medical ebook, journal, and article free

SYMPTOMS AND SIGNS Type 1 diabetes Increased urination is a consequence of osmotic diuresis secondary to sustained hyperglycemia. This results in a loss of glucose as well as free water and electrolytes in the urine. Thirst is a consequence of the hyperosmolar state, as is blurred vision, which often develops as the lenses are exposed to hyperosmolar fluids. Weight loss despite normal or increased appetite is a common feature of type 1 when it develops subacutely. The weight loss is initially due to depletion of water, glycogen, and triglycerides; thereafter, reduced muscle mass occurs as amino acids are diverted to form glucose and ketone bodies. Lowered plasma volume produces symptoms of postural hypotension. Total body potassium loss and the general catabolism of muscle protein contribute to the weakness. Paresthesias may be present at the time of diagnosis, particularly when the onset is subacute. They reflect a temporary dysfunction of peripheral sensory nerves, which clears as in...

PATHOLOGY Detailed histological studies of pancreatic tissue are available from a limited number of cases of human acute pancreatitis. A histological spectrum of acute pancreatitis is recognized ranging from mild, interstitial disease to coagulation necrosis. 3 Interstitial pancreatitis may lead to local and systemic complications but is rarely fatal; necrotizing pancreatitis may be fatal in up to 30% of cases. Interstitial In interstitial pancreatitis the gland is edematous, but its gross architecture is preserved. Parenchymal inflammatory cells are present together with interstitial edema. Disruption of the normal acinar cell architecture is common and may contribute to the reduced enzyme secretion characteristic of acute pancreatitis. Zymogen granules are displaced from their fusion site in the apical domain of the cell and become dispersed throughout the cell, and the apical membrane appears contracted and microvilli disappear. 4 Zymogen granules fuse with each other instead of the...

Essentials of Diagnosis The diagnosis is based on clinical suspicion, family history, and preexisting long-standing infection or debilitating illness. Microscopic examination of biopsy (eg, gingival, renal, rectal) or surgical specimens is diagnostic. Fine-needle biopsy of subcutaneous abdominal fat is a simple and reliable method for diagnosing secondary systemic amyloidosis. General Considerations Amyloidosis is a group of disorders manifested by impaired organ function due to infiltration with insoluble protein fibrils. Different fibrils can be correlated with the clinical syndromes. In primary amyloidosis (AL), the protein fibrils are monoclonal immunoglobulin light chains, whereas in secondary amyloidosis (AA), protein deposits are derived from acute phase reactant apolipoprotein precursors. Familial amyloidosis syndromes commonly cause infiltrative neuropathies. Other types of amyloidosis may also be hereditary. Over 20 types of fibrils have been identified in amyloid deposits. A...

Essentials of Diagnosis The diagnosis is based on clinical suspicion, family history, and preexisting long-standing infection or debilitating illness. Microscopic examination of biopsy (eg, gingival, renal, rectal) or surgical specimens is diagnostic. Fine-needle biopsy of subcutaneous abdominal fat is a simple and reliable method for diagnosing secondary systemic amyloidosis. General Considerations Amyloidosis is a group of disorders manifested by impaired organ function due to infiltration with insoluble protein fibrils. Different fibrils can be correlated with the clinical syndromes. In primary amyloidosis (AL), the protein fibrils are monoclonal immunoglobulin light chains, whereas in secondary amyloidosis (AA), protein deposits are derived from acute phase reactant apolipoprotein precursors. Familial amyloidosis syndromes commonly cause infiltrative neuropathies. Other types of amyloidosis may also be hereditary. Over 20 types of fibrils have been identified in amyloid deposits. A...