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Dutcher bodies Intranuclear membrane bound inclusion bodies found in plasma cells purchase dostinex 0.5mg amex womens health 99 weight loss tips. Dysfibrinogenemia A hereditary condition in which there is a structural alteration in the fibrinogen molecule buy dostinex 0.5mg on-line menstrual tea. Dyshematopoiesis Abnormal formation and/or development of blood cells within the bone marrow dostinex 0.25mg low price menstruation through the ages. Dyspoiesis Abnormal development of blood cells frequently characterized by asynchrony in nuclear to cytoplasmic maturation and/or abnormal granule development. Echinocyte A spiculated erythrocyte with short, equally spaced projections over the entire outer surface of the cell. Effector lymphocytes Antigen stimulated lymphocytes that mediate the efferent arm of the immune response. The cell is an oval to elongated ellipsoid with a central area of pallor and hemoglobin at both ends; also known as ovalocyte, pencil cell, or cigar cell. Embolism the blockage of an artery by embolus, usually by a portion of blood clot but can be other foreign matter, resulting in obstruction of blood flow to the tissues. Embolus A piece of blood clot or other foreign matter that circulates in the blood stream and usually becomes lodged in a small vessel obstructing blood flow. Endothelial cells Flat cells that line the cavities of the blood and lymphatic vessels, heart, and other related body cavities. Granules contain acid phosphatase, glycuronidase cathepsins, ribonuclease, arylsulfatase, peroxidase, phospholipids, and basic proteins. Eosinophilia An increase in the concentration of eosinophils in the peripheral blood (>0. Associated with parasitic infection, allergic conditions, hypersensitivity reactions, cancer, and chronic inflammatory states. Erythroblastic island A composite of erythroid cells in the bone marrow that surrounds a central macrophage. These groups of cells are usually disrupted when the bone marrow smears are made but may be found in erythroid hyperplasia. The least mature cells are closest to the center of the island and the more mature cells on the periphery. It is caused by an antigen— antibody reaction in the newborn when maternal antibodies traverse the placenta and attach to antigens on the fetal cells. It contains the respiratory pigment hemoglobin, which readily combines with oxygen to form oxyhemoglobin. The cell develops from the pluripotential stem cell in the bone marrow under the influence of the hematopoietic growth factor, erythropoietin, and is released to the peripheral blood as a reticulocyte. The average life span is about 120 days, after which the cell is removed by cells in the mononuclear-phagocyte system. Erythrocytosis An abnormal increase in the number of circulating erythrocytes as measured by the erythrocyte count, hemoglobin, or hematocrit. Erythrophagocytosis Phagocytosis of an erythrocyte by a histiocyte; the erythrocyte can be seen within the cytoplasm of the histiocyte as a pink globule or, if digested, as a clear vacuole on stained bone marrow or peripheral blood smears. Erythropoiesis Formation and maturation of erythrocytes in the bone marrow; it is under the influence of the hematopoietic growth factor, erythropoietin. Essential A myeloproliferative disorder affecting primarily thrombocythemia the megakaryocytic element in the bone marrow. Also called primary thrombocythemia, hemorrhagic thrombocythemia, and megakaryocytic leukemia. Evan’s syndrome A condition characterized by a warm autoimmune hemolytic anemia and concurrent severe thrombocytopenia. Extracellular matrix Noncellular components of the hematopoietic microenvironment in the bone marrow. Extramedullary Red blood cell production occurring outside the erythropoiesis bone marrow. Extramedullary the formation and development of blood cells at hematopoiesis a site other than the bone marrow. Extrinsic pathway One of the three interacting pathways in the coagulation cascade. The term extrinsic is used because the pathway requires a factor extrinsic to blood, tissue factor. This indicates a true pathologic state in the anatomic region, usually either infection or tumor. Faggot cell A cell in which there is a large collection of Auer rods and/or phi bodies. The result falling outside the control limits or violating a Westgard rule is due to the inherent imprecision of the test method. Small amounts can be found in the peripheral blood proportional to that found in the bone marrow. The presence of fibrin degradation products is indicative of either fibrinolysis or fibrinogenolysis. Fibrin monomer the structure resulting when thrombin cleaves the A and B fibrinopeptides from the α and β chains of fibrinogen. Fibrinogen group A group of coagulation factors that are consumed during the formation of fibrin and therefore absent from serum. The bonds between glutamine and lysine residues are formed between terminal domains of γ chains and polar appendages of α chains of neighboring residues. The red tinge is caused by the presence of a glycoprotein and the purple by ribosomes. Flow chamber the specimen handling area of a flow cytometer where cells are forced into single file and directed in front of the laser beam. Fluorochrome Molecules that are excited by light of one wavelength and emit light of a different wavelength. Forward light scatter Laser light scattered in a forward direction in a flow cytometer. During normal lymphocyte development, rearrangement of the immunoglobulin genes and the T cell receptor genes results in new gene sequences that encode the antibody and surface antigen receptor proteins necessary for immune function. In humans, the genome consists of 3 billion base pairs of dna divided among 46 chromosomes, including 22 pairs of autosomes numbered 1—22 and the two sex chromosomes. Genotype the genetic constitution of an individual, often referring to a particular gene locus. It dehydrogenates glucose-6-phosphate to form 6- phosphogluconate in the hexose monophosphate shunt. This provides the erythrocyte with reducing power, protecting the cell from oxidant injury. Glutathione A tripeptide that takes up and gives off hydrogen and prevents oxidant damage to the hemoglobin molecule. Glycoprotein Ib A glycoprotein of the platelet surface that contains the receptor for von Willebrand factor and is critical for initial adhesion of platelets to collagen after an injury. Glycosylated Hemoglobin that has glucose irreversibly hemoglobin attached to the terminal amino acid of the beta chains. Gower hemoglobin An embryonic hemoglobin detectable in the yolk sac for up to eight weeks gestation.

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Adenosine An agent that improves the maintenance of red cell viability and is capable of restoring the adenosine triphosphate content of stored red cells 0.5 mg dostinex visa breast cancer prognosis. Agammaglobulinemia the absence of plasma gamma globulin due to either congenital or acquired states purchase dostinex 0.25mg line women's health center waldorf. Alleles Alternate forms of genes that code for trains of the a B same type; for example buy generic dostinex 0.25 mg line menstruation or pregnancy bleeding, the genes Fy and Fy are alleles. Aminiocentesis the process of removing fluid from the amniotic sac for study, for example, chromosome analysis or biochemical studies. This secondary response occurs on 110 subsequent exposure to a previously encountered and recognized foreign antigen. Autologous donation may take the form of predeposit or autotransfusion, for example, intraoperative autotransfusion, hemodilution, or postoperative auto transfusion. Avidity (of an antiserum) A measure of the ability and speed with which an antiserum agglutinates red cells as a property of the combining constrant (K) Bombay phenotype the failure of an individual to express inherited A or B genes because of the lack of at least one H gene and the subsequent lack of the resulting H precursor substance. Co-dominant genes Tow or more allelic genes, each capable of expressing in single dose. Compatibility test A series of procedures used to give an indication of blood group compatibility between the donor and the recipient and to detect irregular antibodies in the recipient’s serum. Cord blood Blood taken from the umbilical vein or the umbilical cord of a newborn Delayed hemolytic transfusion reaction A rapid increase in antibody concentration and destruction of transfused red cells a few days after transfusion usually due to low amount of antibody undetectable in pretransfusion tests on the recipient, which are stimulated to high titers by the transfusion of red cells possessing the offending antigen. Eluate In blood banking, the term denotes an antibody solution made by recovery into a fluid medium of antibodies that have been taken up by red cells (i. Immune Response Any reaction demonstrating specific antibody response to antigenic stimulus. Immunoglobulin antibody containing globulins including those proteins without apparent anti body activity that have the same antigen specificity and are produced by similar cells. Incompatible transfusion Any transfusion that results in an adverse reaction in the patient (including reduced red cell survival). Inheritance the acquisition of characteristics by transmission of chromosomes and genes from ancestor to descendant. A procedure based on the differences in solubility between adult and fetal hemoglobin. The test is performed on a maternal blood specimen to deterct fetal-maternal hemorrhage. Also known as non-red cell- immune antibodies Non-red cell-immune see Naturally occurring antibody. The observed or discernible characteristics of an individual Phenotype as determined by his or her genotype and the environment in which he or she develops. This form of destruction of erythrocytes is due to an IgG protein that reacts with the red blood cells in colder parts of the body and subsequently causes complement components to bin irreversibly to erythrocytes. It is 113 commonly seen as an acute transient condition secondary to viral infection. The length of survival of blood ce4lls after infusion into the human body, believe to be related to the structural and metabolic status of the cell membran Prenatal. A possible cause of false- negative antigen- antibody reactions due to an excessive amount of antibody. Quality control A control of all facets of daily work to ensure a high level of performance. Reagent red cells red cells used in laboratory testing Recessive gene A gene that gives rise only to its corresponding character when present in “double dose”(i. Secondary response A second response to exposure to a foreign antigen, resulting in the production of large amounts of antibody. Pseudoagglutination or the false cluming of erythrocytes when the cells are suspended in their own serum. This phenomenon resembles agglutination and is due to the presence of an abnormal protein in the serum, plasma expanders, such as dextran, or wharton’s jelly from cord blood samples. The complementary relationship between the binding sites of anibodies directed against determinants of a similar- type antigen. Sensitization(of red cells) the specific attachment of antibody to its antigenic receptors on red cells without agglutination or lysis. Sialic acid Any of a family of amino sugars containing nine or more carbon atoms that are nitrogen- and oxygen- substituted acylderivatives of neuraminic acid. It is a component of lipids, polysaccharides, mucoproteins and it is the main substance removed from the red cells by enzyme treatment. The complementary relationship between the binding sites of anibodies directed against determinants of a similar- type antigen. A type of enzyme that catalyzes the transfer of a monosaccharide molecule from a donor substrate to the precusrsor substance. This type of biochemical activity is related to the development of A,B, and H antigens Transplacental hemorrhage. This form of autoimmune anemia is associated with antibodies reactive at warm temperatures. Wharton’s jelly A mucoid connective tissue that makes up the matrix of the umbilical cord Zeta potenitial the difference in electrostatic potential between the net charge at the cell membrane and the charge at the surface of shear. Tibebu M, the Blood Bank Manual, Ethiopian Red cross society, National Blood Transfusion Service, Addis Ababa, 1998. W h a t i s t h e m o s t l i k e l y c a u s e o f t h e p o o r r e s p o n s e? InvestigatingBleeding DisordersinChildhood A D avid son, F D esai, M H end ricks RedCrossChildren’sHospital TheHistory FourimportantQuestions Isthechildableeder? W h a t i s t h e m o s t i m p o r t a n t i n v e s t i g a t i o n t o c o n f i r m t h i s? W h a t i n v e s t i g a t i o n s a r e r e q u i r e d t o p r o v e t h e d i a g n o s i s? W h a t i n v e s t i g a t i o n s a r e r e q u i r e d t o p r o v e t h e d i a g n o s i s? Produced in collaboration with the Ethiopia Public Health Training Initiative, the Carter Center, the Ethiopia Ministry of Health, and the Ethiopia Ministry of Education. Important Guidelines for Printing and Photocopying Limited permission is granted free of charge to print or photocopy all pages of this publication for educational, not-for-profit use by health care workers, students or faculty. All copies must retain all author credits and copyright notices included in the original document. Under no circumstances is it permissible to sell or distribute on a commercial basis, or to claim authorship of, copies of material reproduced from this publication. Except as expressly provided above, no part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission of the author or authors. This material is intended for educational use only by practicing health care workers or students and faculty in a health care field. Hence, the authors hope that this lecture note would be immensely useful in solving this existing problem at significant level.

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Sexual History A detailed history of sexual Fluid Intake function is vital to a thorough the amount and type of fuid assessment of pelvic foor consumed on a daily basis should disorders cheap dostinex 0.5 mg otc menstruation belt. Obstetric History the number and type of deliveries are important as well as any history of perineal or anal sphincter injury purchase dostinex 0.25mg online women's health your best body meal plan week 1. Other relevant parts of the history Surgical History Previous pelvic surgery buy dostinex line women's health clinic midland tx, including Neurological history prolapse and incontinence surgery, Women should be questioned should be noted. Any history of multiple sclerosis, parkinsonism, spinal cord injury, stroke or spina bifda should also 6 Causes of Incontinence I. Excessive urine production Diabetes Mellitis and Insipidus Diuretics Cardiac failure Adapted from Textbook of Female Urology and Urogynaecology Eds Cardozo and Staskin. Lower Lower urinary tract symptoms are urinary tract symptoms were categorized as storage, voiding defned by the standardization sub and post micturition symptoms. Symptoms may the complaint by the patient who either be volunteered or described considers that he/she voids too during the patient interview. In general, lower urinary tract Nocturia is the complaint that the 8 individual has to wake at night Stress urinary incontinence is the one or more times to void. Urgency urinary incontinence is the complaint of involuntary leakage Urinary incontinence is the accompanied by or immediately complaint of any involuntary preceded by urgency. If it is used to denote leakage, and whether or not the incontinence during sleep, it individual seeks or desires help should always be qualifed with because of urinary incontinence. Intermittent stream or Double voiding (Intermittency) is the term Continuous urinary incontinence used when the individual describes is the complaint of continuous urine fow which stops and starts, leakage and may denote urinary on one or more occasions, during fstula. Bladder sensation can be defned, Hesitancy is the term used when during history taking, into four an individual describes diffculty categories. Straining to void describes the muscular effort used to initiate, Increased: the individual feels an maintain or improve the urinary early frst sensation of flling and stream. Terminal dribble is the term used Reduced: the individual is aware when an individual describes a of bladder flling but does not feel prolonged fnal part of micturition, a defnite desire to void. Absent: the individual reports no sensation of bladder flling or Post micturition symptoms are desire to void. Feeling of incomplete emptying is a self – explanatory term for Slow stream is reported by the a feeling experienced by the individual as the perception individual after passing urine. In is a reasonable option for most fact some symptoms, like nocturia, patients with incontinence. If cannot be properly evaluated record keeping for 7 days increases without a chart. Frequency – a patient’s burden the number of volume charts are critical for the days required to evaluate voiding distinction between nocturnal symptoms should be reduced. Microscopic haematuria can › Mulitple sclerosis be easily identifed by dipsticking › Diabetes Mellitus because of the presence of • Reduced mobility haemoglobin. The detection of • Alzheimers haematuria is important because • Medical therapy, i. Special investigations Urodynamic Investigations Urinalysis Urinalysis is not a single test What is meant by the term - complete urinalysis includes Urodynamic investigations? Dipstick urinalysis that ‘the bladder often proves to is certainly convenient but false be an unreliable witness’, meaning positive and false negative results that the presenting symptoms may occur. It is considered an of the patient and the eventual inexpensive diagnostic test able to diagnosis of the problem are often identify patients with urinary tract at variance. Videocystourethrography is used in advanced centres and is the Urodynamic tests have been gold standard of the investigation developed to confrm the of female urinary incontinence. These upon conventional cystometry to tests identify the etiology of provide an accurate diagnosis. Their use is sometimes debatable, Increasingly, ultrasound imaging is since grade A evidence supporting also being used to measure both the general use of urodynamics in bladder neck descent and bladder the investigation of incontinence, wall thickness. Urofowmetry (otherwise resistance pressure has recently known as a ‘free fow been pioneered. However, at present which involve flling and its widespread use as a routine voiding cystometry (the latter urodynamic tool is questionable being a so – called ‘pressure – and it should only be used in fow’ study). Depending on the sophistication of the apparatus used, either a leak Basic tests which should be – point pressure measurement, or performed on patients prior to urethral pressure proflometry may urodynamic testing include a be performed additionally as a test urine microscopy and culture, of urethral function. Urodynamic and a measurement of residual testing can either be static or urine volume, either by catheter ambulatory. A bladder diary (frequency / volume chart) is 13 also a necessary aid to diagnosis. They also require a patient suffering from urinary considerable expertise and access incontinence is not adequately to sophisticated equipment. Failure to recognize concomitant detrusor overactivity and / or Clinical Indications for voiding dysfunction may also Urodynamics Investigations affect the outcome of appropriate There are many etiological factors surgery. Certainly the most Table 1 lists the most important common problems are urodynamic indications for urodynamic studies. Complex symptomatology urethral diverticulae, urethral instability, the urethral syndrome 4. Medico – legal cases must be emphasized that many 14 Clinical Diagnosis versus History, clinical examination and basic tests urodynamic diagnosis Over the past 35 years there have In the ongoing search for an uncomplicated and cost – effective been ongoing discussions in the approach to the pre – operative literature on how best to evaluate evaluation of a patient for patients with incontinence. The accuracy of history alone Most of the early papers looked In summary the addition of other clinical parameters and simple at the discriminatory value of a pure history of either stress offce tests do enhance the sensitivity of a history. In summary, it is clear In South Africa, Urogynaecology as from the majority of studies that a subspeciality is still in its infancy. The symptom of stress incontinence may be very sensitive, and this is an area which urgently but is so nonspecifc as to render it requires development, particularly of little diagnostic value. Medical practice is increasingly History is best used as a guide to becoming dogged by litigation and the subsequent evaluation process and to serve as a measure of practitioners have to be able to disease severity. They are often also run by staff who are not properly trained to provide good quality results and interpretation. It is these practitioners who should be at the forefront of attempts to develop mechanisms which are aimed a providing the best possible service for their patients. Where a Gynaecological surgical intervention is planned, Examination the responsible surgeon should determine exactly what may It is impossible to perform an be required at operation – so adequate urogynaecological that the appropriate consent examination without using a can be obtained and the correct Sims speculum and in some intervention planned. The vulva and vagina are inspected for any the women’s mobility and general lesions, atrophy or excoriation. The woman is then asked to cough or valsalva while the clinician observes for any stress Neurological incontinence. She is then asked to turn onto her left side and the examination Sims speculum is used to inspect the anterior and posterior vaginal the spinal segments S2,3. It is imperative be assessed by testing the tone, that the middle compartment is strength and sensation in the 17 also adequately assessed for any Grade I: Descent halfway to the uterine or vaginal vault descent. It does are not adequately explained by not give a quantitative impression the fndings at examination, it may of the severity of the prolapse. This length, perineal body size or the is accomplished by asking her to length of the urogenital hiatus.

Referral: All patients must be referred to a gynecologist for evaluation and decision on mode of treatment discount dostinex 0.25mg with amex women's health center tampa general hospital. Decision of treatment for malignant trophoblastic tumours is best done in hospital under specialist care purchase dostinex in united states online menstruation tissue discharge. If total tumour removal is not possible quality 0.5 mg dostinex womens health initiative study results, then maximum debulking (cyto-reductive) surgery should be done. Chemotherapy Adjuvant chemotherapy: Is indicated for all unfavourable histologies as well as advanced stages. The most common warning sign of skin cancer is a change in the appearance on exposed areas of the skin, such as a new growth or a sore that will not heal. Surgery: the aim of sugery is total local excision where possible; wide local excision and graft; amputation sometimes is required. Locally destructive methods such as curetting, desiccating or cryotherapy may be emplyted. Radiotherapy: Indication: Positive margin, high grade disease or inoperable tumour. Chemotherapy: S: Topical 5- fluorouracil for very superficial lesions or carcinoma in situ. Detection/Prevention: Frequent self-check or screening exercise and prompt treatment of early keratotic changes. Investigation:  None or minimal if lesion is small  Radiological: Chest x-ray in case of clinically suspected lung involvement or abdominal ultrasound in case of suspected liver metastases. Detection/Prevention: Frequent self-check or screening exercise and prompt treatment of naevus. May use large fractions: 30Gy/6F/1 wk  Excision margins are involved or very close  Palliative intent (brain mets, fungation or profuse bleeding, bone pain, etc) 2. Treatment: Chemotherapy:  Adults: S: Adriamycin 40mg/sq m i/v D1 Plus S: Vincristine 1. Note:  Sequential hemibody irradiation is sometimes necessary for aggressive disease. They may interfere with vital functions such as: Respiratory, swallowing, sight, speech and mastication. Important aetiological factors include excessive intake of tobacco either by smoking or chewing and alcohol intake (particularly spirits). Other features include: Non-healing ulcers, lymphadenopathy, hoarseness, pain and difficult in swallowing. Decisions of treatment for head and neck tumours are best discussed at Tumour board. Treatments  the treatment plan for an individual patient depends on a number of factors: in the exact location of the tumor, the disease stage, the person’s age and general health. Surgery:  Partial or total laryngectomy is for advanced stages only where voice is compromised. Tumour present as “goiter” and can remain silent for decades without any discomfort. Clinical features: Presence of a thyroid mass or scar, laryngeal nerve palsy, hoarseness, dyspnoea, dysphagia. Treatment  Radioactive iodine ablation  Further thyroxine replacement therapy (for life). Symptoms: Difficult in swallowing (dysphagia) is the commonest symptom which is associated with weight loss and poor performance status. Dilatation with or without intubation should always be considered to ensure continued ability to swallow. Look for pallor, weight loss, supraclavicular foss nodes, abdominal and rectal examination, epigastric mass, hepatomegally, periumbilical nodes. Surgery: Total or partial gastrectomy, bypass with or without tumour removal eg gastrojejunostomy. There is a strong association of this cancer and hepatitis B infection and/or alcohol consumption. Right upper abdominal swelling and pain often associated with weight loss, fever, jaundice. Histology: Hepatocellular carcinoma 90%, Cholangiocarcinoma 7%, Hepatoblastoma, angiosarcoma, sarcomas 3%. Anatomic extent of involvement: A: One lobe only; B: Two lobes; C: Metastatic disease; D: Cirrhosis. Surgery: Lobectomy where feasible Chemotherapy is not effective; However single agent Doxorubicin is used. Early stages may be superior to surgery in the sense that sphincter function is preserved. Treatment Surgery  Modified radical mastectomy  Lumpectomy  Simple mastectomy with axillary node dissection  Toilet mastectomy to improve patient’s quality of life. Detection/Prevention  Any woman particularly at the age of 50 years should undergo mammography annually  Anyone with familial risk ought to start earlier Self breast examination on monthly basis 7. This may be visible to the naked eye gross hematuria or detectable only by microscope. Other possible symptoms include: Dysuria or increased frequency and bilharzia exposure, weight loss and anaemia. Decisions of treatment for urinary bladder tumour are best discussed at Tumour board. Treatment:  Surgery: Total cystectomy is mutilating and causes poor quality of life. Prostate cancer is associated with circulating testosterone and family history is significant in a very small percentage of patients. However, very often patient may present with bone pain – backache or pathological fracture. Bilateral orchidectomy is a surgical procedure which aims at surgical castration  Hormonal therapy: May be given as the sole treatment for patients deemed unfit for surgery. Alternatively hormonal therapy is used as adjunct to other treatments with the intention of reducing the chance of local recurrence or metastatic disease. Palliative radiotherapy is valuable to bone metastases, massive haematuria, spinal cord compression, pathological fracture, etc as indicated. Detection/Prevention: Prostate cancer is among the cancers in human beings which could be prevented by screening procedures. Lymphocytes are in the lymph nodes and other lymphoid tissues (such as the spleen and bone marrow). Clinical features:  Peripheral lymph node enlargement (commonest site- neck 281 | P a g e  Hepatomegally and/or splenomegally in advanced stages. Then there is a slight fall in the middle age, following by a rise after 50 years.