Langerhans Cell Histiocytosis

Langerhans Cell Histiocytosis Langerhans cell histiocytosis (LCH or histiocytosis X) is the most common form of dendritic cell type of histiocytic disorders. LCH can be divided into three groups on the basis of the number of lesions and systems involved: the unifocal (localized) form, presents between 5 and 15 years of age, in approxi ­mately 70% of LCH cases, limited to a single bone or a few bones, and may involve the lung. Multiple bones as well as the reticuloendothelial system (i.e., the liver, spleen, lymph nodes, and skin) involvement and diabetes insipidus are seen in multifocal unisystem (chronic re ­curring) form which constitutes approximately 20% of cases. Typi ­cally seen between 1 to 5 years of age. The fatal form is the multifocal multisystem (fulminant) form comprising ap ­proximately 10% of LCH cases. Seen in the first 2 years of life and it disseminately involves the reticuloendothelial system, anemia, and thrombocytopenia. Eosinophilic granuloma, Hand-Schà ¼ller-Christian disease, and Letterer-Siwe disease are older names used when these were thought to be different diseases; these names should now be discouraged. Langerhans cell histiocytosis is characterised by uncontrolled monoclonal proliferation of abnormal Langerhans cells, which can infiltrate ubiquitously all the tissues or organs as well as lymph nodes. The histiocytic infiltration is followed by chronic inflammation and the formation of granulomas. Uncontrolled immune response activation is the most likely etiology by an as yet unknown antigen. Bone lesions are seen in approxi ­mately 80% of LCH patients. LCH has a predilection to involve the flat bones with skull being the most common flat bone involved, followed by the mandible, ribs, pelvis, and spine. Skull lesions can be either asymptom ­atic or manifest with focal pain and soft-tissue swelling in the scalp. â€Å"Punched-out† lytic lesions are seen in skull lesions seen on radiographs with asymmetric destruc ­tion of the inner and outer cortices, which results in a characteristic bevelled edge. Mastoid bone is the classical location when temporal bone is affected. Calvarial disease lacks periosteal reaction unlike other bone lesions. The term geographic skull is used when skull lesions grow in size and coalesce, creating a map like appearance. Vertebra plana (symmetric flattening of vertebral body) is seen with involvement of spine. Diaphyseal or metaphyseal involvement seen in long bones. â€Å"Floating teeth† is seen if there is enough alveolar d estruction. Other findings include hepatomegaly with solid or cystic lesions in liver. Lymphadenopathy with cervical predominance. MRI brain will reveal absence of posterior pituitary bright spot, and thickening of pituitary stalk if there is CNS involvement. Lung involvement shows centrilobular nodules or cysts of varying sizes, with mid- to upper-lung distribution and spar ­ing of costophrenic angles. Meyer et al conducted a study in 1995 in Philadelphia on 42 patients. 83% of the patients had at least one affected bone. All children with lesions of the skull base (Fig 1 ) and seven of eight with facial lesions (Fig 2) had bone destruction with associated soft-tissue masses. Calvaria 13 Intracranial soft tissue 4 Skull base/face 15 According to D’Ambrosio et al 2008, who did study on 100 patients in New York Ninety-six percent of the patients in this series had bone involvement. Fifty-eight of 96 patients (60%) had a solitary bone abnormality, and 38 patients (40%) had multiple lesions. By far, the most common bone involved in the series was the skull, affecting 52 of 96 patients (54%). In particular, the calvarium was affected in 45% of patients. Of the patients with calvarial involvement, the parietal bone was most commonly affected. The maxilla and/or maxillary sinus was affected in 8% of patients in the series. In the study done by Khatami et al 2010 in Iran on 48 patients, 38 of them (79.2%) had bone involvements; skull was involved the most (66.7%), followed by Pelvis (31.3%), Femur (31.3%), Sphenoid (30.0%) and ribs (16.7%), temporal bone in 4.2% Radiation Issue of CT Concerns about carcinogenicity of computed tomography radiation began in the early 2000s. In recent times many examination protocols and software and hardware modifications have been made to reduce CT radiation dose. The definite risk of radiation exposure is not quantified. So, it is better to follow the principle of As Low As Reasonably Achievable (ALARA). This can be achieved by ensuring that the examination is clinically indicated and by keeping the radiation dose to the minimum with the help of technical advances as described below126. Tube current modulation is a very useful tool to control patient exposure with CT examinations. In this technique the scanner will produce less number of x-ray photons in regions of lower attenuation and higher values of tube current in regions of increased attenuation. This is of two types: Angular modulation and z-axis modulation. In angular modulation differences in attenuation in x-y plane is measured with the help of two localisers (lateral and anteroposterior views) and the tube current is modulated accordingly during rotation. In z-axis modulation the attenuation differences along the length of the patient are calculated with a single anteroposterior localiser and the tube current is modulated. The z-axis organ based tube current modulation is as much or more effective than thyroid and eye shields at reducing radiation, without the regional image noise caused by shields. Newer reconstruction technique called iterative reconstruction significantly reduces the patient dose. In this the initial projected image is iteratively compared with the model image of the vendor. Then the algorithm intelligently decreases the noise in the image. There by a noise less image can be obtained even with a low dose CT. But this technique is more time consuming than the conventional filtered back projection technique. With the newer development of hybrid iterative reconstruction which uses both the above techniques, the speed has been considerably increased. Accurate patient centering can also decrease the patient radiation. Other techniques such as optimization of tube potential, beam-shaping filters also make a significant contribution to dose reduction. Newer developments which hold promise to reduce the radiation dose in the future are compressed sensing, volume of interest and interior tomography techniques, and photon-counting detectors127-136. Low dose MDCT of PNS can be done by reducing the mAs. This is the most effective way of reducing patient exposure. The effective dose delivered by a standard dose MDCT protocol is 0.70 mSv in men and 0.76 mSv in women, whereas the effective dose delivered by a low dose MDCT protocol is 0.047 mSv in men and 0.051 mSv in women which is equivalent to standard four view radiography of PNS. Low dose CT can be used for the follow up of patients with chronic sinusitis and in tumors where the presence of soft tissue mass or bone destruction is used for follow up18.

Why I Deserve a Scholarship

I believe that I deserve a Big33 Scholarship for several reasons. My high attendance, academic achievement, determination, time management, financial need, motivation for college and to achieve better are all reasons I will discuss of why I believe I deserve a scholarship. The first reason is because I am very diligent in my studies and attend my classes every day. In my entire schooling career I missed very minimal amounts of school. I have obtained perfect attendance in grades 9th, 11th, and am working on 12th grade. In my 10th grade year I only missed one day of school. I have also had high honor roll every year in high school and plan to continue it throughout college. Another reason is I am very determined when it comes to both work and school. I take both of these aspects very seriously and when I’m given an assignment or task, I feel very obligated to not only complete it, but do so both correctly and in a timely manner. Also I am very good at managing many things at one time. For example, in my sophomore and junior year in high school I managed school, homework, church volunteer work, practicing the piano and attending my lessons and performances, babysitting (about 40 hours per week on the weekends, overnight) family and church activities and spending time with my friends, family and boyfriend. In my senior year I am managing school, homework, work, college and scholarship applications, practicing the piano and attending my lessons and performances, babysitting my nephew about one night per week, family activities, church events, student government events, and spending as much time as I can find with my friends, family, and boyfriend. Also, with just working a minimum wage job, I do not have enough money to go to college on my own funds. I am putting away a little bit of money from each pay check since I started my job but this, though it does add up and will help greatly is not going to be enough to cover my total of six years of schooling that is required to reach the position that I desire. My main motivation for going to college is to get ahead of the society. I want to make something of myself instead of being like so many Americans today and not having enough education to stay employed in the jobs that are bombing and have a high potential for growth. Nursing greatly interested me because I enjoy working with people and like to make their day better in any way I can. I absolutely love infants and that is why I want to continue my education until I reach a level of a Neonatal nurse. I want to obtain a job that I love to go to everyday. The quote by Confucius â€Å"Choose a job you love and you’ll never have to work a day in your life† is a huge motivation to me. That is why I chose nursing as my major, so I would get to work with infants, my favorite thing to do. These are a few reasons of why I believe that I deserve a scholarship from Big33 so that I can continue my education from high school and attend college.

Grossberg And Hartog Reaction Paper - 1071 Words

Grossberg and Hartog Reaction Paper Asha McWilliams In A Judgement for Solomon: The d’Hauteville Case and Legal Experience in Antebellum America, Grossberg outlines the complex legal experiences of the d’Hauteville family and the effect their experiences have on Antebellum America. On August 22, 1837, Ellen Sears and Paul Daniel Gonzalve Grand d’Hauteville were married and moved to Switzerland. In the winter of 1838, Ellen became pregnant and pleaded with Gonzalve to let her return to America to give birth to her child. After much pleading, Gonzalve gave in and let Ellen leave; however, after giving birth, Ellen refused to return to Switzerland, citing cruel treatment from Gonzalve as her reason for staying away. Eventually Ellen†¦show more content†¦Furthermore, they gave legitimacy to Ellen’s claims of mental cruelty. Yet, the court couldn’t give Ellen â€Å"unrestrained maternal power,† so the ruling pertained only to the â€Å"present custody of the child.† This meant that Gonzalve could bring the case again, whenever he so chose. The public reaction was largely divided, with regional and social divisions becoming apparent. The press verdict was far from unanimous, with newspapers in various regions espousing far different ideas. While a Philadelphia paper praised the idea of the discretionary power of judges in protecting the welfare of children, papers in New York and Boston continued to promote the idea of paternal power. Thus, an apparent shift in public opinion was underway. The emergence of divisive new ideas indicated the progressive movement towards greater maternal rights. This drastic change in public opinion can be best understood by analyzing the case of Abigail and Asa Bailey. In 1792, Abigail Bailey was quickly granted a divorce from Asa Bailey. However, Abigail waited twenty-two years to file this petition for divorce, as Asa, first had an affair just three years after their marriage in 1770. It is interesting to compare Abigailâ€℠¢s case to Ellen’s because in both cases, each woman repeatedly cites her hesitation to take legal action because of what she believes to be her duty to her husband. However, what is considered cruel enough to justify breaking

Horror Films And Gothic Horrors - 2537 Words

HORROR FILMS In this paper, I will be discussing reviews on horror films and gothic horrors using the movie mama as my main example. My aim is to analyse the horror genre and the emotional effects it has on different people. My objectives are to identify and analyse the generic elements of the horror genre, gather people’s opinions about the horror genre and to find out the reasons for these opinions. To aid my research, I have prepared and shared out questionnaires with open and closed ended questions to gather people’s opinions. I have also held focus groups. During the twentieth century, definitions of gothic books and films have broadened and changed significantly almost beyond original recognition. However, one of the reasons for the gothics continued popularity is its ability to change and recreate itself. There are some key elements that characterise twentieth-century gothic, one of them would be that in the early part of the century, the manner in which the real-life horror of two world wars takes over from the imagined horrors of the super natural and superstitious. Tortured individuals who in the nineteenth century refused to play dead began to do so on a massive scale during and after the First World War Armitt (2011) The horror genre really has no clearly defined boundaries and so displays characteristics associated with science fiction, fantasy, adventure and sometimes even thriller. The genre isShow MoreRelatedEvolution of Horror Essays1497 Words   |  6 Pages2013 The Evolution of Horror For centuries, stories of monsters, demons and other unholy abominations have brought fear to the hearts of audiences in commercially convenient doses. 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