Clinical Laboratory Diagnosis Fifth EditionPDF电子书下载

CHAPTER Ⅰ THE MOUTH 23

Saliva and Sputum 23

The Saliva 23

Functions of Saliva 23

Secretion of Saliva 23

Characteristics of Normal Saliva 24

Digestion of Starch 25

Indications for the Examination of Saliva 25

Collection of Saliva 25

The Examination of Saliva 25

Normal and Pathologic Findings of Saliva 26

Chemical Methods 27

Pathologic Conditions of the Mouth 29

Oral Lesions 29

Ptyalism 31

Xerostomia or Aptyalism 31

Stomatitis 31

Vincent＇s Angina 33

Thrush 33

Pyorrhea Alveolaris 33

Leukoplakia 34

Miscellaneous Conditions 34

CHAPTER Ⅱ THE STOMACH 35

Physiology of the Stomach 35

Stomach Contents 38

Test Meals 39

Examination of Stomach Contents 45

Normal and Pathologic Findings After a Test Meal 46

Acidity Curves 56

Acidity Curves After an Ewald Breakfast 56

Acidity Curves After Other Important Test Meals 59

Additional Examinations of the Stomach 60

Motor Power and Emptying-time 60

Absorptive Power 60

Size and Position 61

The Phenolphthalein Test 61

Gastroscopic Examination 61

Chemical Methods 61

Qualitative Analysis 61

Quantitative Analysis 67

Gastric Diseases 76

Peptic Ulcer 76

Carcinoma of the Stomach 77

Acute Catarrhal Gastritis 78

Chronic Gastritis 78

Achylia Gastrica 79

Gastric Neurosis 79

Syphilis of the Stomach 79

Gastro-intestinal Syndrome Complexes 80

Hypersecretion and Hyperchlorhydria 80

Atony of the Stomach 80

Acute Dilatation of the Stomach 81

Chronic Dilatation of the Stomach 81

CHAPTER Ⅲ THE DUODENUM AND RELATED ORGANS 82

Duodenal Contents 82

Duodenal Fluid 82

Pancreatic Juice 82

Bile 82

Indications for the Examination of Duodenal Contents 83

Contraindications for the Collection of Duodenal Contents 84

Collection of Duodenal Contents and Bile 84

Examination of Duodenal Contents and Bile 86

Normal and Pathologic Findings of Duodenal Contents 87

Chemical Methods 94

Qualitative Analysis 94

Quantitative Analysis 95

Special Analysis 97

The Liver 99

Functions of the Liver 99

Bilirubin and Its Decomposition Products 100

Functional Tests 101

Diseases of the Gall-bladder 110

Jaundice or Icterus 110

Cholecystitis 112

Cholelithiasis 112

Catarrhal Cholangitis 113

Suppurative Cholangitis 113

Diseases of the Liver 113

Cirrhosis of the Liver 113

Carcinoma of the Liver 115

Abscess of the Liver 115

Acute Yellow Atrophy of the Liver 115

Acute Infectious Hepatitis 115

Diseases of the Pancreas 116

Carcinoma of the Pancreas 116

Acute Pancreatitis 116

Chronic Pancreatitis 117

Cysts of the Pancreas 117

Pancreatic Hemorrhage 118

Calculi of the Pancreas 118

CHAPTER Ⅳ THE INTESTINE 119

The Feces 119

Composition of Feces 119

Indications for a General Examination of Feces 119

Indications for a Search for Parasites and Ova 120

Collection of Feces 120

Examination of Feces 120

Normal and Pathologic Findings of a Stool Examination 121

Intestinal Parasites Most Commonly Found in the United States 124

Classification of the Parasites to be Discussed 124

Discussion of Intestinal Parasites 127

Endamoeba histolytica 127

Endamoeba coli，Endolimax nana，Iodamoeba butschlii，and Dientamoeba fragilis 136

Trichomonas hominis 136

Giardia lamblia 137

Chilomastix mesnili 138

Isospora hominis 138

Balantidium coli 139

Taenia solium 140

Taenia saginata 143

Diphyllobothrium latum 143

Hymenolepis nana 145

Echinococcus granulosus 146

Fasciola hepatica 148

Clonorchis sinensis 148

Fasciolopsis buski 148

Paragonimus westermani 148

Schistosoma haematobium 149

Schistosoma mansoni 149

Schistosoma japonicum 149

Ascaris lumbricoides 151

Enterobius(Oxyuris)vermicularis 152

Necator americanus 153

Ancylostoma duodenale 155

Strongyloides stercoralis 155

Trichocephalus trichiurus 157

Trichinella spiralis 158

Chemical Methods 160

Qualitative Analysis 160

Quantitative Analysis 161

Intestinal Diseases 167

Appendicitis 167

Diarrhea 168

Chronic Constipation 168

Carcinoma of the Colon 170

Chronic Ulcerative Colitis 170

Acute Enteritis 170

Amebiasis 171

Bacillary Dysentery 172

Chronic Enteritis 172

Mucous Colitis 172

Dilatation of the Large Colon 173

Intestinal Obstruction 173

CHAPTER Ⅴ METABOLISM 174

Review of Carbohydrate Metabolism 174

General Considerations 174

Carbohydrates in the Body 175

Glucosuria 177

Glucose Tolerance Tests 178

Variations in Glucose Content of the Blood 185

Disorders Involving Carbohydrate Metabolism 186

Diabetes Mellitus 186

Benign Glucosurias 190

Diabetes Insipidus 191

Hyperinsulinism and Hypoglucemia 191

Chronic Adrenal Insufficiency 192

Subcutaneous Epinephrine Test 192

Four-hour ACTH Test 193

Water Test 193

The Sodium Deprivation Test 195

Galactose Tolerance Test 197

Review of Nitrogen Metabolism 197

General Considerations 197

Non-protein Nitrogen 200

Urea and Ammonia 200

Uric Acid 204

Creatine and Creatinine 207

Excretion of Nitrogenous Waste Products 211

Amino-acids 212

Plasma Proteins 212

Review of Fat Metabolism 213

Plasma Lipoids in Disease 215

Review of Organic Acid Metabolism 216

Review of Mineral Metabolism 216

Review of Acid-base Balance of the Body 223

Regulation of Acid-base Balance 224

Acid-base Composition of Blood Plasma 229

Review of Water Metabolism 231

Basal Metabolism 234

Principle of the Test 234

Preparation of the Patient 234

Technic of the Test for Patients Fifteen Years of Age and Older 234

Technic of the Test for Infants and Children Under Fifteen Years of Age 237

Essentials for the Approval of a Basal Metabolism Report 238

Factors Influencing the Basal Metabolic Rate 238

Pathologic Conditions Influencing the Basal Metabolic Rate 240

Value of the Basal Metabolism Test 241

CHAPTER Ⅵ CHEMICAL ANALYSIS OF THE BLOOD 242

General Considerations 242

Collection of Blood 243

Possible Causes of Hemolysis 243

Containers for Blood Specimens 243

Blood Required for Analysis 244

Anticoagulants and Preservatives 246

Separation of Plasma or Serum 247

Apparatus Required for Blood Chemical Analysis 247

The Calibration of Micropipets 249

Visual Photometric(Colorimetric)Analysis 250

Objective Photometric Analysis 253

Objective Photometers 255

Spectrophotometers 256

Scale Readings on Objective Photometers and Spectrophotometers 257

The Use of Standard Solutions and Calibration Curves 257

General Formula when Readings Are in Terms of Optical Density 258

Calibration Curves 259

Flame Photometry 262

Ultramicro Methods(Refer to This Page for Detailed Index) 263

Common Sources of Error in Clinical Chemical Determinations 265

The Significance of Numerical Reports 266

Methodology 267

Analysis of Blood 267

Index of Blood Chemical Analyses(Refer to this Page for Detailed Index) 267

Summary 434

Summary of Blood Chemical Analyses 435

CHAPTER Ⅶ THE KIDNEYS 440

The Urine 440

Routine Examination of Urine 441

Normal and Pathologic Findings of Urine 442

Kidney Function Tests 454

General Considerations 454

Value of the Various Kidney Function Tests 454

Technic of the Various Kidney Function Tests 455

Comparison of Findings in the Various Renal Function Tests 467

Diseases of the Kidneys 467

Nephritis 467

Nephrosis 471

Uremia 474

Acute Congestion of the Kidneys 475

Chronic Passive Congestion of the Kidneys 475

Amyloid Degeneration of the Kidney 476

Renal Tuberculosis 476

Pyelitis and Pyelonephritis 476

Renal Calculus(Nephrolithiasis) 477

Hydronephrosis 477

CHAPTER Ⅷ CHEMICAL ANALYSIS OF THE URINE 478

Qualitative Analysis of the Urine(Refer to this Page for Detailed Index) 478

Quantitative Analysis of the Urine(Refer to this Page for Detailed Index) 478

CHAPTER Ⅸ HEMATOLOGY 542

A Review of Normal Hematohistology 542

The Origin of the Blood Cells 542

Recommended Nomenclature in Hematology 543

Formed Elements of the Blood 562

Monocytic Series 552

Granulocytic Series 553

Lymphocytic Series 555

Erythrocytic Series 556

Thrombocytic Series 556

Site of Hematopoiesis 556

Fate of the Blood Cells 558

General Procedures 559

Method for Obtaining Blood Sample 559

Examination of the Blood 561

Hemoglobin 561

Hemocytometer 567

Erythrocyte Count 570

Sedimentation-rate 573

Mean Corpuscular Hemoglobin 576

Color Index 576

Mean Corpuscular Volume 577

Volume Index 577

Mean Corpuscular Hemoglobin Concentration 579

Saturation Index 579

Mean Corpuscular Diameter 580

Mean Corpuscular Average Thickness 581

Leukocyte Count 582

The Stained Blood Film 585

Wright＇s Method 585

Special Staining Methods 590

Anomalies of the Blood Cells 592

Anomalies of the Erythrocytes 592

Anomalies of the Leukocytes 594

Bone Marrow 597

Outline for Examination of the Bone Marrow 605

Diseases of Erythropoiesis 606

The Anemias 606

Classification of the Anemias 607

Microcytic Anemias 608

Hypochromic Anemias 608

Iron Deficiency Anemias 608

Iron Metabolism 609

Morphologic Characteristics 610

Hemolytic Anemias 618

Macrocytic Anemias 618

Cellular Deficiencies 618

Cellular Factors Not Yet Elucidated 624

Normocytic Anemias 624

Sudden Blood Loss 625

Incfeased Erythrocyte Destruction 625

Blood Volume 633

Hemoconcentration 638

Hemolytic Anemias 641

Intra-corpuscular Defects 641

The Hemoglobinopathies 643

Extra-corpuscular Defects 658

Determination of Blood Groups 663

Blood Bank Procedures 688

Deficient Erythrocyte Formation 692

The Polycythemias 697

？ypersplenism 699

？iseases of Leukopoiesis 701

Leukemoid Reactions 701

Eosinophilia 701

Basophilia 703

Lymphocytosis 703

Monocytosis 707

Non-specific Leukemoid Reactions 707

Bone Marrow Stimulation 707

Extramedullary Hematopoiesis 708

Leukopenias 708

Impaired Formation Predominant 708

Increased Destruction Predominant 710

Hematopoietic Neoplasms 714

Leukosis 714

Acute Leukemias 715

Subacute Leukemias 718

Chronic Leukemias 718

Miscellaneous Leukemias 720

Atypical Forms of Chronic Leukemia 720

Plasmacytic Myeloma 721

Lymphoblastomas 725

Follicular Lymphoblastoma 725

Reticulum Cell Sarcoma 726

Lymphosarcoma 726

Hodgkin＇s Disease 726

Lipoid Histiocytoses 726

Lipoid Histiocytosis 727

Gaucher＇s Disease 727

Disorders of Hemostasis 731

Sequence of Events to Repair Damaged Vessel 731

Preliminary Diagnostic Procedures 731

Bleeding-Time 731

Coagulation and Coagulation Time 732

Clot Retraction 733

Capillary Resistance 733

Classification of Hemorrhagic Disorders 735

Disorders Primarily Affecting the Vessel Wall 735

Bleeding Associated with Reduced Number of Thrombocytes 736

Classification of the Thrombopathies 738

Bleeding Associated with Defects in Blood Coagulation 741

Phase Ⅰ—Formation of Thromboplastin 741

Phase Ⅱ—Formation of Thrombin 744

Phase Ⅲ—Formation of Fibrin 744

Laboratory Tests 744

One-stage Prothrombin Time 744

Thromboplastin Generation Test 747

Two-stage Prothrombin Test 740

Thrombin Generation Test 751

Prothrombin Consumption Test 752

Modified Prothrombin Consumption Test 753

Disorders of Phase Ⅰ(Hypothromboplastinemias) 754

Deficiency of Thrombocyte Thromboplastin 756

Deficiency of Antihemophilic Globulin 756

Deficiency of Plasma Thromboplastic Component 756

Deficiency of Plasma Thromboplastic Antecedant 757

Deficiency of Hageman＇s Trait 757

Disorders of Phase Ⅱ(Hypothrombinemias) 757

Hypoprothrombinemias 757

Stable Factor Deficiency 750

Labile Factor Deficiency 760

Bleeding Associated with Circulating Anticoagulants 760

Disorders of Phase Ⅲ(Hypofibrinogenemias) 765

Congenital Afibrinogenemia 765

Constitutional Fibrinopenia 765

Acquired Fibrinopenia 765

Disorders in the Fibrinolytic Mechanism 766

Parasites of the Blood 767

Malarial Parasites 767

Borrelia Recurrentis 767

Trypanosoma Gambiense 768

Filaria Bancrofti 768

Trichinella Spiralis 768

CHAPTER Ⅹ IMMUNOLOGY AND SEROLOGY 770

Immune Bodies 771

Reactions in Which Immune Bodies are Used 772

Agglutination Tests 772

Widal Test 772

Other Agglutination Tests 775

The Isohemagglutinins 782

Precipitin Tests 782

Identification of Proteins 782

Diagnosis of Echinococcus Disease 784

Tests Based Upon Immune Bodies of the Third Order 784

Complement Fixation 784

Wassermann Reaction 785

Complement-fixation Test for Syphilis(Kolmer) 787

Other Complement-fixation Tests 799

Additional Tests for Syphilis 802

The Kahn Precipitation Test 802

The Kahn Test with Spinal Fluid 800

The VDRL Slide Flocculation Test 812

The VDRL Tube Flocculation Test 819

The VDRL Spinal Fluid Test 820

The Treponema Pallidum Immobilization Test 821

CHAPTER Ⅺ CEREBROSPINAL FLUID 823

Physiology of the Cerebrospinal Fluid 823

Composition of the Cerebrospinal Fluid 823

Indications and Contraindications for Collection of the Cerebrospinal Fluid 824

Routine Examination of the Cerebrospinal Fluid 826

Normal and Pathologic Findings of Cerebrospinal Fluid 826

The Cerebrospinal Fluid in Disease 842

CHAPTER Ⅻ TRANSUDATES AND EXUDATES 843

Collection of Fluids 843

Routine Examination 843

Findings of the Examination 843

Synovial Fluid 845

Disease Processes Associated with the Accumulation of Transudates 846

Disease Processes Associated with the Occurrence of Exudates 847

CHAPTER ⅩⅢ GENERAL BACTERIOLOGY 848

Collection of Specimens 848

Bacteriologic Technic 851

Examination of Specific Materials 854

Bacteriologic Diagnosis 858

The More Common Bacteria as Classified by Bergey 888

Fungi and Yeasts 893

Technics Used in Mycology 906

Special Preparations and Examinations 910

Sensitivity Tests for the Antibiotics 917

Antibiotic levels in Body Fluids 920

Preparation of Culture Media 924

Stains and Staining Methods 943

CHAPTER ⅩⅣ THE SPUTUM 952

The Sputum 952

Important Contents of the Sputum 952

Indications for Analysis of the Sputum 952

Collection of the Sample 952

The Examination of Sputum 952

Routine Examination of Sputum 953

Normal and Pathologic Findings of Sputum 954

The Sputum in Disease 963

Acute Bronchitis 963

Chronic Bronchitis 963

Putrid Bronchitis 963

Fibrous or Plastic Bronchitis 963

Bronchiectasis 964

Bronchial Asthma 964

Bronchopulmonary Lithiasis 964

Pulmonary Tuberculosis 965

Acute Lobar(Croupous)Pneumonia 966

Bronchopneumonia 966

Influenza 967

Pneumoconiosis 968

Pulmonary Abscess 968

Pulmonary Gangrene 969

Malignant Disease of the Lung 969

Chronic Passive Congestion 969

Pulmonary Edema 969

Infarction 969

CHAPTER ⅩⅤ SKIN TESTS AND OTHER BIOLOGIC EXAMINATIONS 971

The Schick Test for Antitoxin Immunity to Diphtheria 971

The Dick Test for Susceptibility to Scarlet Fever 973

The Schultz-Charlton Reaction；the Rash Extinction Test for Scarlet，Fever 975

Tuberculin Reactions 975

Tests for Hypersensitivity 979

Passive Transfer 981

Nasal Smears for Eosinophil Count 981

Reaction to Horse Serum 982

Frei Test for Lymphogranuloma Inguinale 982

Intracutaneous Test for Argyria 983

Skin Test for Lead Poisoning 983

Skin Test for Echinococcus Infestation(Hydatid Disease) 983

Skin Test for Trichinosis 984

Trichophytin Test 984

Brucella Skin Test 985

Skin Test for Chancroid 985

Test for Coccidioidomycosis 985

Test for Glanders 985

Test for Histoplasmosis 986

Test for Trichinosis 986

Test for Tularemia 986

Test for Mumps 986

McClure-Aldrich Test(Intradermal Salt Solution) 987

Smallpox Vaccination 988

The Rabbit Test for Pregnancy(Schneider Modification of the Aschheim-Zondek Test) 988

The Frog Test for Pregnancy 990

The Spermatozoa Count 901

CHAPTER ⅩⅥ LABORATORY METHODS IN PEDIATRIC PROCEDURES 994

The Stomach 994

Methods for Study of Gastric Acidity 995

Interpretation of the Findings of Gastric Analysis 997

Demonstration of Tubercle Bacilli in Gastric Contents 998

The Duodenal Fluid 998

Cystic Fibrosis of the Pancreas 999

Screening Test for Fibrocystic Disease of the Pancreas 999

The Celiac Syndrome 999

The Stool 1001

Points of Special Interest 1001

Normal Stools 1002

Factors Influencing the Character of Normal Stools 1002

Findings of Stool Analysis 1003

Stools in Specific Conditions 1004

Constipation 1004

Diarrhea 1004

Intussusception 1005

Pyloric Stenosis 1005

Congenital Atresia 1005

Stricture of Anal Canal 1005

Hirschsprung＇s Disease(Megacolon) 1005

Celiac Disease 1005

Pancreatic Steatorrhea 1006

Acute Intestinal Indigestion 1006

Marasmus 1006

Cholera Infantum 1006

Bacillary Dysentery 1006

Epidemic Diarrhea 1007

Pellagra 1007

The Urine 1007

Kidney Function Tests 1013

Blood Chemistry 1015

Cerebrospinal Fluid 1018

CHAPTER ⅩⅦ TROPICAL DISEASES 1020

Tropical Diseases 1020

The Important Protozoa of Man 1020

Bacterial Diseases 1021

Rickettsial Diseases 1021

Virus Diseases 1022

Dysentery 1022

Kala-azar 1022

Cutaneous Leishmaniasis(Oriental Sore) 1025

Mucocutaneous Leishmaniasis(Espundia) 1026

African Trypanosomiasis(African Sleeping Sickness) 1028

Chagas＇Disease 1030

Malaria 1032

Blackwater Fever 1040

Relapsing Fever 1040

Yaws 1042

Pinta 1044

Infectious Jaundice(Weil＇s Disease) 1045

Granuloma Inguinale 1046

Cholera 1049

Rat-bite Fever 1050

Plague 1051

Tularemia 1052

Brucellosis(Undulant Fever) 1053

Typhoid Fever 1054

Leprosy 1054

Typhus Fever 1055

American Spotted Fevers 1056

Scrub Typhus(Tsutsugamushi Disease) 1057

Q-Fever 1058

Trench Fever 1058

Bartonellosis(Verruga Peruana and Oroya Fever) 1059

Yellow Fever 1060

Rift Valley Fever 1061

Dengue 1061

Sandfly Fever(Phlebotomus Fever) 1062

Other Virus Diseases 1062

CHAPTER ⅩⅧ MILK AND WATER ANALYSIS 1064

Milk Analysis 1064

Collection of Sample 1064

Chemical Analysis 1064

Bacteriologic Analysis 1068

Bacteria Count 1068

Coliform Count 1071

Hemolytic Streptococci 1072

Tubercle Bacilli 1072

Brucella 1073

Bacteriologic Testing of Infant Formula 1073

Efficiency of Hospital Sterilization 1075

Water Analysis 1075

CHAPTER ⅩⅨ HISTOLOGIC TECHNIC 1080

Index of Staining Technic 1080

Index of Fixation and Sectioning Technic 1082

Index of Supplementary Methods 1083

Index of Solutions and Stains 1083

Fixation and Sectioning Technic 1085

Staining Technic 1090

Supplementary Methods 1123

Solutions and Stains 1124

CHAPTER ⅩⅩ LEGAL MEDICINE AND TOXICOLOGY 1137

General Considerations 1137

Essential Factors in the Diagnosis of Poisoning by Clinical Findings 1138

Diseases Simulating Poisoning 1138

Clinical Symptoms Associated With Poisoning and Various Diseases 1138

Collection of Specimens 1140

Blood Stains 1141

The General Search for Poisons 1141

Preparation of Specimens for Analysis 1142

Poisons Which are Volatile with Steam 1142

Metallic Poisons 1148

Alkaloids and Other Organic Poisons 1150

General Tests 1151

Strychnine 1152

Atropine 1152

Cocaine 1152

Opium Alkaloids 1153

Nicotine 1153

Barbiturate Soporifics and Analgesic Drugs 1154

Barbiturate Drugs 1155

Other Neutral or Acidic Organic Poisons 1156

Salicylates 1156

Aniline Derivatives 1156

Caffeine 1157