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Proceedings of the Twenty-Eighth International Symposium on Blood Transfusion, Groningen, NL, Organized by the Sanquin Division Blood Bank North-East, Groningen.
It is in many ways fitting that the last of these international symposia on blood transfusion should end with neonatal blood transfusion. The most fragile, least well studied and most at risk population requires special care and concern. We need to expand our knowledge of their unique physiology, biochemical pathways and in planning treatment and interventions, always "do no harm."
This proceedings of the last Groningen symposium presents a wealth of information on developmental immunology, the molecular basis of haematopoeisis, physiological basis of bleeding and thrombosis, transfusion risks and benefits and lastly, future therapies. Infants provide us with much to learn but in turn they will be the providers of (through cord blood) and the recipients of (through cellular engineering) the best that science can offer. Translational research, which has been the thrust of these presentations for 28 years, will benefit them in a way that no scientist could have ever predicted.
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Product Description
Lippincott's Illustrated Reviews: Pharmacology, Fourth Edition enables rapid review and assimilation of large amounts of complex information about the essentials of medical pharmacology. Clear, sequential pictures of mechanisms of action actually show students how drugs work, instead of just telling them. As in previous editions, the book features an outline format, over 500 full-color illustrations, cross-references to other volumes in the series, and over 125 review questions. Content has been thoroughly updated, and a new chapter covers toxicology. New to this edition will be a companion Website containing all of the illustrations, fully searchable text, and an interactive question bank. NOTE: International Edition available for sales outside North America and Caribbean (ISBN: 978-1-60547-200-3) "Doody's Core Titles™ 2009."
Product Details
* Paperback: 560 pages
* Publisher: Lippincott Williams & Wilkins; Fourth Edition edition (July 1, 2008)
* Language: English
* ISBN-10: 0781771552
* ISBN-13: 978-0781771559
* Product Dimensions: 10.8 x 8.4 x 0.9 inches
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Review
"The book does an excellent job of integrating basic science concepts with clinical medicine. Each of the organ system chapters reviews the normal anatomy, physiology and histology, then follows with the pathophysiology, clinical findings, and pathology of the more commonly encountered disorders. Additionally there are chapters on genetic diseases, immune diseases and neoplasia which similarly link basic science principles with clinical disease entities. Each chapter contains periodic "checkpoint" questions which guide the reader to the most important concepts. Each chapter also ends with several case studies with questions and discussions, similar to those encountered on board examinations."
Product Description
A complete case-based review of the essentials of pathophysiology – covering all major organs and systems
This trusted text introduces you to clinical medicine by reviewing the pathophysiologic basis of the signs and symptoms of 100 diseases commonly encountered in medical practice. Each chapter first describes normal function of a major organ or organ system, then turns attention to the pathology and disordered physiology, including the role of genetics, immunology, and infection in pathogenesis. Underlying disease mechanisms are described, along with their systems, signs, and symptoms, and the way these mechanisms themselves determine the most effective treatment.
This unique interweaving of physiological and pathological concepts will put you on the path towards thinking about signs and symptoms in terms of their pathologic basis, giving you an understanding of the “whys” behind both illness and treatment.
Features
* NEW full-color presentation
* 111 case studies (22 new ones) provide an opportunity for you to test your understanding of the pathophysiology of each clinical entity discussed
* A complete chapter devoted to detailed analyses of the cases
* “Checkpoint” review questions appear throughout every chapter
* Numerous tables and diagrams encapsulate important information
* References for each chapter topic
* NEW sections in the chapters on liver disease and inflammatory rheumatic diseases and a completely rewritten chapter on male reproductive tract disorders
Product Details
* Paperback: 752 pages
* Publisher: McGraw-Hill Medical; 6 edition (October 20, 2009)
* Language: English
* ISBN-10: 0071621679
* ISBN-13: 978-0071621670
* Product Dimensions: 10.9 x 8.5 x 1.2 inches
* Shipping Weight: 3.3 pounds (View shipping rates and policies)
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Heart Structure and Blood Supply
It seems odd that the tissues making up the heart must have their own separate blood supply. You might think that the torrent of blood rushing through the heart every minute would more than adequately meet the needs of the organ. The walls of the heart, however, consist of layers of specialized muscle. These walls are quite thick—the wall of the left ventricle is often over 1 inch thick. Since the lining of the heart is watertight, the blood cannot seep through the layers of muscle to provide the nourishment essential to these constantly working masses. Blood is carried through the muscle layers that form the heart wall by means of the two coronary arteries. These two small vessels branch off the aorta just after it leaves the heart and curl back across the surface of the chambers, sending twigs through the walls (Fig. 4-1).
The coronary arteries are so named because of the supposed resemblance to a crown or “corona†of the little arteries as they encircle the heart. These arteries divide into smaller and smaller branches, like all blood vessels in the body, until they become so small that only one blood cell at a time can move through them. At this point the vessels are called capillaries. After the blood has passed through the capillaries, and the tissues have extracted the needed oxygen, it returns by way of veins, which become larger and larger until they, like all other veins in the body, empty into the right atrium. The veins from the wall of the heart, or coronary veins, empty into the right atrium through a structure called the coronary sinus.
The blood supply of the tissues in the wall of the heart is not very good; thousands of people die every year because of this curious fact. Most organs and tissues of the body have a “reserve†or collateral blood supply. Each finger, for instance, has two arteries, one on each side. These arteries are connected by many cross-channels, or collateral vessels. If the artery is cut on one side, the collateral or cross-connections from the artery on the other side would probably provide sufficient blood to maintain life in the tissues of the finger. The same “safety†feature is true in most of the major areas of the body. It is not true in the wall of the heart.
The coronary arteries tend to be end arteries, meaning that each branch follows its own course to some area of the heart muscle with relatively few connections to other branches nearby. If one of these coronary branches is plugged by hardening or by a blood clot, the muscle that depends on it for blood will die. A form of gangrene actually sets in. (Some people's coronary arteries have many more cross-connections than others. The more of these cross-connections an individual has, the less likely he or she is to die of coronary artery disease. In 10,000 or 20,000 years the process of evolution may result in a race with a good coronary blood supply by virtue of the early death of those without it.)
The names of the chief branches of the coronary arteries are important because they will be used repeatedly in this book. Learn them now; they're very simple.
There are two main coronary arteries leading out of the aorta—the right and left coronary arteries. After about an inch, the left coronary artery divides into two principal branches. The left anterior descending branch comes down the front of the heart, roughly along the septum between the two ventricles. The circumflex branch of the left coronary artery coils around the left side and back of the heart. The right coronary artery divides into a number of branches that course through the right chambers of the heart as well as through a large part of the left ventricle.
Note: There are four coronary arteries to remember:
The left main coronary artery (before it divides): LMCA.
The right coronary artery: RCA.
The left anterior descending branch of the left main coronary artery: LAD.
The circumflex branch of the left main coronary artery: LCA or LCirc.
Blood Flow Through the Heart
Blood is pumped through the chambers of the heart and out through the great vessels by a simple squeezing action of the heart chambers. You have probably seen a bulb syringe with a glass nozzle like the one pictured in Figure 3-1. Suppose it is full of water. If you squeeze forcefully, expelling the water, you would be imitating the contraction of a heart chamber. This is called systole (sis-toe-lee). After the syringe had been emptied, imagine that you placed the nozzle in a container of water and let the bulb expand so that it filled. This is what a heart chamber does when it relaxes and fills with blood. The movement is called diastole (die-as-toe-lee). You can picture the process by holding your left hand over your right, fists clenched. If your left hand represents the atria, your right hand will represent the ventricles. Now clench your left fist (the atria) while opening your right fist (the ventricles). This is what happens during atrial systole when the atria are pumping blood down into the ventricles. Next, open your left fist and clench your right. This is what happens during ventricular systole when the ventricles are pumping blood out into the two great arteries and the atria are refilling. By alternately opening and clenching your two fists you can similate the coordinated beat of the heart.
Note: The cycle of a heartbeat, in other words, goes through these stages:
Atrial systole: The atria contract, forcing the blood down into the ventricles.
Ventricular systole: The ventricles contract, forcing the blood out the pulmonary artery and aorta.
Atrial diastole: This starts during ventricular systole as the atria begin refilling with blood from the great veins.
Ventricular diastole: This takes place during atrial systole as blood from the atria fills the ventricles.
The rhythmic contraction and relaxation of the ventricles does the work of pumping the blood: atrial contraction is much less important and, in fact, many patients live for years without any pumping action from the atria. If the ventricles stop beating, death follows within minutes.
