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In this procedure a small incision (about 2 inches) is made at the base of the neck and a scope is passed into the middle of the chest discount 10mg domperidone visa treatment dry macular degeneration. Biopsy samples can be obtained from these centrally located lymph nodes but not from the airway or lungs buy 10mg domperidone treatment alternatives. This procedure is done under general anesthesia and typically does not require an overnight hospital stay order domperidone 10mg free shipping medications 44334 white oblong. This procedure is done under general anesthesia and will require a hospital stay for several days or longer. This includes how large the tumor is and whether there is evidence for metastasis (cancer spread) to other areas including lymph nodes within the chest or to distal organs outside the chest. One of the best indicators of the extent of cancer is involvement of the lymph nodes. Lymph nodes are tiny glands that help the body fight infection but are often the first areas for tumor metastasis. The prognosis and treatment will depend on the stage or extent of disease at the time of diagnosis. An A and B subgroup is applied to stages to separate those within a stage who have certain findings associated with a better or worse prognosis. When diagnostic techniques and/or treatments are developed and impact on survival, the staging system is revised. Although there are complexities in the staging system that are beyond the scope of this chapter, the basic criteria for classification are as follows: Stage 0 also known as carcinoma in situ is a very early stage of cancer where the cells are not yet invading. Rarely, if ever do we make the diagnosis of lung cancer at Stage 0, but it is our hope that newer screening techniques will be developed to achieve this. Prognosis The higher the stage, the more advanced the cancer and poorer the prognosis. The percentage of patients who live at least five years after being diagnosed is termed the five-year survival rate. For patients diagnosed with stage I lung cancer, the five-year survival rate is 56%, though rates are higher for the A subgroup (73%). This relatively favorable survival substantially decreases as the disease spreads. Good prognostic factors at the time of diagnosis include early staging at the time of diagnosis, the patient s good general functional ability called performance status which includes daily activities as well as function assessed by pulmonary and cardiac tests and either no weight loss or weight loss of less than 5% at the onset of disease. The treatment of cancer has become a field involving multiple modalities, or types of interventions. Based on the type and extent of disease, a therapeutic plan is designed by a pulmonologist, thoracic surgeon, medical oncologist who may administer chemotherapy and a radiation oncologist who may administer radiation therapy. In latter stages of disease, pain or palliative physicians are an important addition to this process. Depending on location and size of the tumor, the surgical approach can be performed by video assisted thoracoscopic surgery or by open lung thoracotomy. In general, when possible, the entire lobe of the lung where the cancer is found is removed (lobectomy). This involves the use of medications designed to kill cancerous cells in the body. There are many drugs for the oncologist to consider, and treatment choices (involving the selection and number of agents) are individualized to the patient. As new research is accepted and mainstreamed into general clinical practice, chemotherapy recommendations will change. The goal of radiation therapy is to target x-ray beams directly at cancer cells while minimizing damage to adjacent tissue. This type of cancer is on the decrease from a peak in 1986 when it represented 18% of all lung cancers. When these tumors secrete these biologically-active substances, the condition is called a paraneoplastic syndrome. These syndromes can cause a variety of symptoms depending on the substance released. These tumors tend to be closer to the bronchial tree or the airways and may present with an obstructive pneumonia. Symptoms reflect metastatic organ involvement with bone pain due to bone involvement, fatigue and jaundice from liver involvement, and fatigue, headaches or seizures from brain involvement. The limited stage refers to disease that is confined to one side of the chest and may be encompassed within a tolerable radiation field. Extensive stage disease is more common and extends beyond that one side of the lung and may include collections of fluid around in the lungs and around the heart caused by cancer cells. Other factors associated with a better prognosis include age less than 55 years, female gender, and higher functional status (the ability of the patient to carry out daily life activities). Treatment with combined chemotherapy and radiation therapy achieves a response rate of 80% but three-year survival even for limited disease is only 14 - 20%.

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A sign of some health centre or hospital generic domperidone 10mg with visa medications that cause weight gain, telling degree of dehydration in a child with diarrhoea is if it seems restless and the carer to feed sips of uid to irritable (easily upset) domperidone 10 mg fast delivery symptoms meaning, and drinks eagerly if offered uids purchase 10 mg domperidone with visa treatment uti infection. The most vulnerable children are the youngest ones, particularly before their second birthday. In Ethiopia, 23% of deaths in children aged under ve years is due to diarrhoeal diseases around 73,000 such deaths every year. For adults, laboratory examination is required to diagnose faeco-oral diseases accurately. At Health Post level, you should base your diagnosis on the specic symptoms and signs, for example, whether there is diarrhoea and (if yes) is it watery or bloody, and does it have a foul smell? If your diagnosis is ascariasis, you can treat the adult patient as described in Study Session 34. How to make or suspect a diagnosis of specic faeco-oral diseases will be discussed in Study Sessions 33 and 34, when we talk in more detail about types that you may encounter in your community. Patients without diarrhoea are treated depending on the type of infectious agent responsible, and you will learn more about the specic treatments for each condition in Study Sessions 33 and 34. For patients with diarrhoea, especially children, the core measure in the treatment is rapid and adequate rehydration uid replacement usually by drinking uids. In the most severe cases the uid has to be given intravenously (directly into a vein). Rehydration is the most important component of treatment for diarrhoea and it should be started as soon as possible and continued for as long as necessary. The sugar and salts are absorbed into the child s body, replacing what it has lost in the diarrhoea; the salts also help water to be absorbed across the inamed lining of the gut, where it has been damaged by the action of infectious agents. For children with diarrhoea, the measures that you need to undertake during treatment are briey summarised in Box 32. First, you have to assess the degree of dehydration and classify the child as having no, some or severe dehydration, depending on specic symptoms and signs. Check for other general danger signs indicating other major health problems, such as malaria, malnutrition or pneumonia, and treat them; e. For adults with diarrhoea, assess whether the patient can take uids orally, and if they cannot, refer them immediately to the nearest higher level health facility. Most of the prevention and control measures are relatively simple and easy to apply. You have an important role in educating your community by explaining what simple steps can be taken to reduce the risk of faeco-oral diseases. So, in addition to the effective treatment of cases, you need to help families put into effect the measures outlined below. Each measure has been given a distinguishing letter, so you can relate it to the questions that follow the descriptions. Ways to prevent faecal contamination of hands A Wash hands with soap and clean water: A1 After defaecation, or cleaning the bottom of a child, or changing an infant s nappy (diaper). A2 After working with soil, or after children have been playing on soil, where there has been open defaecation by people or animals. Ways to prevent contamination from unsafe food C Prepare and eat food safely: C1 Observe thorough hand hygiene before and during any contact with food C2 Ensure that all utensils are completely clean; allow them to air dry after washing (don t wipe with a cloth) C3 Wash raw vegetables and fruits thoroughly in clean water C4 Cook other food items thoroughly, particularly meat and sh C5 Eat cooked food while it is hot and reheat food thoroughly if it has cooled C6 Cover food so it cannot be exposed to ies. D Promote exclusive breastfeeding of infants under six months old: D1 If babies or young children are fed animal milk or formula, the bottle and teat, or cup and spoon, should be thoroughly washed with clean water and soap before every feed D2 Animal milk should be boiled and cooled before drinking D3 Formula milk should be mixed with boiled cooled water. E Control ies: E1 Cover food to prevent contamination by ies E2 Dispose of faeces and other wastes safely, so ies cannot land on sewage. Malnutrition during and after illness is increases the susceptibility of children to develop severe symptoms if they are describedindetailintheNutrition exposed to infection. A child who is suffering from a condition such as measles or Module pneumonia is also more vulnerable to develop a faeco-oral disease, because their immune system is overloaded by infection. Giving vitamin A supplements with the measles vaccine at the age of nine months, and every six months thereafter until the age of ve years, also helps to promote health and increase resistance to infection. So, ensuring that parents and other caregivers know about and follow all these good practices can help to reduce the risks to children from faeco-oral diseases. Summary of Study Session 32 In Study Session 32, you have learned that: 1 Faeco-oral diseases are caused by infectious agents whose route of exit from the body is in the faeces, and whose route of entry to new hosts is via the mouth. Diarrhoea is the second most important cause of death among children aged under ve years. Write your answers in your Study Diary and discuss them with your Tutor at the next Study Support Meeting. You can check your answers with the Notes on the Self-Assessment Questions at the end of this Module. The child appears lethargic, his eyes are sunken, he is not interested in drinking and when you pinch the skin of his abdomen it takes more than two seconds for the skin to return to the normal position.

On auscultation order domperidone 10 mg free shipping treatment 10, musical wheezes may be heard during both inspiration and expiration cheap domperidone 10 mg amex treatment tmj, and the expiratory phase of respiration may be prolonged discount domperidone 10 mg medicine during the civil war. These auscultory findings tend to be present uniformly throughout the lungs in uncomplicated asthma exacerbation. Asymmetry of auscultory findings might be caused by concomitant disease such as pneumonia, or by a complication of the asthma itself, such as occlusion of a large bronchus with a mucous plug. In severely ill patients, extreme bronchial plugging and loss of effective mechanical ventilation may be associated with disappearance of the wheezing and a marked decrease in all audible breath sounds. In these critically ill patients, alveolar ventilation has almost disappeared, and they may be cyanotic. When the asthmatic patient is not having an acute exacerbation, there may be no demonstrable abnormalities on auscultation even when evidence of reversible airway obstruction can be demonstrated with pulmonary function studies. In many instances, asthma is chronic, and wheezes may be heard even while the patient is feeling subjectively well. In some cases, wheezes will not be heard during normal respiration but can be heard if the patient exhales forcefully. Atopic Dermatitis The findings on physical examination of a patient with atopic dermatitis also vary widely. In an infant 4 to 6 months of age, the initial manifestation usually is erythema and edema. Initial lesions are most likely to occur on the cheeks, in the antecubital fossa, the popliteal spaces, or about the neck and ears. The papules then may form small vesicles, and when these vesicles rupture there may be oozing and crusting. In the chronic form, lichenification of the skin is the predominant cutaneous finding. The cosmetic effects of the chronic form are often very disturbing to the patient. If such abnormalities are present, other illnesses or complications should be suspected. The differential white blood cell count is usually normal, with the frequent exception of eosinophilia that may range from 3% to 10%. Eosinophilia of 12% to 20% is seldom present in allergies to extrinsic antigens unless there is also an infection. Chest radiographs may be necessary to rule out concomitant disease or complications of asthma. Chest radiographs in patients with asthma may reveal hyperinflation or bronchial cuffing; however, most often they are normal ( 3). Conventional radiographs of the sinuses provide limited information and may have high false-positive and false-negative rates. All or some of these procedures may be necessary to establish the correct diagnosis. Gross and microscopic findings in nasal secretions and in sputum have been described in allergic patients. These changes include eosinophils, Curschmann spirals, Charcot-Leyden crystals, and Creola bodies. Although interesting findings, their presence or absence may or may not be of diagnostic value. They may yield some insight into the type and severity of the functional defect and, more importantly, may provide an objective means for assessing changes that may occur with time or may be induced by treatment. It must be remembered that single sets of values describe conditions at designated points in time, and conditions such as asthma have rapid pathophysiologic changes. A flow volume loop may demonstrate extrathoracic obstruction such as vocal cord dysfunction. Provocation Tests Although nasal or bronchial challenges with specific antigens to confirm immediate sensitivity are rarely performed in routine practice, they are nevertheless important tools in research studies. Nonspecific bronchial reactivity may be assessed with methacholine or histamine and is occasionally used in the diagnosis of asthma. Food challenges may be necessary in the diagnosis of food allergies and are performed on a regular basis in clinical practice. Double-blind placebo-controlled food challenges are the gold standard in the diagnosis of food allergies and may occasionally be required. Provocation testing should be performed in a supervised setting with emergency treatment available. Pathogenesis of Skin Testing Immediate response elicited by skin testing peaks in 15 to 20 minutes and involves production of the wheal and flare reaction characteristic of atopic sensitization. Mast cell degranulation and subsequent release of histamine is responsible for the immediate reaction ( 6). The wheal and erythema reaction can be reproduced by injection of histamine into the skin. Skin Testing Techniques Currently, two methods of skin testing are widely used: prick/puncture tests and intracutaneous tests.

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Treatmentinvolvesdebridement purchase domperidone 10 mg with mastercard medicine vial caps,treat- is preceded by a high volume serous discharge from the ment of any infection purchase domperidone 10 mg with visa symptoms liver disease, application of zinc paste and in wound site and necessitates surgical repair domperidone 10mg low cost symptoms 1dpo. Late postoperative complications, which may occur Investigations weeksoryearsaftersurgery,includeadhesions,strictures Pyrexial patients require investigations. Injury or abnormal func- or isotope bone scanning to identify the source of infec- tion within the nervous system causes neuropathic pain. Itmaybe triggered by non-painful stimuli such as light touch, so- Management calledallodynia. Examplesofcausesincludepostherpetic r Prophylaxisagainstinfectionincludesmeticuloussur- neuralgia, peripheral neuropathy, e. Neuropathic pain is often dif- Severely contaminated wounds may be closed by de- culttotreat,partlybecauseofitschronicbutepisodicna- layed primary suture. The principal reason for treating pain is to relieve suf- r Supercial surgical site infections may respond to an- fering. It improves patients ability to sleep and their tibiotics (penicillin and ucloxacillin, depending on overall emotional health. Deeper surgical site infections may re- can also have other benets: postoperatively it can im- quire the removal of one or more skin sutures to al- prove respiratory function, increase the ability to cough low drainage of infected material. Abscesses generally and clear secretions, improve mobility and hence reduce require drainage either by surgery or radiologically the risk of complications such as pneumonia and deep guided aspiration alongside the use of appropriate an- vein thromboses. Assessing pain Pain control To diagnose and then treat pain rst requires asking the Many medical and surgical patients experience pain. Often, if pain is treated aggres- Surgery causes tissue damage leading to the release of sively and early, it is easier to control than when the pa- localchemicalmediatorsthatstimulatepainbres. In Pain may be induced by movement, which is sometimes some cases where verbal communication is not possible unavoidable, e. In contrast, immobility can cause pain due to resenting degrees of pain is useful. Depressionandfearoftenworsentheperception and these may require separate treatment plans. In a patient who is already taking analgesia, it is use- ful to assess their current use, the effect on pain and any Types of pain side-effects. Thepatientshouldalsobeaskedabouthisor Tissue damage causes a nociceptive pain, which can be her beliefs about drugs they have been given before. A loading dose is given rst, then the alerted to these and provided with means by which these patient presses a button to deliver subsequent small bo- can be treated early. This prevents respiratory depression due to acci- method for choosing appropriate analgesia depending dental overdose by the patient repeatedly pressing the on the severity of pain. If the patient becomes overly sedated, the de- cancer patients but is useful for many types of pain. If patients are not adequately tially, analgesia may be given on an as needed basis, but analgesed, the bolus dose is increased. This system is if frequent doses are required, regular doses should be not suitable for patients who are too unwell or confused given, so that each dose is given before the effect of the to understand the system and be able to press the button. Acombinationofdifferentdrugs often improves the pain relief with fewer adverse effects. Local and regional anaesthetic After analgesia is initiated, if it is ineffective at maximal Local anaesthetic is useful perioperatively. Certain drugs givenaround the wound or as a regional nerve block are contraindicated or used with caution in patients with to provide several hours of pain relief. Postoperative patients may descend the sia is useful for surgery of the lower half of the body. However, complications codeine, dihydrocodeine or tramadol orally or intra- include hypotension due to sympathetic block, urinary muscularly are added to regular paracetamol or an retention and motor weakness. Co-analgesics Modes of delivery of opioids These are other drugs that are not primarily analgesics, The oral route is preferred for most patients, but for but can help to relieve pain. In particular, neuropathic patients unable to take oral medication or for rapid re- pain is relatively insensitive to opioids; drugs such as an- lief of acute pain, intramuscular or intravenous boluses tidepressants and anticonvulsants are more effective, e. Tramadol is a weak opioid boluses for continued pain is that often there is a delay that has some action at adrenergic and serotonin recep- between the patient experiencing pain and analgesia be- tors and so may be useful for combination nociceptive ing given. Muscle spasm often responds to continuous infusion by a syringe driver may be appro- benzodiazepines. In Non-pharmacological treatment stable patients with severe ongoing pain, a transdermal In addition to prescribing analgesia, it is important to patch may be suitable. These release opioid in a con- consider other methods that relieve pain, such as treat- trolled manner, usually over 72 hours. Nasal colonisation and skin clearance is achieved by topical cream and antiseptic washes. Approximately 10% of patients admitted to a hospital Prevention of nosocomial infections in the United Kingdom acquire a nosocomial infection. The principles are to avoid transmission by always wash- Infections may be spread by droplet inhalation or direct ing hands after examining a patient, strict aseptic care hand contact from hospital staff or equipment. The pa- of central lines and isolation of cases in a side-room or tients most at risk are those at extremes of age, those even by ward.

The blood pressure has a wide pulse Aortic stenosis pressure (high systolic and low diastolic pressure) buy cheap domperidone 10 mg on-line symptoms stomach cancer. Various signs of the high-velocity blood ow Aortic stenosis is a pathological narrowing of the aortic have been described but are rare order domperidone 10mg with amex medications look up. There is however turbulent r Echocardiography is diagnostic buy generic domperidone 10mg medications like zovirax and valtrex, often showing cusp ow across these valves, which become thickened and thickening and calcication. Severe stenosis may develop over a period of the degree of stenosis and can measure left ventricular 20 30 years. It may lead to thicken- r Treatment includes management of angina and car- ing and calcication of the aortic valve, which is often diac failure. This pres- r Severe stenosis (pressure gradient over 60 mmHg) or sure overload results in left ventricular hypertrophy and symptomatic stenosis are indications for surgery (see arelative ischaemia of the myocardium with associ- page 30). As the stenosis becomes more severe, re- but this is increased if coronary artery bypass is also duced coronary artery perfusion exacerbates myocardial required. Balloon valvuloplasty may be used in pa- ischaemia even if the coronary arteries are normal. Im- tients unt for surgery or to improve cardiac function paired left ventricular emptying is most apparent dur- prior to surgery. Ischaemia and hypertrophy of the left ventricle may lead Prognosis to arrhythmias and left ventricular failure. Clinical features Patients are asymptomatic until there is severe steno- sis when they present with exercise-induced syncope, Pulmonary stenosis angina or dyspnoea. Narrowing of the pulmonary valve, resulting in pressure On examination the pulse is low volume and slow ris- overload of the right ventricle. On palpation there may be an aortic systolic thrill felt in the right second intercostal space. Aetiology The apex is slow and thrusting in nature but not dis- This is almost invariably a congenital lesion either as an placed. On auscultation there may be a systolic ejection isolated lesion or as part of the tetralogy of Fallot. Rarely click, followed by a mid-systolic ejection murmur heard itmaybeanacquiredlesionsecondarytorheumaticfever best in the right second intercostal space and radiating or the carcinoid syndrome. The murmur is best heard with the patient leaning forward with breath held in expiration. Pathophysiology The obstruction to right ventricular emptying results Investigations in right ventricular hypertrophy and hence decreased r Chest X-ray may show a post-stenotic dilation of the ventricular compliance, which leads to right atrial ascending aorta and left ventricular hypertrophy. Patients with mild r Organic tricuspid regurgitation occurs with rheuma- pulmonary stenosis are asymptomatic (diagnosed inci- tic mitral valve disease, infective endocarditis and the dentally from the presence of a murmur or the presence carcinoid syndrome. Patients the tricuspid valve is seen particularly in intravenous mayhavenon-specicsymptomssuchasfatigueordysp- drug abusers. Syncope is a sign of critical stenosis, which requires plasia of the tricuspid valve with abnormal valve urgent treatment. Auscultation reveals a click and harsh Pathophysiology mid-systolic ejection murmur heard best on inspiration Regurgitation of blood into the right atrium during sys- in the left second intercostal space often associated with tole results in high right atrial pressures and hence right a thrill. A left parasternal heave may also be felt due to atrial hypertrophy and dilatation. In the chronic un- cases intervention is required before decompensation of treated patient there can be hepatic cirrhosis from the the right ventricle occurs. Echocardiography is diagnostic and is also essential to assess right ventricular function. Tricuspid regurgitation Denition Management Retrograde blood ow from the right ventricle to the Functional tricuspid regurgitation usually resolves with rightatrium during systole. Cardiac arrhythmias A cardiac arrhythmia is a disturbance of the nor- Aetiology mal rhythm of the heart. Tachycardias are also subdivided according to their Clinical features origin: Most patients are asymptomatic but occasionally post- r Sinustachycardia. If bradycardia is episodic and severe, syncope r Ventricular tachyarrhythmias such as ventricular may occur. However, in patients with bundle branch block Most cases do not require treatment other than with- and in cases where the rapid rate of supraventricu- drawal of drugs or treatment of any underlying cause. Carotid sinus massage typically leads to a Denition sudden and sometimes prolonged sinus pause. Aetiology/pathophysiology Sinustachycardia is a physiological response to main- tain tissue perfusion and oxygenation. Clinical features Investigations Palpitations with an associated rapid, regular pulse rate. In addition anti-arrhythmic drugs may be required to Management controlanytachycardia. Atrial arrhythmias Sinus node disease Atrial ectopic beats Denition Sinusnode disease or sick sinus syndrome is a tachy- Denition cardia/bradycardia resulting from damage to the sinus Atrial ectopic beats include extrasystoles and premature node. Aetiology/pathophysiology Aetiology Sinusnode disease is relatively common in the elderly Atrial ectopics are common in normal individuals.

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When the strains used in the extract were investigated individually cheap 10 mg domperidone with visa symptoms high blood pressure, they varied in their quantities of the four most important allergens discount domperidone 10 mg with mastercard symptoms restless leg syndrome. Other studies demonstrated that disrupted spore antigens did not cross-react with either mycelial or culture filtrate allergens ( 121) buy domperidone 10mg mastercard medicine dispenser. Common allergens occur within the fumigatus and niger groups, which are allergenically distinct from the versicolor, nidulans, and glaucus groups (99). Asp f 1 has been cloned and identified as a cytotoxin, mitogillin, which is excreted from the fungus only during growth ( 122,123). A combination of Asp f 1, Asp f 3, and Asp f 5 has a sensitivity of 97% for diagnosing Aspergillus sensitivity (125). Pen c 1 is a 33-kDa alkaline serine protease with 93% IgE reactivity among patients sensitive to Penicillium species (128,129). Pen c 3 has 83% sequence homology with Asp f 3 peroxisomal membrane protein allergen (131). Sensitivity to spores of the Basidiomycetes is a significant precipitant of allergic disease. Asthma epidemics have been reported in association with elevated Basidiomycetes spore counts (133). Several species have been shown to be allergenic, and extracts from these species show multiple antigens and allergens ( 134). Up to 20% of asthmatic individuals demonstrate positive skin test results to Basidiomycetes species ( 135). Cop c 1 from Coprinus comatus has been cloned, but only 25% of basidiomycete-allergic patients respond ( 136). Psi c 2 from Psilocybe cubensis mycelia was also cloned and shows some homology with Schizosaccharomyces pombe cyclophilin (137). Candida albicans is the most frequently isolated fungal pathogen in humans; however, its role in allergic disease is relatively minimal. The other major allergen appears to be enolase, which cross-reacts as noted before. Candida also secretes an acid protease, which produces IgE antibodies in 37% of Candida-allergic patients (141). Candida sensitivity is also associated with eczema related to infection with the human immunodeficiency virus ( 142). Atmospheric fungal spore counts frequently are 1,000-fold greater than pollen counts ( 99), and exposure to indoor spores can occur throughout the year ( 143). This is in contrast to pollens, which have distinct seasons, and to animal dander, for which a definitive history of exposure usually can be obtained. Some species do show distinctive seasons; nevertheless, during any season, and especially during winter, the number and types of spores a patient inhales on a given day are purely conjectural. In the natural environment, people are exposed to more than 100 species of airborne or dust-bound microfungi. The variety of fungi is extreme, and dominant types have not been established directly in most areas. The spores produced by fungi vary enormously in size, which makes collection difficult. Moreover, both microscopic evaluation of atmospheric spores and culturing to assess viability are necessary to fully understand the allergenic potential of these organisms. Although most allergenic activity has been associated with the spores, other particles such as mycelial fragments and allergens absorbed onto dust particles may contain relevant activity. Lastly, more than half of the outdoor fungus burden (Ascomycetes and Basidiomycetes) have spores that have not been studied or are practically unobtainable. Fungi are members of the phylum Thallophyta, plants that lack definite leaf, stem, and root structures. They are separated from the algae in that they do not contain chlorophyll and therefore are saprophytic or parasitic. The mode of spore formation, particularly the sexual spore, is the basis for taxonomic classification of fungi. Many fungi have two names because the sexual and asexual stages initially were described separately. Many fungi produce morphologically different sexual and asexual spores that may become airborne. The Deuteromycetes ( fungi imperfecti ) are an artificial grouping of asexual fungal stages that includes many fungi of allergenic importance ( Aspergillus, Penicillium, and Alternaria). These fungi were considered imperfect, but are now known to be asexual stages (form genera or form species of Ascomycetes). These fungi reproduce asexually by the differentiation of specialized hyphae called conidiophores, which bear the conidia or asexual spore-forming organs. The various species of these fungi are differentiated morphologically by the conidia. Hyphae are filamentous strands that constitute the fundamental anatomic units of fungi. The mycelium is a mass of hyphae, and the undifferentiated body of a fungus is called a thallus.