Disseminated Cryptococcosis
A 49-year-old woman presented to the emergency department with a 2-week history of headache, dizziness, and pruritic rash. She had undergone kidney transplantation for focal segmental glomerulosclerosis 4 months earlier. Her medications included prednisone, mycophenolate mofetil, and tacrolimus. Physical examination revealed diffuse, umbilicated, pink papules with crusting on her face (Panel A), trunk, arms, and legs. On lumbar puncture, the opening pressure was 22 cm of water (reference range, 6 to 25). India ink staining of the cerebrospinal fluid showed encapsulated budding yeast. Cryptococcal antigen titers of the serum and cerebrospinal fluid were 327,680 U and 20,480 U, respectively (reference range, <2). Cryptococcus neoformans was grown on culture of the cerebrospinal fluid. A biopsy specimen of the skin obtained from the patient’s left arm showed numerous yeastlike organisms surrounded by mucinous capsules (Panel B), confirming a diagnosis of disseminated cryptococcosis. In immunocompromised patients, umbilicated skin lesions may represent cryptococcal infection. Treatment with liposomal amphotericin B and flucytosine was initiated, and the cutaneous and central nervous system symptoms resolved.
Stomach
Foot X-ray AnatomyAnatomy of liverAbdominal aortic aneurysmImage of trachea blocked by chewing gum### Anatomy of the Heart: Summary The heart is a muscular organ responsible for pumping blood throughout the body, supplying oxygen and nutrients while removing waste products. It is located in the thoracic cavity, between the lungs, and is roughly the size of a fist. #### 1. **Structure:** - **Chambers:** The heart has four chambers: - **Right Atrium:** Receives deoxygenated blood from the body via the superior and inferior vena cavae. - **Right Ventricle:** Pumps deoxygenated blood to the lungs through the pulmonary arteries. - **Left Atrium:** Receives oxygenated blood from the lungs via the pulmonary veins. - **Left Ventricle:** Pumps oxygenated blood to the rest of the body through the aorta. - **Valves:** The heart contains four main valves that ensure unidirectional blood flow: - **Tricuspid Valve:** Located between the right atrium and right ventricle. - **Pulmonary Valve:** Located between the right ventricle and pulmonary arteries. - **Mitral (Bicuspid) Valve:** Located between the left atrium and left ventricle. - **Aortic Valve:** Located between the left ventricle and the aorta. #### 2. **Wall Layers:** - **Epicardium:** The outer layer, also known as the visceral pericardium. - **Myocardium:** The thick, muscular middle layer responsible for contraction. - **Endocardium:** The inner layer that lines the chambers and valves. #### 3. **Blood Supply:** - The heart receives its blood supply from the coronary arteries, which branch off the aorta. The **right coronary artery** supplies the right side of the heart, while the **left coronary artery** branches into the left anterior descending and circumflex arteries, supplying the left side. #### 4. **Electrical System:** - The heart's rhythmic contractions are controlled by its electrical conduction system, which includes: - **Sinoatrial (SA) Node:** The natural pacemaker located in the right atrium. - **Atrioventricular (AV) Node:** Receives impulses from the SA node and transmits them to the ventricles. - **Bundle of His and Purkinje Fibers:** Distribute the electrical impulse throughout the ventricles, leading to contraction. #### 5. **Function:** - The heart functions in two primary circulatory loops: - **Pulmonary Circulation:** Moves deoxygenated blood from the right side of the heart to the lungs for oxygenation. - **Systemic Circulation:** Distributes oxygenated blood from the left side of the heart to the rest of the body. The anatomy of the heart is crucial for its role in maintaining effective circulation and overall cardiovascular health. Understanding its structure helps in diagnosing and treating various heart conditions.