循環
A syndrome of myocardial infarction with angiographically normal coronary arteries exists. approximately 2 percent of patients with myocardial infarction demonstrate no obstructive lesions on coronary arteriography . these patients tend to be young , have a low incidence of coronary risk factors , and often have no history of angina pectoris prior to infarction . the prognosis for survival after the acute event is usually good . the cause is unknown , but possible etiologies include coronary emboli , coronary artery spasm , coronary artery disease in smaller vessels beyond the resolution of coronary arteriography and coronary arterial thrombosis with recanalization.
Dissection of the aorta involving the coronary arteries or dissection of the coronary arteries themselves may occur in patients with connective tissue abnormalities of the aorta ( for example , Marfan' syndrome). in situ thrombosis may occur in certain rare disorders ( for example , polycythemia vera, thrombocytosis , or disseminated intravascular coagulation ). Spasm of the coronary artery ( Prinzmetal's angina ) is another nonatherosclerotic cause.
消化
Roentgenograms may contribute significantly to the diagnosis. Plain films of the abdomen demon strate radiopaque calculi in less than 10 percent of patients. Oral cholecystography is usually not performed in patients with acute cholecystitis, either because the clinical state prevents the oral administration of the contrast agent or because the emergency nature of the problem requires a decision earlier than can be obtained with this method. Intravenous cholangiography may be a valuable procedure in establishing the nature of the right upper quadrant pain, because the common duct may be visualized by this method in approximately 60 percent of patients with acute cholecystitis. If the gallbladder is seen, the patient does not have acute cholecystitis. If the common duct is visualized and the gallbladder is not visualized, this is supporting evidence for the diagnosis of acute cholecystitis.
泌尿
Although some infections of the kidney may arise as a result of hematogenous dissemination , most urinary tract infections 「ascend」 via a portal of entry in the urethra . most pathogens responsible for community-acquired urinary tract infections are part of the subject's normal bowel flora . Escherichia coli is the most common isolate and , in the female , colonization of the vaginal and periurethral mucosa may antedate infection of the urinary tract . the longer and protected male urethra may account for the lower incidence of urinary tract infection in men . motile bacteria may swim upstream , and reflux of urine from the bladder into the ureters may predispose to the development of kidney infection . Congenital anomalies or obstruction of urine flow at any level also predispose to infection。
內分泌
The paramount goal of treating endocrine and metabolic disorders is the restoration of a normal hormonal and metabolic substrate milieu in the tissues . this includes establishing normal concentration of these substances in the blood and tissues and stimulating their physiologic excursios with meals, stress , and other life events. For example , insulin treatment must be coordinated with patient's patterms of caloric intake and physical exercise. Glucocorticoid replacement must be adjusted to mimic the physiologic increase in adrenal glucocorticoid secretion that would normally accompany the response to illness. Particularly in metabolic diseases , appropriate modification in diet , physical activity , and body weight are often the first line of treatment . this approach is often the only intervention required in the management of type I diabetes mellitus or certain hyperlipidemias , for example. Because endocrine therapy almost invariably alerts the lab parameters needed to establish the diagnosis , it is vital to obtain adequate samples for testing before the initiation of treatment.
神經系統
The basic nerve cell is called a neuron . Neurons are composed of a cell body , containing the nucleus , with the addition of threadlike projections of the cytoplasm known as nerve fibers . The nerve fibers are of two kinds: dendrites , which conduct impulses to the cell body ; and axons , which conduct impulses away from the cell body.The dendrites of sensory neurons are very different from those of other neurons . They are usually single and they may be very long (as much as 3 feet )or they may be short ; but in any case , they do not have the treelike appearance so typical of other dendrites . Each sensory nerve fiber (dendrite) has a special structure called the receptor , or end organ , where the stimulus is received and the sensory impulse begins . Sensations such as pain , touch , hearing and seeing which involve these sensory neurons will be discussed later .
感覺皮膚
One defect that is often responsible for eyestrain in children is farsightedness, or hyperopia. In this condition the light rays are not bent sharply enough to focus on the retina, with the result that the eye cannot focus properly on nearby objects. The eyeball may be too short, so that the actual focal point is behind the retina. This is normal in the infant, but usually corrects itself by the time the child uses his eyes more for near vision. To certain extent it is possible to use the ciliary muscle in the process of thickening the lens to focus objects on the too - near retina. However, this causes constant strain. Visual tests may not show that the condition exists unless drops which paralyze the ciliary muscles are used. Hence any suggestion of eyestrain should lead to consulting a specialist who has a license to practice medicine and who will use the drops as necessary.
肌肉
The joints as well as the bones proper are subject to attack by the tuberculosis organism , and the result may be a gradual destruction of parts of the bone near the joint . the organism is carried by the blood stream , usually from a focus in the lungs or lymph nodes , and may cause considerable damage before it is discovered the bodies of several vertebrae sometimes are affected; or one hip or other single joint may be diseased . the patient may complain only of difficulty in walking , and diagnosis is difficult unless an accompanying lung tuberculosis has been found . this disorder is more common in children.
細胞
The primary function of white blood cells is toengulf and destroy foreign substances. This function is known as phagocytosis. White blood cells are attracted to infected tissue as a result of chemical message sent by the tissue (a process called chemotaxis). The white blood cells pass through the capillary walls and infiltrate the infected tissue by a process called diapedesis. Pus is a mixture of pathogenic organisms, white blood cells, dead bacteria and white blood cells, and their by-products. The granulocytescontribute to tissue repair and produce antibodies, chemicalsubstances used to offset specifc substances (antigens) that have entered the body.