Chronic lymphatic leukemia

Chronic lymphatic leukemia is characterized by the excessive accumulation of mature appearing lymphocytes in the peripheral blood, associated with infiltration of the bone marrow, spleen and lymph nodes. More than 90% of this disease is due to expansion of B lymphocytes. Some clinical features are common form of chronic leukemia, found more in males than females, bleeding manifestations are extremely common, slowly developing anaemia and about 25% of the patients are asymptomatic. The main investigation of chronic lymphatic leukemia are mild to moderate anaemia, total leukocyte is raised to the range of 50,000-2,00,000 per microlitre, peripheral smear examination which results more than 95% of the cells are mature appearing lymphocytes of small variety, bone marrow is hyper cellular with infiltration of small and medium sized lymphocytes, direct coomb’s test may be positive indicating an autoimmune hemolytic process, lymph node biopsy shoes well differentiated ,small non-cleaved lymphocytes, serum folic acid levels are low. But clinical staging includes three stages such as stage A, stage B, stage C. In stage A there is no anaemia or thrombocytopenia but there will be a less than 3 areas of lymphoid enlargement. In stag B also there is no anaemia or thrombocytopenia but here unlike stage A 3 or more areas of lymphoid enlargement. In stage C, anaemia or thrombocytopenia are present. While coming to treatment stage A requires no treatment but only reassurance, in stage B fludarabine is the drug of choice in young patients, but in stage C chlorambucil is the drug of the choice, fludarabine in young patients, packed cell transfusion for anaemia.

Bell’s palsy

Clinical pathology of Bell’s palsy is severity in a given case varies from simple conduction block to severe axonal degeneration. Clinical features are onset is acute, sometimes history of exposure to cold is present .Mild pain at atylomastoid foramen for a few days precede the palsy. Examination shows isolated lower motor neuron facial paralysis with or without loss of taste sensation at anterior two-third of tongue and hyperacusis. Some features of lower motor facial nerve palsy are paralysis of all the muscles of facial expression on the side of skin, drooping of corner of mouth, effacement of creases and skin fold on the affected side, weakness of frowning and eye closure since the upper facial muscles are weak, drooling of saliva from angle of mouth, on asking patient to show his teeth, the angle of mouth deviates away from the side of lesion, corneal ulceration due to inability to close the eye during sleep. Differential diagnosis of Bell’s palsy is herpe zoster of 7th nerve, middle ear disease with 7 th nerve compression, trauma, and diabetic mononeropathy. Investigations of Bell’s palsy are no specific confirmatory diagnostic procedure .It can be treated by adhesive tape to keep the eye closed so as to prevent corneal ulceration

Aspiration Pneumonia

Aspiration Pneumonia occurs due to abnormal entry of fluid, particulateexogenous substances or endogenous secretions into the lower airways. It is of two types namely chemical Aspiration Pneumonia and bacterial Aspiration Pneumonia. Some of predisposing factors are reduced consiousness,dysphagia of the upper gastrointestinal tract including esophageal disease, surgery involving the upper airways or oesophagus and gastric reflux, mechanical disruption of the glottic closure or cardiac sphincter due to tracheotomy ,endotracheal intubation, bronchoscopy, upper endoscopy and nasogastric feeding, miscellaneous conditions such as protracted vomiting, large volume tube feeding and feeding gastrostomy.Chemical aspiration pneumonia occurs due to aspiration of substances that are toxic to the lower airways, independent of bacterial infection. It includes chemical pneumonitis associated with the aspiration with the aspiration of gastric acid. Clinical features of chemical aspiration pneumonia are symptoms with low grade fever and prominent dysponea, examination reveals cyanosis and diffuse crepitations, chest radiograph shows infiltrates involving dependent pulmonary segments which usually develop within 2 hours of aspiration. Bacterial aspiration pneumonia is caused by bacteria that normally reside in the upper stomach. Some of the clinical features are in most cases involve anaerobic bacteria that normally reside in the gingival crevices, many patients have accompanying weight loss and anaemia caused by chronic process. Diagnosis of bacterial aspiration pneumonia re presence of putrid discharge in sputum or pleural fluid is regarded as diagnostic of anaerobic infection, chest radiograph shows involvement of dependent pulmonary segments which are favored in aspiration. Some treatments to overcome bacterial aspiration pneumonia are penicillin should prefer to the patients, Clindamvcin is now the preferred drug for anaerobic infections above the diaphragm including pulmonary infections

Angina pectoris

Angina pectoris is a clinical syndrome of discomfort due to transient myocardial ischemia. It is worsened by factors which increase myocardial oxygen requirement or reduce supply. Transient myocardial ischemia is due to one or both of obstruction of coronary flow by atheroma. Clinical features are follows 1.Pian is usually in location and brought on by exertion. It is relieved by rest and sublingual nitrates, Pain seldom lasts more than 20 minutes, 2.Angina decubitus is pain while lying flat, 3.Nocturnal angina is an unusual form of angina occurring on aortic regurgitation, 3.Prinzmetal’s angina or variant angina is pain which comes capriciously due to coronary arterial spasm and is accompanied by transient ST segment elevation on ECG. Physical examinations are usually negative, but may find tendon xanthomas, thickening of Achilles tendons, aortic valve disease, diabetes, peripheral vascular disease and obesity. Some physical examinations are rise in blood pressure and heart rate, fourth heart sound and relief of pain by carotid sinus massage. Investigations are 1.Electrocardiography –ECG is normal in most patients at rest and in between attacks. Patients may require exercise testing, 2.Myocardial perfusion scanning using small radioactive thallium; 3.Echocardigraphy and radionuclide blood pool scanning provide information about ventricular function

Amoebic liver abscess

Amoebic liver abscess is produced by involvement of liver by entamoeba histolytica. It is one type of disease occur due to infections. The clinical manifestations are insidious onset of fever, sweats, weight loss, chills and rigors. Some patients have an acute onset of fever. There may be pain in the right hypochondrium resulting from stretching of the liver capsule. Diaphragmatic irritation may give rise to referred pain in the right shoulder. Clinical examination may reveal enlargement of the liver, upward extension of the liver dullness on percussion, point tenderness in the poster lateral portion of lower right intercostal space and bulging of the intercostal spaces. Amoebic liver abscess has some complications such as spontaneous external rupture may result in granuloma cutis, direct extension into lung may result in amoebic lung abscess, and rupture into peritoneal cavity may result in peritonitis, metastatic brain abscess, spleenic abscess and rupture into stomach are rare complications. Immunodiagnostic tests are less invasive and are useful in community surveillance studies, skin test to demonstrate delayed type hypersensitivity is positive only in patients with cured kala-azar, increased productions of immunoglobulin’s and chopra’s antimony tests. Blood transfusions to correct anaemia and treatment of intercurrent bacterial infections with antibodies are the best treatment.

Acne vulgaris

Acne vulgaris is a disorder characterized by chronic inflammation of blocked pilosebaceous follicles. It predominantly affects teenagers. Some aetiologiacal factors are increase in sebum excretion, which is probably androgen mediated, Increased and abnormal keratinisation at the exit of the pilosebaceous follicle causes obstruction to the flow of serum and the sebum patients with acne contains an excess of free fatty acids ,which may be responsible for triggering the inflammatory process. The main clinical features are lesions are limited to the face, shoulders, upper chest and back, seborrhea is often present, open comedowns are due to plugging of the pilosebaceous orifice by keratin and sebum, closed comedowns are due to accretions of sebum and keratin deeper in the pilosebaceous ducts. Local managements are regular washing of soap and water, antibacterial skin cleansers containing chlorhexidine, preparations containing benzyl alcohol and retinoic acid. But the systematic measures are long term antibiotic therapy with oxytetracycline, minocycline, or erythromycin for duration of 3 months to 2 years, Isotretinonin given in a four month course can reduce sebum excretion and hormonal treatment in the form of a combined anti-androgen pill, can be given in courses as an oral contraceptive. Physical measures are incision and drainage of cysts.