Pediatrics Cardiovascular Issues - Modificat

Curs Engleza Medicala Volumul II
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Content
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DESPRE ACT ........................................................................................................... 1 CONTENT ................................................................................................................ 2 PEDIATRIC ISSUES ................................................................................................ 6
INFANCY ................................................................................................................................. 6 CHILDHOOD ............................................................................................................................. 6 PATHOLOGY OF THE LIFESPAN .................................................................................................. 6 DISEASES OF INFANCY AND CHILDHOOD .................................................................................... 7 SYMPTOMS AND COMPLICATIONS .............................................................................................. 8 DIAGNOSIS .............................................................................................................................. 8 PREVENTION AND TREATMENT .................................................................................................. 9 RESPIRATORY SYNCYTIAL VIRUS .............................................................................................. 9 SYMPTOMS AND DIAGNOSIS .................................................................................................... 10 PREVENTION AND TREATMENT ................................................................................................ 10 DIGESTIVE PROBLEMS IN CHILDREN ......................................................................................... 10 SPITTING UP .......................................................................................................................... 10
When to visit the doctor ....................................................................................................... 11
A NOTE ABOUT SLEEPING POSITION ......................................................................................... 11 VOMITING AND PROJECTILE VOMITING ...................................................................................... 11
Treatment for vomiting......................................................................................................... 12 When vomiting becomes a concern ..................................................................................... 12
DIGESTIVE SYSTEM ABNORMALITIES ........................................................................................ 12 ABNORMALITIES OF THE ESOPHAGUS ....................................................................................... 12 ABNORMALITIES OF THE STOMACH ........................................................................................... 13 ABNORMALITIES OF THE INTESTINES ........................................................................................ 13 ABNORMALITIES OF THE LIVER AND GALL BLADDER .................................................................... 14 ABNORMALITIES OF THE ABDOMINAL WALL................................................................................ 14 ABNORMALITIES OF THE ANUS AND RECTUM ............................................................................. 14 TYPES OF HEART DISEASE OBSERVED IN CHILDREN AND ADOLESCENTS ...................................... 14 ACQUIRED HEART DISEASE ..................................................................................................... 15 RHEUMATIC HEART DISEASE ................................................................................................... 15 KAWASAKI DISEASE ................................................................................................................ 16 OTHER HEART DISEASE TYPES ................................................................................................ 16 HEMATOLOGIC CONDITIONS IN CHILDREN ................................................................................. 16
Types of Red Blood Diseases ............................................................................................. 17 Types of White Blood Cell Diseases .................................................................................... 17 Types of Platelets Diseases ................................................................................................ 17
HEMOPHILIA .......................................................................................................................... 18 NEUROLOGICAL CONDITIONS IN CHILDREN ................................................................................ 18

Causes of neurological disorders......................................................................................... 19
METABOLIC DISORDERS.......................................................................................................... 19
Congenital malformations .................................................................................................... 19 Immune disorders ................................................................................................................ 19 Toxins and environmental factors ........................................................................................ 19 Nutritional deficiencies......................................................................................................... 20 Hypoxia/asphyxia ................................................................................................................ 20 Complications during childbirth ............................................................................................ 20 Prematurity/low birth weight................................................................................................. 20 Postnatal infections ............................................................................................................. 20
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Neoplasm ............................................................................................................................ 21
ENDOCTRINE CONDITIONS IN CHILDREN ................................................................................... 21 TREATING A GROWTH DISORDER ............................................................................................ 21

First Symptoms ................................................................................................................... 22 Diagnosis ............................................................................................................................ 22
MARFAN SYNDROME .............................................................................................................. 23

Causes ................................................................................................................................ 23
NEUROCUTANEOUS SYNDROMES ............................................................................................ 23 TYPES OF NEUROCUTANEOUS SYNDROMES ............................................................................. 23 METABOLIC SYNDROME.......................................................................................................... 24

Causes ................................................................................................................................ 24 Symptoms ........................................................................................................................... 25
CARDIOVASCULAR SYSTEM .............................................................................. 26

DIAGNOSTIC, PROCEDURAL, AND LABORATORY ........................................................................ 26 TERMS .................................................................................................................................. 26 DIAGNOSTIC PROCEDURES AND TESTS.................................................................................... 26
Laboratory Tests ................................................................................................................. 27
DISEASES OF THE BLOOD VESSELS ......................................................................................... 28 CORONARY ARTERY DISEASE ................................................................................................. 29 GENERAL HEART AND LUNG DISEASES .................................................................................... 29 VALVE CONDITIONS ............................................................................................................... 30 CONGENITAL HEART CONDITIONS ........................................................................................... 30 SURGICAL TERMS .................................................................................................................. 30 MEDICAL EQUIPMENT ...................................................................................................... 31 HOSPITAL DEPARTMENTS ....................................................................................................... 32
DRUGS BRIEF HISTORY ................................................................................... 33

HIPPOCRATES ....................................................................................................................... 33 GERM THEORY AND BACTERIOLOGY......................................................................................... 35 FIRST W ORLD W AR ............................................................................................................... 36 PUBLIC HEALTH ..................................................................................................................... 36 POST-W ORLD WAR II............................................................................................................. 36
NOTE...................................................................................................................... 39 ALTE SERVICII ALE AGENIEI ACT .................................................................... 44

CURSURI DE LIMBI STRINE ..................................................................................................... 44 LANGUAGE CAFE ................................................................................................................... 45 TRADUCEREA ........................................................................................................................ 45
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PEDIATRIC ISSUES
Sources: Medical terminology. Language for health care (3rd edition) Authors Nina Thierer ; Deborah Nelson ; Judy K. Ward; La Tanya Young Dictionary for medical terms (4th edition) A & C Black- London
Infancy
A baby, also referred to as a newborn or infant, is born. At birth, personnel in the delivery room give the baby an Apgar score, a rating at both 1 and 5 minutes after birth for the following: A (activity); P (pulse); G (grimace or reflex); A (appearance of the skin); and R (respiration). The scoring is from 1 to 10. A total score of 710 is considered normal; below that, there may be need for special help from medical personnel. For the first four weeks of life, the infant is referred to as a neonate. During the neonate period, body functions adjust to living outside the womb: temperature control, digestive system, respiratory system, sensory system, and the beginning of social development all start to change during this period. Neonatology is the medical specialty concerned with the care and treatment of neonates with severe health problems or who may have been born prematurely. Neonatologists are specialists in neonatology. The remainder of the infancy period lasts the first year. During the next period, the child is often referred to as a toddler. The toddler is a young child who becomes competent at walking, begins to speak, and begins to handle some of the activities of daily living by himself or herself. This occurs in the period between the end of the first year and age three. Pediatrics is the specialty that treats children from the neonate stage through adolescence. Pediatricians are the practitioners of this specialty.
Childhood
Childhood is the period of life from infancy to puberty. Puberty is a sequence of development of secondary sex characteristics beginning around ages 8 to 12. Childhood years vary because puberty may start very early or very late. Also, the onset of puberty is generally earlier in girls than in boys.
Pathology of the Lifespan

The majority of diseases occur at the beginning (infancy) and at the end (old age) of life. Diseases or disorders may be determined or caused by genes (biological inheritance), environmental causes (as exposure to a virus or bacteria), or trauma (sudden, massive injury). A geneticist is a specialist in genetics (the science of biological inheritance) who can counsel people with genetic abnormalities who wish to have children. Some congenital diseases (severe spina bifida, anencephaly) are devastating. In some cases, geneticists can predict the odds of the newborn inheriting a gene. It is also possible to observe (via ultrasound) the fetus during its development. Fetuses are treated in utero (while in the uterus), either with medication or
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surgically, for a number of conditions. In addition, blood tests reveal genetic clues to disorders carried by the parents
Diseases of Infancy and Childhood

Neonates born prematurely, after less than 37 weeks of gestation, often have underdeveloped lungs and other problems. Advances in neonatology save many premature infants. Birth after 40 weeks of gestation may also cause or indicate fetal problems, including high fetal weight. Infants may die suddenly in an unknown manner (sudden infant death syndrome or SIDS ), usually while sleeping. Safety measures that can prevent some suffocation deaths and/or respiratory problems are to place the infant on its back to sleep, avoid pillows or stuffed animals in the crib, and to avoid smoking in the house. Infants may also experience trauma (as in falls) or may contract infections (such as streptococcus or strep throat). As children grow, they experience many of the diseases of the body systems. Some childhood diseases help to strengthen the immune system for later life. For example, a childhood bout with chicken pox usually offers lifelong immunity against a disease that can have much more devastating effects in older people. Respiratory tract infections affect the nose, throat, and airways and may be caused by any of several different viruses.

Common respiratory tract infections include the common cold and influenza. Typical symptoms include nasal congestion, a runny nose, scratchy throat, cough, and irritability. The diagnosis is based on symptoms. Good hygiene is the best way to prevent these infections, and routine vaccination can prevent influenza. Treatment aims to relieve symptoms.
Children develop on average six viral respiratory tract infections each year. Viral respiratory tract infections include the common cold and influenza. Doctors often refer to these as upper respiratory infections (URIs), because they cause symptoms mainly in the nose and throat. In small children, viruses also commonly cause infections of the lower respiratory tractthe windpipe, airways, and lungs. These infections include croup, bronchiolitis, and pneumonia. Children sometimes have infections involving both the upper and lower respiratory tracts.In children, rhinoviruses, influenza viruses (during annual winter epidemics), parainfluenza viruses, respiratory syncytial virus (RSV), enteroviruses, and certain strains of adenovirus are the main causes of viral respiratory infections. Most often, viral respiratory tract infections spread when children's hands come into contact with nasal secretions from an infected person. These secretions contain viruses. When the children touch their mouth, nose, or eyes, the viruses gain entry and produce a new infection. Less often, infections spread when children breathe air containing droplets that were coughed or sneezed out by an infected person. For various reasons, nasal or respiratory secretions from
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children with viral respiratory tract infections contain more viruses than those from infected adults. This increased output of viruses, along with typically lesser attention to hygiene, makes children more likely to spread their infection to others. The possibility of transmission is further enhanced when many children are gathered together, such as in child care centers and schools. Contrary to what people may think, other factors, such as becoming chilled, wet, or tired, do not cause colds or increase a child's susceptibility to infection.
Symptoms and Complications

When viruses invade cells of the respiratory tract, they trigger inflammation and production of mucus. This situation leads to nasal congestion, a runny nose, scratchy throat, and cough, which may last up to 14 days. Fever, with a temperature as high as 101 to 102 F (about 38.3 to 38.9 C), is common. The child's temperature may even rise to 104 F (40 C). Other typical symptoms in children include decreased appetite, lethargy, and a general feeling of illness (malaise). Headaches and body aches develop, particularly with influenza. Infants and young children are usually not able to communicate their specific symptoms and just appear cranky and uncomfortable. Because newborns and young infants prefer to breathe through their nose, even moderate nasal congestion can create difficulty breathing. Nasal congestion leads to feeding problems as well, because infants cannot breathe while suckling from the breast or bottle. Because infants are unable to spit out mucus that they cough up, they often gag and choke. The small airways of young children can be significantly narrowed by inflammation and mucus, making breathing difficult. Children breathe rapidly and may develop a high-pitched noise heard on breathing out (wheezing) or a similar noise heard on breathing in (stridor). Severe airway narrowing may cause children to gasp for breath and turn blue (cyanosis). Such airway problems are most common with infection caused by parainfluenza viruses and RSV. Affected children need to be seen urgently by a doctor. Some children with a viral respiratory tract infection also develop an infection of the middle ear (otitis media) or the lung tissue (pneumonia). Otitis media and pneumonia may be caused by the virus itself or by a bacterial infection that develops because the inflammation caused by the virus makes tissue more susceptible to invasion by other germs. In children with asthma, respiratory tract infections often lead to an asthma attack.
Diagnosis
Doctors and parents recognize respiratory tract infections by their typical symptoms. Generally, otherwise healthy children with mild upper respiratory tract symptoms do not need to see a doctor unless they have trouble breathing, are not drinking, or have a fever for more than a day or two. X-rays of the neck and chest may be taken in children who have difficulty breathing, stridor, wheezing, or audible lung congestion. Blood tests and tests of respiratory secretions are rarely helpful.
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Prevention and Treatment
The best preventive measure is practicing good hygiene. An ill child and the people in the household should wash their hands frequently. In general, the more intimate physical contact (such as hugging, snuggling, or bed sharing) that takes place with an ill child, the greater the risk of spreading the infection to other family members. Parents must balance this risk with the need to comfort an ill child. Children should stay home from school or child care until the fever is gone and they feel well enough to attend. Influenza is the only viral respiratory infection preventable by vaccination. All children aged 6 to 59 months should receive a yearly vaccination, as should older children with certain disorders. Such disorders include heart or lung disease (including cystic fibrosis and asthma), diabetes, kidney failure, and sickle cell disease. Additionally, children whose immune system is compromised (including children with human immunodeficiency virus [HIV] infection and those undergoing chemotherapy) should receive the vaccine. Antibiotics are not necessary to treat viral respiratory tract infections. Children with respiratory tract infections need additional rest and should maintain normal fluid intake. Acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can be given for fever and aches. School-aged children may take a nonprescription (over-the-counter) decongestant for bothersome nasal congestion, although the drug often does not help. Infants and younger children are particularly sensitive to the side effects of decongestants and may experience agitation, confusion, hallucinations, lethargy, and rapid heart rate. In infants and young children, congestion may be relieved somewhat by using a cool-mist vaporizer to humidify the air and by suctioning the mucus from the nose with a rubber suction bulb.
Respiratory Syncytial Virus

Respiratory syncytial virus causes upper and lower respiratory tract infections.
Respiratory syncytial virus is a very common cause of respiratory infections in children. Typical symptoms include a runny nose, fever, cough, and wheezing, and a severe infection can lead to respiratory distress. The diagnosis is based on symptoms and their occurrence at expected times of year. Oxygen and drugs are given only to children that develop breathing problems.
Respiratory syncytial virus (RSV) is a very common cause of respiratory tract infection, particularly in children. Nearly all children have been infected by age 4 years, many in the first year of life. Infection does not provide complete immunity, so reinfection is common, although usually less serious. Outbreaks typically occur in winter and early spring. The first infection often involves the lower respiratory tract, most commonly causing bronchiolitis. Later infections usually involve only the upper respiratory tract. Children who have had bronchiolitis have an increased risk of developing asthma when they are older. Children with serious underlying disorders (such as congenital heart disease, asthma, cystic fibrosis, or immune
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system suppression) or who were born prematurely are at particular risk of developing serious illness. Adults are also infected with RSV, and the elderly may develop pneumonia.
Symptoms and Diagnosis

A runny nose and fever begin 3 to 5 days after infection. About half of children with a first infection also develop a cough and wheezing, indicating lower respiratory tract involvement. In infants younger than 6 months old, the first symptom may be a period of not breathing (apnea). Some children, usually young infants, develop severe respiratory distress, and a few die. Doctors usually recognize RSV infection when the typical symptoms occur at the expected time of year or during an outbreak. Tests are usually not performed unless doctors are trying to identify an outbreak. When necessary, samples of nasal secretions are sent for a rapid antigen test.
Prevention and Treatment

Doctors may give monthly injections of palivizumab, which contains antibodies against RSV, to children who are at high risk of developing a severe RSV infection. Children who receive palivizumab are less likely to need hospitalization, but doctors are not sure whether this treatment prevents death or serious complications.Children who have difficulty breathing are taken to a hospital. Depending on their condition, doctors may treat them with oxygen and drugs, such as albuterol or epinephrine, to open the airways (bronchodilators). Ribavirin, an antiviral drug, is no longer recommended except for children whose immune system is severely compromised.
Digestive Problems in children

Feeding intolerance is when a newborn baby has trouble either keeping milk or formula down, or emptying the stomach. Minor episodes of feeding intolerance are common during the first few days of life and usually disappear without any special treatment. For some newborn babies, feeding intolerance is a sign of an important medical problem. There may be an infection of the bloodstream or elsewhere, or there may be a congenital malformation affecting the stomach or intestines. Persistent or severe feeding intolerance and bile-stained vomiting demand prompt investigation and treatment.
Spitting up
Many newborn babies and young infants are prone to spitting up some of their breast milk or formula during or shortly after a feeding. Some newborn babies spit-up only occasionally, and others spit-up with every feeding. Spit-up effortlessly rolls out of the babys mouth, sometimes with a burp. Spitting up, also called gastroesophageal reflux, occurs when the ring of muscle at the top end of the stomach does not close properly. Spitting up decreases as the baby gets older, and it generally goes away before the baby reaches one year of age. You can reduce the amount that your baby spits up by trying the following: Feed your baby before she becomes frantically hungry.
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If you are bottle feeding, feed her smaller amounts, as overfeeding can make spitting up worse. Your baby does not have to finish a bottle. If you are bottle feeding, make sure the nipple is neither too large nor too small. A nipple that is too large will cause the milk to flow too fast; a nipple that is too small will cause your baby to swallow a lot of air. Keep feeding times quiet and calm, and try to minimize distractions. Avoid tight diapers because they put pressure on the abdomen. Dont put pressure on your babys tummy. Burp your baby a couple of times during feedings, to get rid of some of the air in her tummy. Dont interrupt her feeding, but instead burp her when she takes a break. Hold your baby upright after each feeding.
When to visit the doctor

Usually spitting up is harmless; however, it can pose a problem if it leads to poor weight gain, choking, or acid damage to the esophagus. If your baby experiences any of the following symptoms when she spits up, bring her to the doctor: streaks of blood in the spit-up spit-up that causes your baby to choke or gag spit-up that causes your baby to turn blue problems gaining weight vomiting or projectile vomiting
A note about sleeping position

Putting your newborn baby to sleep on her back is considered one of the best things you can do to help prevent sudden infant death syndrome (SIDS). Although you may be concerned about putting your newborn baby to sleep on her back if she is prone to spitting up, there is no need to worry. There is no increase in choking in newborn babies who are put to sleep on their backs.
Vomiting and projectile vomiting

Vomiting is more forceful than spitting up, and it involves more than just a couple of tablespoons of stomach contents. Vomiting can be a sign of a viral infection in the stomach, a reaction to something the baby ate, or another gastrointestinal problem.
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Treatment for vomiting
Initial treatment for vomiting involves feeding your baby in smaller amounts. If you are breastfeeding, reduce the amount of time that your baby spends at the breast at each feeding. You may need to feed your baby more frequently to make up for the smaller feedings.You may need to temporarily replace breast milk or formula with an electrolyte solution such as Pedialyte. If this is the case, offer your baby the clear fluid for eight hours after the vomiting has stopped. Feed your baby small amounts at frequent intervals: about 5 mL (one teaspoon) every five minutes to start. After four hours without vomiting, double the amount each hour. If your baby vomits at this point, let her stomach rest for one hour and then start the feedings again with smaller amounts.
When vomiting becomes a concern

If there is a viral infection, vomiting is often accompanied by diarrhea. If there is green bile in the vomit, it could be a sign of a blockage in the intestine, which requires immediate attention and possibly emergency surgery. Contact your doctor immediately if the vomiting appears to be excessive, if there is green bile or blood in the vomit, or if the vomiting is accompanied by diarrhea. Also call the doctor if your newborn baby shows signs of dehydration such as dry mouth, less than six wet diapers per day, sunken eyes, a sunken fontanelle, or dry skin. Projectile vomiting is when spit-up or vomit forcefully flies out of a babys mouth. If your baby begins projectile vomiting, contact your doctor immediately. It could be a sign of pyloric stenosis, which is a common condition in young infants. Pyloric stenosis occurs when there is a narrowing of the lower tubular portion of the stomach that prevents food from leaving the stomach. Surgery is used to correct this problem.
Digestive system abnormalities

Some babies are born with birth defects in their digestive system. They form as the result of something going wrong with the development of the babys digestive system during pregnancy. It is important to keep in mind that these abnormalities are rare. They may require treatment with surgery.
Abnormalities of the esophagus

Tracheoesophageal fistula/esophageal atresia is a condition where the esophagus is not properly connected to the stomach and there is a small connection between the windpipe, called the trachea, and the esophagus. This is caused by a problem with the partitioning of the esophagus from the trachea during development of the unborn baby. One complication of this condition is that milk refluxes from the esophageal pouch and may be inhaled into the lungs. Another complication is that the milk could flow across the fistula from the esophageal pouch into the lungs. Aspiration of milk into the lungs causes respiratory distress and inflammation within the lungs. Babies born with tracheoesophageal fistula/esophageal atresia must not be fed water, glucose solution, breast milk, or any other form of milk. Oral secretions are removed from the esophageal pouch with a suction tube called a replogyle tube. Tracheoesophageal fistula/esophageal atresia is repaired by surgery and most babies begin tube feeding a few days after their operation.
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Tracheoesophageal fistula is a small opening between the windpipe and the esophagus. It often occurs in combination with esophageal atresia, a condition in which the esophagus is not properly connected to the stomach. Babies born with these conditions are fed with a feeding tube directly into the stomach. After several weeks, the malformations are repaired with surgery. Congenital hiatal hernia occurs when the esophagus is not long enough, which causes the stomach to pull up through the diaphragm. Hiatal hernia may cause no symptoms, or it may result in a condition called gastroesophageal reflux, in which the stomach contents flow back into the esophagus. Surgery is sometimes required to correct congenital hiatal hernia. Esophageal stenosis is an esophagus that is too narrow. Surgery may be needed to ease the narrowing.
Abnormalities of the stomach

Pyloric stenosis blocks the passage of food from the stomach to the intestine, which causes severe vomiting. This is one of the most common conditions in young infants. Pyloric stenosis occurs when the round end of the stomach enlarges and the lower, tubular portion of the stomach becomes extremely narrow. This narrowing is what blocks food from leaving the stomach. Surgery is used to correct this problem.
Abnormalities of the intestines

Malrotation with volvulus happens when parts of the gastrointestinal system end up in the wrong place as a result of a developmental problem. Normally in early pregnancy, the unborn babys gastrointestinal tract moves into the umbilical cord to develop and grow. Soon after, the gastrointestinal tract moves back into the abdomen and rotates into its final position. If this process does not occur properly, parts of the gastrointestinal tract can end up in the wrong place. This is called malrotation. Sometimes the gastrointestinal tract ends up twisting around itself to such an extent that the blood supply to part of the intestine is reduced. This twisting of the intestine is called volvulus. Nearly all newborn babies with malrotation with volvulus have bile-stained vomiting. They must be investigated very promptly because they require emergency surgery to prevent part of the small intestine from being strangled. If the gastrointestinal tract does not develop properly, parts of it can end up in the wrong place. This is called malrotation. Sometimes the gastrointestinal tract ends up looping around itself to the extent that a blockage forms that could reduce the blood supply, and this is called volvulus. Malrotation with volvulus requires emergency surgery. Intestinal atresia is a malformation where part of the intestine is very narrow or disconnected from the rest of the gastrointestinal tract. Most often, this occurs at a spot just below the stomach called the duodenum. Intestinal atresia can be repaired with surgery. Hirschsprungs disease is a condition where nerve cells called ganglia are not properly formed on the inner walls of the intestine. This causes the bowel to contract and spasm, and block part of the lower intestine. Surgery is used to correct this condition. The surgeon removes the section of the intestine that is missing the ganglia and then reattaches the two ends of the healthy intestine. The outlook for babies who have gone through this surgery is very good.
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Abnormalities of the liver and gall bladder
Biliary atresia is damage to the biliary tract and/or the bile ducts within the liver. In this condition, the biliary tract or the bile ducts within the liver have not developed properly within the womb, perhaps due to an infection in the baby during pregnancy. As a result, bile is trapped inside the liver, which causes liver damage and scarring. This is a rare condition. About 20% of newborn babies with this condition can have their biliary tract repaired with surgery. The remainder of patients will require a liver transplant.
Abnormalities of the abdominal wall

Omphalocele is a condition where the abdominal organs protrude through the umbilical region, surrounded by a sac called amnion. This condition occurs when the gastrointestinal organs do not completely move back from the umbilical cord to the abdomen in early pregnancy. This is a rare but very serious condition with a 25% rate of infant death. This condition is often associated with cardiac abnormalities, neural tube defects, and chromosomal abnormalities. Omphalocele is treated with surgery. Gastroschisis is a condition where the abdominal organs protrude through the body wall. The organs hang outside the body beside the umbilical cord. The protruding organs are not covered with the protective membrane called amnion, and therefore they may be damaged by exposure to amniotic fluid. Unlike omphalocele, gastroschisis is not associated with chromosomal abnormalities or other severe defects. Surgery is usually quite successful in the treatment of this condition. The survival rate for gastroschisis is excellent.
Abnormalities of the anus and rectum

There are different types of malformations of the anus and rectum. The opening of the anus may be missing, which is a condition called imperforate anus, and there may be a small opening called a fistula running from the rectum to the urinary tract or to the vagina. Abnormalities of the anus and rectum can be corrected with surgery. If the opening of the anus is missing, the surgeon will create a new opening. If there is a fistula present, the surgeon will close it. Depending on the nature and severity of these malformations, children may have full, partial, or no control over their bowel movements.
Types of heart disease observed in children and adolescents

Congenital heart disease (CHD) is the type of heart disease that a baby is born with. In reality, it is a defect, or abnormality of the heart or blood vessels near the heart, and not a disease, so many people use the term congenital heart defect. The majority of children born today with CHD will survive and with proper treatment be able to lead a normal or near-normal life. Some kinds of CHD are mild and may not be diagnosed in infancy. Other types of CHD are severe and will be diagnosed soon after birth. Some will also be diagnosed in prenatal screening. Examples of CHDs are: Atrial septal defect (a hole between the upper 2 chambers of the heart).
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Ventricular septal defect (a hole between the lower 2 chambers of the heart). Coarctation of the aorta (the main artery leaving the heart [aorta] is constricted). Transposition of the great arteries (the 2 large arteries leaving the right and left sides of the heart are switched). Tetralogy of Fallot (a complex condition involving several structural defects).
Acquired heart disease

This type of heart disease is not present at birth. Two major types of acquired heart disease in children are rheumatic heart disease and Kawasaki disease.
Rheumatic heart disease

Rheumatic heart disease is the most common acquired heart disease in many countries of the world, especially in developing countries. It is a condition where the heart muscle and heart valves are damaged due to rheumatic fever. Rheumatic fever is caused by streptococcal bacteria, and usually begins as a consequence of strep throat in children that were undiagnosed or were not treated or undertreated. Primary prevention of acute rheumatic fever (the prevention of initial attack) is achieved by treatment of acute throat infections caused by group A streptococcus. This is achieved by up to 10 days of an oral antibiotic (usually penicillin) or a single intramuscular penicillin injection. People who have had a previous attack of rheumatic fever are at high risk for a recurrent attack, which worsens the damage to the heart. Prevention of recurrent attacks of acute rheumatic fever is known as secondary prevention. This involves regular administration of antibiotics, and has to be continued for many years. Secondary prevention programmes are currently thought to be more costeffective for prevention of RHD than primary prevention and may be the only feasible option for low- to middle-income countries in addition to poverty alleviation efforts. Surgery is often required to repair or replace heart valves in patients with severely damaged valves.
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Kawasaki disease
Kawasaki disease is characterized by fever, rash, swollen hands and feet, bloodshot eyes, swollen lymph nodes, a strawberry appearance to the tongue, and an acute inflammation of the blood vessels, especially the coronary arteries. Its cause is unknown but may be some kind of infectious agent. Occurs in young children 80% or more are less than 5 years old, and occurs more in boys than in girls. Kawasaki disease is most common in Japan, but has been seen in virtually every country in the world and is the leading cause of acquired heart disease among children in developed countries. In some children, especially those who are undiagnosed or untreated or not treated soon enough, serious heart damage can occur.
Other heart disease types

Other heart disease types that have been observed in children, but that are also seen in adults, include Chagas disease a parasite borne infection that primarily affects rural populations in low-income countries , cardiomyopathy and infectious endocarditis. Children can also develop abnormal heart rhythms, especially those with certain kinds of CHD. Childhood overweight/obesity can lead to heart disease risk in later life Risk factors for CVD are determined to a great extent by behaviours learned in childhood and continued into adulthood such as dietary habits. Childhood and adolescent overweight is one of the most important current public health concerns. Overweight and obese children and adolescents are likely to develop a number of precursors for CVD, such as type-2 diabetes, hypertension, dyslipidemia and the metabolic syndrome. There is strong evidence that an epidemic of childhood obesity has led to a significant increase in the prevalence of cardiovascular risk factors, which, if left unchecked, is likely to lead to an epidemic of premature CVD.
Hematologic conditions in children

Blood disorders are diseases of the blood including: red blood cells, which carry oxygen to the bodys tissues white blood cells, which help your childs body to fight infections platelets, which work to help your childs blood clot properly
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clotting factors, proteins found in blood that help stop bleeding after a cut or surgery
Types of Red Blood Diseases

Iron-deficiency anemia: low iron levels that lead to decreased hemoglobin, which helps carry oxygen through the blood to all parts of the body G6PD deficiency (also called RBC enzyme abnormalities): an inherited condition in which a child lacks an enzyme that protects red blood cells Hemolytic anemias: the abnormal breakdown of red blood cells Sickle cell disease: a common inherited disorder caused when the red blood cells become sticky and oddly shaped Thalassemia (Cooleys anemia): a genetic condition in which one of the two proteins that help make up hemoglobin in red blood cells is lacking Neutropenia: caused by a decreased amount of white blood cells that may be caused by disease or chemotherapy treatment Anemia: due to a chronic condition such as kidney disease, cancer, or lead poisoning
Types of White Blood Cell Diseases

Neutropenia: a condition caused by a decrease of white blood cells, as a result of disease or chemotherapy treatment Leukemia: a cancer of the blood that develops in the spongy center of some bones (called the bone marrow) Lymphoma: a blood cancer that develops in your childs lymph system and includes two types: Hodgkin and non-Hodgkin lymphoma Myelodysplastic syndrome: blood cancer affecting the bone marrow
Types of Platelets Diseases

Thrombocytopenia: a condition caused by too few platelets and results in abnormal bleeding Thrombocytosis: a condition caused by too many platelets, which can lead to clots in the blood vessels
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Idiopathic thrombocytopenic purpura: caused by a low number of platelets that results in abnormal bruising and bleeding Qualitative platelet disorders
Hemophilia
There are three main types of hemophilia: hemophilia A: the most common form, caused by a lack of blood clotting factor VIII hemophilia B: caused by a low supply of factor IX von Willebrand disease (vWF): this type of hemophilia causes prolonged bleeding
Symptoms of hemophilia include: excessive bleeding bruising easily joint bleeds (causing chronic pain and immobility) bleeding into the muscles (causing swelling, pain, and redness) bleeding from injury or in the brain (brain hemorrhage)
Treatment for hemophilia depends on your childs severity and may include: factor concentrates blood transfusions surgery limiting contact sports immunizations administered under the skin rather than in the muscle
Neurological conditions in children

Neurological disorders are wide ranging. They have various causes, complications and outcomes. Many result in additional needs requiring life-long management. Symptoms of neurological disorders vary. Physical, cognitive (to do with thinking), emotional and behavioural symptoms may be present, with specific disorders having combinations or clusters of these symptoms. For example, cerebral palsy tends to have more physical symptoms whereas ADHD
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tends to have more effect on behaviour. Many neurological disorders emerge during the early years of development and may be diagnosed at birth. Some are diagnosed later because symptoms only appear when: A child misses developmental milestones or has developmental difficulties (e.g. ADHD). A damaging infection occurs (e.g.meningitis). An accident causes brain injury.
Causes of neurological disorders

Congenital disorders are present at birth but some disorders are acquired (develop after birth). Those with an unknown cause are called idiopathic.
Metabolic disorders
Metabolism refers to the chemical processes that occur in the body. Disorders of the metabolism can cause lasting damage and must be identified as early as possible (e.g blood or urine tests). Examples of metabolic dis orders include phenylketonuria (PKU) and diabetes. PKU is an inherited disorder where phenylalanine (present in food) can reach high concentration in blood serum. This causes damage to brain cells and to intellectual ability. Similarly in diabetes an inability to control blood glucose levels can result in damage to brain cells.
Congenital malformations
Congenital defects are believed to be the result of complex interactions between genes, environment and behaviours. An example is tuberous sclerosis, a condition where children have growths in regions such as the brain, heart, eyes, skin, kidneys and lungs. They may also experience epilepsy, learning difficulties/impairments.
Immune disorders
Immune disorder such as Paediatric Autoimmune Neuropsychiatric Disorder associated with Streptococcal infection (PANDAS) can cause emotional challenges, abnormal body movements, obsessive compulsive disorder (OCD) and tic disorders including Tourettes syndrome. It is believed that the area of the brain responsible for movement and behaviouris affected by PANDAS
Toxins and environmental factors

Neuro-toxins can enter and damage a childs developing system through the placenta during fetal development. Consequently a child may develop intellectual and behavioural problems. Neurotoxins include alcohol (linked to fetal alcohol syndrome), lead (linked to intelligence, learning and memory problems), mercury (linked to learning and development disorders), tobacco (linked to challenging behaviours and developmental impairments) and some food additives (linked to higher rates of ADHD in children).
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Nutritional deficiencies
Nutrients are needed for growth. A deficiency of nutrients during the last three months of pregnancy can decrease the number of brain cells. A deficiency of folic acid (a B vitamin) could lead to a neural tube defect (NTD) e.g. spina bifida (open spine). Infections TORCH infections, including sexually transmitted infections, can be passed from mother to baby during pregnancy. TORCH infections (because of their initial letters) include. Toxoplasmosis, other infections (hepatitis B, syphilis, varicella-Zosteer virus, HIV and Parovirus B19), Rubella, Cytomegalovirus and Herpes simplex virus. These infections can cause developmental abnormalities in the unborn child. Chorioamnionitis can be a cause of cerebral palsy
Hypoxia/asphyxia
Perinatal asphyxia is the condition resulting from deprivation of oxygen (hypoxia). Hypoxic ischaemia is insufficient blood flow causing reduced blood oxygen content. If a developing baby in the uterus does not have enough oxygen then it may have hypoxic ischemic encephalopathy (neurological damage caused by low oxygen). The effects of severe HIE can include cerebral palsy, intellectual impairments and epilepsy
Complications during childbirth

The protective skull is not fully formed at birth making the brain vulnerable to physical injury. The supply of blood and oxygen from the umbilical cord can also become affected at birth. As the brain is dependent upon thi s supply of oxygen, deprivation of oxygen can cause brain damage.
Prematurity/low birth weight

Low birth weight may indicate growth problems in the womb and has been associated with a greater likelihood of developing cognitive impairments, speech and language impairments, attention problems, social difficulties, hyperactivity and learning impairments. Some may arise because of associated complications during childbirth.
Postnatal infections
Encephalitis (inflammation of the brain) can be caused by m any types of infection (usually viral). Some people may develop neurological long term consequences following encephalitis, including memory problems, behavioural changes, speech impairments, and epilepsy. Meningitis is caused by a bacterial or viral infection that inflames the meninges (membranes surrounding the brain and spinal cord). The inflammation and swelling can damage the brain and nerves. Complications are more likely following bacterial meningitis than with viral meningitis. Lasting symptoms include hearing impairments, memory difficulties, coordination and balance problems, learning impairments, epilepsy, cerebral palsy, speech impairments, and loss of vision.
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Spinal cord injuries. Car accidents, falls, or sports accidents can cause spinal cord injuries. The degree of damage depends on where the damage occurs and what part of the body the injured spinal area controls. Spinal injuries can lead to loss of muscle function.
Neoplasm
Neoplasmis an abnormal mass of tissue producing tumours. Tumours can develop in t he brain or spinal cord. They can be benign (noncancerous) or malignant (cancerous). Malignant tumours are the most dangerous, so early diagnosis is very important. Benign tumours can have neurological consequences as they increase pressure on other parts of the brain, damaging healthy tissue. Symptoms include seizures , limb weakness, difficulty walking, speech impairments and swallowing difficulties, strange sensations, learning impairments or challenging behaviours, vision and hearing impairments. Toxins Exposure to environmental chemicals or toxins during childhood can lead to neurological impairment.
Endoctrine conditions in children

Endocrine diseases (diseases involving hormones, the chemical messengers of the body) involve a deficiency or excess of hormones and can be responsible for growth failure during childhood and adolescence. Growth hormone deficiency is a disorder that involves the pituitary gland (the small gland at the base of the brain that secretes several hormones, including growth hormone). A damaged or malfunctioning pituitary gland may not produce enough hormones for normal growth. Hypothyroidism is a condition in which the thyroid gland fails to make enough thyroid hormone, which is essential for normal bone growth. Turner syndrome, one of the most common genetic growth disorders, occurs in girls and is a syndrome in which there's a missing or abnormal X chromosome. In addition to short stature, girls with Turner syndrome usually don't undergo normal sexual development because their ovaries (the sex organs that produce eggs and female hormones) fail to mature and function normally. Your doctor or an endocrinologist will look for signs of the many possible causes of short stature and growth failure. Blood tests may be done to look for hormone and chromosome abnormalities and to rule out other diseases associated with growth failure. A bone age X-ray might be done and special scans (such as an MRI) can check the pituitary gland for abnormalities. To measure the ability of the pituitary gland to produce growth hormone, the doctor (usually a pediatric endocrinologist) may do a growth hormone stimulation test. This involves giving the child medications that cause the pituitary gland to secrete growth hormone, then drawing several small blood samples over time to check growth hormone levels.
Treating a Growth Disorder

Although the treatment of a growth problem usually isn't urgent, earlier diagnosis and treatment of can help some kids catch up with peers and increase their final height. If an underlying medical condition is identified, specific treatment may result in improved growth. Growth failure due to hypothyroidism, for example, is usually treated with thyroid hormone replacement pills. Growth hormone injections for children with growth hormone deficiency, Turner
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syndrome, and chronic kidney failure may help kids reach a more normal height. Human growth hormone is generally considered safe and effective, although full treatment may take many years and not all kids will have a good response. Neurofibromatosis (NF) is a neurocutaneous syndrome that can affect many parts of the body, including the brain, spinal cord, nerves, skin, and other body systems. NF can cause growth of non-cancerous tumors on nerve tissue, producing skin and bone abnormalities. Effects of NF vary widely some children live almost unaffected by it; rarely, others can be severely disabled. NF is defined by tumors, called neurofibromas, that grow along nerves in the body or on or under the skin. As the tumors increase in size, they can press on vital areas of the body, causing problems in the way the body functions. Neurofibromas often first appear in childhood, especially during puberty. NF is occasionally diagnosed in infancy (in children with more apparent cases), but more often in kids between 3 and 16 years old. The first noticeable sign is almost always the presence of brown caf au lait spots. These distinctive spots don't hurt or itch and never progress to anything more serious than spots. They can be found anywhere on the body, though not usually on the face. Tiny ones freckles may be seen under the arms or in the groin area. Many neurofibromas can be removed. Although usually benign (noncancerous), an estimated 3%-5% become cancerous. Muscular dystrophy (MD) is a genetic disorder that gradually weakens the body's muscles. It's caused by incorrect or missing genetic information that prevents the body from making the proteins needed to build and maintain healthy muscles. A child who is diagnosed with MD gradually loses the ability to do things like walk, sit upright, breathe easily, and move the arms and hands. This increasing weakness can lead to other health problems. There are several major forms of muscular dystrophy, which can affect the muscles to varying degrees. In some cases, MD starts causing muscle problems in infancy; in others, symptoms don't appear until adulthood. There is no cure for MD, but researchers are quickly learning more about how to prevent and treat it. Doctors are also working on improving muscle and joint function and slowing muscle deterioration so that those with MD can live as actively and independently as possible.
First Symptoms
Many kids with muscular dystrophy follow a normal pattern of development during their first few years of life. But in time common symptoms begin to appear. A child who has MD may start to stumble, waddle, have difficulty going up stairs, and toe walk (walk on the toes without the heels hitting the floor). A child may start to struggle to get up from a sitting position or have a hard time pushing things, like a wagon or a tricycle. Kids with MD often develop enlarged calf muscles (called calf pseudohypertrophy) as muscle tissue is destroyed and replaced by fat.
Diagnosis
When first suspecting that a child has muscular dystrophy, a doctor will do a physical exam, take a family history, and ask about any problems particularly those affecting the muscles that the child might be having.In addition, the doctor may perform tests to determine what type of MD is involved and to rule out other diseases that could cause the problem. These might include a blood test to measure levels of serum creatine kinase, an enzyme that's released into the bloodstream when muscle fibers are deteriorating. Elevated levels indicate that something is
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causing muscle damage. The doctor also may do a blood test to check the DNA for gene abnormalities or a muscle biopsy to look for patterns of deterioration and abnormal levels of dystrophin, a protein that helps muscle cells keep their shape and length.
Marfan Syndrome
Marfan syndrome is a progressive genetic disorder that affects the body's connective tissue. Connective tissue is everywhere in the body, providing structure and support for cells. Think of it as a sort of "glue" that helps support every organ, blood vessel, bone, joint, and muscle. In people with Marfan syndrome, this "glue" is weaker than normal because of a defect in the body's production of the protein fibrillin, a major component of connective tissue. Weakened connective tissue can lead to problems in many parts of the body, especially the heart, eyes, and bones. Even though the disease has no cure, the good news is that doctors can successfully treat just about all of its symptoms. Just a few decades ago, most people with Marfan syndrome didn't live past 40. Now, thanks to new research and treatments, those who are diagnosed early and get good medical care have just about the same lifespan as everyone else.
Causes
Marfan syndrome is pretty rare, affecting about 1 in every 5,000 people. Researchers have traced the disorder to a defect in a gene found on chromosome 15. It's this mutation (change) that causes the abnormality in the production or the structure of fibrillin. About 75% of the time, the gene for Marfan syndrome runs in families, getting passed down to kids from parents who have the disease. The gene is autosomal dominant, which means every child born to a parent who has Marfan syndrome has a 50% chance of having it too. In the remaining 25% of cases, though, neither parent has the disease; the genetic mutation responsible for Marfan syndrome occurs spontaneously in either the egg or sperm cell at the time of conception. No one knows what causes this mutation, but those born with it have a 50% chance of passing it on to their kids.
Neurocutaneous Syndromes
Neurocutaneous syndromes are disorders that lead to growth of tumors in various parts of the body. They're caused by the abnormal development of cells in an embryo and characterized by the presence of tumors in various parts of the body (including the nervous system) and by certain differences in the skin.While some can be diagnosed at birth, others don't produce symptoms until later in life. Although neurocutaneous syndromes cannot be cured, treatments can help manage symptoms and any health problems that occur.
Types of Neurocutaneous Syndromes

Common neurocutaneous syndromes that affect kids include:
neurofibromatosis, types 1 and 2 (NF1 and NF2) Sturge-Weber syndrome tuberous sclerosis (TS)
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ataxia-telangiectasia (A-T) von Hippel-Lindau disease (VHL)
Symptoms vary widely from condition to condition, and they affect different kids in different ways. Often, the full effects of these diseases even if detected at birth do not emerge until a child grows up. The educational, social, and physical problems that the conditions cause must be managed throughout a child's life.
Metabolic Syndrome
Not to be confused with metabolic disease (which occurs when hormones and other chemicals in the body fail to interact properly), metabolic syndrome describes a cluster of risk factors that put kids on the road to heart disease and type 2 diabetes. Kids with metabolic syndrome have at least three of these risk factors: excessive belly fat high blood pressure (hypertension) abnormal levels of blood fats (lipids), including cholesterol and triglycerides hyperglycemia (high blood sugar)
Acanthosis nigricans (AN) is a skin condition that causes increasingly thicker and darker patches or streaks around joints and body areas with many creases and folds (such as knuckles, armpits, elbows, knees, and the sides and back of the neck). Some people also develop AN on their palms, groin, lips, or, in very rare cases, non-crease areas like the face, back, arms, or legs. The skin may stay soft, which is why the word "velvety" is often used to describe the symptoms of AN. Acanthosis nigricans is not an infection and isn't contagious. A few kids might have mild itching, but otherwise AN itself is harmless. Still, a doctor will run tests to rule out underlying causes that could require treatment. Managing AN means treating the conditions that are causing the skin darkening (known as hyperpigmentation).
Causes
The exact causes of acanthosis nigricans vary and are often unknown. In some cases, it can be hereditary, occurring in otherwise healthy children and teens. Although not dangerous in these cases, it can make kids self-conscious about their appearance. AN is commonly found in children with elevated blood insulin levels, a condition often associated with kids who are overweight or obese or have diabetes. Sometimes AN can be a warning sign of other more serious conditions, such as certain cancers and endocrine problems, along with type 2 diabetes and the health issues associated with obesity. In rare cases, AN can be caused by certain medications, such as oral contraceptives and cholesterol medications.
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Symptoms
Usually, the only signs of AN will be dark, thick, velvety patches of skin increases and folds, usually in the neck, armpits, or groin, but sometimes also the lips, palms, knuckles, soles of the feet, and other areas. In rare cases, children may have mild itching in the affected areas.
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CARDIOVASCULAR SYSTEM
Diagnostic, Procedural, and Laboratory Terms
Treatment of cardiovascular disease requires a precise understanding of the structure and function of the heart and of the parts of the body that affect the hearts functioning. Doctors order many types of diagnostic tests based on their observations of a patient. They may order clinical procedures whose results will indicate certain specific conditions or they may order laboratory tests to find disease-causing factors or evidence of a specific disease. Sometimes, test results are used to rule out conditions, in which case, physicians look for other causes of disease.
Diagnostic Procedures and Tests

Doctors who specialize in the diagnosis and treatment of cardiovascular disease (cardiology ) are called cardiologists. Cardiologists usually see patients who already have some type of cardiovascular problem or indication of disease. In addition, cardiac surgeons are specialists who perform heart surgery. The cardiologist often starts an examination with auscultation (listening to sounds within the body through a stethoscope). Some abnormal sounds a physician may hear are a murmur, a bruit, or a gallop. Each sound is a clue to the patients condition. A sphygmomanometer is then usually used to measure blood pressure. One common diagnostic test is a stress test or exercise tolerance test ( ETT ). Patients are asked to exercise on a treadmill while technicians take certain measurements, such as heart rate and respiration. A stress test may be used to diagnose coronary artery disease or it may give a risk factor for heart attack. Another common test is electrocardiography, which produces an electrocardiogram (ECG, EKG ), which measures the amount of electricity flowing through the heart by means of electrodes placed on the patients skin at specific points surrounding the heart. A Holter monitor is a portable type ofelectrocardiograph or instrument that performs an electrocardiogram over a 24-hour period. Various diagnostic procedures can be performed by producing some type of image. Taking x-rays after a dye has been injected is called angiocardiography (x-ray of the heart and its large blood vessels), angiography (x-ray of the hearts large blood vessels), arteriography (x-ray of a specific artery), aortography (x-ray of the aorta), or venography or phlebography (x-ray of a specific vein). The tests are called an angiocardiogram, angiogram, arteriogram, aortogram, or venogram or phlebogram. A ventriculogram is an x-ray showing the ventricles. Ventriculograms measure stroke volume ( SV ), the amount of blood going out of a ventricle in one contraction; cardiac output ( CO ), the amount of blood ejected from a ventricle every minute; and the ejection fraction, the percentage of volume of the contents of the left ventricle ejected with each contraction. Another x-ray test, digital subtraction angiography (DSA ), requires two angiograms with different contrast material to compare the results of the two tests in a computer. Ultrasound tests, or ultrasonography or sonography, produce images by
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measuring the echoes of sound waves against various structures. Doppler ultrasound measures blood flow in certain blood vessels. Echocardiography records sound waves to show the structure and movement of the heart. The test itself is called an echocardiogram. Figure 6-10 shows an echocardiogram. Radioactive substances that are injected into the patient can provide information in a cardiac scan, a test that measures movement of areas of the heart, or in nuclear medicine imaging. Positron emission tomography (PET) scans are one form of nuclear imaging. A PET scan of the heart produces three-dimensional images of the hearts blood flow and other functional processes. Another form of nuclear imaging is multiple-gated acquisition (MUGA) angiography. A MUGA scan is a noninvasive method that provides a movielike image of the beating heart. It allows for evaluation of the function of ventricles. Magnetic resonance imaging (MRI) uses magnetic waves to produce images. A cardiac MRI uses radio waves to provide images of the heart while beating and provides a detailed image of the heart and shows any lesions in the large blood vessels of the heart. Cardiac catheterization is used to sample the blood in the chambers of the heart to determine the oxygen content and blood pressure in the chambers. Cardiac output can also be checked. This procedure involves passing a small plastic catheter into the heart through a vein or artery. A vein is used for right-sided catheterization while an artery is used for a left-sided approach into the heart. The veins and arteries of the legs and arms are most commonly used.
Laboratory Tests
Laboratory tests are crucial for determining what may be happening to a patient or for evaluating risk factors for heart disease. Drug therapy, clinical procedures, and lifestyle changes may all be recommended largely on the basis of laboratory test results. All laboratory tests have a range of normal values (also called reference ranges). Some of these ranges change as new studies are done and views of what constitutes a healthy value (such as for cholesterol readings) is revised. Laboratory tests may fall outside of normal ranges due to a variety of reasons, age, gender, dietary habits, problems with collection, and so on. Results are viewed as one part of an entire exam in focusing on a diagnosis. The flow of blood in the arteries is affected by the amount of cholesterol and triglycerides (fatty substances or lipids ) contained in the blood. Lipids are carried through the blood by lipoproteins. Low-density lipoproteins ( LDL ) and very low-density lipoproteins ( VLDL ) cause cholesterol to form blockages in the arteries and are referred to as bad cholesterol. High-density lipoproteins ( HDL, referred to as good cholesterol) actually remove lipids from the arteries and help protect people from the formation of blockages or fatty deposits, called plaque. One factor that increases LDL and VLDL is a diet high in saturated fats (animal fats and some vegetable fats that tend to be solid). The processing of some shortenings or margarines produces transfats (man-made fats), which are thought to cause particular risk for heart disease and cancer. Polyunsaturated fats (certain vegetable oils such as olive) do not raise LDL or VLDL. Laboratory tests performed on blood samples determine the levels of lipoproteins in the blood. Adult cholesterol readings below 200 are considered to pose little risk for coronary artery disease (this number is controversial and varies as new studies are performed). The importance of cholesterol testing is evidenced by the fact that the chance of heart disease is reduced by 2 to 3 percent for each percentage point reduction in the cholesterol level. A lipid profile (a series of laboratory tests performed on a blood sample) gives the lipid, triglyceride, glucose, and other values that help in evaluating a patients risk factors. A laboratory test that can be used to diagnose a myocardial infarction earlier than most other laboratory tests measures the levels of troponin T and troponin I, proteins found in the heart.
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As levels of the two rise, it usually indicates the early stages of an acute myocardial infarction. If only one level rises, failure or muscle trauma. A fairly new test for the evaluation of heart disease is the IMA (ischemia modified albumin). It is used with troponin and ECG to rule out acute coronary syndrome (ACS) patients with chest pain. Tests for C-reactive protein indicate levels of inflammation which is considered an accurate predictor of cardiovascular disease. Another important laboratory test of blood is the cardiac enzyme test or study (also called a serum enzyme test ), which measures the levels of enzymes released into the blood by damaged heart muscle during a myocardial infarction. The three enzymes that help evaluate the condition of the patient are GOT ( glutamic oxaloacetic transaminase ), CPK ( creatine phosphokinase), and LDH ( lactate dehydrogenase ). The enzymes may indicate the degree of injury to the heart or the seriousness of an attack. Research to find markers for heart disease is ongoing. For example, brain natriuretic peptide (a hormone found in the body) levels have been found to be higher in patients with congestive heart failure.
Diseases of the Blood Vessels

Blood vessels can become damaged, diseased, or even destroyed, as when plaque, buildup of fatty material, is deposited on the wall of an artery. An atheroma is plaque specifically on the wall of an artery, which can build up to cause atherosclerosis. An embolus is a mass traveling through the bloodstream causing a blockage in the vessel. A thrombus is a stationary blood clot, usually formed from elements of the blood. Figure 6-13 shows the difference between an embolus and a thrombus. Thrombophlebitis is an inflammation of a vein with a thrombus. Thrombosis is the presence of a thrombus in a blood vessel. Deep vein thrombosis (DVT) forms in a deep vein or in a vein within a structure rather than one on the surface of a structure. Thrombotic occlusion is the occlusion or closing of a vessel caused by a thrombus. Any blockage in a blood vessel can lead to ischemia, or insufficient blood flow. Blood vessels can have a constriction, or narrowing, due to contraction. An occlusion is the closing off of a blood vessel due to a blockage. A weakness in an artery wall can cause a ballooning or aneurysm, which can fatally rupture. Loss of elasticity or hardening of the arteries (arteriosclerosis) can lessen blood flow. Inadequate blood supply, particularly to the blood vessels in the legs, causes claudication, limping. Intermittent claudication, irregular attacks of claudication, is helped by resting. Peripheral vascular disease is a general term for vascular disease in the lower extremities. A sudden drop in the supply of blood to a vessel (an infarction ) can cause an area of dead tissue, or necrosis (an infarct ). The general term for lack of flow through a blood vessel is perfusion deficit. An area of blood insufficiency in the body is called ischemia. Insufficiently oxygenated areas of the body may develop cyanosis, a bluish or purplish discoloration of the skin caused by deficient oxygenation of the blood. Veins sometimes become twisted or enlarged (varicose veins). Hemorrhoids are varicose veins in the anal region. An inflammation of a vein is called phlebitis (which most often occurs in the lower legs). An inflammation of an artery is called arteritis. Minute hemorrhages in the blood vessels in the skin are called petechiae. Numbness or pain in the fingers caused by arterial spasms is called Raynauds phenomenon. Raynauds phenomenon may be an indicator of some serious connective tissue or autoimmune diseases. Most often, it is a reaction to cold or to emotional stress. Once a trigger starts the phenomenon, three color changes usually take place. First, the finger(s) turn absolutely white when the blood flow is blocked by the spasm; second, the finger becomes cyanotic from the slow return of blood to the site; and third, as blood fills the finger, a darker red color appears. Treatment of Raynauds not linked to another disease is usually as
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simple as wearing gloves when removing items from the freezer and when going out in cold weather. BuergersDisease is an inflammation of the peripheral arteries and veins in the arms and legs with clot formations. Symptoms of Buergers include intense pain in the affected area that is exacerbated or aggravated by exercise and relieved by rest. The primary cause of Buergers is long-term smoking of tobacco that results in clot formation in the vessels until the entire vessel is destroyed and circulation to that area is seriously compromised.
Coronary Artery Disease

Coronary artery disease ( CAD ) refers to any condition that reduces the nourishment the heart receives from the blood flowing through the arteries of the heart. Such diseases include aortic stenosis or narrowing of the aorta. Coarctation of the aorta is also an abnormal narrowing of the aorta. Stenosis is any narrowing of a blood vessel. Pulmonary artery stenosis slows the flow of blood to the lungs. Angina or angina pectoris (sometimes referred to as cardiac pain) can result from lack of oxygen to the heart muscle. Angina is usually categorized in degrees from class I to class IV. A person with class I angina (able to withstand prolonged exertion) will have no limits to normal activity. Severe angina (class IV) requires strict limitations on any activity except rest.
General Heart and Lung Diseases

When the heart suffers an attack that causes insufficient blood flow to the heart or ischemia, one is said to have a coronary or heart attack. These are informal terms for a myocardial infarction (MI) or acute myocardial infarction (AMI), a disruption in the hearts activity usually caused by blockage (a clot or plaque) of blood flow to a coronary artery. Myocardial infarctions are often classified by the location of the area to which blood flow is restricted; for example, an anterior myocardial infarction is one in which the anterior wall of the heart is affected, and a posterior one involves the hearts posterior wall. Cardiac arrest or asystole is a sudden stopping of the heart. Such an attack can be fatal or, with treatment, can be a warning to make medical and lifestyle changes to ward off a further attack. Approximately 1.5 million people suffer heart attacks annually. One-third of these people do not survive. Before age 50, men are much more likely to suffer heart attacks than are women, who are thought to be protected by their production of estrogen before menopause. After menopause, the risk for women is approximately the same as for men. Some diseases of the heart are specific inflammations, such as endocarditis, myocarditis, pericarditis, or bacterial endocarditis. Other conditions of the heart have to do with fluid accumulation. Congestive heart failure occurs when the heart is unable to pump the necessary amount of blood. People suffering from congestive heart failure usually experience shortness of breath, edema, enlarged organs and veins, and irregular breathing patterns. Pulmonary edema or accumulation of fluid in the lungs can result from this failure. Fluid accumulation in the pericardial sac causes cardiac tamponade. An intracardiac tumor is a tumor in a heart chamber. Cardiomyopathy is disease of the heart muscle.
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Valve Conditions
The heart valves control the flow of blood into, and out of the heart. Valve irregularities affecting the flow of blood can be serious. Aortic regurgitation or reflux is a backward flow of blood through the aortic valve. An abnormal narrowing of the opening of the mitral valve ( mitral stenosis ) affects the opening and closing of the valve. Mitral insufficiency or reflux is a backward flow of blood through the mitral valve. Similarly, mitral valve prolapse is a backward flow of blood, but it is due to the abnormal protrusion of one or both of the mitral cusps into the left atrium. Tricuspid stenosis is an abnormal narrowing of the opening of the tricuspid valve. Sometimes, infections or inflammation may cause valve damage. Valvulitis is the general term for a heart valve inflammation. Rheumatic heart disease is damage to the heart, usually to the valves, caused by an untreated streptococcal infection. Some infections can cause a clot on a heart valve oropening ( vegetation ).
Congenital Heart Conditions

Congenital heart disease results from a condition present at birth. Some common conditions are patent ductus arteriosus, a disease in which a small duct remains open at birth; septal defect, an abnormal opening in the septum between the atria or ventricles; and tetralogy of Fallot, actually a combination of four congenital heart abnormalities (ventricular septal defect, pulmonary stenosis, incorrect position of the aorta, and right ventricular hypertrophy) that appear together.
Surgical Terms
Cardiovascular surgery usually involves opening up or repairing blood vessels or valves; removal, repair, or replacement of diseased portions of blood vessels; or bypass of blocked areas. The goal of most cardiovascular surgery is to improve blood flow, thereby allowing proper oxygenation and nourishment of all the cells of the body. Many types of heart surgery are now minimally invasive procedures. Most heart operations require opening up the chest to access the heart. However, devices such as lasers, robotic devices, and miniature surgical instruments now allow surgeons to perform certain procedures through a keyhole, a small opening in the chest. A balloon catheter is used in balloon catheter dilation (also called percutaneous transluminal coronary angioplasty or PTCA ) to open the passageway inside a blood vessel so that blood can flow freely. A balloon valvuloplasty involves the use of a balloon catheter to open narrowed cardiac valve openings. Similarly, angioplasty or coronary angioplasty is the opening of a blood vessel using a balloon catheter. Cardiac catheterization uses a catheter threaded through an artery or vein into the heart to observe blood flow. Angioscopy uses a fiberoptic catheter to view the interior of a blood vessel. Surgery that involves the use of cardiac catheterization is called endovascular surgery. During surgery, a stent or an intravascular stent may be inserted to hold a blood vessel passageway open. Many stents are now drug-eluting stents meaning that they include slowly released medication that helps to maintain the open passageways. Such procedures also help to break up blockages. Sometimes it becomes necessary to create a detour or a bypass around blockages. Coronary bypass surgery or CABG (coronary artery bypass graft) is performed to attach the vessel to be used for the bypass.
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A graft, particularly of a blood vessel from another part of the body, can be used to bypass an arterial blockage. Saphenous (leg) veins or mammary (chest) arteries are two types of vessels used for this procedure. The number of arteries that are bypassed determines whether a CABG is a triple (three arteries bypassed) bypass, a quadruple (four) bypass, and so on. Fontans operation creates a bypass from the right atrium to the main pulmonary artery. Sometimes it is necessary to divert blood flow from the heart during surgery. This procedure, cardiopulmonary bypass (also called extracorporeal circulation ), circulates the blood through a heart-lung machine and back into systemic circulation. Surgical removal and replacement of the entire heart is called a heart transplant. Valve replacement is the removal and replacement of a heart valve. Surgical removal of a thrombus is a thrombectomy; of an embolus, an embolectomy; of an atheroma, an atherectomy; and of hemorrhoids, a hemorrhoidectomy. An endarterectomy removes the diseased lining of an artery, while an arteriotomy is an incision into an artery, as to remove a clot. A valvotomy is the incision into a cardiac valve to remove an obstruction. Venipuncture is a small puncture for the purpose of drawing blood ( phlebotomy). Some surgeries are for the purpose of reconstruction or repaira valvuloplasty is done to reconstruct a cardiac valve. Other surgical procedures, such as anastomosis, are performed to connect blood vessels and to implant devices, such as pacemakers, that help regulate body functions. Pacemakers are small computers that provide electrical stimulation to regulate the heart rate. They can be attached temporarily (usually with a small box worn outside the body and a sensor attached to the outside of the chest) or permanently (the lead is surgically inserted into a blood vessel leading to the heart).
MEDICAL EQUIPMENT
A medical device is an instrument, apparatus, implant, in vitro reagent, or similar or related article that is used to diagnose, prevent, or treat disease or other conditions, and does not achieve its purposes through chemical action within or on the body (which would make it a drug). Whereas medicinal products (also called pharmaceuticals) achieve their principal action by pharmacological, metabolic or immunological means, medical devices act by other means like physical, mechanical, or thermal means. Medical devices vary greatly in complexity and application. Examples range from simple devices such as tongue depressors, medical thermometers, and disposable gloves to advanced devices such as computers which assist in the conduct of medical testing, implants, and prostheses. The design of medical devices constitutes a major segment of the field of biomedical engineering. A surgical instrument is a specially designed tool or device for performing specific actions of carrying out desired effects during a surgery or operation, such as modifying biological tissue, or to provide access for viewing it. Over time, many different kinds of surgical instruments and tools have been invented. Some surgical instruments are designed for general use in surgery, while others are designed for a specific procedure or surgery. Accordingly, the nomenclature of surgical instruments follows certain patterns, such as a description of the action it performs (for example, scalpel, hemostat), the name of its inventor(s) (for example, the Kocher forceps),[1] or a compound scientific name related to the kind of surgery (for example, a tracheotome is a tool used to perform a tracheotomy).
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Hospital departments
Hospitals vary widely in the services they offer and therefore, in the departments (or "wards") they have. Each is usually headed by a Chief Physician. They may have acute services such as an emergency department or specialist trauma centre, burn unit, surgery, or urgent care. These may then be backed up by more specialist units such as: Emergency department Cardiology Intensive care unit Paediatric intensive care unit Neonatal intensive care unit Cardiovascular intensive care unit Neurology Oncology Obstetrics and gynaecology
Some hospitals will have outpatient departments and some will have chronic treatment units such as behavioral health services, dentistry, dermatology, psychiatric ward, rehabilitation services, and physical therapy.Common support units include a dispensary or pharmacy, pathology, and radiology, and on the non-medical side, there often are medical records departments, release of information departments, Information Management (aka IM, IT or IS), Clinical Engineering (aka Biomed), Facilities Management, Plant Ops (aka Maintenance), Dining Services, and Security departments.
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DRUGS BRIEF HISTORY

Drugs, both medicinal and recreational, can be administered in a number of ways. Many drugs can be administered in a variety of ways rather than just one. Bolus is the administration of a medication, drug or other compound that is given to raise its concentration in blood to an effective level. The administration can be given intravenously, by intramuscular, intrathecal or subcutaneous injection. Inhaled, (breathed into the lungs), as an aerosol or dry powder. (This includes smoking a substance) Injected as a solution, suspension or emulsion either: intramuscular, intravenous, intraperitoneal, intraosseous. Insufflation, or snorted into the nose. Orally, as a liquid or solid, that is absorbed through the intestines. Rectally as a suppository, that is absorbed by the rectum or colon. Sublingually, diffusing into the blood through tissues under the tongue. Topically, usually as a cream or ointment. A drug administered in this manner may be given to act locally or systemically. Vaginally as a suppository, primarily to treat vaginal infections
Hippocrates
Hippocrates of Kos (c. 460 c. 370 BCE), considered the "father of Western medicine .The Hippocratic Corpus is a collection of around seventy early medical works from ancient Greece strongly associated with Hippocrates and his students. Most famously, Hippocrates invented the Hippocratic Oath for physicians, which is still relevant and in use today. Hippocrates and his followers were first to describe many diseases and medical conditions. He is given credit for the first description of clubbing of the fingers, an important diagnostic sign in chronic suppurative lung disease, lung cancer and cyanotic heart disease. For this reason, clubbed fingers are sometimes referred to as "Hippocratic fingers". Hippocrates began to categorize illnesses as acute, chronic, endemic and epidemic, and use terms such as, "exacerbation, relapse, resolution, crisis, paroxysm, peak, and convalescence." Another of Hippocrates's major contributions may be found in his descriptions of
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the symptomatology, physical findings, surgical treatment and prognosis of thoracic empyema, i.e. suppuration of the lining of the chest cavity. His teachings remain relevant to present-day students of pulmonary medicine and surgery. Hippocrates was the first documented chest surgeon and his findings are still valid. The Greek Galen was one of the greatest surgeons of the ancient world and performed many audacious operationsincluding brain and eye surgeries that were not tried again for almost two millennia. Later, in medieval Europe, Galen's writings on anatomy became the mainstay of the medieval physician's university curriculum along; but they suffered greatly from stasis and intellectual stagnation. In the 1530s, however, Belgian anatomist and physician Andreas Vesalius took on a project to translate many of Galen's Greek texts into Latin. Vesalius's most famous work, De humani corporis fabrica, was greatly influenced by Galenic writing and form. The works of Galen were regarded as authoritative until well into the Middle Ages. The Romans invented numerous surgical instruments, including the first instruments unique to women as well as the surgical uses of forceps, scalpels, cautery, cross-bladed scissors, the surgical needle, the sound, and speculas. Romans also performed cataract surgery Paracelsus (1493-1541), was an erratic and abusive innovator who rejected Galen and bookish knowledge, calling for experimental research, with heavy doses of mysticism, alchemy and magic mixed in. The point is that he rejected sacred magic (miracles) under Church auspisces and looked for cures in nature. He preached but he also pioneered the use of chemicals and minerals in medicine. His hermetical views were that sickness and health in the body relied on the harmony of man (microcosm) and Nature (macrocosm). He took an approach different from those before him, using this analogy not in the manner of soul-purification but in the manner that humans must have certain balances of minerals in their bodies, and that certain illnesses of the body had chemical remedies that could cure them. Most of his influence came after his death. Paracelsus is a highly controversial figure in the history of medicine, with most experts hailing him as a Father of Modern Medicine for shaking off religious orthodoxy and inspiring many researchers; others say he was a mystic more than a scientist and downplay his importance. The practice of medicine changed in the face of rapid advances in science, as well as new approaches by physicians. Hospital doctors began much more systematic analysis of patients' symptoms in diagnosis. Among the more powerful new techniques were anaesthesia, and the development of both antiseptic and aseptic operating theatres. Actual cures were developed for certain endemic infectious diseases. However the decline in many of the most lethal diseases was more due to improvements in public health and nutrition than to medicine. It was not until the 20th century that the application of the scientific method to medical research began to produce multiple important developments in medicine, with great advances in pharmacology and surgery. Medicine was revolutionized in the 19th century and beyond by advances in chemistry and laboratory techniques and equipment, old ideas of infectious disease epidemiology were replaced with bacteriology and virology. Bacteria and microorganisms were first observed with a microscope by Antonie van Leeuwenhoek in 1676, initiating the scientific field microbiology.
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Germ theory and bacteriology
In the 1830s in Italy, Agostino Bassi traced the silkworm disease muscardine to microorganisms. Meanwhile in Germany, Theodor Schwann led researches on alcoholic fermentation by yeast and proposed that they were alive that is, microorganismsa claim derided by leading chemists, such as Justus von Liebig, seeking solely physicochemical explanation, and alleging that Schwann's was regressing to vitalism. In 1847 in Vienna, Ignaz Semmelweis (18181865), by requiring physicians to clean their hands before attending childbirth, dramatically cut new mothers' death rate due to childbed fever, yet his principles were marginalized and attacked by professional peers. Starting in 1857 by confirming Schwann's fermentation experiments, Louis Pasteur in France placed his eminent reputation behind the belief that yeast are microorganisms, and closed his paper by indicating that such process might also explain contagious diseases. In 1860, Pasteur's report on bacterial fermention to butyric acid motivated fellow Frenchman Casimir Davaine to establish a similar species, which he called bacteridia, as the pathogen of the disease anthrax, costly to the cattle industry. Yet bacteridia were found inconsistently and dismissed as a disease byproduct, not cause. British surgeon Joseph Lister, however, already took cue and introduced antisepsis to wound treatment in 1865. German physician Robert Koch, noting fellow German Ferdinand Cohn's report of a spore stage of a certain bacterial species, traced the life cycle of Davaine's bacteridia, identified spores, inoculated laboratory animals with them, and reproduced anthraxa breakthrough for experimental pathology and germ theory of disease. Pasteur's group added ecological investigations confirming spores' role in the natural setting, while Koch published a landmark treatise in 1878 on the bacterial pathology of wounds. In 1881, Koch reported discovery of the "tubercle bacillus", cementing germ theory and Koch's acclaim. Upon the outbreak of a cholera epidemic in Alexandria, Egypt, two medical missions went to investigate and attend the sick, one was sent out by Pasteur and the other actually led by Koch. Koch's group returned victorious in 1883, having discovered the cholera pathogen. In Germany, however, Koch's bacteriologists had to vie against Max von Pettenkofer, Germany's leading proponent of miasmatic theory. Pettenkofer conceded bacteria's casual involvement, but maintained that other, environmental factors were required to turn it pathogenic, and opposed water treatment as a misdirected effort amid more important ways to improve public health.The massive cholera epidemic in Hamburg in 1892 devastasted Pettenkoffer's position, and yielded German public health to "Koch's bacteriology On losing the 1883 rivalry in Alexandria, Pasteur switched research direction, and introduced his third vaccinerabies vaccinethe first vaccine for humans since Jenner's for smallpox.From across the globe, donations poured in, funding the founding of Pasteur Institute, the globe's first biomedical institute, which opened in 1888. Along with Koch's bacteriologists, Pasteur's groupwhich preferred the term microbiologyled medicine into the new era of "scientific medicine" upon bacteriology and germ theory. Accepted from Jakob Henle, Koch's steps to confirm a species' pathogenicity became famed as "Koch's postulates". Although his proposed tuberculosis treatment, tuberculin, seemingly failed, it soon was used to test for infection with the
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involved species. In 1905, Koch was awarded the Nobel Prize in Physiology or Medicine, and remains renowned as the founder of medical microbiology.
First World War

The ABO blood group system was discovered in 1901, and the Rhesus group in 1937, facilitating blood transfusion. During the 20th century, large-scale wars were attended with medics and mobile hospital units which developed advanced techniques for healing massive injuries and controlling infections rampant in battlefield conditions. Thousands of scarred troops provided the need for improved prosthetic limbs and expanded techniques in plastic surgery or reconstructive surgery. Those practices were combined to broaden cosmetic surgery and other forms of elective surgery. During the First World War, Alexis Carrel and Henry Dakin developed the Carrel-Dakin method of treating wounds with an irrigation, Dakin's solution, a germicide which helped prevent gangrene.The Great War spurred the usage of Roentgen's X-ray, and the electrocardiograph, for the monitoring of internal bodily functions. This was followed in the inter-war period by the development of the first anti-bacterial agents such as the sulpha antibiotics.
Public health
The 1918 flu pandemic killed at least 50 million people around the world.It became an important case study in epidemiology.Bristow shows there was a gendered response of health caregivers to the pandemic in the United States. Male doctors were unable to cure the patients, and they felt like failures. Women nurses also saw their patients die, but they took pride in their success in fulfilling their professional role of caring for, ministering, comforting, and easing the last hours of their patients, and helping the families of the patients cope as well.
Post-World War II
Smallpox vaccination in Niger, 1969. A decade later, this was the first infectious disease to be eradicated.Most countries have seen a tremendous increase in life expectancy since 1945. However, in southern Africa, the HIV epidemic beginning around 1990 has eroded national health. A cochlear implant is a common kind of neural prosthesis, a device replacing part of the human nervous system. The World Health Organization was founded in 1948 as a United Nations agency to improve global health. In most of the world, life expectancy has improved since then, and was about 67 years as of 2010, and well above 80 years in some countries. Eradication of infectious diseases is an international effort, and several new vaccines have been developed during the post-war years, against infections such as measles, mumps, several strains of influenza and human papilloma virus. The long-known vaccine against Smallpox finally eradicated the disease in the 1970s, and Rinderpest was wiped out in 2011. Eradication of polio is underway. Tissue culture is important for development of vaccines. Though the early success of antiviral vaccines and antibacterial drugs, antiviral drugs were not introduced until the 1970s. As infectious diseases have become less lethal, and the most common causes of death in developed countries are now tumors and cardiovascular diseases, these conditions have received increased attention in medical research. Tobacco smoking as a cause of lung cancer was first researched in the 1920s, but was not widely supported by publications until the 1950s. Cancer treatment has been
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developed with radiotherapy, chemotherapy and surgical oncology. Oral rehydration therapy has been extensively used since the 1970s to treat cholera and other diarrhea-inducing infections. Hormonal contraception was introduced in the 1950s, and was associated with the sexual revolution, with normalization of abortion and homosexuality in many countries. Family planning has promoted a demographic transition in most of the world. With threatening sexually transmitted infections, not least HIV, use of barrier contraception has become imperative. The struggle against HIV has improved antiretroviral treatments, and in the late 2000s (decade), male circumcision was cited to diminish infection risk (circumcision and HIV). In 2013, the first patient was cured from HIV. X-ray imaging was the first kind of medical imaging, and later ultrasonic imaging, CT scanning, MR scanning and other imaging methods became available. Genetics have advanced with the discovery of the DNA molecule, genetic mapping and gene therapy. Stem cell research took off in the 2000s (decade), with stem cell therapy as a promising method. Evidence-based medicine is a modern concept, not introduced to literature until the 1990s. Prosthetics have improved. In 1958, Arne Larsson in Sweden became the first patient to depend on an artificial cardiac pacemaker. He died in 2001 at age 86, having outlived its inventor, the surgeon, and 26 pacemakers. Lightweight materials as well as neural prosthetics emerged in the end of the 20th century. The expression surgical instrumentation is somewhat interchangeably used with surgical instruments, but its meaning in medical jargon is really the activity of providing assistance to a surgeon with the proper handling of surgical instruments during an operation, by a specialized professional, usually a surgical technologist or sometimes a nurse or radiologic technologist. There are several classes of surgical instruments:
Graspers,such as forceps Clamps and occluders for blood vessels and other organs Retractors, used to spread open skin, ribs and other tissue Distractors, positioners and stereotactic devices Mechanical cutters (scalpels, lancets, drill bits, rasps, trocars, Ligasure, Harmonic scalpel etc.) Dilators and specula, for access to narrow passages or incisions Suction tips and tubes, for removal of bodily fluids Sealing devices, such as surgical staplers Irrigation and injection needles, tips and tubes, for introducing fluid Tyndallers, to help "wedge" open damaged tissues in the brain. Powered devices, such as drills, dermatomes
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Scopes and probes, including fiber optic endoscopes and tactile probes Carriers and appliers for optical, electronic and mechanical devices Ultrasound tissue disruptors, cryotomes and cutting laser guides Measurement devices, such as rulers and calipers
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Curs Engleza Medicala Volumul II Note
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Alte servicii ale Ageniei ACT

Oferta noastr de servicii include: cursuri de limbi strine club conversaional Language Cafe traducere i intermediere pentru servicii conexe (legalizare notarial) interpretariat week-end-uri i tabere lingvistice
Cursuri de limbi strine

Ne propunem ca prin cursurile i atelierele noastre de limbi strine s sprijinim cursanii n procesul de formare a competenelor lingvistice specifice, prin exersarea noiunilor de gramatic, mbogirea i diversificarea vocabularului, precum i prin exersarea limbii strine studiate n cadrul atelierelor speciale de Creative Session i Club conversaional. Noutatea atelierelor noastre const n metodele originale i interactive de predare, care vor include patru ingrediente principale: 1. Stilul ludic. Prin joc, Cursantul descoper cuvinte i situaii noi, ntr-o manier relaxant i accesibil. 2. Stilul experimental. Cursantul nva din experienele acumulate, nsuindu -i modaliti inedite de a se raporta la realitatea nconjurtoare. 3. Stilul algoritmic completeaz perfect tabloul nvrii, ajutndu -i pe cursani s-i consolideze noiunile predate, prin nlnuirea logic a pailor nvrii. 4. Stilul euristic i ndeamn pe cursani s descopere singuri rspunsurile la ntrebri, cptnd astfel ncredere n ei i dezvoltndu-i propriile metode de nvare, sub ndrumarea atent a profesorului. Ce v propunem? nsuirea i fixarea unui vocabular de baz; dezvoltarea i mbuntirea tuturor competenelor lingvistice: noiuni de gramatic, vocabular, abiliti de scriere, citire, ascultare i vorbire; exersarea i dezvoltarea aptitudinilor de conversaie, prin discuii pe teme dintre cele mai diverse; caracterul interactiv al cursurilor: activiti creative, jocuri de rol, etc; Cursurile noastre se adreseaz att persoanelor care doresc s i mbunteasc noiunile de limbi strine, aduli i copii, dar i companiilor care doresc s se integreze mai uor n contextul profesional existent pe plan internaional, depind barierele de natur lingvistic sau cultural. Dac dorii s participai la unul dintre cursurile noastre sau avei nevoie de informaii suplimentare, nu ezitai s ne contactai!
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Language Cafe
Vino alturi de noi n fiecare vineri, s nvm engleza printr-o metod ieit din tipare! Las deoparte crile greoaie, uit de minutele care nu mai trec sau de metodele de studiu nvechite! La noi te ateapt un mediu prietenos, bun dispoziie, culoare, muzic, film, cafea, fursecuri, toate pentru ca tu, cursantul cruia i plac lucrurile diferite, s te ntorci acas cu un bagaj de cunotine mult mai variat i mai bogat! Nu vei ti cum trece timpul, alturi de moderatorii notri, care i propun cele mai variate activiti: discuii pe teme interesante, jocuri de rol, exerciii de memorie, scrabble, pictionary, hangman, telefonul fr fir, whos who, precum i alte provocri i surprize! Scopul este s ncurajm partea practic a nvrii, s aducem mpreun oameni din medii diferite i s ne diversificm vocabularul fr stres i obligaii! Cum? Unde? Cnd? Pentru a verifica programul clubului de conversaie, trimite un e -mail ctre: office@cursurisitraduceri.ro Durata unei edine este de 1,5 h 2h si mai ales cursul este GRATUIT! Participani pot la sfritul atelierului, dac vor, s fac o donaie pentru a rsplti moderatorul pentru efortul de a pregti activitile i materialele necesare unei bune desfurri a clubului Language Cafe Participarea la curs se face doar pe baz de rezervare! Este acesta un club de conversaie? Da, este un concept de club de conversaie, unde nvm s ne exprimm mai uor ntr -o limb strin, folosind cunotinele deja acumulate. Cui se adreseaz Language Cafe? Tuturor celor crora le lipsete exerciiul conversaiei n limba englez Este necesar s am deja cunotine de englez? Da, recomandm ca participanii s aib cel puin un nivel mediu de cunotine. Vom face gramatic la curs? Accentul se va pune pe partea de discurs, povestioare, nouti, conversaie. V ateptm la cursuri!le ACT!
Traducerea
Traducerea unui text are n vedere mai mult dect simpla transpunere a cuvintelor dintr-o limb n alta, se refer la realizarea de echivalene ct mai precise, att la nivel semantic (pstrarea sensului termenilor i expresiilor) ct i la realizarea unui text fluent, natural i uor de neles de ctre cel ce recepioneaz mesajul. Este o modalitate de a TRANSMITE informaii ctre persoane care aparin unor medii culturale i naionaliti diferite. Traducerea le permite oamenilor s COMUNICE i s ACIONEZE n sensul unui obiectiv comun. Astfel, un traductor are nevoie de cunotine temeinice, att n limba surs, ct i n limba int, pentru a se putea ridica la nlimea exigenelor acestei profesii.
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Orizontul cultural amplu, capacitatea de adaptare, acurateea i seriozitatea sunt caliti eseniale pentru orice traductor, care poate fi asemnat cu un inginer care trebuie s le tie pe toate i nc ceva pe deasupra, aadar, s tie ce i unde s caute astfel nct s realizeze coeziunea mesajului i s pstreze nuanele culturale impuse de materialul n sine. Oferta noastr de traduceri include: traducere; scanarea documentelor; tiprirea documentelor pe suport de hrtie; intermedierea pentru legalizarea documentelor; transport la client; convertirea documentelor din orice format ne-editabil n format editabil; aranjarea documentelor finale astfel nct s se pstreze formatul original; la cerere, preluarea/ predarea documentelor prin curierat; omogenizarea textului n cazul documentelor de dimensiuni mari, care au fost mprite mai multor traductori; Pentru c oferim: securitatea informaiilor garania unui serviciu de calitate profesionalismul personalului i deschiderea ctre comunicare optim, pe toat perioada derulrii proiectelor; preluarea i realizarea comenzilor n cel mai scurt timp posibil; disponibilitate pentru preluarea proiectelor ample; estimare rapid de tarif, pentru orice format de document; tarife competitive; flexibilitate n stabilirea condiiilor contractuale;
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De asemenea, suntem deschii colaborrii n cadrul unor proiecte precum training -ul lingvistic pentru angajai, aplicaii de team building (week-end lingvistic) i organizare de evenimente cu profil socio-educaional. Oferta noastr de traduceri include: Orice combinaie lingvistic: englez, spaniol, francez, german etc. Orice tip de material: cataloage, brouri, pagini web, manuale rapoarte etc. Orice format de fiier: Ms Office, Open Office, PDF, JPG, HTML, XLIFF etc. Asigurm: corectur (revizie lingvistic, proofreading) scanare livrarea documentelor n formatul dorit, prin pot sau curier
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Pentru informaii, ne putei contacta:
Adresa: Str. Popa Nan nr. 19A, etaj 2, sector 2, Bucureti Web http://www.cursurisitraduceri.ro http://www.tabaraengleza.ro
Facebook https://www.facebook.com/AgentiadeCursurisiTraduceri
Alina-Mihaela Blaa Administrator Tel: 0763817051 / 0727.752.650 E-mail: mihaela.balasa@cursurisitraduceri.ro / mihaela.act@gmail.com Petre Udrea Director de programe lingvistice Tel: 0724.535.295 E-mail: petre.udrea@cursurisitraduceri.ro / petre.act@gmail.com
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2013 - 2014 E-mail: mihaela.balasa@cursurisitraduceri.ro mihaela.act@gmail.com Mobil: 0727.752.650 Web: http://www.cursurisitraduceri.ro

Pediatrics Cardiovascular Issues - Modificat

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Curs Engleza Medicala Volumul II

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Curs Engleza Medicala Volumul II

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Curs Engleza Medicala Volumul II

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HEMOPHILIA .......................................................................................................................... 18 NEUROLOGICAL CONDITIONS IN CHILDREN ................................................................................ 18

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ENDOCTRINE CONDITIONS IN CHILDREN ................................................................................... 21 TREATING A GROWTH DISORDER ............................................................................................ 21

MARFAN SYNDROME .............................................................................................................. 23

CARDIOVASCULAR SYSTEM .............................................................................. 26

DRUGS BRIEF HISTORY ................................................................................... 33

NOTE...................................................................................................................... 39 ALTE SERVICII ALE AGENIEI ACT .................................................................... 44

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Curs Engleza Medicala Volumul II

Pathology of the Lifespan

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Curs Engleza Medicala Volumul II

Diseases of Infancy and Childhood

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Curs Engleza Medicala Volumul II

Symptoms and Complications

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Curs Engleza Medicala Volumul II

Respiratory Syncytial Virus

Curs Engleza Medicala Volumul II

Symptoms and Diagnosis

Prevention and Treatment

Digestive Problems in children

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When to visit the doctor

A note about sleeping position

Vomiting and projectile vomiting

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When vomiting becomes a concern

Digestive system abnormalities

Abnormalities of the esophagus

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Abnormalities of the stomach

Abnormalities of the intestines

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Abnormalities of the abdominal wall

Abnormalities of the anus and rectum

Types of heart disease observed in children and adolescents

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Acquired heart disease

Rheumatic heart disease

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Other heart disease types

Hematologic conditions in children

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Types of Red Blood Diseases

Types of White Blood Cell Diseases

Types of Platelets Diseases

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