SURGICAL ANATOMY OF THE HAND AND UPPER EXTREMITY SURGICAL ANATOMY OF THE HAND AND UPPER EXTREMITY on pdf

 SURGICAL ANATOMY OF THE HAND AND UPPER EXTREMITY SURGICAL ANATOMY OF THE HAND AND UPPER EXTREMITY on pdf 

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SURGICAL ANATOMY OF THE

HAND AND UPPER EXTREMITY

SURGICAL ANATOMY OF THE

HAND AND UPPER EXTREMITY

JAMES R. DOYLE, M.D.

Emeritus Professor of Surgery (Orthopaedics)

John A. Burns School of Medicine

University of Hawaii

Honolulu, Hawaii

Editor-in-Chief

The Journal of Techniques in Hand

and Upper Extremity Surgery

MICHAEL J. BOTTE, M.D.

Co-Director

Hand and Microsurgery Service

Division of Orthopaedic Surgery

Scripps Clinic

La Jolla, California

Orthopaedic Surgery Service

San Diego VA Health Care System

Clinical Professor

Department of Orthopaedic Surgery

University of California, San Diego

School of Medicine

San Diego, California

Illustrated by Elizabeth Roselius

with contributions by Christy Krames

Acquisitions Editor: Robert Hurley

Developmental Editor: Keith Donnellan

Production Editor: Thomas J. Foley

Manufacturing Manager: Benjamin Rivera

Cover Designer: Christine Jenny

Compositor: Lippincott Williams & Wilkins Desktop Division

© 2003 by LIPPINCOTT WILLIAMS & WILKINS

530 Walnut Street

Philadelphia, PA 19106 USA

LWW.com

All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any

form or by any means, including photocopying, or utilized by any information storage and retrieval system

without written permission from the copyright owner, except for brief quotations embodied in critical

articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties

as U.S. government employees are not covered by the above-mentioned copyright.

Printed in China

Library of Congress Cataloging-in-Publication Data

Doyle, James R.

Surgical anatomy of the hand and upper extremity / James R. Doyle and Michael J. Botte.

p. ; cm.

Includes bibliographical references and index.

ISBN 0-397-51725-4

1. Hand—Anatomy. 2. Arm—Anatomy. I. Botte, Michael J. II. Title.

[DNLM: 1. Arm—anatomy & histology. 2. Hand—anatomy & histology. WE 805

D754s 2003]

QM 548 .D69 2003

611′.97—dc21

2002030007

Care has been taken to confirm the accuracy of the information presented and to describe generally

accepted practices. However, the authors and publisher are not responsible for errors or omissions or for any

consequences from application of the information in this book and make no warranty, expressed or implied,

with respect to the currency, completeness, or accuracy of the contents of the publication. Application of

this information in a particular situation remains the professional responsibility of the practitioner.

The authors and publisher have exerted every effort to ensure that drug selection and dosage set forth in

this text are in accordance with current recommendations and practice at the time of publication. However,

in view of ongoing research, changes in government regulations, and the constant flow of information

relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug

for any change in indications and dosage and for added warnings and precautions. This is particularly

important when the recommended agent is a new or infrequently employed drug.

Some drugs and medical devices presented in this publication have Food and Drug Administration

(FDA) clearance for limited use in restricted research settings. It is the responsibility of the health care

provider to ascertain the FDA status of each drug or device planned for use in their clinical practice.

10 9 8 7 6 5 4 3 2 1

To Julie Kaye Frances and Robert E. Carroll, M.D., friends and mentors.

J.R.D.

To my mother, Verona Louise Minning-Botte, M.D., and

my father, Joseph Michael Botte, M.D.

For their love, encouragement, and support

and for being the best teachers that I ever had.

M.J.B.

CONTENTS

Contributing Authors ix

Foreword by David P. Green xi

Preface xiii

SECTION I: SYSTEMS ANATOMY 1

1 Skeletal Anatomy 3

2 Muscle Anatomy 92

Appendix 2.1. Muscles of the Hand and Forearm

and Arm: Origin, Insertion, Action, and

Innervation 180

Appendix 2.2. Muscle Compartments and Fascial

Spaces of the Upper Extremity 183

Appendix 2.3. Human Forearm Muscle Difference

Index Values: A Comparison of Architectural

Features of Selected Skeletal Muscles of the Upper

Extremity 184

3 Nerve Anatomy 185

Appendix 3.1. Dermatomes of the Upper

Extremity 226

4 Vascular Systems 237

SECTION II: REGIONAL ANATOMY 295

5 Brachial Plexus 297

Vincent R. Hentz and Y. Mark Hong

6 Arm 315

7 Elbow 365

8 Forearm

Part 1: Flexor Forearm 407

Part 2: Extensor Forearm 461

9 Wrist 486

Richard A. Berger, James R. Doyle, and Michael J. Botte

10 Hand

Part 1: Palmar Hand 532

Part 2: Dorsal Hand 642

Appendix: Anatomic Signs, Syndromes, Tests, and

Eponyms 667

Subject Index 693

CONTRIBUTING AUTHORS

Richard A. Berger, M.D., Ph.D. Professor, Departments of Anatomy and Orthopaedic

Surgery, Mayo Clinic, Rochester, Minnesota

Vincent R. Hentz, M.D. Chief, Hand Division, and Professor of Functional Restoration (Hand), Department of Surgery, Stanford University School of Medicine, Palo

Alto, California

Y. Mark Hong, B.S. Department of Surgery, Stanford University School of Medicine,

Palo Alto, California

FOREWORD

The best surgeons are those well versed in anatomy. A surgeon can never learn too much anatomy, but up until now,

he or she had to go to many sources to glean a broad base of

anatomical knowledge. My own career illustrates this point.

As a medical student, I began with Gray’s massive and dry

tome, learning anatomy for the sake of anatomy, with no

clinical relevance. Then, as a resident, I discovered

Hollinshead’s three-volume text that added functional implications. I also found, at that time, Henry’s classic book with

its quaint Irish-English prose and manual mnemonics. As a

young surgeon, I sought out books that would give me quick,

snapshot glimpses of anatomy that I could memorize and

carry in my head at least until the next day in the operating

room. Grant’s Atlas was the first of these, which was later

replaced on my shelf by McMinn and Hutchings’ magnificent atlas with its lifelike-quality color plates. Specialized texts

such as Sunderland and Spinner have described wonderfully

detailed and precise anatomy, but with a limited focus.

Now the hand and upper extremity surgeon has what all

of the above resources offered and more, packed into a single volume. The thoroughness of Gray, the practical applications of Hollinshead, and the clarity of McMinn and

Hutchings have been blended into one unified source.

More than sixty crisp photographic prints depict

detailed cadaver anatomy with a precision and clarity that

rivals McMinn. Most of the drawings were created by Elizabeth Roselius, a master among contemporary medical

illustrators. The exceptionally high quality of these illustrations is complemented by a text that is not only thorough,

but also replete with clinical applications.

Another pleasant surprise in this text is the appendix of

anatomic signs, syndromes, tests, and eponyms, where even

the surgeon who has studied the history of surgery will find

new or more accurate information. Practical lessons in the

Greek and Latin derivations of words explain why similarsounding words that evolve from separate sources have different meanings.

One of the authors, James R. Doyle, was the first to

describe in detail the flexor pulley system in the fingers

(1975) and later in the thumb (1977). Jim Doyle has studied the anatomy of the hand throughout his entire professional career with the eye of an artist who can perceive

details better than most of us, with an inherent tenacity fired

even harder during a fellowship year with Robert E. Carroll,

and with an exquisite and careful attention to detail. This

book is the culmination of his life-long dedication.

Michael Botte, his co-author, brings to this project the

thoroughness and precision of a true scientist, and his input

is significant. The collaboration of Doyle and Botte has produced a remarkable piece of work that will benefit not only

the entire surgical community, but our patients as well.

Every serious hand surgeon will find a readily accessible

spot on his or her bookshelf for this text.

David P. Green, M.D.

Clinical Professor

Department of Orthopaedics

University of Texas Health

Science Center at San Antonio

San Antonio, Texas

PREFACE

Our goal has been to assemble between two covers a comprehensive collection of anatomical material designed to aid

the hand and upper extremity surgeon in the evaluation and

treatment of patients. A comprehensive knowledge of

anatomy is a major prerequisite for safe and effective

surgery. Although written by hand surgeons for hand surgeons, the authors believe that this text will also be useful to

hand therapists, anatomists, neurologists, neurosurgeons,

sports medicine surgeons and physicians, physiatrists, and

bioengineers because it is a compendium of anatomic

knowledge. The science of anatomy and the art of surgical

technique are intertwined topics that are not easily separated. Although this book is not designed as a text on operative surgery, overlap with surgical technique is inevitable,

appropriate, and complementary to the goal of the book.

Although another anatomy textbook may seem redundant, we hope the reader will agree that this text represents

a unique and current collection of material, which may not

be conveniently found elsewhere. Much of the information

can be found in other resources such as texts and journals

but we hope the reader, who like us has had difficulty recalling where we found a particular bit of information that we

now need to review or utilize in a timely fashion, will come

to value this comprehensive resource. Our primary goal in

this text is to provide a readily available source for this

information that is user friendly, easily portable, and clinically relevant.

We hope that the arrangement, clarity, and brief yet

comprehensive presentations of these topics will be of sufficient uniqueness to earn the designation of original, but we

readily admit that paraphrasing and adoption of others’

original concepts have been used (although we have done

our best to give credit where it was due). The words of Anatole France (passed on to us by Adrian Flatt) bear repetition

here, “When a thing has been said and said well, have no

scruples, take it and copy it.”

The text is divided into sections on Systems Anatomy

and Regional Anatomy, followed by an Appendix on

Anatomic Eponyms, Signs, Syndromes and Tests. The section on Regional Anatomy represents the practical component of this text because it provides the reader with

anatomic landmarks, relationships, surgical approaches,

clinical correlations, and the anatomy of selected anatomic

variations found in that region. The student of anatomy

will also recognize the immense value of the systems

approach, found in the section on Systems Anatomy, in

providing a comprehensive and overall view of a given

anatomic structure or system.

The authors take great pride in the color photographs of

fresh cadavers used in this text. A quote by Emanuel

Kaplan, about color photographs, from his foreword to

Milford’s 1968 classic monograph on Retaining Ligaments of

the Digits of the Hand seems appropriate here as well, “The

natural color illustrations add precision and eliminate the

imaginary interpretive creativity leading to error.” We hope

that the quality of our color photography can approach that

of Milford and warrant the affirmation of Kaplan on the

value of natural color photographs. We hope these color

photographs, along with the excellent illustrations, will

serve to make the anatomy in this text as realistic as possible. We also believe that the combination of these two art

forms along with the descriptive text will provide the reader

with appropriate information, which will permit accurate

preoperative evaluation, diagnosis, and effective surgical

treatment.

Anatomy, as a surgeon must deal with it, is three dimensional, but only two dimensions can be portrayed in a text.

This fact should immediately indicate to the reader that

there is no substitute for personal experience in the dissection room. In a two-dimension text, structures are often

portrayed as lying side by side when in reality they may be

vertically arrayed. A good example is the usual depiction of

the radial and ulnar arteries in the proximal forearm. The

ulnar artery is depicted as lying to the ulnar side of the

radial artery in the same anatomic plane whereas, in reality,

the ulnar artery is deep and ulnar to the radial artery and is

often difficult to find. The reader should also note that the

anatomic variations included are those that the authors perceive to have some practical clinical relevance to the region

and that the list of variations is not encyclopedic.

Reported differences in anatomy may be due to

anatomic variations as well as inter-observer variability and

subsequent interpretation of the observation. It would seem

reasonable to assume that all observers of a particular region

or segment of anatomy would see or observe the same

things and interpret what they saw in a similar uniform

fashion. Such is not the case, and although many points of

anatomy are agreed upon there are many that are not. Two

illustrative examples come readily to mind: (1) the arcade of

Struthers’ in the arm and (2) the location of the sesamoid

bones about the MP joint of the thumb. Some authors

describe in detail the arcade of Struthers’ 8 cm above the

medial humeral epicondyle and attach clinical significance

to it as a potential site of ulnar nerve compression in the

arm. Others claim that it does not exist or at least that they

have never seen it and thus it has no clinical relevance. The

location of the ulnar and radial sesamoid bones about the

MP joint of the thumb have been reported to be in the

adductor pollicis and flexor pollicis brevis tendons respectively or in the palmar plate where they possess articular cartilage and articulate with the thumb metacarpal; two

entirely different pictures of the same structures. Interobserver variability may be illustrated by the imperfect, yet

humorous, analogy of six blind persons examining a camel.

Each of their descriptions are based upon their particular

location about the camel. Their significant inter-observer

variation results in a series of descriptions that would confound even a camel veterinarian. The authors include themselves in those observers who may be subject to imperfect

observation as well as faulty interpretation. Thus, there may

be a lively correspondence and commentary generated by

this text.

We believe that studies that have large numbers of specimens in their data base have a greater potential for reflecting what might be considered more common and thus

likely to be encountered in the day to day practice of

surgery. Studies with small numbers of specimens in which

several patterns or categories of anatomical arrangement are

noted tell us that significant variation exists. It may not tell

us the true incidence of a given pattern or arrangement in

spite of the authors’ conscientious reporting of one, two, or

three cases in their series which demonstrated a particular

pattern or arrangement. Such studies though, are still

important and tell us that significant variation exists in that

particular structure or region and that the surgeon must be

prepared to encounter such an arrangement or even a new

and unreported pattern or arrangement.

By now, the reader has begun to appreciate the fact that

anatomy is not a “fixed” science, but rather an evolving or

developing endeavor with many remaining challenges and

opportunities.

All authors have their own methods for placing thoughts

on paper. This quote from Wallace Stegner1, although

directed at the writer of autobiography or fiction, seems

appropriate, “You take something that is important to you,

something you have brooded about. You try to see it as

clearly as you can, and to fix it in a transferable equivalent.

All you want in the finished print is the clean statement of

the lens, which is yourself, on the subject that has been

absorbing your attention.”

The authors wish to recognize their debt to those surgeons and anatomists who have studied and described their

anatomic findings in the upper extremity and to our many

mentors and colleagues who have taught, encouraged, and

inspired us.

Finally, the authors wish to acknowledge their debt to

Robert Hurley and Keith Donnellan of the editorial staff at

Lippincott Williams & Wilkins who have patiently guided

and encouraged us throughout this process in such a competent and professional manner. We also owe a great debt to

Elizabeth Roselius, medical artist, for her understanding of

complex anatomic concepts and her ability to convert those

concepts into clear and concise drawings.

James R. Doyle, M.D.

Michael J. Botte, M.D.

1 Stegner WE, Where the bluebird sings to the lemonade springs. New

York: Random House, 1992.

concise Book pdf

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Concise Book of

Medical Laboratory Technology

Methods and Interpretations

Concise Book of

Medical Laboratory Technology

Methods and Interpretations

Ramnik Sood MD (Path, Gold Medalist)

Consultant

Reem Medical and Diagnostic Center

Healthcare Mena Limited

Sharjah

United Arab Emirates

2nd Edition

New Delhi | London | Philadelphia | Panama

The Health Sciences Publisher

Headquarters

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© 2015, Ramnik Sood

The views and opinions expressed in this book are solely those of the original contributor(s)/author(s) and do not necessarily represent

those of editor(s) of the book.

All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic,

mechanical, photocopying, recording or otherwise, without the prior permission in writing of the publishers.

All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their

respective owners. The publisher is not associated with any product or vendor mentioned in this book.

Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the

subject matter in question. However, readers are advised to check the most current information available on procedures included and

check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and

duration of administration, adverse effects and contraindications. It is the responsibility of the practitioner to take all appropriate safety

precautions. Neither the publisher nor the author(s)/editor(s) assume any liability for any injury and/or damage to persons or property

arising from or relate♥d to use of material in this book.

This book is sold on the understanding that the publisher is not engaged in providing professional medical services. If such advice or

services are required, the services of a competent medical professional should be sought.

Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material. If any

have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity.

Inquiries for bulk sales may be solicited at: jaypee@jaypeebrothers.com

Concise Book of Medical Laboratory Technology: Methods and Interpretations

First Edition: 2009

Second Edition: 2015

ISBN 978-93-5152-333-8

Printed at

Jaypee Brothers Medical Publishers (P) Ltd

Dedicated to

the Readers

Preface to the Second Edition

I authored an exhaustive book entitled “Medical Laboratory Technology – Methods and Interpretations” that hit the stands

in mid-eighties in the previous century and is now running in its 6th edition. This was the first such book in the subcontinent and was much appreciated and used by technologists and pathologists alike. The book has seen testimonies in courts

and has been appreciated in the west too. However, in our subcontinent, I was requested by many technologists that they

wanted a little younger sister of the book popularly known as MLT authored by me.

And so was born the Concise Book of Medical Laboratory Technology: Methods and Interpretations. The book essentially

covers everything presented in MLT-6 but in an abridged/shortened and easy-to-digest format. The book is presented in

a flowing noninterrupted format and not in a cumbersome experiment-wise cascading flow. There is no break in the style

that runs smoothly and is easier to absorb and assimilate. As experiments are a part of any course, more stress has been

laid out in the book to understand the intricacies of relevant theories and even troubleshooting all experiments that you

would conduct during the course of your study. As I have written multiple modules for many Universities in India, I did not

have to think for too long to devise a style and format for this book. You will find everything from ESR to PCR and you will

find foam test for bile pigments as also complete automation in urinalysis. You will find basic biochemistry as also detailed

cytogenetics. So whatever be your course or query, you will find it within the covers of this short but sweet book now going

into its second edition.

The book is designed for you not to mug but to understand and elicit the answers from the book of all questions in your

mind. I am aware that this book is used by most of your teachers and tutors too.

Nothing wrong that you are holding now. It will help you all your life!

Ramnik Sood

The first book on Medical Laboratory Technology from the house of Jaypee’s came out in 1985 and has been the best seller

in its class till date. The title “Medical Laboratory Technology – Methods and Interpretations” has seen 6 editions. The latest

one hit the stands in January this year and was released in two volumes. It is a four-color book and has over 1670 pages. The

reader base of all editions of our vastly popular title “MLT” has been upcoming laboratorians, undergraduate and postgraduate

medical students. It was requested by a few institutes to produce a little smaller version of the two-volume set that would

be suitable for the upcoming Laboratory Technology students. So here it is! It is exhaustive yet precise and concise too.

The book will help you to appreciate things as they appear in real life under the microscope and otherwise. All current

technologies find a mention within the covers of this book. Gone are the days when we had to prepare reagents first thing

in the morning (or the days usage); therefore, the current trend of consuming ready-to-use reagents/kits is followed here

to make your job and understanding simpler. So, what is available in the market for all investigations, is what is presented

here. The Tulip Group has very kindly given us the rights to reproduce the text related to all their kits and reagents in this

book. Latest instruments are not forgotten too.

Most important—

Parasitology section is presented in ample detail as it is relevant to all the developing nations.

Quality control/assurance is mentioned in appropriate details. Working is not enough. Working properly and producing

nothing but the most accurate reports are the order of the day. This book will not fail you there. Follow the recommendations to the hilt and you would be running the most accurate laboratory available anywhere.

Should problems arise! The book has “Troubleshooting” section for every possible test mentioned inside. If this happens – then what! If that happens – then what! You will find all answers.

From ESR to PCR – you will find everything.

The book is based on most syllabi as applicable to most institutes in India and elsewhere internationally.

All necessary care has been taken to weed out any discrepancies/typographical errors at the time of going to press.

However, if anything has remained inadvertently, the publishers/author do not take any responsibility for the same in any

manner whatsoever.

Learning can be enjoyable experience, flip a few pages to experience that.

Ramnik Sood

Preface to the First Edition

Chapter 1. Laboratory 1

Laboratory Set-up 3

Code of Conduct for Medical Laboratory

Personnel 6

Accidents 6

Accidents in the Laboratory 10

Universal Work Precautions (Uwp) for

Laboratory Personnel (Especially in

Relation to Hiv Transmission) 15

Medicolegal Aspects of Clinical Practice 17

Laboratory Instruments 17

Chapter 2. Sterilization 29

Methods Commonly Used for Sterilization 29

Modern Day Disinfection 34

Chapter 3. SI Units 41

Liter 41

Gram 41

Mole (Mol) 41

International Unit (U) 42

Conversion Factors Between Conventional

and System International Units (Siu) 42

Chapter 4. Fundamental Chemistry 52

Indicators 52

Solutes, Solvents and Solutions 52

Periodic Table of Elements 54

Chapter 5. Urine Analysis 56

Composition of Urine 56

Gross Examination of Urine 57

Chemical Examination of Urine 60

Multiple Reagent Strips for Urinalysis 71

Automation in Urinalysis 78

Special Urine Tests 82

Microscopy of the Urinary Sediment 92

Chapter 6. Renal Function and its

Evaluation 104

Renal Physiology in Brief 104

Functions of the Kidney 104

Concentration: Dilution Tests 105

Phenol Red Test 105

Clearance Tests 106

Principles of Precise Tests of Renal

Function 107

Maximal Tubular Capacity (Tm) 108

Contents

Chapter 7. Stool Examination 112

Specimen Collection 112

Inspection of Feces 113

Chapter 8. Medical Parasitology 124

Medical Parasites 124

Intestinal Protozoa of Man 124

Laboratory Examination for

Parasites 201

Chapter 9. Clinical Hematology 205

Ways of Obtaining Blood 205

Anticoagulants 206

Blood Collection System 208

Hemoglobin 210

Anemia 211

Hematocrit/Packed Cell Volume (Pcv) 212

Blood Cell Counts 213

Erythrocyte Indices 216

Complete Blood Count (Cbc) 217

Erythrocyte Sedimentation Rate (Esr) 220

Blood Film Examination 222

Rapid Diagnostics 225

Development of Blood Cells and

Sites of Blood Formation 227

Morphological Types of Red Blood Cells 234

Qualitative Assessment of G6pd

Deficiency 240

Examination of Fetal Hemoglobin 244

Laboratory Diagnosis of Disorders Related to

Rbcs 248

Thalassemias (Reduced Synthesis Rate) 256

Normal White Cell Values and Physiological

Variations 259

White Blood Cells 263

Quality Control in Hematology 270

Chapter 10. Clinical Hematology:

Bleeding Disorders 272

Platelets, Coagulation and Bleeding Disorders:

Laboratory Investigations 272

Laboratory Diagnosis of Platelet Disorders 272

Quality Assurance for Routine Hemostasis

Laboratory 278

Buffered 3.2% Citrate Solution (Profact) 280

Prothrombin Time (Quick One-Stage Method)

Liquiplastin® 283

Sensitive Thromboplastin Reagent for

Prothrombin Time (Pt)

Determination (Isi = 1.0) Uniplastin® 285

xii Concise Book of Medical Laboratory Technology: Methods and Interpretations

Thromboplastin Reagent for

Prothrombin Time (Pt)

Determination, Lyoplastin®

(Lyophilized Reagent, Isi = 1.0) 287

Aptt/Pttk Cephaloplastin Reagent for Partial

Thromboplastin Time (Aptt)

Determination Using Ellagic Acid as

Activator Liquicelin-E® 293

Normal and Abnormal Control Plasmas for

Coagulation Assays Plasmatrol H-I/Ii

® 296

Fibroscreen Thrombin Time Test for Qualitative

Estimation of Fibrinogen Fibroscreen® 297

Fibrinogen Estimation-Quantitative

Fibroquant, Reagent for Quantitative

Estimation of Fibrinogen 299

Fibrinolytic Activity 301

Fdps A Qualitative and Semiquantitative Latex

Slide Test for Detecting Cross

Linked Fibrin Degradation Products in

Human Plasma X-L Fdp 302

Laboratory Diagnosis of Coagulation

Disorders 304

Automation in Coagulation Analysis 305

Troubleshooting 309

Prothrombin Time 310

Dptt/Pttk 312

Fibrinogen Estimation 314

Chapter 11. Blood Banking

(Immunohematology) 317

Blood Group Antibodies 317

Anti-A, Anti-B, Anti-Ab Blood Grouping

Antisera for Slide and Tube Tests 320

Anti-A, Anti-B, Anti-Ab Monoclonal }|Blood

Grouping Antibodies for Slide and Tube

Tests 321

Anti-A1 Lectin Dolichos Biflorus

Lectin for Slide and Tube Tests 322

Anti-H Lectin Ulex Europaeus Lectin

for Slide and Tube Tests 323

Physiological Saline Solution for Serological

Applications (Sodium Chloride 0.9%

W/V) 325

Bovine Serum Albumin 22% Solution

for Serological Applications 325

Concentrated Iso-Osmotic Phosphate Buffered

Saline for Serological Applications 327

Red Cell Preserving Solution for Serological

Applications 328

Abo Grouping 329

Rh Blood Group System 331

Anti-D (Rho) Human (Igg) Polyclonal Blood

Typing Antibodies for Slide

and Modified Tube Tests 333

Anti-D (Rho) (Igm) Monoclonal Blood Typing

Antibodies for Slide and Tube Tests 335

Anti-D (Rho) (Igg) Monoclonal Blood Typing

Antibodies for Slide and Modified Tube

Tests 336

Anti-D (Rho) (Igm + Igg) Monoclonal Blood

Typing Antibodies for Slide and Tube

Tests 338

Anti-human Igg Monospecific Coomb’s

Reagent for Direct and Indirect

Antiglobulin Test 353

Anti-human Globulin Reagent for Direct and

Indirect Antiglobulin Tests 356

Preparing Coomb’s Control Cells Agtrol® 358

Low Ionic Salt Solution for Serological

Applications 359

Stabilized, Activated Papain Enzyme Solution

for Serological Applications 361

Blood Transfusion 363

Trouble Shooting 372

Chapter 12. Cerebrospinal and Other

Body Fluids 382

Cerebrospinal Fluid 382

Synovial Fluid (Sf) 388

Pleural Fluid 389

Pericardial Fluid (Pf) 391

Peritoneal Fluid 392

Amniocentesis and Amniotic Fluid

Analysis, Diagnostic 394

Chapter 13. Semen Analysis 398

Semen Analysis 398

Chapter 14. Sputum Examination 405

Sputum 405

Common Respiratory Disorders 406

Chapter 15. Pregnancy Tests 411

Bioassays 411

Immunologic Methods 412

Slide Test for Pregnancy 412

Slide Test for Pregnancy 414

Elisa Pregnancy Test 416

Dipstick Ict Pregnancy Test 416

Device Ict Pregnancy Test 417

Dipstick Ict, Urine/Serum

Pregnancy Test 418

Device Ict Urine/Serum

Pregnancy Test 419

Troubleshooting 421

Rapid Formats 423

Chapter 16. Examination of

Gastrointestinal Contents 425

Normal Saliva—Constituents 425

Gastric Juice 425

Examination of Duodenal Contents 430

Composition of Bile 430

Pancreatic Function Tests 430

Sweat Electrolytes Pilocarpine

Iontophoresis 432

Contents xiii

Chapter 17. Diabetes Mellitus:

Laboratory Diagnosis 434

Diabetes Mellitus 434

Glycosylated Hemoglobin Kit (Ion Exchange

Resin Method) for the Quantitative

Determination of Glycohemoglobin in

Blood (for in Vitro Diagnostic use Only) 443

Rapid Diagnostics 448

Chapter 18. Liver Function Tests 454

Tests of Excretion by the Liver 454

Evaluation of Synthesis in Liver 457

Evaluation of Enzyme Activity 458

Suggested Liver Function Tests 458

Chapter 19. Clinical Chemistry 461

Colorimetry 461

Photometer 462

Clinical Chemistry 465

Total Proteins 478

Serum Albumin 479

Serum Cholesterol 481

Hdl Cholesterol 484

Blood Glucose 490

Uric Acid 492

Calcium 493

Phosphorus 497

Chloride 500

Serum Iron and Tibc 501

Trace Elements 503

Zinc 503

Zinc (Colorimetric Method) 503

Copper 504

Magnesium 506

Automation in Clinical Chemistry 508

Principles of Quality Assurance and

Standards for Clinical Chemistry 514

Chapter 20. Enzymology 519

Alpha-amylase 519

Lipase 520

Phosphatases 522

Transaminases 530

Gamma-glutamyl Transpeptidase (Ggtp)

Blood 536

Lactic Dehydrogenase 538

Automation in Clinical Chemistry: Random

Access Autoanalyzer 546

Chapter 21. Blood Gases and

Electrolytes 548

Blood Gases 548

Automation in Blood Gas Analysis 556

Avl Compact 2 Blood Gas Analyzer 557

Electrolyte Analysis by Flamephotometer 558

Rapid Diagnostics in Electrolyte Analysis 561

Chapter 22. Serology/Immunology 563

Basic Immunology 563

Technologies 568

Enzyme Immunoassay 572

Chemiluminescence: The Technology 585

Polymerase Chain Reaction 587

Ria 590

Liquid Handling Systems 591

Streptavidin-Biotin Systems 594

Representative Elisa/Clia Techniques 595

Examples of Detailed Elisa

Methods 597

Tests for Syphilis 608

Modified Vdrl Reagent Trepolipin® 610

Toluidine Red Unheated Serum Test for Rapid

Serodiagnosis of Syphilis Redgen® 613

Latex Slide Test for Vdrl Syphfinal 615

Rapid Plasma Reagin (Rpr) Card Test/Carbon

Antigen for Syphilis Testing (Carbogen) 618

One-step Test for Syphilis: Dipstick

Syphicheck® 621

One-step Test for Syphilis (Device)

Syphicheck 622

Third Generation Double Antigen Sandwich

Enzyme-linked Immunosorbent Assay

(Elisa) for the Detection of Antibodies to

Treponema Pallidum in Human

Serum or Plasma Trepolisa 3.0 624

Tests for Typhoid/Enteric Fever Widal

Antigen Set/Antigens for Tube Tests

(Typhochek) 624

Widal Antigen Set/Antigens for Slide

and Tube Tests (Tydal)® 627

Reduced Widal Antigen Set: O and H

for Tube Tests (Vital Widal) 630

Positive Control for Widal Test 631

Rapid Test for Detection Igm Antibodies to

S. typhi in Serum/Plasma/Whole Blood

(Device) Enterocheck – Wb 632

Slide and Tube Test for Detection of Antibodies

to Brucella Abortus/Melitensis Brucel

A/M 635

Slide Screening Test for Brucella Antibodies

(Brucel-Rb)

® 636

Brucellosis Positive Control 638

Rapid Test for Igm and Igg Antibodies

to Dengue Virus: Dengue Fever

(Denguecheck-Wb) (Device) 639

Test for Infectious Mononucleosis

(Immutex) 643

Rapid Test for Igm Antibodies to Leptospira:

Leptospirosis (Leptochek-Wb) (Device) 645

Rapid Test for Malaria Pan/Pv/Pf

(Paramax-3®) (Device) 647

Slide Test for C-reactive Protein (Rhelax

Crp) 650

Slide Test for Antistreptolysin O (Rhelax

Aso®) 653

Slide Test for Rheumatoid Factors

(Rhelax Rf) 656

Slide Test for Anti-deoxyribonucleoprotein

(Rhelax Sle) 659

xiv Concise Book of Medical Laboratory Technology: Methods and Interpretations Australia Antigen Hbsag (Virutex Hbsag) 662

One-Step Test for Hbsag Virucheck Device 664

Hcv Flavicheck Device 665

Toxoplasma Infections 668

Rapid Immunoconcentration

Test for Hiv-1 and Hiv-2

Antibodies Flow through

Method Retroquick-Hiv 669

Rapid Test for Simultaneous/Differential

Detection of total Antibodies to Hiv1 and Hiv-2 in Human Serum/Plasma

Retroscreen 671

Tuberculosis 673

Rapid Test for Detection of Antibodies

to Mycobacterium tuberculosis

(Device) Serocheck-Mtb 676

Tb Igg, Iga, Igm Ab, Mfd Anda 678

Tumor Markers 679

Tumor Markers Standard Methodologies Available on Elisa and Clia, as on Ria too 683

Ca 15-3 (Carcinogenic Antigen 15-3) 683

Ca 19-9 (Carbohydrate Ag 19-9, Gicam

Gastrointestinal Cancer Antigen)

Blood Mfd: Can Ag, 683

Ca 242 Mfd: Can Ag, 684

Ca 125 (Cancer Antigen 125) Mfd:

Monobind 684

Carcinoembryonic Antigen (Cea) Mfd:

Monobind 685

Prostate-specific Antigen (Psa) Total

Prostate Specific Antigen (Tpsa) Elisa,

Mfd: Monobind 685

Prostatic Acid Phosphates (Pap), Blood

Method: Biochemical Analysis 686

Elisa Troubleshooting Aspects 686

Technical Tips 690

Chapter 23. Diagnostic Immunology 693

Qualitative Determination of Plasma Proteins

by Immunoprecipitation 693

Fundamental Quantitative Considerations 698

Turbidimetry 699

An Example of Turbidimetric

Immunoassay 718

C-reactive Protein 720

Turbidimetric Immunoassay for Determination

of C-reactive Protein 722

Turbidimetric Immunoassay for Ultrasensitive

Determination of C-Reactive Protein 723

Turbidimetric Immunoassay for Determination

of Antistreptolysin ‘O’ in Human Serum 724

Turbidimetric Immunoassay for Determination

of Microalbuminuria 724

Immunoglobulins (Ig) 724

Turbidimetric Immunoassay for Estimation of

Immunoglobulin

Iga in Human Serum 725

Turbidimetric Immunoassay for Estimation of

Immunoglobulin Igg in Human Serum 726

Turbidimetric Immunoassay for Estimation of

Immunoglobulin Igm in Human Serum 726

Turbidimetric Immunoassay for Estimation of

Complement C3 in Human Serum 726

Turbidimetric Immunoassay for Estimation of

Complement C4 in Human Serum 727

Turbidimetric Immunoassay for Estimation of

Antithrombin Iii in Human Serum 727

Quantitative Immunoturbidimetric

Assay for Estimation of Fibrinogen 727

Turbidimetric Immunoassay for Estimation of

Lipoprotein (A) in Human Serum 727

Quantitative Turbidimetric

Immunoassay for Estimation of

Apolipoprotein A-I 728

Quantitative Turbidimetric

Immunoassay for Estimation

of Apolipoprotein B 728

Automation in Turbidimetry 729

Chapter 24. The Endocrine System 731

Pituitary Gland 731

Anterior Lobe: Growth Hormone (Gh) 732

Method of Evaluation: StreptavidinBiotin Elisa 733

Corticotropin (Acth) 735

Other Anterior Pituitary Hormones 735

Intermediate Lobe (Pars Intermedia) 736

Posterior Pituitary (Neurohypophysis) 736

Disorders of the Pituitary System 738

Hypothalamus 738

Adrenal (Suprarenal) Gland 738

Mineralocorticoids 738

Glucocorticoids 739

Adrenal Medulla 742

Thyroid 742

Calcitonin 753

Parathyroid 754

Parathyroid Hormone (Intact) Elisa 756

Pancreas 757

Testes 758

Ovary 758

Pineal Gland 759

Hormones and Fertility 759

Male Fertility 760

Female Fertility 763

Algorithm for Evaluating Amenorrhea,

Immunoassays for Lh, Fsh and Prl 768

Adrenal Cortex 775

Adrenal Medulla 777

Testes 779

Steroids 781

17-Β-Estradiol 781

Dheas (Dehydroepiandrosterone Sulfate) 782

∆4-Androstenedione 782

Progesterone 782

17-Alpha-hydroxyprogesterone 783

Total Tri-iodothyronine (T3) 783

Cia™ Insulin (Chemiluminescence

Immunoassay) 788

Contents xv

Chapter 25. Histopathology 791

Preparation of Tissues 791

Routine Staining Procedures 794

Some Staining Techniques in Detail 799

Automation in Histopathology 805

Chapter 26. Cytology 808

Papanicolaou Method of Staining

Smears (Modified) 808

Fnac (Fine-Needle Aspiration Cytology) 809

Smearing Techniques 812

Requirements for Laboratory Set Up 812

Immunoperoxidase Staining for

Cyto and Histopathology 817

Automation in Cytology 818

Chapter 27. Microbiology and

Bacteriology 819

Classification 819

Culture 825

Ready to Pour, Sterilized Pouched Media

for Microbiological Applications

Instaprep 828

Easybact 833

General Instructions for Microbiology 837

Gram-positive Cocci 837

Gram-negative Cocci 839

Anaerobic Spore Bearing Bacilli 840

Aerobic Spore Forming Bacilli 842

Gram-positive Bacilli 842

Mycobacteria 843

Overview of M. tuberculosis: Diagnostic

Approach, Afb Staining, Culture

and Sensitivity 845

Mucolytic, Disinfectant, Specimen

Pretreatment and Buffering System

for Afb Staining and Culture 848

Rapid Two Step Cold Afb Stain 851

Ready to use Lj Solid Medium for

Mycobacterium tuberculosis Isolation 855

Combipack of Solid and Liquid Medium for

Mycobacterium tuberculosis Isolation 857

Primary/Secondary Drug Containing

Lowenstein-Jensen Media Panel Mtb

Sensitivity Tests 861

In Determination of Adenosine Deaminase

Activity in Serum, Plasma and Biological

Fluids 863

Gram-negative Bacilli 865

Spirochetes 871

Gram Stainer 872

Quality Assurance in Bacteriology 872

Color Atlas—Media and Colonies 873

Chapter 28. Mycology 883

Intermediate Superficial Deep Mycoses 884

Deep or Systemic Mycoses 884

Fungi Usually Present as Contaminants but

Which Rarely Cause Disease—Usually in

Patients Chronically Ill from Other

Diseases 885

Mycological Methods 885

Chapter 29. Diagnostic Skin Test 886

Technique of Skin Tests 886

Immunologic Basic for Skin Tests 886

Common Skin Tests 887

Immediate Reaction Type of Skin Tests 887

Delayed Reaction Type of Skin Tests 889

Chapter 30. Cytogenetics 891

Blood Lymphocyte Culture 891

Karyotyping 893

G and Q Bandings 894

Importance of Chromosomal Studies 894

Barr Body Analysis and Buccal Smear for

Staining of Sex Chromatin Mass 895

Chapter 31. World’s Latest and Best

Technologies by Roche 896

Business Areas 896

Revaluating Diagnostics 896

Testing Efficiency and Medical Value 896

Effective Management of Infectious

Diseases 898

Cobas® Modular Platform 900

Your Benefit 900

Cobas® 8000 Modular Analyzer Series 901

Cobas® 8000 Modular Analyzer Series 902

Cobas® 6000 Analyzer Series 903

Cobas® 4000 Analyzer Series 906

Cobas C 311 Analyzer 906

Cobas E 411 Analyzer 906

Cobas C 111 Analyzer 907

Cobas Integra® 400 Plus 908

Cobas P 312 Pre-analytical System 910

Cobas P 512 Pre-analytical System 910

Cobas P 612 Pre-analytical System 911

Cobas P 501 and Cobas P 701

Modular® Pre-analytics Evo 912

Cobas® Connection Modules (Ccm) 913

Cobas® 8100 Automated Workflow Series 914

Cobas® It Solutions 916

Cobas® Middleware Solution 917

Cobas® Laboratory Information System 918

Cobas® Infinity It Solutions 920

Overview of Serum Work Area Tests 921

Ecl—Unique Immunoassay Technology 925

Technology for Homogeneous

Immunoassay Detection 926

Elecsys® Hbsag Ii Quant 926

Elecsys® Hiv Combi Pt 4th Generation (Ag+Ab

Test) 927

The Syphilis Assays 929

Elecsys® Syphilis Immunoassay 929

Elecsys® Torch Panel 930

Elecsys® Troponin T High Sensitive

(Tnt Hs) 931

xvi Concise Book of Medical Laboratory Technology: Methods and Interpretations

Key Benefit: Earlier Diagnosis of Ami 932

Elecsys® Nt-proPnB 932

Elecsys® Tumor Marker Portfolio 933

Elecsys® He4 935

Elecsys® Pro-grp 936

Elecsys® Calcitonin 937

Elecsys® Anti-Tshr 938

Elecsys® Tg Ii 939

Tina-Quant® Lipoprotein (A) Gen 2 Test 940

Tina-Quant® Immunoglobulin A and M

Csf 941

Tina-Quant® Hemoglobin A1c 942

Tina-Quant® Cystatin C Gen 2 942

Elecsys® Preeclampsia 943

Elecsys® Vitamin D Total 945

Elecsys® Il-6, Pct and Tina-Quant® Crp 945

Elecsys® Tacrolimus and Cyclosporine 947

Hemostasis Testing 949

Multiplate® Analyzer 949

Urinalysis 951

Urinalysis From Roche 951

Combur-Test® Strip 951

Urisys 1100® Analyzer 952

Cobas U 411 Urine Analyzer 953

Cobas® 6500 Urine Analyzer Series* 954

Point-of-Care Testing 956

Cobas Poc it Solution 958

Cobas bge Link Software 960

Cobas B 121 System 961

Cobas B 221 System 962

Cobas B 123 Poc System 963

Accu-Chek® Inform Ii System 964

Accu-Chek® Safe-T-Pro Plus 965

Cobas H 232 Poc System 966

Roche Cardiac® Trop T Sensitive Test 967

Coaguchek® Xs System 968

Coaguchek Xs Plus System 969

Accutrend® Plus System 970

Reflotron® Plus System 971

Cobas B 101 System 972

Molecular Diagnostics 974

Solutions from Roche for Molecular

Diagnostics 974

Cobas P 630 Instrument 977

Cobas® Ampliprep Instrument 978

Cobas® Taqman® Analyzer and Cobas®

Taqman® 48 Analyzer 979

Cobas® Ampliprep/Cobas® Taqman® Hcv

Qualitative and Quantitative Tests, V2.0 980

Cobas® Taqman® Mtb Test 981

Cobas P 480 Instrument 982

Cobas® 4800 System V2.0 983

The Cobas® Hpv Test 985

The Cobas® Oncology Tests 985

Cobas® Mrsa/Sa Test 987

Cobas® Cdiff Test 987

Cobas® Hsv 1 and 2 Test 988

Cobas S 201 System 988

Lightcycler® Systems 990

Lightcycler® 2.0 Instrument 991

Test Kits, Validated for Ivd 992

Lightcycler® Septifast Test 992

Lightcycler® Mrsa Advanced Test 993

Magna Pure Systems 993

Symphony System 996

Benchmark Special Stains 997

Primary Antibodies 999

Ihc Detection 1001

Breast Cancer Diagnostics 1002

Prostate Cancer Diagnostics 1003

Hematopathology 1004

Colorectal Diagnostics 1004

Lung Cancer Diagnostic Solutions 1005

Benchmark Ihc/Ish Platform 1007

Benchmark System Features 1007

Digital Pathology 1008

Vantage Workflow Solution 1009