic nonspecific and granulomatous lymphadenitis. Glomerulonephritis occurring with nephritic syndrome: diffuse endocapillary proliferative glomerulonephritis. Glomerulonephritis occurring with nephrotic syndrome: minimal disease changes, focal segmental glomerulosclerosis, mesangiocapillary glomerulonephritis. Glomerulonephritis occurring with nephrotic syndrome: IgA-nephropathy and Membranous nephropathy. Acute and chronic pyelonephritis: etiology, pathogenesis, morphology, complications. Chronic endometritis, endometriosis, endometrial hyperplasia, etiology, morphology. Bacterial meningitis and meningoencephalitis: epidemic cerebrospinal meningitis, purulent non-meningococcal leptomeningitis, tuberculous meningitis and menigoencephalitis. Benjamin Anavi, Department of General and Clinical Pathology, Medical University Plovdiv, 2011 6. Benjamin Anavi, Department of General and Clinical Pathology, Medical University Plovdiv, 2011 Accepted by the Departmental Board Meeting № 7 / dated 8. The cut surface is homogeneous with orange-yellow color - diffuse fatty degeneration (steatosis) of the liver. Under the visceral pleura is seen through the gray to black in color pigment - coal dust accumulated in the form of stripes and spots. Kidney show relatively symmetrical changes - slightly reduced size and increased consistency. In view of the cut surface it is evident that the parenchyma is mainly at the expense of the chilus. The surface of the spleen shows a thick uneven with gray-white color, hyaline-like material deposited on capsular surface and covering the organ as a glaze. In shear surface of the cerebral hemispheres in the white brain matter showing scattered red-brown spots, the size of which ranges from 1-2 mm to 5 mm in diameter. Part of the spleen, the organ diagnosis is based on the presence of smooth and stretched capsule. In shear surface showing small-sized simple (sago) spots with whitish color merging together and forming focal deposition in the lymph follicles (white pulp) of amyloid. Crossover cortex is strongly enhanced by the boundary between it and the pyramids is relatively deleted. Part of the spleen, suggested by the existence of a smooth and extended capsule, below is seen the trabecular structure of parenchyma. Subcapsularly, there is an area measuring 4 / 3 cm, with triangular shape whose apex is directed to chilus, slightly prominating with deleted structure and whitish-yellow color (coagulation necrosis). That area is separated from the surrounding tissue by brown-red band (hyperemic-haemorrhagic area). In renal shear surface in the lower pole, showing whitish-yellow areas with irregular shape, well delimited from the surrounding intact tissue by brown-red band (hyperemic-haemorrhagic area), slightly prominating. Part of the brain, a cut surface that appears gray area of liquefaction with a size 2 / 2 cm finely cystical structure transition into the surrounding tissue. Visible scars and swelling namozachen – massively depressed folds with shallow grooves between them. In the right hemisphere, a unicameral pseudo cystic formation is evident (cavity without epithelial lining) with yellowish smooth walls, with a size about 4 / 3 cm The rest of the brain tissue has an increased volume (swollen). The cut surface is variegated, lobular, with irregular dry yellowish areas of caseous necrosis. Rear surface of the skin is dark brown in color without well-defined line of demarcation.
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