Pathology of Diseases Nabeen C Nayak, Subimal Roy, P Chopra
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s1Pathology of Diseases
s2Pathology of Diseases
Editors Nabeen C Nayak MD, FRC Path, FNA, FASc, FAMS Emeritus Professor of Pathology All India Institute of Medical Sciences New Delhi Senior Consultant and Head Department of Histopathology Sir Ganga Ram Hospital, New Delhi Subimal Roy MD, PhD, FNASc, FAMS Formerly Professor and Head Department of Pathology All India Institute of Medical Sciences New Delhi P Chopra MD, FRC Path, FAMS Professor of Pathology All India Institute of Medical Sciences New Delhi
s3
This book has been developed as a commissioned work by the Government of India under the Core Books Project on Medical Sciences and subsidised through the National Book Trust, India for the benefit of students.
Price: Rs. 222.00
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Pathology of Diseases
© 2000, Nabeen C Nayak, Subimal Roy, P Chopra
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editors and the publisher.
This book has been published in good faith that the material provided by contributors are original. Every effort is made to ensure accuracy of material, but the publisher, printer and editors will not be held responsible for any inadvertent error(s). In case of any dispute, all legal matters to be settled under Delhi jurisdiction only.
First Edition: 2000
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s4Contributors s6Foreword
When I was a medical student nearly six decades ago, William Boyd's Textbook of Pathology was the gold standard, written in excellent style, interesting to read and closely related to clinical diseases which medical students crave for in their preclinical years. Since then, with the relentless expansion of knowledge, the increasing growth of specialities, especially the most recent explosion of knowledge in molecular biology, books on Pathology had undergone a sea change in step with the advancing front of knowledge. Their number has increased, their content is deeper and more diverse. Multi-authored text written by specialists is the norm, the references at the end of each chapter are unending. The impact of all this upon undergraduate and postgraduate students and practitioners of Pathology, as would be expected, is at times bewildering. Excellent treatises on Pathology exist, each with its own forte. Yet there seems to be room for a book that Professor NC Nayak and his colleagues have now produced—a practically oriented text on Systemic Pathology with sufficient but not too extensive theoretical background.
Instead of a series of chapters on General Pathology which students generally read with mixed feelings of enthusiasm and boredom, there is just one chapter, relatively short, the opening chapter, which Professor NC Nayak himself writes on Reaction to Injury which, so to say, forms the substratum of the rest of the chapters on Systemic Pathology. It starts with Rudolph Virchow's Cellular Pathology, considers its evolution into subcellular (organelle) and molecular pathology, taking us through cellular responses to injury including apoptosis, pathogenesis and clinical manifestations, thus revoking Virchow's dictum of the Cell as the Theatre of Life. The book ends with a final chapter on Laboratory Tests in Diagnosis and Management of Diseases, again imparting a practical touch. This chapter spans Histopathology, Cytopathology, Haematology and Biochemical Pathology. The focus is on tests used routinely for diagnosis together with special techniques. The technologies and their diagnostic interpretations are provided in easily readable tabulated form.
Each chapter ends with a small list of support reading; the reader is not encumbered with a voluminous list of references. The legend goes that Max Wintrobe when he was writing his classical textbook on Haematology which ran into many editions, used to include only those references at the end of each chapter which he had personally read. In the present text, there is a lucidity of style, a uniformity of format of each chapter starting with the normal state of each organ system, followed by the usual sequence of aetiology, pathology, pathogenesis, prognosis and treatment, with much new and uptodate information in evidence. The illustrations are in traditional black and white illuminating the text and are of good quality.
The result is a work that is needed, that is readable and uptodate which should prove to be valuable not only to the students of Pathology—undergraduate, postgraduate, faculty and hospital pathologists—but also to similar categories in related disciplines.
Two words about the contributors. They have wide experience; many have had a connection with the Pathology Department of the All India Institute of Medical Sciences either as undergraduate s7students or as residents in training in Pathology or as members of the faculty, or in various combinations thereof. They, along with the other authors succeeded in providing a solid foundation of the global science of Pathology with a distinct flavour of the scene in India and other developing countries.
V Ramalingaswami md d sc frcp frc path frs
National Research Professor
All India Institute of Medical Sciences
New Delhi
s8Preface
This book is the fruition of hard-earned experiences, unceasing efforts in the face of many odds, and wishful thinking of several individuals, all of whom are dedicated teachers and researchers in the science of medicine. The frontal question posed by some when a new textbook arrives on the scene is “Why another one?”. There are, however, many others who have felt the need of a text in Pathology that would be different from the ones currently on the shelves in the sense that without being stressfully detailed it would provide essential basic and updated information on diseases that will enable the student acquire adequate and meaningful knowledge in order to plan and carry out optimal patient care. Additionally, all of us who have been involved for years in teaching Pathology in developing countries have experienced how the students labour through texts primarily directed towards students of the developed world where disease patterns, ethnic set-ups and sociocultural practices are in several ways different from those of ours. Ideally therefore, a text in Pathology suitable for our students should present information in a manner that is relevant, important and applicable to the diagnosis and management of diseases particularly highlighting conditions that are common and important in our populations. The reading matter should be presented in a manner compatible with the learning attitudes of students so that the reader can easily acquire knowledge on the whys and hows of different diseases.
In order to incorporate the phenomenal volumes of new information in Biology and Medicine that have accumulated over the last four decades, textbooks have tended to become progressively larger which most students find difficult to read. The alternatives offered are examination-oriented books, which though smaller and easily manageable, fall short of providing adequate information. What are in fact needed are middle-of-the road texts that give adequate and easily comprehensible facts on diseases without being too voluminous. Each chapter in the present book is written by a Pathologist particularly experienced in that area. All contributors in this text are actively pursuing professional, academic and teaching work in the social, demographic and educational environment of developing countries and possess deep insight into the learning attitudes of students. We have decided to present in this text only diseases of different organs and tissues since these constitute the major part of the curriculum in Pathology and clinical medicine in all medical schools.
Each chapter on system diseases starts with a brief recapitulation of those aspects of normal function and structure that are immediately relevant to the understanding of abnormalities in disease. Time honoured gross and microscopic features of diseased tissues have been optimally supplemented by more recent findings on pathology, pathogenesis, aetiology etc. Only those photographs, diagrams and flow charts that help in proper comprehension of written matter have been included. Each chapter also provides a logical correlation of the symptoms and signs of disease with changes in the tissues. A short list of support reading is given at the end instead of an exhaustive reference list since most students do not use the latter. Unique to the book are two chapters: Chapter 1 deals broadly with the basis of disease, namely injury, spanning from miniscule molecular abnormalities to gross trauma that lead on one hand to adaptive changes and on the other to functional and structural damages; and Chapter 16, a for-the-first-time special one, details the principles, applications and interpretations of laboratory investigations essential for diagnosis and management of disease. s9Relevant laboratory and other tests in common and important diseases are listed out on the basis of pathological changes specific to the disease.
Experienced teachers chosen by the National Book Trust of India's expert committee who reviewed the manuscripts have highly acclaimed them. We believe that this book provides not only an adequate and applicable knowledge base for undergraduate students to practice medicine but will also greatly help graduate students in various specialities of Pathology and clinical sciences to build strong overall concepts on system diseases.
Nabeen C Nayak
Subimal Roy
P Chopra
s10Acknowledgements
Over the years, successive batches of bright young students have helped us learn what they need to know in Pathology and how these should be taught in order that they can practice good scientific medicine and its specialities. We are thankful to them for letting us decide on how to prepare a textbook in Pathology for the present day student. The authors of different chapters more than deserve our indebtedness for their hard work, helpful suggestions based on years of experience and their timely help in the face of several odds. But for their cooperation this book would not have seen its completion. They have also graciously agreed to the minor modifications we have made as editors in their write-ups. Several of our academic colleagues have freely given suggestions and advice on the manner of presentation of various chapters.
The National Book Trust, India (NBTI) and its committee on Medical Publications who have spearheaded the publication of this book, deserve our sincere thanks. At times of serious difficulties, the NBTI stood solidly behind us and actively pursued the completion of this book. While originally planned to include a section of general Pathology in this book, when problems arose in receiving all manuscripts it is the NBTI that supported us in deciding on the present format on pathology of diseases with two special chapters. We feel that this has been an innovative and successful change.
It is a pleasure to have worked with our publisher Jaypee Brothers Medical Publishers and particularly with Mr RK Yadav, Publishing Director who has unhesitatingly met with our various demands and helped with the proofs and the printing with clockwork precision.
Last but not the least we wish to thank our families for their support and encouragement in ungrudgingly letting us spend prolonged periods of time with preparation of the book away from them.