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The red blood cell count (RBC) is the number of red blood cells per unit volume of blood. As with the hemoglobin and hematocrit, the red blood cell count is higher in males than females. Anemia and polycythemia cause a decrease and increase in the red blood cell count respectively. Mean Corpuscular Volume (MCV). Medications, vitamins or supplements – take after the morning blood draw. If supplementing with biotin, stop for 10-14 days prior to blood draw. If (when) testing thyroid markers ONLY and you currently take thyroid medication, test thyroid markers 4-5 hours AFTER taking your thyroid medication. Schedule an appointment (click here for. Specimen for serologic test 7.3 Shipment of serologic specimen 7.4 Complement inactivation 7.5 Serial dilution 7.6 determinations of end point and titer CHAPTER EIGHT: SYPHILIS SEROLOGY 8.1 Treponematoses 8.2 Syphilis 8.3 Tests for syphilis.
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was 28 % and 24 % compared to the values before omeprazole therapy (baseline values). After cessation of omeprazole blood leucocyte and thrombocyte count increased during 13 days to 50 % and 72 % of baseline values. Conclusion: The observed leucocytopenia and thrombocytopenia under omeprazole therapy seems to have an immunological cause. This can be of major impact and physicians should be aware of this possible adverse drug effect. ) Creutzfeld W: Z Gastroenterol (suppl.l) 1995; 33:12-31 z Marks DR et al.: Am J Gastroenterol 1991; 86: 217-218 3 Ottervanger JP et al.: Eur J Haematol 1995; 54: 279-280
6031 PRACTICE PATTERNS IN BARRETT'S ESOPHAGUS - THE PATHOLOGIST'S PERSPECTIVE. Wilfred M. Weinstein, Sheridan D. Wiggett, Joshua 1. Ofman, UCLA Sch of Medicine, Los Angeles, CA; Cedars-Sinai Health System, Los Angeles, CA. Purpose: The diagnosis of Barrett's esophagus (BE) has an important psychological impact on patients and has major economic implications because of lifetime surveillance. The pressure to lengthen surveillance intervals additionally focuses on the need for accuracy of diagnosis and uniform quality of endoscopic biopsy surveillance. Most surveys of practice standards in BE have come from the endoscopist's perspective. We report here the perspective of the pathologist. Methods: A structured questionnaire was developed to evaluate the self-reported practice patterns, attitudes and beliefs of pathologists in regard to BE. The survey was administered to 127 pathologists: 59 at a Los Angeles Pathology Meeting, and 68 at a National GI Pathology Course. Of the respondents, 82% were in private practice, for a mean of 14 years. Results: For information from endoscopists: A. Most pathologists (73%) are given the key landmarks, i.e. both the proximally relocated Z-line and the LES region in suspected BE, less than 25% of the time; B. 63% are given the biopsy locations (ern from the incisors) less than 50% of the time. For surveillance practice, 82% of pathologists report that a 4-quadrant biopsy protocol in BE surveillance is adhered to less than 25% of the time. For the diagnosis of BE: 86% may make the diagnosis of BE if goblet cells are present even if they have no landmark information. Pathologists' attitudes: A. Only 54% believe that the main consequence of the overdiagnosis of BE is that patients will worry about cancer risk for the rest of their lives; B. 63% believe that providing landmark information is the most important area that endoscopists should improve. Conclusions: This study has identified opportunities to improve the practice patterns of both pathologists and endoscopists in Barrett's esophagus. From a patient's perspective these data likely raise two concerns: One is the variation in diagnostic practice in a disorder that carries a lifetime of concern about cancer risk; and secondly, an expectation that in cancer surveillance there must be some kind of standardization of both technique and quality.
6032 WIDESPREAD INTESTINAL VASCULAR LEAKAGE ACCOMPANIES INOS EXPRESSION FOLLOWING MULTIPLE DOSES OF INDOMETHACIN IN THE RAT. Brendan Jr Whittle, Steven M. Evans, William Harvey Research Institute, St Bartholomew's Med Sch, London, United Kingdom; Glaxo Wellcorne, Stevenage, United Kingdom. The non-selective cycio-oxygenase(COX)inhibitor,indomethacin,causes a site-specific expression of the inducible nitric oxide synthase(iNOS) and microvascular leakage in the rat jejunum, 24h following a single dose. In the present study, the effects of multiple doses of indomethacin have been explored, in order to evaluate possible actions on other regions of the gut and on other organs. Indomethacin(lOmglkg s.c) was administered daily for 2 days. Plasma leakage of radiolabelled albumin in the various organs was determined as an index of microvascular injury, while iNOS activity in the tissue was measured by the Ca++insensitive conversion of radiolabelled L-arginine to citrulline. Substantial plasma leakage in the jejunum, caecum, colon, ileum of !i277:+:.32, 135:+:'10, 54:+:.3 and 50:+:'14pJ/gtissue (P<0.05, n=6 for each) was determined 24h after the last dose of indomethacin. Plasma leakage was also observed in the lung and spleen (!i73±10 and 13:+:.5 p,l/g;n=6,P<0.05). Significant expression of iNOS, not observed in controls, was detected in all of these tissues following indomethacin, with 243±3, 201 :+:.9, 123:+:'4, 96±8 and 14:+:'4pmol/min/mg protein in the jejunum, caecum, colon, ileum and spleen. The selective iNOS inhibitor,GW273629(5mglkg s.c) abolished plasma leakage in these organs, in a dose that substantially inhibited (P
result from bacterial translocation from the lumen into the mucosal tissue following COX-inhibition. Such events in the gut may contribute to the intestinal toxicity of non-steroidal anti-inflammatory agents.
6033 ALTERNATIVE MEDICINE IN FUNCTIONAL DYSPEPSIA (FD). RESULTS OF A PROSPECTIVE STUDY (PRESTO) IN 3000 PATIENTS. Martin Wienbeck, Guido Adler, Hans-Dieter Allescher, Paul Enck, Joachim Hartung, Michael P. Manns, Juergen F. Riemann, Meinhard Classen, Dept Int Med 3, Zentralklinikum Augsburg, Augsburg, Germany; Univ of Ulm, Ulm, Germany; Tech Univ, Munich, Germany; Dept of Surg, Univ Tuebingen, Tuebingcn, Germany; Dept of Statistics, Univ Dortmund, Dortmund, Germany; Dept Int Med Univ Hannover, Hannover, Germany; Dept Int Med Clin Ludwigshafen, Ludwigshafen, Germany; Dept Int Med 2, Tech Univ Munich, Munich, Germany. FD still is an enigma. Therapy is mainly based on prokinetic or acid suppressing drugs. But an unknown number of patients seek additional therapy such as self medication and alternative medicine. We, therefore, set out to look for this in a prospective nationwide study. Methods: 3001 patients (1221 males, 1780 females, mean age 50 :+:. 15 years) who consulted their doctor for FD were included and followed prospectively at 1,6, 12 and 18 months. Patients with gastroesophageal reflux disease and peptic ulcer disease were excluded. The 983 participating doctors were free to choose probing drug therapy (PT), drug therapy following endoscopy (ET) or no initially prescribed drug therapy (OT). Results: At 1 month 255/1786 (14.3 %) of PT patients had sought additional therapy, 68/555 (12.3 %) of ET patients and 114/390 (29.2 %) of OT patients. At 6 months the percentages were 14.4, 12.7 and 24.6, respectively, at 12 months 14.3., 11.5 and 18.7, respectively, and at 18 months 14.4., 14.2 and 19.2, respectively. Additional therapy consisted in treatment by paramedics, self medication, special diets and alternative medicine including yoga equivalents, herbs, teas, acupuncture, homeopathic medicine and traditional chinese medicine, but more than 20 other types of alternative medicine were named.The number of methods in alternative medicine decreased at each visit. Conclusions: FD patients on no initial drug therapy have a higher likelyhood of seeking additional therapy and continuing that> 1 year. The data also indicate that a high percentage of patients with FD is willing to spend extra money on non-proven therapy in a national health system which so far paid for almost any type of treatment. Alternative medicine, thus, plays an important role in FD.
6034 THE EFFECT OF BLOOD ON THE SENSITIVITY OF THE RAPID UREASE TEST. Alan 1. Wigg, Peter Bampton, Graeme P. Young, Flinders Med Ctr, Adelaide, Australia. BACKGROUND AND AIMS; Previous studies have suggested that that blood may adversely effect the sensitivity of the urease test resulting in falsely negative tests in acute upper gastrointestinal bleeding. Thus we compared the sensitivity of the rapid urease test (RUT) when gastric biopsies infected with helicobacter pylori(HP) were soaked in blood in vitro, with the sensitivity of the test when biopsies were not soaked in blood. METHODS; We prospectively studied 40 patients with endoscopically suspected HP infection based on any of the following findings; gastritis, duodenitis, gastric or duodenal ulceration. A total of 12 biopsies per endoscopy were taken. 3 biopsies from the gastric antrum and 3 from the gastric body were sent for histological assessment. A previously validated, non-commercial RUT was used in this study. 3 RUT's were performed at each endoscopy using 2 biopsies for each RUT (I antrum, I body). Biopsies of the first RUT were not soaked in blood and acted as a control for each patient. Biopsies for the second and third RUT's were soaked in I ml of the patient's own blood, for I minute and 5 minutes respectively, prior to transfer into urease reagents. RUT's were then incubated for 6 hours at 37°C before reporting. Only patients with the HP organism identified at histology were subsequently included in the study. RESULTS; 20 patients (50%) had HP identified at histology and were included. The major endoscopic findings in these 20 patients were; gastritis(9),gastritis and duodenitis (5),duodenal ulcer (4) and gastric ulcer (2). For the control RUT's 17120were positive (sensitivity = 85%). For the RUT's with prior soaking of gastric biosies in blood for I minute, 19120 were positive (sensitivity=95%). For the RUT'S with prior soaking of biopsies in blood for 5 minutes, 20120 were positive (sensitivity = 100%). The increased sensitivities of the 1 and 5 minute blood soaked RUT's, compared with the control RUT, were not statistically significant (p=0.6 and p=0.2 respectively). CONCLUSIONS; We found that soaking of gastric biopsies in blood does not result in reduced sensitivity of the RUT. This finding suggests that circulating anti-HP antibodies, which must have been present in our patients' blood, or other blood components, are not responsible for falsely negative RUT's. In prior clinical studies comparing bleeding with non-bleeding ulcers, patients using Hz receptor antagonist have not been excluded. We hyopothesise that this may be a reason for false negative RUT's in bleeding ulcers rather than contamination with blood.