By I. Jaroll. University of Arkansas, Fayetteville.

Extramedullary The formation and development of blood cells at hematopoiesis a site other than the bone marrow order pyridium 200mg free shipping. The result falling outside the control limits or violating a Westgard rule is due to the inherent imprecision of the test method cheap pyridium 200mg otc. Fibrin monomer The structure resulting when thrombin cleaves the A and B fibrinopeptides from the α and β chains of fibrinogen generic pyridium 200 mg free shipping. 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. 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. 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. 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. Usually seen in bacterial infections, inflammation, metabolic intoxication, drug intoxication, and tissue necrosis. Granulomatous A distinctive pattern of chronic reaction in which the predominant cell type is an activated macrophage with epithelial-like (epithelioid) appearance. Gray platelet syndrome A rare hereditary platelet disorder characterized by the lack of alpha granules. Hairy cell The neoplastic cell of hairy cell leukemia characterized by circumferential, cytoplasmic, hairlike projections. Helmet cell Abnormally shaped erythrocyte with one or several notches and projections on either end that look like horns. Hematocrit The packed cell volume of erythrocytes in a given volume of blood following centrifugation of the blood. Hematoma A localized collection of blood under the skin or in other organs caused by a break in the wall of a blood vessel. Hematopoiesis The production and development of blood cells normally occurring in the bone marrow under the influence of hematopoietic growth factors. Hematopoietic Specialized, localized environment in microenvironment hematopoietic organs that supports the development of hematopoietic cells. Hematopoietic stem cell Hematopoietic precursor cell capable of giving rise to all lineages of blood cells. Heme The nonprotein portion of hemoglobin and myoglobin that contains iron nestled in a hydrophobic pocket of a porphyrin ring (ferroprotoporphyrin). Hemoconcentration Refers to the increased concentration of blood components due to loss of plasma from the blood. Hemoglobin An intracellular erythrocyte protein that is responsible for the transport of oxygen and carbon dioxide between the lungs and body tissues. Hemoglobin distribution A measure of the distribution of hemoglobin width within an erythrocyte population. Hemoglobin Method of identifying hemoglobins based on electrophoresis differences in their electrical charges. Hemoglobinopathy Disease that results from an inherited abnormality of the structure or synthesis of the globin portion of the hemoglobin molecule. Hemolytic anemia A disorder characterized by a decreased erythrocyte concentration due to premature destruction of the erythrocyte. Hemolytic transfusion Interaction of foreign (nonself) erythrocyte reaction antigens and plasma antibodies due to the transfusion of blood. There are two types of transfusion reactions: immediate (within 24 hours) or delayed (occurring 2 to 14 days after transfusion). Hemopexin A plasma glycoprotein (β-globulin) that binds the heme molecule in plasma in the absence of haptoglobin. Hemosiderin A water insoluble, heterogeneous iron—protein complex found primarily in the cytoplasm of cells (normoblasts and histocytes in the bone marrow, liver, and spleen); the major long-term storage form of iron.

Lymph is filtered through several lymph nodes where it is inspected for foreign substances order 200 mg pyridium with mastercard. Lymphatic Ducts: (Drainage) Eventually buy pyridium 200mg with visa, the lymph vessels empty into the lymphatic ducts which drain into one of the two subclavian veins cheap pyridium 200mg on line. The lymphatic vessels of the left arm drain into the left subclavian lymphatic trunk and lymph channels of the right arm drain into the right subclavian lymphatic trunk. If the lymph nodes are not successful in destroying cancer cells, the nodes may become sites of secondary tumours. Breast Cancer Related Lymphoedema is the build up 48 of fluid in the upper extremity due to impairment of the lymph vessels following removal of the axillary lymph nodes and possibly exacerbated by radiation treatment (Smith and Miller, 1998). Lymphoedema has been reported to occur within days and up to 30 years after breast cancer treatment but most commonly occurs within 12 months post-surgery. Staging of lymphoedema (classification of severity): Stage 0 Lymphatic function is reduced, lymphoedema is present but is not apparent on physical examination Stage 1 Early accumulation of fluid that is relatively high in protein content. Stage 3 A severe increase in irreversible swelling may develop, along with skin changes, such as thickening of the skin, fat deposits, and warty over-growths. In almost all cases an in-depth medical history and physical examination are enough to make a diagnosis. Lymphoedema Assessment Subjective Objective  Current symptoms: Daily pattern, (Always compare to other side) frequency, intensity, duration  Range of motion  Pain  Increase in upper limb  Functional Impairments, dominant volume/circumference hand  Skin condition:  History of Oedema, previous - broken/fragile/shiny/ulcerated/ treatment? Chen et al, (2008) found it a reliable measure for assessing arm volume in breast cancer patients. Technique to measure circumference of upper limb: Ensure the limb is supported and in a straight position. These should be of the appropriate class and size, and a choice of fabrics and colours should be available. It consists of light, rhythmical strokes performed in the direction of normal lymphatic flow. Usually, it is performed for 45-60 minutes, 4 days a week for 2-4 weeks (acute phase of treatment) (Chiefetz and Hanley, 2010). This is a precise and accurate procedure using specific bandages and interfacing materials that provide external support to the skin. The gradient compressive forces push the lymphatic fluid from the interstitium into the lymph vessels increasing lymph reabsorption and stimulating lymphatic transport. In the acute phase (0-5 days) short-stretch bandages are used to reduce limb volume. Their efficiency is increased when exercises are done in conjunction due to dual-action of muscle pump and compression. Once limb volume is reduced substantially, patient is fitted for a compression garment to maintain the achieved volume. Exercise should consist of both range of motion/flexibility and strengthening and should be specific to each individual. Options include direct anatomic plane movements, scapular plane movements, or functional and combined movements (e. Wear gloves when doing duties, shave with electric razor, treat cuts with antiseptic lotion. Chou et al, (2012) carried out a single case study on a patient with unilateral secondary malignant breast – cancer lymphoedema and found that kinesio taping could be another choice for contraindicating pressure therapy patients instead of compressive bandaging, however it should not replace it. Furthermore, 55 Tsai et al, 2009 found that there was no significant difference between kinesio taping and bandaging for the treatment of cancer-related lymphoedema. The network is always present in the axilla and extends along the medial face of the ipsilateral arm, frequently below the cubital cavity and occasionally until the base of the thumb. Altogether 56 out of 116 patients who underwent axillary lymph-node dissection were found to have axillary web syndrome (incidence of 48. It is unrelated to the number of lymph nodes compromised or with the stage of the illness. The management included manual therapy, mostly using soft tissue treatment techniques, combined with education and advice. Pre-morbid range of movement was achieved within 11 treatments, spread over 3 weeks and after 16 weeks the patient experienced no pain. Furthermore, the patient returned to full-time employment after the seventh treatment by a physiotherapist. This results in fibrosis of the vasa nervorum (small arteries supplying blood to peripheral nerves) (Ahmad et al, 1999). Radiation-induced brachial plexopathy can occur when radiotherapy is directed at the chest, axillary region, thoracic outlet, or neck. The radiation dose, treatment technique, and concomitant use of chemotherapy all demonstrate significant association with the development of radiation injury to the brachial plexus (Bajrovic et al, 2004).

This important nutrient is also found in green leafy vegetables buy 200 mg pyridium with amex, broccoli cheap pyridium 200mg overnight delivery, and intact salmon and canned sardines with their soft bones pyridium 200mg mastercard. Nuts, beans, seeds, and shellfish provide 242 Chapter 6 | Bone Tissue and the Skeletal System calcium in smaller quantities. Except for fatty fish like salmon and tuna, or fortified milk or cereal, vitamin D is not found naturally in many foods. Other Nutrients Vitamin K also supports bone mineralization and may have a synergistic role with vitamin D in the regulation of bone growth. While magnesium is only found in trace amounts in the human body, more than 60 percent of it is in the skeleton, suggesting it plays a role in the structure of bone. Inflammation can interfere with the function of osteoblasts, so consuming omega-3 fatty acids, in the diet or in supplements, may also help enhance production of new osseous tissue. These hormones are involved in controlling bone growth, maintaining bone once it is formed, and remodeling it. Hormones That Influence Osteoblasts and/or Maintain the Matrix Several hormones are necessary for controlling bone growth and maintaining the bone matrix. It triggers chondrocyte proliferation in epiphyseal plates, resulting in the increasing length of long bones. Thyroxine, a hormone secreted by the thyroid gland promotes osteoblastic activity and the synthesis of bone matrix. They too promote osteoblastic activity and production of bone matrix, and in addition, are responsible for the growth spurt that often occurs during adolescence. Additionally, calcitriol, the active form of vitamin D, is produced by the kidneys and stimulates the absorption of calcium and phosphate from the digestive tract. In Paget’s disease, new bone is formed in an attempt to keep up with the resorption by the overactive osteoclasts, but that new bone is produced haphazardly. In fact, when a physician is evaluating a patient with thinning bone, he or she will test for osteoporosis and Paget’s disease (as well as other diseases). Osteoporosis does not have the elevated blood levels of alkaline phosphatase found in Paget’s disease. While osteoporosis can involve any bone, it most commonly affects the proximal ends of the femur, vertebrae, and wrist. As a result of the loss of bone density, the osseous tissue may not provide adequate support for everyday functions, and something as simple as a sneeze can cause a vertebral fracture. When an elderly person falls and breaks a hip (really, the femur), it is very likely the femur that broke first, which resulted in the fall. Histologically, osteoporosis is characterized by a reduction in the thickness of compact bone and the number and size of trabeculae in cancellous bone. Not only do their menstrual periods lessen and eventually cease, but their ovaries reduce in size and then cease the production of estrogen, a hormone that promotes osteoblastic activity and production of bone matrix. Anyone with a family history of osteoporosis has a greater risk of developing the disease, so the best treatment is prevention, which should start with a childhood diet that includes adequate intake of calcium and vitamin D and a lifestyle that includes weight-bearing exercise. Promoting proper nutrition and weight-bearing exercise early in life can maximize bone mass before the age of 30, thus reducing the risk of osteoporosis. The fracture itself may not be serious, but the immobility that comes during the healing process can lead to the formation of blood clots that can lodge in the capillaries of the lungs, resulting in respiratory failure; pneumonia due to the lack of poor air exchange that accompanies immobility; pressure sores (bed sores) that allow pathogens to enter the body and cause infections; and urinary tract infections from catheterization. Current treatments for managing osteoporosis include bisphosphonates (the same medications often used in Paget’s disease), calcitonin, and estrogen (for women only). Minimizing the risk of falls, for example, by removing tripping This OpenStax book is available for free at http://cnx. Hormones That Influence Osteoclasts Bone modeling and remodeling require osteoclasts to resorb unneeded, damaged, or old bone, and osteoblasts to lay down new bone. As a result, calcium is released from the bones into the circulation, thus increasing the calcium ion concentration in the blood. Calcitonin inhibits osteoclast activity and stimulates calcium uptake by the bones, thus reducing the concentration of calcium ions in the blood. Hormones That Affect the Skeletal System Hormone Role Growth Increases length of long bones, enhances mineralization, and improves bone density hormone Thyroxine Stimulates bone growth and promotes synthesis of bone matrix Sex Promote osteoblastic activity and production of bone matrix; responsible for adolescent growth hormones spurt; promote conversion of epiphyseal plate to epiphyseal line Calcitriol Stimulates absorption of calcium and phosphate from digestive tract Stimulates osteoclast proliferation and resorption of bone by osteoclasts; promotes Parathyroid reabsorption of calcium by kidney tubules; indirectly increases calcium absorption by small hormone intestine Calcitonin Inhibits osteoclast activity and stimulates calcium uptake by bones Table 6. Calcium ions are needed not only for bone mineralization but for tooth health, regulation of the heart rate and strength of contraction, blood coagulation, contraction of smooth and skeletal muscle cells, and regulation of nerve impulse conduction. Hypocalcemia, a condition characterized by abnormally low levels of calcium, can have an adverse effect on a number of different body systems including circulation, muscles, nerves, and bone. Without adequate calcium, blood has difficulty coagulating, the heart may skip beats or stop beating altogether, muscles may have difficulty contracting, nerves may have 246 Chapter 6 | Bone Tissue and the Skeletal System difficulty functioning, and bones may become brittle. Conversely, in hypercalcemia, a condition characterized by abnormally high levels of calcium, the nervous system is underactive, which results in lethargy, sluggish reflexes, constipation and loss of appetite, confusion, and in severe cases, coma. The bones act as a storage site for calcium: The body deposits calcium in the bones when blood levels get too high, and it releases calcium when blood levels drop too low. When all these processes return blood calcium levels to normal, there is enough calcium to bind with the receptors on the surface of the cells of the parathyroid glands, and this cycle of events is turned off (Figure 6. When blood levels of calcium get too high, the thyroid gland is stimulated to release calcitonin (Figure 6. The epiphyses, which are wider sections at each end of a long bone, are filled with spongy bone and red marrow.