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In small doses it will be found to exert a beneficial influence in conjunctivitis buy gasex 100caps mastercard gastritis diet , and even in chronic disease of the eye itself 100caps gasex amex treating gastritis without drugs. It is also a good remedy in catarrhal disease of mucous membranes cheap gasex 100caps otc gastritis diet kencing, both of the respiratory apparatus, and intestinal canal. It may also be thought of in disease of the ear, especially when associated with disease of the throat. These remedies have not been sufficiently studied; yet, possessing active properties, they are likely to prove valuable. The Euphorbia Corollata exercises a direct influence upon the mucous surfaces, relieving irritation, and promoting functional activity. In quite small doses it improves digestion, both stomachic and intestinal, and tends to overcome constipation and irregularity of the bowels. It may be employed with advantage in some forms of diarrhœa and dysentery, using it in the place of Ipecac. To arrest inflammatory action in the intestinal canal, seems to be its specific use. Honingberger, who gave the herb in doses of 1-25 of a grain, in hemiplegia, obscurity of vision, spermatorrhœa, and yellowness of the cornea. The first is iron by hydrogen, or Quevenne’s; a good article may be known by its iron-gray color and its effervescing with acids; the spurious is black, and effervesces but slightly. It will be a clear, deep-colored tincture, without a trace of yellowness or deposit at the bottom of the bottle. It is a component part of the red corpuscles, and experience has shown that its administration stimulates the formation of these bodies. In proportion as the red corpuscles are increased, blood-making becomes more active and nutrition is improved. It thus becomes a very important remedy in cases of anæmia, with impaired nutrition. As a restorative, it is better to administer the necessary quantity of iron with the food. Experiment has demonstrated that at other times it is appropriated slowly or not at all. It does not require a very large amount to accomplish the object, for iron exists in small quantity in the body. In the selection of the preparation I would be guided by the appearance of the mucous membrane. The reader has probably employed the tincture of chloride in erysipelas, and many regard it as a true specific in the disease, rarely making any other prescription. I think we may say, that in all cases of erysipelas presenting the deep-red discoloration of mucous membranes, with the same deep color of the local disease, the tincture may be prescribed with great confidence. But my experience with the disease has shown me that where the mucous membranes are pallid, the coating of the tongue white and pasty, the sulphite of soda is the best remedy. Rademacher claimed that iron was specific to one of his three epidemic constitutions. This was characterized by pallor of the skin, moderate heat, with a small, thin or soft, empty pulse. His description, so far as I have seen it in translation, is so meager that we can hardly determine the condition in which he valued it so highly, even treating all the cases of pneumonia in a season with iron alone. The preparation of iron employed by the school of Rademacher was a tincture of the acetate, prepared by the following formula: “Take of pure sulphate of iron two ounces and seven drachms; of the pure acetate of lead three ounces: triturate them together in an iron mortar so long as may be needed to reduce them to a soft conformable mass; then put the mass in an iron vessel with six ounces of distilled water and twelve ounces of diluted acetic acid; heat the mixture until it boils. The older the mixture is the pleasanter the smell and taste, and hence it is desirable to make it in large quantities. Recent investigation has shown that the solid blue coloration of tongue is an indication for small doses of iron in any disease. The majority of our readers are well acquainted with the use of tincture of muriate of iron in erysipelas, and have administered it in this disease with a certainty that they rarely feel with regard to other remedies. I don’t think any one, even the most skeptical in regard to specific medication, will question the specific action of this remedy in many cases of this disease. And as it is such a well known example, we will use it to illustrate certain facts in therapeutics. The first proposition I will make is, that it is not specific to all cases of erysipelas. Whilst in many, embracing some of the severest, it is the only remedy needed, in others you might quite as well give water, other than the iron proves a topical irritant. We ask the question, then, in what condition of this disease is it specific, and what are the symptoms indicating its use? Or, in what conditions is it contra-indicated, and what are the evidences that show this? It is easier to pick out the case where other treatment would be preferable, and where we would not use the iron. Take again the case presenting the broad, pallid tongue, with moist, pasty coat, and I would very certainly prefer sulphite of soda; or if it were a moist, dirty tongue, without so much pallor, sulphurous acid. I think it will be if we examine those cases carefully in which iron is the remedy. One of the most pronounced symptoms that I have noticed is a peculiar solid blue color of mucous membranes, sometimes deepening into purple where there is a free circulation. In several cases, other than erysipelas, I have been tempted to prescribe tincture of muriate of iron from this symptom, and with good results. Take a case of erysipelas of the severest type, in which iron is the remedy - what are the results of its administration alone? The pulse is 120 to 130, small and hard; within forty-eight hours it comes down to 80, and is soft and open. The skin is dry and harsh, the urine scanty and high colored, the bowels constipated; in forty eight hours the skin is soft and moist, the urine free, the bowels act without medicine. The nervous system is in a state of extreme irritation, possibly the patient is delirious; in forty-eight hours the patient is conscious and the suffering relieved. Here we have the most marked effect of a sedative, diaphoretic, diuretic, laxative and cerebro-spinant, and yet we have given but the one remedy, tincture of muriate of iron. Yet tincture of muriate of iron is not regarded as an antiseptic, and we have a number of cases of erysipelas, in which iron does not antagonize the blood poison. This remedy has been but little used, and that little has been of the dried root as a tonic. The recent root possesses quite active properties, and is likely to repay investigation. It is stimulant to the circulation, and will doubtless exert the same influence upon all the vegetative functions. The first, for its influence in skin diseases, especially of an herpetic character, and as a general alterative. The second, to improve secretion, and for its influence upon the chylopoietic viscera.

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Plate 26 is a urinary sediment viewed under Answers to Questions 26–30 400× magnification using a brightfield microscope gasex 100 caps with mastercard gastritis diet . Coarse and fine granular casts have the same significance as cellular casts and point to glomerular Body fluids/Identify microscopic morphology/Urine damage purchase gasex without a prescription gastritis zeludac. Plate 27 shows a urinary sediment viewed under colorless uniform six-sided hexagonal plates in 400× magnification using brightfield microscopy cheap gasex 100caps on line gastritis diet . Calcium phosphate crystals form Tis colorless crystal is presumptively identified as: in neutral to alkaline urine and appear as thin A. Hippuric acid Hippuric acid crystals form long six-sided prisms in Body fluids/Identify microscopic morphology/Urine acid urine. Cystine crystals must be differentiated sediment/2 from uric acid on the basis of solubility, polarized 28. Mesothelial cell small numbers in normal pleural, pericardial, and Body fluids/Identify microscopic morphology/Pleural ascites fluids. They are often seen in increased fluid/2 numbers when there is an inflammatory injury involving the serous membranes. Plate 29 is a Wright’s-stained smear of pleural mononuclear or binucleate cells with an open fluid prepared by cytocentrifugation. Te largest chromatin pattern and abundant agranular cell in this field (see arrow) is identified as a: cytoplasm. Metastatic cell from the breast Body fluids/Identify microscopic morphology/Pleural 29. Plate 30 is from a Wright’s-stained peripheral of the nucleus against the cell wall, usually caused by blood film, 1,000×. Which of the following best large vacuoles that form after phagocytosis of describes the cells in this plate? Plate 31 is a Wright’s-stained peripheral blood Answers to Questions 31–35 film, 1,000×. Plate 32 is a Wright’s-stained peripheral blood deficiency, hypothyroidism, and alcoholism. Reactive (atypical) lymphocytes count is increased (usually 15–25 × 103/μL), and B. Te M4 subtype of acute granulocytic leukemia Reactive lymphocytes are larger than normal. Intravascular hemolytic anemia the leukemoid response (and leukoerythroblastosis) B. Plate 35 is from a Wright’s-stained peripheral the Philadelphia (Ph1) chromosome in their blood film, 1,000×. Microcytic, hypochromic with marked cells (leptocytes), and well-defined sickle cells poikilocytosis and increased platelets (drepanocytes) characteristic of sickle cell disease. Macrocytic, hypochromic with marked Sickle cells are elongated with pointed ends, and anisocytosis and normal platelets the Hgb is concentrated in the center of the cell. Microcytic, hypochromic, with mild anisocytosis are rarely seen in patients with sickle cell trait. On average, when more than 20 platelets are seen per oil immersion field, the platelet count is elevated. Plate 36 is a Wright’s-stained peripheral blood Answers to Questions 36–39 film, 1,000×. Plate 39 is from a Wright’s-stained smear of macrocytic anemia, and autoimmune hemolytic peripheral blood, 1,000× from a patient with 9 anemia is usually normocytic, normochromic. Flow cytometry indicates Hematology/Evaluate clinical and laboratory data/ these cells to be B cells in approximately 95% of Leukemia/3 cases. The bone marrow in Waldenström’s macroglobulinemia is infiltrated by plasmacytoid lymphocytes, plasma cells, and mast cells, as well as small lymphocytes; however, a severe peripheral lymphocytosis is not seen. The lymphocyte count is usually 15–25 × 109/L, but the cells are atypical, being characterized by reactive features. Plate 40 is from a Wright’s-stained peripheral Answers to Questions 40–43 blood film, 400×. Hemolytic hospitalized with tachycardia, a rapidly anemias are often normocytic, normochromic. Plate 41 is from a patient’s ethnic background, clinical findings, and Wright’s-stained smear of his peripheral blood, sulfonamide therapy point to a hemolytic episode 1,000×. Which surrounded by a clear perinuclear area that of the following conditions is most likely to be represents the Golgi apparatus. A Blasts are usually 15–20 μ in diameter with a large nucleus containing fine chromatin. Lymphoblasts are differentiated from myeloblasts by cytochemical staining and flow cytometry. Lymphoblasts often display irregular clumping of the chromatin and azurophilic granules. Plate 44 is a Wright’s-stained peripheral blood Answers to Questions 44–47 film, 1,000×. Te white blood cells in this field are negative for peroxidase, chloroacetate esterase, 44. On characteristic of the L1 subtype of acute lymphocytic the basis of these findings, what is the most leukemia. Lymphoblasts with L3 morphology are large and irregular in size and often contain one D. These are characteristics of esterase (specific esterase), and 70% are positive monoblasts. M1 is myeloblastic leukemia without for α-naphthyl acetate esterase (nonspecific maturation. A The control slide shows peroxidase staining of the as plate 46 after peroxidase staining, 1000×. The cytoplasm peripheral blood film, 1,000×, which is used of the blast in plate 47A is strongly positive for as a control. Te blast cell shown in plate 47A is peroxidase, indicating that it is a myeloblast. M5 may be weakly positive, Hematology/Identify microscopic morphology/Special and myeloblasts in M6 are positive. Lymphoblasts, stains/3 hairy cells, erythroid cells, megakaryocytes, and platelets are negative. Plate 48 is from a Wright’s-stained peripheral Answers to Questions 48–52 blood film, 1,000×. Plate 49 is a Wright’s-stained peripheral blood round nucleus that is smaller, the chromatin is more film, 1,000×. Döhle bodies and magnification stained with Sternheimer–Malbin vacuolated neutrophils may be seen in association stain. Transitional epithelial cell and stain reddish pink with Sternheimer–Malbin Body fluids/Identify microscopic morphology/Urine stain. Transitional epithelial cells stain a pale blue, and sediment/2 have far less abundant cytoplasm.