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While recommendations are made, it is important for those utilizing these recommendations to understand that, in some instances, agents and methods of euthanasia identified as appropriate for a particular species may not be available or may become less than an ideal choice due to differences in circumstances. Conversely, when settings are atypical, methods normally not considered appropriate may become the method of choice. Under such conditions, the humaneness (or perceived lack thereof) of the method used to bring about the death of an animal may be distinguished from the intent or outcome associated with an act of killing. Following this reasoning, it may still be an act of euthanasia to kill an animal in a manner that is not perfectly humane or that would not be considered appropriate in other contexts. For example, due to lack of control over free-ranging wildlife and the stress associated with close human contact, use of a firearm may be the most appropriate means of euthanasia. Also, shooting a suffering animal that is in extremis, instead of catching and transporting it to a clinic to euthanize it using a method normally considered to be appropriate (eg, barbiturates), is consistent with one interpretation of a good death. While an essential ingredient in public discourses about animals, sound science is by itself inadequate to address questions of ethics and values that surround the appropriate treatment of animals, especially as they relate to end-of-life issues. Since the 2013 edition, a number of authors20, 21 have probed in greater depth the issue of a good death for animals in both philosophical and ethical terms. In so doing, it hopes to promote greater understanding regarding the contexts or settings involving euthanasia and the complexity of end-of-life issues involving animals. Veterinarians, in carrying out the tenets of their Oath, may be compelled to bring about the intentional death of animals for a variety of reasons. The finality of death is, in part, what makes it an ethically important issue; death forever cuts off future positive states, benefits, or opportunities. The intentional killing of healthy animals, as well as those that are impaired, is a serious concern for the public. This is also true for euthanasia carried out during the course of disease control or protection of public health, as a means of domestic or wild animal population control, in conjunction with animal use in biomedical research, and in the process of food and fiber production. Killing of healthy animals under such circumstances, while unpleasant and morally challenging, is a practical necessity. In thinking seriously about veterinary medical ethics, veterinarians should familiarize themselves with the plurality of public moral views surrounding animal issues and also be cognizant of personal views and complicating factors that may impact their own ethical decision-making. In their capacity as animal advocate and client advisor, the precision and credibility of advice provided by veterinarians will help to advance client compliance. In many instances when veterinarians are called upon to benefit society through their scientific knowledge, practical experience, and understanding of how animals are benefited and harmed, straightforward answers may not be forthcoming. In such cases, veterinarians and animal welfare scientists may have to facilitate conscientious decision-making by promoting ethical dialogue. In these instances, intentional killing need not be motivated by narrow welfare-based interests35 but may be connected to the overall value of death to the animal. It is a being that possesses an internal existence and has needs, desires, preferences, and a psychosocial identity that extends through time. Here, the decision to kill an animal and how to do so will be complicated by external factors, such as productivity, the greater public and general good, economics, and concern for other animals. In laboratory situations, for example, where animals are employed as research subjects and death may be a terminal point, animal welfare considerations are balanced against the merits of the experimental design and merits of the research. These committees must apply the principles of refinement, replacement, and reduction, and ensure a respectful death for research animals. The decision to induce death may also involve whether replacements can be created for the animals that are killed. For example, killing may be justified for disease control or public health purposes, population control, biomedical research, or slaughter for food and/or fiber. In other instances, keeping an animal alive that does not have a life worth living can be justified (eg, research circumstances where it would be impractical to kill the animal or when ensuring its survival would promote a greater good19). There may be instances in which the decision to kill an animal is questionable, especially if the animal is predicted to have a life worth living if it is not killed. One example is the healthy companion animal whose owner wants to euthanize it because keeping it in the home is no longer possible or convenient. This underscores the need for veterinarians to consider the broader context in thinking about what animal care she or he will prescribe. Attention must be given to how the welfare and suffering of the animal are understood within the context of its whole life and in light of socially acceptable ways in which humans and animals interact in different environments. Because veterinarians are committed to improving animal and human health and welfare, and because they work tirelessly to discover causes and cures for animal diseases and promote good animal management, some may feel a sense of disquiet or defeat when euthanasia becomes the better course of action.

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The human-animal relationship should be respected by discussing euthanasia openly, 120 providing an appropriate place to conduct the process, offering the opportunity for animal owners and/or caretakers to be present when at all possible (consistent with the best interests of the animal and the owners and caretakers), fully informing those present about what they will see (including possible unpleasant side ef14 fects), and giving emotional support and information about grief counseling as needed. When death has been achieved and verified, owners and caretakers should be verbally notified. Veterinarians and their staffs may also become attached to patients and struggle with the ethics of the caring-killing paradox, 124, 125 particularly when they must end the lives of animals they have known and treated for many years. Repeating this scenario regularly may lead to emotional burnout, or compassion fatigue. The various ways in which veterinarians cope with euthanasia have been discussed elsewhere. The first setting is the veterinary clinical setting (clinics and hospitals or mobile veterinary practices) where owners have to make decisions about whether and when to euthanize. The decision to euthanize often carries strong feelings of emotion such as guilt, sadness, shock, and disbelief. The ability to communicate well is crucial to helping owners make end-of-life decisions for their animals and is a learned skill that requires training. Behaviors such as vocalization, agonal breaths, muscle twitches, failure of the eyelids to close, urination, or defecation can be distressing to owners. Counseling services for owners having difficulty coping with animal death are available in some communities, and veterinarians are encouraged to seek grief support training to assist their clients. The second setting is in animal care and control facilities where unwanted, homeless, diseased, and injured animals must be euthanized in large numbers. The person performing euthanasia must be technically proficient (including the use of humane handling methods and familiarity with the method of euthanasia being employed), and must be able to understand and communicate to others the reasons for euthanasia and why a particular approach was selected. This requires organizational commitment to provide ongoing professional training on the latest methods, techniques, and materials available for euthanasia. Distress may develop among personnel directly involved in performing euthanasia repeatedly, 133 and may include a psychological state characterized by a strong sense of work dissatisfaction or alienation, which may be expressed by absenteeism, belligerence, or careless and callous handling of animals. Management should be aware of potential personnel problems related to animal euthanasia and determine whether it is necessary to institute a program to prevent, decrease, or eliminate this problem. Researchers, technicians, and students may become attached to animals that must be euthanized in laboratory settings, even though the animals are often purpose-bred for research. Wildlife biologists, wildlife managers, and wildlife health professionals are often responsible for euthanizing animals that are injured, diseased, or in excessive number or those that threaten property or human safety. Although relocation of some animals may be appropriate and attempted, relocation is often only a temporary solution and may be insufficient to address a larger problem. People who must deal with these animals, especially under public pressure to save the animals rather than destroy them, can experience extreme distress and anxiety. In addition, the perceptions of not only the wildlife professionals, but of onlookers, need to be considered when selecting a euthanasia method. As for shelter and laboratory animal workers, on-farm euthanasia of individual animals by farm workers charged with nurturing and raising production animals can take a heavy toll on employees both physically and emotionally. Because euthanasia of zoo animals, animals involved in roadside or racetrack accidents, stranded marine animals, and nuisance or injured wildlife can draw public attention, human attitudes and responses must be considered whenever these animals are euthanized. Natural disasters and foreign animal disease programs also present public challenges. In addition to ensuring good care of animals during euthanasia and considering the psychological well-being of human participants, the physical safety of personnel handling the animals and performing euthanasia needs to be protected. The safe use of controlled substances and diversion control to prevent abuse is also part of the responsibility of those using such substances in the performance of euthanasia. A common characteristic of both sedatives and tranquilizers is that arousal to a conscious state can occur with sufficient stimulation, such that animals sedated or immobilized with these agents may still be consciously aware of, and connected to, their environment. Indeed, humans experienced connected awareness of their environment during sedation with dexmedetomidine sufficient to lose responsiveness, 144 and a state of surgical anesthesia could not be produced even when xylazine was administered at 55 to 88 times the usual dose (0. Instead, an effective dose of a general anesthetic should be used when performing euthanasia with methods causing distress or noxious stimulation prior to loss of consciousness. I6 Mechanisms of Euthanasia Euthanizing agents cause death by 3 basic mechanisms: (1) direct depression of neurons necessary for life function, (2) hypoxia, and (3) physical disruption of brain activity.


  • Multiple congenital anomalies mental retardation, growth failure and cleft lip palate
  • IFAP syndrome
  • Trypanophobia
  • Noonan like syndrome
  • Amelogenesis imperfecta
  • Prader Willi syndrome
  • Schereshevskij Turner
  • Follicular atrophoderma-basal cell carcinoma
  • Pierre Robin syndrome hyperphalangy clinodactyly

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Some common breast cancer signs and symptoms include: Skin changes, such as swelling, redness, or other visible differences in one or both breasts, increase in size or change in shape of the breast(s). Changes in the appearance of one or both nipples, Nipple discharge other than breast milk, General pain in and or, on any part of the breast, Lumps or nodes felt on or inside of the breast; cancerous lumps are often painless and may increase in size as the cancer progresses. Unexplained weight loss over a short period of time (a couple of months) can be a sign of cancer. Preventing other diseases, especially viral infections are crucial to cancer prevention. Reducing your risk of breast cancer Although the presence of a number of risk factors is not a conclusion to the establishment of cancer, modifying the flexible risk factors has significance health benefits. Increase intake of vegetables, fruits, especially vegetables knows to be rich in important antioxidants and phytochemicals. Lack of physical activity is an established risk factor for premenopausal breast cancer and represents part of a complete approach to weight management. Of all the established risk factors for breast cancer, obesity and lack of physical activity stand out as the two that can be most readily and safely modified. The genomic and transcriptomic architecture of 2, 000 breast tumours reveals novel subgroups. Position Paper of the American council on science and health on the risk factors of breast cancer. Treatments of breast cancer Treatment of breast cancer may involve a number of approaches which are largely a function of several factors such as the stage of the disease, the state of the patient, among others. Treatment may involve: Surgery-Depending on the staging and type of the cancer, your doctor will discuss with you the most appropriate type of surgery, ranging from removal of the lump (lumpectomy) to removal of the whole breast (mastectomy) and surrounding tissues. Radiation therapy-It is a cancer treatment that uses high energy X-ray or other types of radiation to kill cancer cells or keep them from growing. Chemotherapy - It is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Hormonal therapy-It is a treatment that removes hormones or blocks their action and stops cancer cells from growing. Targeted therapy­It is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Although the presence or absence of risk factors is not a confirmation for the establishment of cancer or not in an individual, modifying some of the risk factors is crucial in the prevention of breast and other forms of cancer. Tobacco seriously damages our health, and there is every reason to avoid its intake in any form. Both frequent and high consumption of alcohol should be stopped or significantly reduced. Increased consumption of fatty foods and red-meat should be replaced with increase intake of fruits, vegetables and fish. We can control our exposures to ionizing radiation from work place and gadgets such as phones and laptops. Analysis in women before age 35 years and in women before age 45 years with first-degree family history. Through a glass darkly: advances in understanding breast cancer biology, 2000-2010. Epidemiology, major risk factors and genetic predisposition for breast cancer in the Pakistani population. Examining breast cancer growth and lifestyle risk factors: Early Life, Childhood, and Adolescence. An overview of breast cancer epidemiology, risk factors, pathophysiology, and cancer risks reduction. They have two goals in life: to survive and to conquer new territory ­ metastasizing. Cancer is not a single disease, but many with related features Such key events have been called hallmarks of cancer. Cell 2000;100:57-70 4 Definition of Cancer (Continued) A class of genetic disease caused by disregulation of various cellular pathways that orchestrate cell growth and death.

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Plastic Surgery Hospital of the University of Pennsylvania Philadelphia, Pennsylvania Lynn C. Speech-Language Pathology California State University Northridge, California Duane R. Plastic Surgery Rancho Los Amigos Hospital Downey, California Mary Anne Witzel, Ph. Speech-Language Pathology Hospital for Sick Children Toronto, Ontario, Canada Larry Wolford, D. Oral-Maxillofacial Surgery Baylor University Medical Center Dallas, Texas 31 Peer Reviewers Marc W. Professional Affairs Division American Speech-Language-Hearing Association Manuel J. Plastic Surgery * Denotes an individual who has a craniofacial anomaly or is the parent of a child with a craniofacial anomaly. Deformation An external force resulting in the inability of a structure to form correctly. Example: club feet in a woman with oligohydramnios, fibroid tumors or multiple gestation. Disruption Birth defect resulting from the destruction of a normally forming structure. This can be caused by vascular occlusion, teratogen, or rupture of amniotic sac (amniotic band syndrome). Clinical features include holoprosencephaly, cutis aplasia, microcephaly, microapthalmia, cleft lip +/- palate, polydactyly, congenital heart defects. Short stature Broad chest Low hairline Webbed neck Cubitus valgus Renal anomalies and cardiac defects including bicuspid aortic valve and coarctation of the aorta are more common. Clinical features include tall stature, behavioral problems, post pubertal small testes. Small visible chromosome deletions Wolf-Hirshorn (4p-) Cri du Chat (5p-) Wolf Hirshorn Results from a terminal deletion of the short arm of 4. Features includes hypertelorism, broad nasal bridge, cleft lip +/- palate, down turned mouth. Features include microcephaly, growth deficiency, high pitched catcry, congenital heart disease, hypotonia. Features of Contiguous Gene Syndromes Syndromes described before chromosomal etiology was known. Cytogenetic abnormalities are frequently detectable only by high resolution chromosomal analysis. Prader-Willi during infancy Severe hypotonia Failure to thrive Prader-Willi Syndrome Approximately 60% of cases are caused by a paternal deletion of chromosome 15q11. Angelman Syndrome Approximately 70% result from a maternal deletion of 15q11 Severe postnatal growth deficiency Mental retardation "puppet-like gait" Parozysms of inappropriate laughter. Seizures Prader-Willi vs Angelman Syndrome Difficult to differentiate during infancy. Lanes 1 - 4 = normal individuals Lane 5 = Prader-Willi syndrome PraderLane 6 = Angelman syndrome 22q11 Deletion syndrome Includes DiGeorge, Velocardial-facial syndrome and Sprintzen syndrome Occurs in 1/5000 Caused by an interstitial deletion of chromosome 22q11 in over 80% of cases. None are pathanamonic Micrognathia Low-set ears Short palpebral fissures Blunted nose ­ older patients have bulbous nose High arched palate Cleft palate and or Bifid uvula. Single Gene Abnormalities Mutation in the single gene resulting in a dysmorphic phenotype Autosomal Dominant Syndromes One abnormal gene results in an identifiable phenotype. Neurofibromatosis Occurs in 1/3000 individuals Features includes >6 cafй au lait spots, 2 or more neurofibromas, Lisch nodules, optic gliomas, angiofibromas axillary or inguinal freckling. Osteogenesis imperfecta Type I Fractures Osteopenia Blue sclera Hearing loss Short stature Osteogenesis Imperfecta vs Child Abuse Children with multiple bone brakes with an inconsistent story are often thought to be the victims of child abuse. If there are other signs of trauma such as retinal hemorrhages, bruises, and signs of sexual abuse a skin biopsy is not warranted. Autosomal Recessive Syndromes the majority of disorders are inherited in this fashion. If we have a child with someone who carries the same "bad gene" there is a 25% chance of having an affected child.

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Analysis of the data collected may indicate that: (i) female heads of households experience barriers to accessing available resources which male heads of households do not experience; or (ii) that the level of food insecurity of female-headed households is higher than those of male-headed households. Thematic Guidelines: Integrating a Gender Perspective into Vulnerability Analysis. Carry out a rapid gender analysis, which can be sectoral or multisectoral, integrating key questions for the food security sector (see later on in this chapter for examples). What structures was the community using to make food security decisions before the crisis and what are these now? What are the food security-related needs, capacities and aspirations of women, girls, men and boys in the affected population and/or programme? This should include an assessment of production, acquisition and consumption of food as individuals, in their household settings and in their communities. Are distribution sites and routes to reach them safe for women, girls and other at-risk groups? Gender analysis carried out relevant to food security in Somalia Crops: Sorghum and maize are the two key food crops. Planting, weeding, harvesting, guarding and transporting are joint activities of women and men. They are the key sellers of sorghum and predominate as retail vendors in local cereal markets. Maize: Men usually purchase and apply fertilizer and pesticides, cut down the maize stocks, transport and market maize to commercial traders. Both men and women, usually more men, are paid casual workers in the maize harvest. Women use or sell maize fodder (stalks), bang the kernels from the cobs and sell small volumes of maize on local markets. Natural resource harvesting: Foraging for wood and harvesting wild resins are two key forms of natural resource harvesting. Wood foraging: Firewood is primarily collected by women and girls, although men in the north-west in particular actively collect firewood if long distances are involved. Women are the key foragers for wood they will use in building and construction, for home cooking and for firewood sale. For instance, if women were not consulted, the identified priorities do not reflect the needs and priorities of the whole community. This approach facilitates a clearer understanding of the differing levels of the beneficiaries consulted to better identify their needs, capacities and priorities relating to food security. Using the information and data gathered through the gender analysis process, the programme planner can establish a demonstrable and logical link between the programme activities and their intended results in the food security sector, thus ensuring that the identified needs are addressed. In nearly all cases, women did indeed have control and autonomy over the food received, and households with underweight children reported that they (and their nursing mothers) were indeed prioritized within household use. Male-headed families are usually in control of the access to and thus the distribution of food within the household. Increased access for women, girls and people with disabilities to food and agricultural inputs, distribution sites, work sites, workshops or registration points. Number and percentage of women, girls, men and boys with and without disabilities safely accessing the distribution site What are the roles of women, girls, men and boys in food production, procurement and preparation of food? Women and girls spend more time in preparing food for family members since the crisis. In agricultural settings, it is not unusual to find women and girls responsible for the production process. Household food security work shared more evenly between men and women and food preparation roles are no longer assigned solely to women and girls. Percentage of women, girls, men and boys reporting shifts in roles related to food preparation, production and procurement within the household Percentage of boys and girls benefiting from school feeding programmes who score results in the 75th percentile Percentage decrease in absenteeism among children benefiting from school feeding programme Percentage of women and girls who report that they feel more safe and secure due to new alternative cooking technologies Who is responsible for collecting cooking fuel. Acquisition and access to fuel and water are no longer threats to the safety of women and girls. Women and girls report their satisfaction with the access process and outreach methods Consult women, girls, men and boys about times, frequency and locations of food/input distributions, workshops and employment. Awareness-raising sessions are attended by large numbers of male members of the community.

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Metachronous primaries Staging Previous treatment of the organ Histology codes for staging Cancers of Unknown Primary Site There is no evidence of a primary tumor, but the anatomic site is suspected. Component of T0 T0 Description T0 is assigned if there is clinical suspicion of a primary tumor, with evidence of regional or distant metastases, but there is: no evidence of a primary tumor, or the site of the primary tumor remains unknown. It may reflect the extent to which a tumor resembles the normal tissue at that site. Grade may provide important information on the risk of cancer metastasis and prognosis. Component of grade Histologic grade stratification Description Historically, stratification of solid tumors has sometimes included an assessment of the overall histologic differentiation of the cancer. The most common grading schema uses numeric grades from the most or well differentiated (grade 1) to the least differentiated (grade 3 or 4). This system is still used in some cancer types, although site-specific grading systems are used more commonly. The recommended grading system for each cancer type is specified in each chapter and is the grading system to be used by the pathologist and documented in the cancer registry. For many cancer types, more precise and reproducible grading systems have been developed beyond the standard systems, and these may incorporate more specific and objective criteria based on single or multiple characteristics of the cancers. These factors include nuclear grade, number of mitoses identified microscopically (mitotic count), and measures of histologic differentiation. For some cancer types, these systems have been fully validated and largely implemented worldwide. Examples include the Gleason scoring system and the grade grouping for prostate cancer and the Scarff­Bloom­Richardson (Nottingham) grading system for breast cancer. If there is evidence of more than one grade or level of differentiation of the tumor, the highest grade is recorded, assuming that the recommended grading system was used for both biopsy and resection. The cancer registry must record the grade as specified in the disease site chapter, according to the rules only in this chapter and the disease site chapter. This coding convention has been developed and implemented for use in the 8th Edition for appropriate disease sites. Disease site­specific histologic grade stratification Residual Tumor and Surgical Margins the absence or presence of residual tumor after treatment is described by the symbol R (capital R). However, the absence or presence of residual tumor and status of the margins may provide important information that affects subsequent treatment and prognosis and may be recorded in the medical record and cancer registry. The absence or presence of residual tumor at the primary tumor site after treatment is denoted by the symbol R. Indications of residual tumor the presence of residual tumor may: indicate the effect of therapy influence further therapy be a strong predictor of prognosis Indicator of risk the presence or absence of disease at the margin of resection may be a predictor of the risk of recurrent cancer. The presence of residual disease or positive margins may be more likely with more advanced T- or N-category tumors. Margin status following tumor Margin status after tumor resection resection is based on the pathology report (and correlation with the operative report if necessary) and should be recorded by using the following categories: negative margins (tumor not present at the surgical margin) microscopic positive margin (tumor not identified gvrossly at the margin, but present microscopically at the margin). For rare sites, definitions of margin positivity may vary, and relevant interpretation is specified in the respective chapter. Additional information on reporting the response to therapy for some specific cancer types is provided in the respective disease site chapters. Component of response to therapy Response to neoadjuvant therapy Description It is important to record the response to neoadjuvant therapy. For example, some disease sites include "complete, " "partial, " and "no response, " whereas others consist of a numeric scoring system or a "regression score. Histologic confirmation of residual cancer requires identification of non-necrotic tumor cells. Mucin pools, necrosis, or degenerative and reactive changes without viableappearing tumor cells are insufficient for a diagnosis of residual cancer. Mucin pools, necrosis and reactive changes not included in the assessment of residual cancer.

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Seresevskij [3] presented a 25-year-old woman who was the youngest of seven siblings. She was different from all the other siblings by always having been of shorter stature. She had consulted a physician about this problem many 11 times, but was repeatedly told that she would start growing once she started menstruating. Physical examination at the age of 20 revealed a girl 132 cm tall (expected mean height being 158 cm), with a low nuchal hair level, micrognathia, a high arched palate, short neck, and pterygium colli. Axillary or pubic hair growth was lacking and the papillae mammae were introverted and no mammae developed. The German pediatrician Otto Ullrich (1894-1957), Figure 2, [2] was considered one of the fathers of medical genetics in pediatrics. In 1930, at a meeting of the Munich Pediatric Society, Ullrich presented an eight-year-old girl with webbed neck, stunted stature, cubitus valgus and an unusual facial appearance. He attributed all these clinical features to a primary defect in the anterior pituitary gland. Glatzl, who restudied the very same patient, then 66 years of age, demonstrated that her chromosomal constitution was 45, X. An area called "the pseudoautosomal region" has been shown to escape X inactivation. It is essential for the development of the skeleton and is found predominantly in bone fibroblasts. Moreover, a prolonged cell cycle time was shown, both for 45, X and trisomy 21 cells, leading to a slower growth rate and growth retardation of the fetuses [20-23]. So, if the up-regulation to the required cell cycle rate fails, the number of cell cleavages drops and, due to the smaller number of cells, the size of that organ is reduced or the skeletal bones become shorter. In the worst-case scenario, the organ does not reach its final architecture, leaving a cleft palate or a cardiac defect. According to studies, cubitus valgus is seen in 45%, a low posterior hairline in about 40%, and short metacarpals and high arched palate in 35% [4, 24]. It is usually an isolated abnormality but may unfortunately be found in combination with other anomalies such as aortic coarctation, Figure 7. Bicuspid aortic valve to the left and coarctatio aortae and collaterals to the right. Aortic root dilatation is the main cause, with a prevalence of approximately 8 to 42% [27, 31, 33, 34]. Whether the reduction in bone mass or bone density is secondary to poor mineralization or a consequence of a delay in skeletal maturation is not fully understood. One third of girls and women exhibit a minor anomaly of the 20 auricular, which is smaller and often posteriorly rotated. It is estimated that women with a 45, X karyotype suffer presbyacusis 10-20 years earlier than the population as a whole [45]. Hypothyroidism affects growth development negatively, especially the spurt phase, and is also thought to increase the risk of coronary artery disease due to concomitant hypercholesterolemia [52, 53]. A causal relationship between aberrations of the X chromosome and the risk of autoimmune hypothyroidism was also proposed [54-56]. A small number with ring or marker X chromosomes may have mental retardation [61]. This high mortality can be expected, primarily due to the cardiovascular complications [64], and especially in those with 45, X [65]. Short stature and ovarian failure are important characteristic features [6], but there is a broad phenotypic spectrum with less severely affected patients, especially in the mosaic karyotype. Courtesy of Professor Kerstin Albertsson-Wikland - Prenatal period Sex chromosome abnormalities are increasingly detected prenatally through chorionic villous sampling and amniocentesis. As postnatal outcome could not be ascertained with prenatal chromosome analyses, especially in mosaic cases, reevaluation is mandatory [74]. Therefore, physicians and geneticians should familiarize themselves with this controversy before informing parents, as recent reports show that fetuses diagnosed prenatally are electively aborted [74]. Swollen hands and feet are mostly noticed, but a nuchal hygroma may also be present. Physicians should be observant of other congenital anomalies as well; in particular, cardiac and renal conditions.

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Interdigitating dendritic cell tumors in two patients exposed to topical calcineurin inhibitors. Interdigitating dendritic cell sarcoma involving bone marrow in a liver transplant recipient. Malignant fibrous histiocytoma and fibrosarcoma of bone: a re-assessment in the light of currently employed morphological, immunohistochemical and molecular approaches. Interdigitating dendritic cell sarcoma presenting simultaneously with acute myelomonocytic leukemia: report of a rare case and literature review. Metastatic interdigitating dendritic cell sarcoma masquerading as a skin primary tumor: a case report and review of the literature. Immunoelectron microscopic identification of Langerhans cells using a new antigenic marker. Cultured human Langerhans cells resemble lymphoid dendritic cells in phenotype and function. Human epidermal Langerhans cells undergo profound morphologic and phenotypical changes during in vitro culture. Solitary cutaneous dendritic cell tumor in a child: role of dendritic cell markers for the diagnosis of skin Langerhans cell histiocytosis. Long-lasting "Christmas tree rash" in an adolescent: isotopic response of indeterminate cell histiocytosis in pityriasis rosea? An unusual histiocytic proliferation in a patient with persistent non-Hodgkin lymphoma and terminal acute monocytic leukemia. Cutaneous indeterminate cell histiocytosis: a new spindle cell variant resembling dendritic cell sarcoma. Indeterminate cell histiocytosis-a clinicopathological entity with features of both X- and non-X histiocytosis. Indeterminate cell histiocytosis in as- sociation with later occurrence of acute myeloblastic leukaemia. Association between mediastinal germ cell tumors and hematologic malignancies: an update. Extranodal histiocytic sarcoma: clinicopathologic analysis of 14 cases of a rare epithelioid malignancy. Histiocytic sarcoma transdifferentiated from follicular lymphoma presenting as a cutaneous tumor. Reticulum cell neoplasms of lymph nodes: a clinicopathologic study of 11 cases with recognition of a new subtype derived from fibroblastic reticular cells. The nonlymphoid microenvironment of reactive follicles and lymphomas of follicular origin as defined by immunohistology on paraffin-embedded tissues. Fibroblastic reticular cell tumor of the spleen: report of a case and review of the entity. Cutaneous disseminated xanthogranuloma in an adult: case report and review of the literature. Juvenile xanthogranuloma in childhood and adolescence: a clinicopathologic study of 129 patients from the kiel pediatric tumor registry. Multi-modality imaging findings of disseminated juvenile xanthogranuloma with renal involvement in an infant. In tumors of the palate, sinuses, and face, this "perineural" spread usually involves the maxillary division of the trigeminal nerve. Perineural extension is possibly the most insidious form of tumor spread of head and neck malignancy. After invading a nerve, tumor follows the sheath to reach the deeper connections of the nerve, escaping the area of a planned resection. Thus, detection of this form of extension is important in treatment planning and estimation of prognosis. Here the nerve branches send communications to the palate, sinus, nasal cavity, and face. Obliteration of this fat is an important indicator of pathology, including perineural tumor spread. Other signs of perineural extension include enlargement of foramina, increased enhancement in the region of Meckel cave (gasserian ganglion), and atrophy of the muscles innervated by the trigeminal nerve. Adenoid cystic carcinoma is associated with perineural extension most often, but other cell types may exhibit similar behavior.

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Pre-exiStinG ConditionS loss caused by a pre-existing condition is not covered unless such loss begins after 24 months from the policy issue date. Received medical advice or treatment within 24 months before the policy issue date; or 2. Shambaugh Cancer Statistics Branch, National Cancer Institute Assisted by Self-Instructional Manual Committee: Constance Percy Cancer Statistics Branch, National Cancer Institute Dr. Kruse Bethesda, Maryland Louisiana Regional Medical Program under the direction of C. C-Some Characteristics D-Diagnostic E-Derivation of Cancer of Cancer Descriptions of Cells and Tissues Section F-Classification Section G-Selection Glossary of Terms Selected Index Bibliography of Tissues and Neoplasms of Cases and Identification. At the end of these two blocks of instruction, you should be able to answer some of the general questions about the tissue composition of sarcomas and carcinomas. Also, you should be able to look at some of the names for common types of cancer and list the type of cancerous tissue associated with each name. In Section G you will learn the how to identify and code the diagnostic terms used to describe the morphology 1 and behavior of neoplasms. Many of these words you have encountered already, and you may feel that you know the definitions for most of them. Even so, it would be a good idea for you to review this material, especially since it contains general information about cancer and tumor registries. Cancer is the name commonly used for what your doctor would call a malignant 1 tumor. If you were to look at sections of the body through a microscope, you would see that all of the sections are made up of tiny units called cells. Each organ, such as liver, heart, lungs, and stomach, is constructed of different types of these cells, arranged in different ways. As your body grows, ages, and is put to different uses, its parts change in size and shape. A muscle that is not used becomes smaller (atrophies); its cells do not divide as actively. In most parts of the body, the cells continually divide and form new ones, to supply the material for growth or to replace worn-out or injured cells. When you cut your finger, for instance, the cells divide rapidly until the tissue is healed and the skin is repaired; and then they go back to their normal rate of division. Sometimes these tumors remain in the part of the body in which they start, often growing quite large and pressing on neighboring structures but not spreading to other parts of the body. Frequently, they are completely enclosed in a protective sheath or envelope of tissue. They destroy the part of the body in which they originate and they spread to other parts where they start new growth and cause new destruction. It is this spread of cancer (metastasis) to vital organs that generally kills the patient. In the beginning, any tumor, benign or malignant, can usually be removed from the body by surgery or destroyed by x-ray or other radiation therapy (when amenable to such treatment). However, the untreated malignant tumor, even in a non-vital part of the body, eventually will kill the cancer patient because it will metastasize to other organs. The important thing to remember is that most malignant tumors begin in the same way as benign tumors-as a local growth. The term neoplasm means "new growth" (neo = new; plasm = protoplasm, the essential material of plant and animal cells). In practice, however, the terms tumor and neoplasm often are used interchangeably. Table of Contents Manuals Tumors arise because of the uncontrolled growth or multiplication of cells. There are two general types of tumors: benign (non-cancerous) tumors and malignant (cancerous) tumors.

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Commonwealth Secretariat and Healthlink Worldwide 23 Worksheet 1: "Tendai" (substitute appropriate gender-neutral name) Tendai is 10 years old. Puberty: My Body, My Self 2. Ask participants to discuss the answers to the questions and record them on their worksheet. Ensure that there is at least one literate person in each group to take responsibility for this task. Bring the groups back together and have them report their answer to each question. Discuss what different assumptions are made when Tendai is male or female, and explore why we make these assumptions. Stress the Following All cultures have traditional roles assigned to women and men. These are based on social expectations, not on the natural abilities of women and men. For girls and boys to grow into healthy women and men, we must look at these traditional roles and expectations, and change some of them so that we can work together as equals in improving our lives and the lives of our communities. Many traditional female and male roles exist regarding sex and sexuality, and we will continue to explore these ideas as we work together in this program. Puberty: My Body, My Self Step 7 Talking about Puberty Pair Exercise (20 minutes) Divide the group into pairs. If culturally appropriate, encourage them to be creative and encourage girls to act out male roles or boys to act out female roles (in some societies, girls and boys, or participants of different ages, might not be comfortable performing with each other; arrange the pairs the way you think would be most effective). Role-play #1: One person plays the mother (aunt, grandmother); the other plays a 12-year-old girl. The girl is worried because she has not developed breasts, although most of her friends have. The 26 mother (aunt, grandmother) comforts the girl, letting her know that the age when breasts start forming varies and that breast sizes vary. Role-play #2: One person plays a 12-year-old boy; the other plays the older brother. The older brother explains why his voice is cracking and what to say to people when they tease him. One girl teases the other girl because she is taller than all the other girls in the group. The tall girl explains that boys and girls grow at different paces and to different heights. She also explains why she does not like being teased and asks the other girl to be a nicer person. Role-play #4: One person plays a 12-year-old boy; the other plays his father (uncle, grandfather). The boy is worried because he is growing hair under his arms and a little on his face. The father (uncle, grandfather) comforts him and tells him that most boys develop hair in new places as they grow older. The friend is worried because she has not yet started having periods but the 11-year-old girl has. The girl comforts her friend, letting her know that the age when girls start menstruation varies. The boy comforts his friend, letting him know that the age when boys start the physical changes of puberty varies. The father tries to talk to his son about relationships, sex and reproductive health. To help you prepare gather several young people and ask them the following questions: Who do youth talk to about puberty? Use this information to create or adjust the role plays to make the session more relevant to participants. Puberty: My Body, My Self Step 8 Take-Home Messages (15 minutes) Close the session by stressing the following: All of these physical, emotional, and relationship changes are natural. It is important not to tease or make fun of others who may develop earlier or later.


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