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Book Details
Abstract
Underwood’s Pathology (formerly General and Systematic Pathology) is an internationally popular and highly acclaimed textbook, written and designed principally for students of medicine and the related health sciences. Pathology is presented in the context of modern cellular and molecular biology and contemporary clinical practice. After a clear introduction to basic principles, it provides comprehensive coverage of disease mechanisms and the pathology of specific disorders ordered by body system. An unrivalled collection of clinical photographs, histopathology images and graphics complement the clear, concise text.
For this sixth edition, the entire book has been revised and updated. Well liked features to assist problem-based learning – including body diagrams annotated with signs, symptoms and diseases and a separate index of common clinical problems – have been retained and refereshed.
Additional value is provided by the complementary online version – hosted on studentconsult.com - which includes the complete, fully searchable text, downloadable images, clinical case studies and a revised, interactive self-assessment section to check your understanding and aid exam preparation. This all combines to make Underwood’s an unsurpassed learning package in this fascinating and most central medical specialty.
- Contents perfectly matches needs of medical students.
- Very clinical approach is ideally suited to integrated courses.
- Each organ system chapter begins with a brief review of normal structure and function, emphasizing aspects that are important to an understanding of the subsequently discussed disease processes.
- Offers an unrivalled superb collection of clinical photographs, histopathology images, and graphics, approximately 700 in all, that richly depict the appearance of both healthy and diseased tissues.
- Extensive International Advisory Board validates contents.
- New co-editor, Dr Simon Cross.
- Structure of chapters revised to make the book much easier to use during courses that are problem- or case-based.
- Several new contributors and re-written chapters.
- Expanded International Advisory Board.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| Underwood's Pathology: a Clinical Approach | i | ||
| Copyright page | iv | ||
| Table of Contents | v | ||
| Preface | vi | ||
| Acknowledgements | vii | ||
| International Advisers | viii | ||
| Contributors | ix | ||
| Index of Patient Symptoms | x | ||
| 1 Basic Pathology | 1 | ||
| 1 What is pathology? | 3 | ||
| History of pathology | 4 | ||
| Morbid anatomy | 4 | ||
| Microscopic and cellular pathology | 4 | ||
| Molecular pathology | 5 | ||
| Cellular and molecular alterations in disease | 5 | ||
| Scope of pathology | 5 | ||
| Clinical pathology | 5 | ||
| Subdivisions of clinical pathology | 5 | ||
| Techniques of pathology | 5 | ||
| Gross pathology | 5 | ||
| Light microscopy | 6 | ||
| Histochemistry | 7 | ||
| Immunohistochemistry and immunofluorescence | 7 | ||
| Electron microscopy | 7 | ||
| Biochemical techniques | 7 | ||
| Haematological techniques | 7 | ||
| Cell cultures | 7 | ||
| Medical microbiology | 7 | ||
| Molecular pathology | 7 | ||
| Learning pathology | 7 | ||
| Disease mechanisms | 7 | ||
| Systematic pathology | 7 | ||
| Building knowledge and understanding | 8 | ||
| Pathology in the problem-oriented integrated medical curriculum | 8 | ||
| The problem-oriented approach | 8 | ||
| The disease-oriented approach | 9 | ||
| Making diagnoses | 9 | ||
| Diagnostic pathology | 9 | ||
| Autopsies | 9 | ||
| Pathology and populations | 9 | ||
| Causes and agents of disease | 9 | ||
| The health of a nation | 9 | ||
| Preventing disability and premature death | 10 | ||
| Further reading | 10 | ||
| 2 What is disease? | 11 | ||
| What is disease? | 12 | ||
| Limits of normality | 12 | ||
| Responses to the environment | 12 | ||
| Adaptation | 12 | ||
| Disease: failure of adaptation | 12 | ||
| Darwinian medicine | 12 | ||
| Ageing and adaptation | 12 | ||
| Disease predisposition as an adaptive advantage | 13 | ||
| Characteristics of disease | 13 | ||
| Aetiology | 13 | ||
| Identification of the causes of disease | 13 | ||
| Probability of disease | 13 | ||
| Host predisposition to disease | 14 | ||
| Causes and agents of disease | 15 | ||
| Causal associations | 15 | ||
| Koch’s postulates | 16 | ||
| Pathogenesis | 16 | ||
| Latent intervals and incubation periods | 16 | ||
| Structural and functional manifestations | 16 | ||
| Structural abnormalities | 16 | ||
| Functional abnormalities | 17 | ||
| What makes patients feel ill? | 17 | ||
| Lesions | 17 | ||
| Pathognomonic abnormalities | 17 | ||
| Complications and sequelae | 17 | ||
| Prognosis | 17 | ||
| Remission and relapse | 18 | ||
| Morbidity and mortality | 19 | ||
| Disability and disease | 19 | ||
| Nomenclature of disease | 19 | ||
| Primary and secondary | 19 | ||
| Acute and chronic | 19 | ||
| Benign and malignant | 19 | ||
| Prefixes | 20 | ||
| Suffixes | 20 | ||
| Eponymous names | 20 | ||
| Syndromes | 20 | ||
| Numerical disease coding systems | 20 | ||
| Principles of disease classification | 20 | ||
| General classification of disease | 20 | ||
| Congenital diseases | 21 | ||
| Fetal origins of adult disease | 22 | ||
| Acquired diseases | 22 | ||
| Inflammatory diseases | 22 | ||
| Vascular disorders | 22 | ||
| Growth disorders | 22 | ||
| Injury and repair | 22 | ||
| Metabolic and degenerative disorders | 22 | ||
| Iatrogenic diseases | 22 | ||
| Epidemiology | 22 | ||
| Epidemiological clues to the causes of disease | 23 | ||
| Disease incidence, prevalence, remission and mortality rates | 23 | ||
| Geographic variations | 23 | ||
| Historical changes in disease incidence and mortality | 24 | ||
| Socio-economic factors | 25 | ||
| Occupational factors | 25 | ||
| Hospital and community contrasts | 26 | ||
| Age and disease | 26 | ||
| Common causes of mortality and morbidity | 26 | ||
| Further reading | 26 | ||
| 3 What causes disease? | 27 | ||
| Causes of disease | 28 | ||
| Predisposing factors and precursors of disease | 28 | ||
| Prenatal factors | 28 | ||
| Aetiology and age of disease onset | 28 | ||
| Multifactorial aetiology of disease | 29 | ||
| Evidence for genetic and environmental factors | 29 | ||
| Family studies | 29 | ||
| Studies on twins | 29 | ||
| Studies on migrants | 29 | ||
| Association with gene polymorphisms | 30 | ||
| HLA types | 30 | ||
| Blood groups | 31 | ||
| Cytokine genes | 31 | ||
| Gender and disease | 31 | ||
| Racial differences | 31 | ||
| Genetic abnormalities in disease | 32 | ||
| Gene structure and function | 32 | ||
| Nuclear DNA | 32 | ||
| Nuclear genes | 33 | ||
| Gene linkage and recombination | 33 | ||
| Gene transcription and translation | 33 | ||
| Homeobox genes | 33 | ||
| Mitochondrial genes | 34 | ||
| Mitochondria and ageing | 34 | ||
| Techniques for studying genetic disorders | 34 | ||
| Modes of inheritance in families | 34 | ||
| Homozygous and heterozygous states | 34 | ||
| Chromosomal analysis | 35 | ||
| Molecular analysis of genetic disorders | 36 | ||
| Functional and positional genetics | 36 | ||
| Genetic linkages | 36 | ||
| DNA polymorphisms | 36 | ||
| Polymerase chain reaction | 37 | ||
| Diseases due to genetic defects | 38 | ||
| Abnormal chromosome numbers | 38 | ||
| Autosomes | 38 | ||
| Sex chromosomes | 38 | ||
| Fragile sites and chromosomal translocations | 38 | ||
| Single gene defects | 38 | ||
| X-linked single gene disorders | 40 | ||
| Environmental factors | 40 | ||
| Chemical agents causing disease | 40 | ||
| Mechanisms of chemical injury | 40 | ||
| Corrosive effects | 40 | ||
| Metabolic effects | 40 | ||
| Membrane effects | 41 | ||
| Mutagenic effects | 41 | ||
| Allergic reactions | 41 | ||
| Important chemical agents | 41 | ||
| Smoking | 41 | ||
| Alcohol | 41 | ||
| Dusts | 41 | ||
| Drugs | 41 | ||
| Physical agents causing disease | 42 | ||
| Mechanical injury | 42 | ||
| Thermal injury | 42 | ||
| Radiation injury | 42 | ||
| Infective agents | 42 | ||
| Bacteria | 43 | ||
| Bacterial pili and adhesins | 44 | ||
| Bacterial toxins | 44 | ||
| Exotoxins | 44 | ||
| Endotoxins | 44 | ||
| Aggressins | 46 | ||
| Undesirable consequences of immune responses | 46 | ||
| Viruses | 47 | ||
| DNA and RNA viruses | 48 | ||
| Tissue specificity | 49 | ||
| Pathogenesis of cell injury | 49 | ||
| Yeasts and fungi | 49 | ||
| Mycotoxins | 52 | ||
| Parasites | 53 | ||
| Prions | 53 | ||
| Further reading | 53 | ||
| 2 Disease Mechanisms | 55 | ||
| 4 Disorders of growth, differentiation and morphogenesis | 57 | ||
| Definitions | 58 | ||
| Growth | 58 | ||
| Differentiation | 58 | ||
| Morphogenesis | 58 | ||
| Normal growth, differentiation and morphogenesis | 59 | ||
| Regeneration and replication | 59 | ||
| The cell cycle | 59 | ||
| Molecular events in the cell cycle | 60 | ||
| Duration of the cell cycle | 60 | ||
| Therapeutic interruption of the cell cycle | 60 | ||
| Apoptosis: physiological cell death in growth and morphogenesis | 61 | ||
| Regulation of apoptosis | 61 | ||
| The intrinsic pathway | 61 | ||
| The extrinsic pathway | 62 | ||
| The execution phase | 62 | ||
| Apoptosis in development | 62 | ||
| Differentiation and morphogenesis | 63 | ||
| Control of normal differentiation | 63 | ||
| Cell position and inductive phenomena | 63 | ||
| Control of gene expression in the establishment of phenotype | 64 | ||
| Epigenetic regulation of gene expression | 65 | ||
| Stem cells and transdifferentiation | 65 | ||
| Maintenance and modulation of an attained differentiated state | 66 | ||
| Normal differentiation and morphogenesis: summary | 66 | ||
| Abnormalities of growth, differentiation and morphogenesis | 66 | ||
| Increased growth: hypertrophy and hyperplasia | 66 | ||
| Physiological hypertrophy and hyperplasia | 67 | ||
| Pathological hypertrophy and hyperplasia | 67 | ||
| Apparently autonomous hyperplasias | 67 | ||
| Hyperplasia in tissue repair | 68 | ||
| Skin | 70 | ||
| Liver | 70 | ||
| Heart | 71 | ||
| Decreased growth: atrophy | 71 | ||
| Physiological atrophy and involution | 71 | ||
| Pathological atrophy | 71 | ||
| Decreased function | 71 | ||
| Loss of innervation | 71 | ||
| Loss of blood supply | 72 | ||
| ‘Pressure’ atrophy | 72 | ||
| Lack of nutrition | 72 | ||
| Loss of endocrine stimulation | 72 | ||
| Hormone-induced atrophy | 72 | ||
| Decreased growth: hypoplasia | 72 | ||
| Metaplasia | 72 | ||
| Congenital disorders of differentiation and morphogenesis | 73 | ||
| Chromosomal abnormalities affecting whole chromosomes | 73 | ||
| Autosomal chromosomes | 73 | ||
| Sex chromosomes | 74 | ||
| Parts of chromosomes | 74 | ||
| Single gene alterations | 74 | ||
| Enzyme defects | 74 | ||
| Defects in receptors or cellular transport | 74 | ||
| Non-enzyme protein defects | 74 | ||
| Anomalies of fetal development | 75 | ||
| Embryo division abnormalities | 75 | ||
| Teratogen exposure | 75 | ||
| Failure of cell and organ migration | 75 | ||
| Anomalies of organogenesis | 76 | ||
| Agenesis (aplasia) | 76 | ||
| Atresia | 76 | ||
| Hypoplasia | 76 | ||
| Maldifferentiation (dysgenesis, dysplasia) | 76 | ||
| Ectopia, heterotopia and choristomas | 76 | ||
| Complex disorders of growth and morphogenesis | 76 | ||
| Neural tube defects | 76 | ||
| Disorders of sexual differentiation | 76 | ||
| Cleft palate and related disorders | 77 | ||
| Further reading | 78 | ||
| 5 Responses to cellular injury | 79 | ||
| Cellular injury | 80 | ||
| Causative agents and processes | 80 | ||
| Physicochemical agents | 80 | ||
| Biological agents | 81 | ||
| Blockage of metabolic pathways | 81 | ||
| Cellular respiration | 81 | ||
| Glucose deprivation | 81 | ||
| Protein synthesis | 81 | ||
| Loss of growth factor or hormonal influence | 81 | ||
| Ischaemia and reperfusion injury | 81 | ||
| Free radicals | 81 | ||
| Failure of membrane integrity | 82 | ||
| DNA damage or loss | 82 | ||
| Patterns of cellular injury and death | 83 | ||
| Autophagy | 83 | ||
| Lethal cell injury | 83 | ||
| Necrosis | 83 | ||
| Coagulative necrosis | 84 | ||
| Colliquative necrosis | 84 | ||
| Caseous necrosis | 84 | ||
| Gangrene | 84 | ||
| Fibrinoid necrosis | 84 | ||
| Fat necrosis | 85 | ||
| Patterns of cell death in systematic pathology | 85 | ||
| Repair and regeneration | 85 | ||
| Cell renewal | 85 | ||
| Stem cells | 85 | ||
| Complete restitution | 86 | ||
| Organisation | 86 | ||
| Granulation tissue | 86 | ||
| Wound contraction and scarring | 87 | ||
| Outcome of injuries in different tissues | 87 | ||
| Skin | 87 | ||
| Incised wound: healing by first intention | 87 | ||
| Tissue loss: healing by second intention | 87 | ||
| Keloid nodules | 87 | ||
| Mechanism of skin healing and repair | 88 | ||
| Gastrointestinal tract | 88 | ||
| Mucosal erosions | 88 | ||
| Mucosal ulceration | 88 | ||
| Bone | 89 | ||
| Fracture healing | 89 | ||
| Problems with fracture healing | 89 | ||
| Liver | 89 | ||
| Kidney | 90 | ||
| Muscle | 90 | ||
| Neural tissue | 90 | ||
| Modifying influences | 91 | ||
| Age | 91 | ||
| Disorders of nutrition | 91 | ||
| Neoplastic disorders | 91 | ||
| Cushing’s syndrome and steroid therapy | 91 | ||
| Diabetes mellitus and immunosuppression | 91 | ||
| Vascular disturbance | 91 | ||
| Denervation | 92 | ||
| Injury due to ionising radiation | 92 | ||
| Definition and sources | 92 | ||
| Electromagnetic radiation | 92 | ||
| Particulate radiation | 92 | ||
| Ultraviolet light | 92 | ||
| Units of dose | 92 | ||
| Background radiation | 93 | ||
| Mode of action | 93 | ||
| Effects on tissues | 93 | ||
| Early effects | 93 | ||
| Late effects | 94 | ||
| Bone marrow | 94 | ||
| Intestine | 94 | ||
| Skin | 94 | ||
| Gonads | 94 | ||
| Lung and kidney | 94 | ||
| Whole body irradiation | 95 | ||
| Ionising radiation and tumours | 95 | ||
| Principles of radiation protection | 96 | ||
| Further reading | 97 | ||
| 6 Disorders of metabolism and homeostasis | 99 | ||
| Inborn errors of metabolism | 100 | ||
| Disorders of carbohydrate metabolism | 100 | ||
| Disorders of amino acid metabolism | 100 | ||
| Phenylketonuria | 100 | ||
| Alkaptonuria | 101 | ||
| Homocystinuria | 101 | ||
| Storage disorders | 101 | ||
| Disorders of cell membrane transport | 101 | ||
| Channelopathies | 101 | ||
| Cystic fibrosis | 101 | ||
| Cystic fibrosis transmembrane conductance regulator (CFTR) | 102 | ||
| Clinicopathological features | 102 | ||
| Diagnosis | 102 | ||
| Treatment | 102 | ||
| Porphyrias | 102 | ||
| Clinicopathological features | 103 | ||
| Disorders of connective tissue metabolism | 104 | ||
| Osteogenesis imperfecta | 104 | ||
| Marfan’s syndrome | 104 | ||
| Acquired metabolic disorders | 104 | ||
| Gout | 104 | ||
| Aetiology | 105 | ||
| Clinicopathological features | 105 | ||
| Water homeostasis | 105 | ||
| Dehydration | 105 | ||
| Water excess | 105 | ||
| Oedema and serous effusions | 106 | ||
| Inflammatory oedema | 106 | ||
| Venous oedema | 106 | ||
| Lymphatic oedema | 106 | ||
| Hypoalbuminaemic oedema | 107 | ||
| Ascites and pleural effusions | 107 | ||
| Electrolyte homeostasis | 108 | ||
| Sodium and potassium homeostasis | 108 | ||
| Hypernatraemia | 108 | ||
| Hyponatraemia | 108 | ||
| Hyperkalaemia | 108 | ||
| Hypokalaemia | 108 | ||
| Calcium homeostasis | 108 | ||
| Hypercalcaemia | 108 | ||
| Hypocalcaemia | 109 | ||
| Acid–base homeostasis | 109 | ||
| Acidosis and alkalosis | 109 | ||
| Respiratory acidosis | 109 | ||
| Metabolic acidosis | 109 | ||
| Respiratory alkalosis | 109 | ||
| Metabolic alkalosis | 109 | ||
| Metabolic consequences of malnutrition | 109 | ||
| Protein–energy malnutrition | 110 | ||
| Malnutrition in children | 110 | ||
| Kwashiorkor | 110 | ||
| Marasmus | 111 | ||
| Cachexia | 111 | ||
| Vitamin deficiencies | 111 | ||
| Thiamine (B1) deficiency | 111 | ||
| Folate and vitamin B12 deficiency | 111 | ||
| Vitamin C deficiency | 112 | ||
| Vitamin D deficiency | 112 | ||
| Vitamin K deficiency | 112 | ||
| Obesity | 113 | ||
| Metabolic syndrome | 113 | ||
| Trace elements and disease | 113 | ||
| Aluminium | 113 | ||
| Copper | 114 | ||
| Iodine | 114 | ||
| Lead | 114 | ||
| Mercury | 114 | ||
| Tissue depositions | 115 | ||
| Calcification | 115 | ||
| Dystrophic calcification | 115 | ||
| ‘Metastatic’ calcification | 115 | ||
| Amyloid | 116 | ||
| Classification | 116 | ||
| Systemic amyloidosis | 116 | ||
| Myeloma-associated amyloidosis | 117 | ||
| Reactive (secondary) amyloidosis | 117 | ||
| Senile amyloidosis | 117 | ||
| Haemodialysis-associated amyloidosis | 118 | ||
| Hereditary amyloidosis | 118 | ||
| Localised amyloidosis | 118 | ||
| Clinical effects and diagnosis | 118 | ||
| Further reading | 119 | ||
| 7 Ischaemia, infarction and shock | 121 | ||
| Non-thromboembolic vascular insufficiency | 122 | ||
| Thromboembolic vascular occlusion | 123 | ||
| Clot | 123 | ||
| Thrombosis | 123 | ||
| Role of platelets | 123 | ||
| Thrombus formation | 123 | ||
| Arterial thrombosis | 123 | ||
| Venous thrombosis | 124 | ||
| Clinical effects | 124 | ||
| Fate of thrombi | 125 | ||
| Embolism | 125 | ||
| Pulmonary embolism | 125 | ||
| Systemic embolism | 126 | ||
| Embolic atheroma | 127 | ||
| Platelet emboli | 127 | ||
| Infective emboli | 127 | ||
| Fat embolism | 127 | ||
| Gas embolism | 128 | ||
| Amniotic embolism | 128 | ||
| Tumour embolism | 128 | ||
| Embolism of foreign matter | 128 | ||
| Infarction | 128 | ||
| Reperfusion injury | 128 | ||
| Morphology of infarcts | 128 | ||
| Gangrene | 129 | ||
| Capillary ischaemia | 130 | ||
| Susceptibility to ischaemia | 130 | ||
| Low-flow infarction | 130 | ||
| ‘Watershed’ areas | 130 | ||
| Portal vasculature | 130 | ||
| Arterial stenoses | 130 | ||
| Infarction and metabolic activity | 131 | ||
| Shock | 131 | ||
| Cardiogenic shock | 132 | ||
| Hypovolaemic shock | 132 | ||
| Other vascular effects of bacterial toxaemia | 132 | ||
| Further reading | 132 | ||
| 8 Immunology and immunopathology | 133 | ||
| Defence against infection | 134 | ||
| Non-specific defences | 134 | ||
| Innate immunity | 134 | ||
| Specific immunity | 134 | ||
| Key molecules | 134 | ||
| Antigens | 134 | ||
| Antibody | 135 | ||
| T-cell receptors | 136 | ||
| Major histocompatibility complex antigens | 137 | ||
| Accessory and co-stimulatory molecules | 138 | ||
| Cytokines | 139 | ||
| Structural organisation of the immune system | 139 | ||
| T- and B-lymphocyte development | 140 | ||
| Primary and secondary lymphoid organs | 140 | ||
| Functional organisation of the immune response | 142 | ||
| Antigen presentation | 142 | ||
| Antibody production | 142 | ||
| Cell-mediated responses | 143 | ||
| Non-specific effector mechanisms | 143 | ||
| Complement | 143 | ||
| Complement activation | 143 | ||
| Classical pathway activation | 144 | ||
| Alternative pathway activation | 144 | ||
| Lectin pathway activation | 144 | ||
| The membrane attack complex | 144 | ||
| Biological effects of complement | 144 | ||
| Control of the complement pathway | 144 | ||
| Macrophages | 145 | ||
| Neutrophil polymorphonuclear leucocytes | 145 | ||
| Antibody-dependent cell-mediated cytotoxicity | 145 | ||
| Natural killer cells | 145 | ||
| Outcomes of immune responses | 145 | ||
| Direct effects of antibody | 146 | ||
| Indirect effects of antibody | 146 | ||
| Killing of target cells | 146 | ||
| Inflammation | 146 | ||
| Immunodeficiency | 146 | ||
| Primary antibody deficiencies | 146 | ||
| Transient hypogammaglobulinaemia of infancy | 147 | ||
| X-linked agammaglobulinaemia (XLA) – Bruton’s disease | 148 | ||
| Hyper-IgM syndrome | 148 | ||
| Selective IgA deficiency | 148 | ||
| Common variable immunodeficiency | 148 | ||
| Primary defects in cell-mediated immunity | 148 | ||
| Severe combined immunodeficiency | 148 | ||
| DiGeorge syndrome (‘Catch 22’ anomaly) | 148 | ||
| Primary defects in phagocyte function | 149 | ||
| Chronic granulomatous disease | 149 | ||
| Primary complement deficiency | 149 | ||
| Secondary immunodeficiency | 149 | ||
| Acquired immune deficiency syndrome (AIDS) | 150 | ||
| Transmission of HIV | 150 | ||
| Clinical spectrum of HIV infection | 151 | ||
| Immunopathogenesis of HIV infection | 151 | ||
| Therapeutic options | 151 | ||
| Hypersensitivity reactions | 152 | ||
| Immediate hypersensitivity (type I) | 152 | ||
| Antibody to cell-bound antigen (type II) | 153 | ||
| Immune complex hypersensitivity (type III) | 153 | ||
| Delayed-type hypersensitivity (type IV) | 154 | ||
| Autoimmunity and autoimmune disease | 156 | ||
| Patterns of autoimmune disease | 156 | ||
| Organ-specific autoimmune diseases | 156 | ||
| Non-organ-specific autoimmune diseases | 156 | ||
| Epidemiology of autoimmune disease | 157 | ||
| Immunological tolerance | 157 | ||
| Thymic tolerance | 157 | ||
| Peripheral tolerance | 157 | ||
| Immunological ignorance | 157 | ||
| Anergy | 157 | ||
| Regulation and suppression | 157 | ||
| B-cell tolerance | 158 | ||
| Breakdown of tolerance | 158 | ||
| Overcoming peripheral tolerance | 158 | ||
| Molecular mimicry | 158 | ||
| Aetiology of autoimmune disease | 158 | ||
| Genetic factors | 158 | ||
| Environmental factors | 158 | ||
| Hormones | 158 | ||
| Infection | 159 | ||
| Drugs | 159 | ||
| Ultraviolet radiation | 159 | ||
| Mechanisms of tissue damage | 159 | ||
| Treatment of autoimmune diseases | 159 | ||
| Replacement of function | 159 | ||
| Suppression of the autoimmune response | 159 | ||
| Principles of organ transplantation | 160 | ||
| Histocompatibility genetics | 160 | ||
| Kidney transplantation | 160 | ||
| Selection of recipient and donor | 160 | ||
| The post-transplantation period | 161 | ||
| Clinical rejection | 161 | ||
| Immunopathology of graft rejection | 161 | ||
| Immunosuppression | 161 | ||
| Graft survival | 162 | ||
| Complications | 162 | ||
| Transplantation of other organs | 162 | ||
| Liver transplantation | 162 | ||
| Heart transplantation | 163 | ||
| Pancreatic transplantation | 163 | ||
| Skin grafting | 163 | ||
| Corneal grafting | 163 | ||
| Bone marrow transplantation | 163 | ||
| Selection and preparation of patients | 163 | ||
| Complications | 163 | ||
| Peripheral blood stem cell transplantation | 164 | ||
| Further reading | 164 | ||
| Websites | 164 | ||
| 9 Inflammation | 165 | ||
| Acute inflammation | 166 | ||
| Causes of acute inflammation | 166 | ||
| Microbial infections | 166 | ||
| Hypersensitivity reactions | 166 | ||
| Physical agents | 166 | ||
| Irritant and corrosive chemicals | 166 | ||
| Tissue necrosis | 166 | ||
| Essential macroscopic appearances of acute inflammation | 166 | ||
| Redness (rubor) | 166 | ||
| Heat (calor) | 166 | ||
| Swelling (tumor) | 167 | ||
| Pain (dolor) | 167 | ||
| Loss of function | 167 | ||
| Early stages of acute inflammation | 167 | ||
| Changes in vessel calibre | 167 | ||
| Increased vascular permeability | 167 | ||
| Features of the fluid exudate | 168 | ||
| Ultrastructural basis of increased vascular permeability | 168 | ||
| Other causes of increased vascular permeability | 168 | ||
| Tissue sensitivity to chemical mediators | 169 | ||
| Formation of the cellular exudate | 169 | ||
| Margination of neutrophils | 169 | ||
| Adhesion of neutrophils | 169 | ||
| Neutrophil emigration | 169 | ||
| Diapedesis | 169 | ||
| Later stages of acute inflammation | 170 | ||
| Chemotaxis of neutrophils | 170 | ||
| Chemical mediators of acute inflammation | 170 | ||
| Chemical mediators released from cells | 170 | ||
| Plasma factors | 170 | ||
| Role of tissue macrophages | 171 | ||
| Role of the lymphatics | 171 | ||
| Role of the neutrophil polymorph | 171 | ||
| Movement | 171 | ||
| Adhesion to microorganisms | 171 | ||
| Phagocytosis | 172 | ||
| Intracellular killing of microorganisms | 172 | ||
| Release of lysosomal products | 172 | ||
| The role of mast cells | 172 | ||
| Special macroscopic appearances of acute inflammation | 172 | ||
| Effects of acute inflammation | 172 | ||
| Beneficial effects | 172 | ||
| Harmful effects | 174 | ||
| Sequelae of acute inflammation | 174 | ||
| Resolution | 174 | ||
| Suppuration | 174 | ||
| Abscess | 175 | ||
| Organisation | 175 | ||
| Progression to chronic inflammation | 175 | ||
| Systemic effects of inflammation | 176 | ||
| Pyrexia | 176 | ||
| Constitutional symptoms | 176 | ||
| Weight loss | 176 | ||
| Reactive hyperplasia of the reticuloendothelial system | 176 | ||
| Haematological changes | 176 | ||
| Amyloidosis | 176 | ||
| Chronic inflammation | 177 | ||
| Causes of chronic inflammation | 177 | ||
| Primary chronic inflammation | 177 | ||
| Transplant rejection | 177 | ||
| Progression from acute inflammation | 177 | ||
| Recurrent episodes of acute inflammation | 177 | ||
| Macroscopic appearances of chronic inflammation | 178 | ||
| Microscopic features of chronic inflammation | 178 | ||
| Paracrine stimulation of connective tissue proliferation | 178 | ||
| Cellular cooperation in chronic inflammation | 178 | ||
| Macrophages in chronic inflammation | 179 | ||
| Specialised forms of macrophages and granulomatous inflammation | 179 | ||
| Epithelioid histiocytes | 179 | ||
| Histiocytic giant cells | 181 | ||
| Langhans giant cells | 181 | ||
| Foreign body giant cells | 181 | ||
| Role of inflammation in systemic and organ-specific diseases | 181 | ||
| Further reading | 182 | ||
| 10 Carcinogenesis and neoplasia | 183 | ||
| General characteristics of neoplasms (tumours) | 184 | ||
| Definitions | 184 | ||
| Incidence of tumours | 184 | ||
| Structure of tumours | 184 | ||
| Stroma | 184 | ||
| Tumour shape and correlation with behaviour | 185 | ||
| Tumour histology | 185 | ||
| Classification of tumours | 186 | ||
| Behavioural classification | 186 | ||
| Benign tumours | 186 | ||
| Malignant tumours | 187 | ||
| Histogenetic classification | 188 | ||
| Histological grade (degree of differentiation) | 189 | ||
| Nomenclature of tumours | 189 | ||
| Epithelial tumours | 190 | ||
| Benign epithelial tumours | 190 | ||
| Malignant epithelial tumours | 190 | ||
| Carcinoma in situ | 190 | ||
| Connective tissue and other mesenchymal tumours | 191 | ||
| Benign connective tissue and mesenchymal tumours | 192 | ||
| Malignant connective tissue and mesenchymal tumours | 192 | ||
| Eponymously named tumours | 192 | ||
| Miscellaneous tumours | 192 | ||
| Teratomas | 192 | ||
| Embryonal tumours: the ‘blastomas’ | 192 | ||
| Mixed tumours | 192 | ||
| Endocrine tumours | 193 | ||
| Hamartomas | 193 | ||
| Cysts | 193 | ||
| Biology of tumour cells | 193 | ||
| Aberrant proliferation and cellular immortalisation | 194 | ||
| Genomic instability in tumour cells | 194 | ||
| Mitotic and apoptotic activity | 194 | ||
| Metabolic and other abnormalities | 194 | ||
| Tumour products | 194 | ||
| Carcinogenesis | 195 | ||
| Identification of carcinogens | 196 | ||
| Epidemiological evidence | 196 | ||
| Occupational and behavioural risks | 197 | ||
| Scrotal carcinoma | 197 | ||
| Lung carcinoma | 197 | ||
| Carcinoma of the cervix | 197 | ||
| Bladder carcinoma | 197 | ||
| Direct evidence | 197 | ||
| Thorotrast | 197 | ||
| Thyroid carcinoma and radiation in children | 197 | ||
| Experimental testing | 198 | ||
| Known or suspected carcinogens | 198 | ||
| Chemical carcinogens | 198 | ||
| Polycyclic aromatic hydrocarbons | 199 | ||
| Aromatic amines | 199 | ||
| Nitrosamines | 199 | ||
| Azo dyes | 199 | ||
| Alkylating agents | 200 | ||
| Oncogenic viruses | 200 | ||
| Human papillomavirus | 200 | ||
| Epstein–Barr virus | 200 | ||
| Radiant energy | 201 | ||
| Ultraviolet light | 201 | ||
| Ionising radiation | 202 | ||
| Hormones | 202 | ||
| Bacteria, fungi, parasites and miscellaneous carcinogens | 202 | ||
| Bacteria | 202 | ||
| Fungi | 202 | ||
| Parasites | 202 | ||
| Miscellaneous: asbestos | 202 | ||
| Host factors in carcinogenesis | 202 | ||
| Race | 203 | ||
| Diet | 203 | ||
| Constitutional factors | 203 | ||
| Inherited predisposition | 203 | ||
| Age | 203 | ||
| Sex | 203 | ||
| Premalignant lesions and conditions | 203 | ||
| Transplacental carcinogenesis | 204 | ||
| Cellular and molecular events in carcinogenesis | 205 | ||
| Experimental observations | 205 | ||
| Latency | 205 | ||
| Initiation, promotion and progression | 205 | ||
| Genetic abnormalities in tumours | 206 | ||
| Chromosomal abnormalities | 206 | ||
| Genetic mechanisms in carcinogenesis | 207 | ||
| Genomic instability | 207 | ||
| Tumour suppressor genes | 208 | ||
| ‘Caretakers’ and ‘gatekeepers’ | 208 | ||
| Oncogenes | 209 | ||
| Activation of oncogenes in tumours | 210 | ||
| Autocrine stimulation of neoplastic cell growth | 211 | ||
| Epigenetic contribution to tumour growth | 211 | ||
| Interaction of carcinogens with oncogenes and tumour suppressor genes | 211 | ||
| Behaviour of tumours | 212 | ||
| Invasion and metastasis | 212 | ||
| Invasion | 213 | ||
| Proteinases and inhibitors | 213 | ||
| Clinicopathological significance | 214 | ||
| Metastasis | 214 | ||
| The metastatic sequence | 214 | ||
| Routes of metastasis | 215 | ||
| Haematogenous metastasis | 215 | ||
| Lymphatic metastasis | 215 | ||
| Transcoelomic metastasis | 215 | ||
| Clinical effects of tumours | 216 | ||
| Local effects | 216 | ||
| Metabolic effects | 216 | ||
| Tumour type-specific effects | 216 | ||
| Non-specific metabolic effects | 216 | ||
| Prognosis | 217 | ||
| Prognostic indices | 217 | ||
| Tumour type | 217 | ||
| Tumour grade | 217 | ||
| Tumour stage | 217 | ||
| Tumour dormancy | 218 | ||
| Early detection of cancer by screening | 218 | ||
| Hallmarks | 219 | ||
| Further reading | 219 | ||
| Websites | 219 | ||
| 11 Ageing and death | 221 | ||
| Ageing | 222 | ||
| 3 Systematic Pathology | 245 | ||
| 13 Cardiovascular system | 246 | ||
| Common clinical problems from cardiovascular disease | 247 | ||
| Diseases of the arteries and other vessels | 248 | ||
| Normal arterial structure | 248 | ||
| Age-related vascular changes | 248 | ||
| Atherosclerosis | 249 | ||
| Atherosclerotic lesions | 249 | ||
| What causes atherosclerosis? | 250 | ||
| How do lesions develop? | 251 | ||
| Clinical manifestations of atherosclerosis | 252 | ||
| Plaque morphology and the vulnerable plaque concept | 252 | ||
| Preventive and therapeutic approaches to atherosclerosis and atherothrombosis | 253 | ||
| Surgical and percutaneous interventions | 253 | ||
| Aneurysms | 253 | ||
| Atherosclerotic aortic aneurysms | 253 | ||
| Aortic dissection (dissecting aneurysms) | 253 | ||
| ‘Berry’ aneurysms | 254 | ||
| Capillary microaneurysms | 254 | ||
| Vasculitic aneurysms | 254 | ||
| Mycotic aneurysms | 255 | ||
| Hypertension | 255 | ||
| Aetiological classification | 255 | ||
| Epidemiology | 255 | ||
| Essential hypertension | 256 | ||
| The sympathetic nervous system | 256 | ||
| The renin–angiotensin–aldosterone system | 256 | ||
| Dietary sodium and potassium | 256 | ||
| Secondary hypertension | 257 | ||
| Renal disease and hypertension | 257 | ||
| Endocrine causes | 257 | ||
| Coarctation of the aorta | 257 | ||
| Drug therapy | 257 | ||
| Pathological classification | 257 | ||
| Benign (essential) hypertension | 257 | ||
| Malignant hypertension | 257 | ||
| Pulmonary hypertension | 258 | ||
| Vascular and systemic effects | 258 | ||
| Vascular changes | 258 | ||
| Heart | 258 | ||
| Nervous system | 259 | ||
| Kidneys | 259 | ||
| Diabetic vascular disease | 259 | ||
| Vasculitis | 259 | ||
| Pathogenesis | 259 | ||
| Systemic vasculitis | 259 | ||
| Cutaneous small vessel vasculitis | 260 | ||
| Cranial (giant cell) arteritis | 261 | ||
| Pulseless (Takayasu’s) disease | 261 | ||
| Buerger’s disease | 261 | ||
| Diseases of veins | 262 | ||
| Normal venous structure | 262 | ||
| Venous thrombosis | 262 | ||
| Varicosities | 262 | ||
| Diseases of lymphatics | 263 | ||
| Normal lymphatic structure | 263 | ||
| Lymphatic involvement in disease | 263 | ||
| Tumours of blood vessels | 263 | ||
| Benign tumours | 263 | ||
| Malignant tumours | 263 | ||
| Cardiac disease | 263 | ||
| Normal structure and function of the heart | 263 | ||
| Heart failure | 264 | ||
| Pathophysiology | 264 | ||
| Ventricular function in heart failure | 264 | ||
| Neurohormonal changes in heart failure | 265 | ||
| Other pathophysiological changes in heart failure | 265 | ||
| Clinicopathological features | 266 | ||
| Dyspnoea | 266 | ||
| Systemic venous congestion and oedema | 266 | ||
| Other pathophysiological changes | 266 | ||
| Ischaemic heart disease | 267 | ||
| Pathophysiology | 267 | ||
| Myocardial infarction | 267 | ||
| Clinical features | 267 | ||
| Morphology | 268 | ||
| Serology | 268 | ||
| Clinical classification: STEMI versus non-STEMI | 269 | ||
| Complications | 270 | ||
| Unstable angina | 270 | ||
| Chronic ischaemic heart disease | 270 | ||
| Clinical features | 270 | ||
| Morphology | 271 | ||
| Sudden cardiac death | 271 | ||
| Aetiology | 271 | ||
| Prevention | 272 | ||
| Valvular heart disease | 272 | ||
| Pathophysiology | 272 | ||
| Clinicopathological features | 273 | ||
| Mitral incompetence | 274 | ||
| Mitral stenosis and rheumatic fever | 274 | ||
| Aortic stenosis | 275 | ||
| Aortic incompetence | 275 | ||
| Tricuspid and pulmonary valve disease | 275 | ||
| Infective endocarditis | 275 | ||
| Aetiology | 275 | ||
| Morphology | 275 | ||
| Endocarditis in unusual hosts | 276 | ||
| Patients with prosthetic heart valves | 276 | ||
| The elderly | 276 | ||
| Drug addicts | 276 | ||
| Complications | 277 | ||
| Local effects | 277 | ||
| Systemic effects | 277 | ||
| Diagnosis, treatment and prevention | 277 | ||
| Investigations | 277 | ||
| Treatment | 278 | ||
| Prevention | 278 | ||
| Non-infective endocarditis | 278 | ||
| Pericarditis and myocarditis | 278 | ||
| Pericarditis | 278 | ||
| Acute pericarditis | 278 | ||
| Chronic pericarditis | 279 | ||
| Glossary | 721 | ||
| Index | 731 | ||
| A | 731 | ||
| B | 734 | ||
| C | 737 | ||
| D | 741 | ||
| E | 743 | ||
| F | 744 | ||
| G | 745 | ||
| H | 747 | ||
| I | 749 | ||
| J | 751 | ||
| K | 751 | ||
| L | 752 | ||
| M | 753 | ||
| N | 756 | ||
| O | 757 | ||
| P | 758 | ||
| Q | 761 | ||
| R | 761 | ||
| S | 762 | ||
| T | 765 | ||
| U | 767 | ||
| V | 767 | ||
| W | 768 | ||
| X | 769 | ||
| Y | 769 | ||
| Z | 769 |