Measles

Since the number of leukocytes in the blood reflects the state of the body's defenses, this figure are interested physicians of all specialties. Its definition includes a minimum of research which prescribed to all patients in a hospital or clinic.
In a healthy person the number of leukocytes in the blood is inconstant. After heavy physical work, taking a hot bath, in women during pregnancy, during childbirth and menstruation before they increase. The same occurs after a meal. Therefore, the results of the analysis was objective, it must take on an empty stomach in the morning without breakfast, you can only drink a glass of water.

Normally, the content of leukocytes in 1 liter of blood an adult ranges from 4,0-9,0 x109. In children it is higher: at the age of one month - 9,2-13,8 x109 / l, from 1 to 3 years - 6-17x109 / L, aged 4 to 10 years - 6,1-11,4 x109 / l.
Increased number of white blood cells is called leukocytosis, a decrease - leukopenia. Most often leukocytosis occurs in patients with infections (pneumonia, scarlet fever), purulent diseases (appendicitis, peritonitis, cellulitis), severe burns. Leukocytosis develops within 1-2 h after the onset of intensive bleeding. Gout can also be accompanied by leukocytosis. Under certain leukemia leukocyte count increases by several orders of magnitude.

Although the penetration of microbes in the human body normally stimulates the immune system, resulting in the number of leukocytes in the brand name viagra blood increases, with some infections observed the opposite pattern. If the body's defenses are exhausted and the immune system can not fight, the number of leukocytes decreased. For example, leukopenia with sepsis indicates a serious condition the patient and poor prognosis. Some infections (typhoid, measles, rubella, chicken pox, malaria, brucellosis, influenza, viral hepatitis) suppress the immune system, so they can be accompanied by leukopenia. Reducing the number of white blood cells may also in systemic lupus erythematosus, certain leukemias, and metastatic bone tumors.
The source of leukocytes is the bone marrow. Radiation, certain drugs (phenylbutazone, cytostatics, antiepileptic drugs) damage it. As a result, produced an insufficient number of leukocytes, manifested leukopenia.

White blood cells differ in structure and purpose. Among them distinguish granulocytes (neutrophil, eosinophil, basophil), as well as lymphocytes and monocytes. Granulocytes contain granules that are stained with special dyes and visible under a microscope. Granules of neutrophils - gray, eosinophils - orange, basophils - purple.
Nucleus of mature neutrophils have a waist - segments, so they are called segmented. In immature cells revealed elongated rod-core - this neutrophilic stab granulocytes. Even more "young" neutrophilic granulocytes are known as "metamyelocytes (" young ").

Most of the blood of mature segmented neutrophils, less - to stab the young forms are rare. The ratio of the number of mature and immature forms can be judged from the intensity of blood. With the loss of blood to replenish her body begins to produce large numbers of cells. Because they do not have time to mature in the bone marrow, blood, there are many immature forms. Similar processes occur in purulent diseases (appendicitis, peritonitis), sepsis, when the body is trying to develop more cell-defense. In leukemia leukocytes begin to multiply uncontrollably, so the blood also appears a lot of immature forms.
Percentages of certain types of leukocytes in peripheral blood is called leukocyte formula. It is calculated per 100 leukocytes. Wbc allows the physician to visualize what a lot of white blood cells, and some small. Study of leukocyte formula helps in determining the severity of infectious disease, the diagnosis of leukemia. Increased number of immature neutrophils called leukocyte shift to the left of the formula.
Neutrophils

The main purpose of neutrophils - to protect the body against infections. They phagocytize bacteria, that is, "swallow" and "digest" them. In addition, neutrophils can produce specific antimicrobial substances.
Infections, neutrophils accumulate in large quantities in the site of entry of bacteria into the body. Pus - this is nothing like the dead neutrophils.

In normal adult human blood nuclear neutrophils constitute 1-5% of all leukocytes, segmented - 45-65%. Increased number of neutrophils, particularly immature forms, indicates the presence of infection (abscess, appendicitis, pneumonia, pyelonephritis, tonsillitis, meningitis, septicemia). Similar changes are observed in myocardial infarction, burns, lead poisoning, severe blood loss, leukemia.
With some infections (typhoid, malaria, some forms of tuberculosis, hepatitis, influenza, measles, rubella), the number of neutrophils, on the contrary, decreases. Reducing the number of neutrophils may occur in systemic lupus erythematosus, the effects of radiation and toxic chemicals (aniline, benzene, cytostatics), under certain anemias and leukemias.
Eosinophils

Eosinophils remove excess histamine, which appears in allergic diseases. If infection with worms eosinophils penetrate into the lumen of the intestine are destroyed there, as a result of released substances that are toxic to worms.
Normally, the content of eosinophils in the blood is 1-5% of all leukocytes. The number of eosinophils increased in bronchial asthma, allergic dermatitis, drug allergy, infection by parasites (Ascaris, Echinococcus, opisthorchid, giardia), and some leukemias and tumors, nodular periarteritis.
Basophils

Neither allergic reaction does not go without the participation of basophils. They play a role in inflammation.
Normally, the content of basophils in the blood of a minor - to 0,5% of all leukocytes. Increasing the number of basophils is extremely rare - in allergic reactions, some of leukemia, chlamydia, reduce thyroid function in the treatment of estrogen.
Lymphocytes

Lymphocytes - the main body patrols. They check, not whether it penetrated foreign molecules and microbes do not come out whether the cells own body out of control - not mutated if they do not have a multiply uncontrollably and become a tumor.
Key informants lymphocytes - macrophages. They travel through the body, collect samples, they seem suspicious, and deliver them to lymphocytes.
In normal lymphocytes in the blood of an adult is 25-35% of all leukocytes. Children under 6 years of lymphocytes in the blood significantly more than neutrophils, and after 6 years the number of lymphocytes decreased and neutrophils - increases.
Increasing the number of lymphocytes observed in some infections (whooping cough, hepatitis, cytomegalovirus infection, tuberculosis, syphilis), and leukemia. With infectious mononucleosis lymphocytes also increased, but their shape changes, and only superficially, they resemble monocytes. Hence the name of the disease.
Reducing the number of lymphocytes (lymphocytopenia) is characteristic of severe viral diseases, cancers, immunodeficiencies, as well as the appointment of glucocorticoids.
Monocytes

Mononuclear cells - immature cells. Its core functions, they begin to perform, when converted into macrophages - large mobile cells that are found in virtually all organs and tissues. Macrophages - a kind of stretcher-bearers. They "eat" bacteria, dead cells, and can "swallow" the particle is almost equal to them in size. Macrophages, as already mentioned, help the lymphocytes in the Viagra prolong intercourse implementation of immune responses.
In normal monocytes constitute 1-8% of all leukocytes. The number of monocytes increases in some infectious diseases (infectious mononucleosis, malaria, syphilis, brucellosis). In tuberculosis of an increase in the number of monocytes - a sign of disease activity, it is important to the ratio of monocytes to the number of lymphocytes: the norm, it is 0,3-1, and an increase in the activity of tuberculosis - is greater than 1. Increased number of monocytes may in sarcoidosis, leukemia, chlamydia, systemic lupus erythematosus, rheumatoid arthritis and certain vasculitis.
Sometimes the doctor is not satisfied with a blood test and re-appointment. Thus, it evaluates the dynamics of the disease and treatment efficacy. In some cases it is sufficient only to re-determine the total number of leukocytes without calculating the leukocyte formula. In other cases, a doctor interested in more detailed data on the immune system. In this case, it assigns immunogram. On this analysis will be discussed in the next issue.

Narrow specialist

Small Earring started yelling at four in the morning. In the evening like it was almost right, well, except that small sopelki, and at night the whole family gave a light. And that was particularly clear - the temperature is normal, no cough, pokakal normal. Boys seven months only, try to figure out what was wrong with him! Hours of 11 am had to call Larissa Zakharovna - a district pediatrician - an elderly man, an attentive and experienced. Listened, tapped, looked into her mouth, squeezed his tummy - all right, but only touched the right ear - Shackle already squealed. Clearly - otitis media.
Referrals to a specialist. Well, at least the diagnosis is made, and it's good. Had to meet the clinic. Near the door with the inscription "audiologist" - the people! But with children under one year took the queue, and Sergei still crying in the corridor is quite loud. So after 25 minutes have already fallen into the study.
Took two young women - a doctor and a nurse. The doctor with my sister did not mistake - on his head and nice big round mirror screwed. The whole process took a few seconds. Special funnel inserted in the ear, mirror beam to the right - and is - otitis media. Discharged into the ear drops and for some reason in the nose, some other pills. All bought, began to drip and swallowing, by the evening Serega quiet, only occasionally poskulival, and two days later was healthy. Again went to Laura (Larisa Zakharovna have not bothered), it looked into the eye - okay, that's slavnenko.
Doctor with a mirror on the head (ENT) is for narrow specialists. He knows how to do many things, completely inaccessible, even to such an experienced doctor as Larissa Zakharovna - can, for example, to look into the ear.

Narrow medical specialties there is big set, and it is inevitable - too much has become known medical science. And be, like some 100 years ago, the doctor simply did not get - can not get himself and to operate, and take delivery, and to treat diarrhea. But to become a specialist in a fairly small field of medicine - are quite capable, but in this case, life has to learn and improve.
Identify the specialized expertise is almost impossible. But there are experts on individual human bodies (dermatologist - skin, mammologist - mammary gland, proctologist - rectum, vertebrologist - the spine, a cardiologist - heart, etc.), experts on a whole body system (neurologist - the nervous system, endocrinology - Endocrine, Gastroenterology - digestive, etc.). Some doctors treat certain types of disease or even any one disease: phthisiatrician - tuberculosis, an oncologist - cancer, hematology - blood diseases, venereal diseases - it is clear that, etc. There are specific kinds of diagnosis by means of various devices, such as radiologists, medical ultrasound. Allocate subspecialties and treatments (surgery, therapists), and age of patients (pediatricians, gerontologists). And within each listed specialty can find dozens more narrow areas.
There is no doubt that the more often a particular doctor treats a specific disease, the better the results, because the more experience, more knowledge, to develop appropriate skills, are well known drugs, etc. And the results of surgery for heart disease, call it ( this vice) "mitral stenosis", it will be the best surgeon in town by the name of K N, which made 200 operations is at the heart of it is on the mitral valve and it was for stenosis ...
The obvious conclusion: the key to successful treatment lies in the fact that patients with certain brand name viagra disease got an appointment to the specialist - the specialist for this very disease. Remains "small" - to establish the diagnosis. This, probably, and should be dealt with specialists not narrow, or, as they are commonly called, the general practitioners. Typical representatives of the latter is, at first glance, the closest to our house doctors - pediatricians and internists precinct. Although the above analysis suggests that the disease for pediatric therapists are left. Gastric ulcer - a gastroenterologist, diabetes - an endocrinologist, a heart attack - a cardiologist, a stroke - to a neurologist, pregnancy - to the obstetrician-gynecologist, etc. It remains except bronchitis da flu cure himself. But with a special desire and those patients that remain, you can "attach": bronchitis - a pulmonologist, the flu - to infectious diseases.
But what about the relationship of all organs and systems as the most important thing, from college all the doctors instilled rule: treat the patient rather than the disease? With this more difficult. A further snag is that only some, particularly healthy lucky, I am concerned that one thing. But if you ugorazdilo to 40 years to "earn" and gastritis, and hypertension, and chronic tonsillitis? So, as well as running in circles between the gastroenterologist, a cardiologist and an otolaryngologist?
I do not want to run! Want to come to one man whom you believe, which is respected, who are not shy, and one with it all the questions easily decided. And so in theory seems to be a must. But, unfortunately, only theoretically.
To quote a very interesting document. It's called the "International Code of Medical Ethics. So, quote:
"The physician must put at the heart of compassion and respect for human dignity and the patient is fully responsible for all aspects of care, regardless of their own professional expertise" (emphasis mine, - EK).
You have carefully read? You do not have the impression that our trips to narrow specialists in a strange manner inconsistent with the International Code of Medical Ethics? Really imagine it? You probably thought that we have doctors and medicine are illiterate unethical? You have decided wrongly, and this paradox, we now illustrate.
So you've decided to arrange your mouth. Tired of enduring - it hurts, there comes a cold, there is a tooth wobbles and after eating half an hour out of the holes have to pick out the meat. You have come to the most ordinary state free health clinic. You will examine the dental therapist, said that, here and here caries, is he cured himself with this tooth to the surgeon (to vomit), with this - to parodontist (treat), then to the prosthetist - build a bridge. About the turn of every specialist we do not say it's a separate issue. If you have a lot of time and steady mind, within six months you may well be able to finish the treatment.
With the same problems you have come to a private dentist. The same affable doctor cured you and caries and periodontal disease, tooth removed and carried prosthesis. When in the process of tooth extraction problems, the doctor invited a specialist - a surgeon, a dentist who decided these issues. Please note that you are not sent to the surgeon, saying those that "I can not answer for it, and the surgeon came to you.
A dentist who you trust, in accordance with the International Code of Medical Ethics, took over full responsibility for all aspects of treatment and in case of difficulty called in to help a specialist - a specialist to whom he and trusts.
In the first case (public clinic) responsible for the results of treatment was divided between four doctors, in the second (private dental office) - just one. However, this one was for his work in five times more than those four combined (assuming that these four will be given time to pay).
Hopefully, it will not seem insignificant to you!

Every day and every hour of the doctor to make responsible decisions. Decisions on which depend the lives and health! It is logical to assume that responsible decisions should be appropriately rewarded - in this case can perhaps be seen not only logic, but also ethics. Perhaps, the International Code of Medical Ethics, the word "doctor" implies something else? Quite another man with another way of life that can at least work to think about patients and not about any money for buy new uniforms and how to repay his neighbor, a businessman.
Unworthy of a civilized society assessment of medical work has led and leads to the fact that the doctor deliberately avoids the critical decisions. And in order to share the responsibility and did not find the culprit then, need a lot of doctors. We are on the road and went. When, after the treatment, disposal, prosthetics clinic in the state you razbolitsya tooth, try to figure out who to blame? Poorly sealed, poorly offered treatment, and removed the bad or poor bridge built? And after the private office - here it is, darling. So he will not deny it - he (and free!) Lie down, and overhauls.
Why general practitioners messing with your gastritis? More responsibility and pay the same. Go-ka you to a gastroenterologist. Or do you think that the therapist does not know how to cure gastritis?
Wait, you say, pay a salary, but there is also a conscience and ethics, and medical debt. Well, about the doctor's duty to know everything very well, but about the duty of society to the doctors? It is somehow forgotten. And if society is to see a doctor is unethical, it is difficult to obtain from the doctor that same ethic.
But there is one thing - the material base of medicine itself. Good to be a dentist with his hands, when the office is overseas miracle of technology, costing thousands (sometimes tens of thousands) overseas, and very conventional units. A buzzing instrument of torture in the dentist's office and 20 state masochists in the queue for this infernal invention - it's from a horror movie? So in fact not from the movie, even of our life with you, from our free medicine.
Let us remember where we started. Larissa came Zakharovna and sent the child to the audiologist. Why? That treatment of otitis media is too complicated? No, just the specialist can see the eardrum and accurate diagnosis.
There is a tool called an otoscope - a special form of a small flashlight to inspect the eardrum. If otoscope was Larisa Zakharovna, she would herself otitis diagnosed, and she would have them treated. None of the domestic enterprise otoscopes not released, but thousands of imported models, and each overseas medical otoscope, of course, there is. This lantern is worth about $ 50.
Larissa Zakharovna never (!) Does not afford to buy otoscope for $ 50 because a month makes these $ 50. Not surprisingly, in our local medical equipment otoscopes not sold - no demand {Now (2007) Larisa Zakharovna already receives $ 120. But she can not afford to spend on an otoscope almost half the salary ... So basically nothing has changed}.
So much for the illustration of the political economy of socialism: our greatest treasure - the people: we will not release otoscopes, we will be releasing otolaryngologist!

The entire complex, multistage, cumbersome and very inconvenient system specialists, without a doubt, is the offspring of an appropriate system of health care.
Admiring free and universally available, proud constitutional guarantees, we forgot about for whom to narrow specialists. No, the masses of patients, perhaps, do not forget - they do not know really, but the doctors, the doctors have forgotten that's for sure.
Narrow specialist - is an assistant and consultant to your physician, the man who, in accordance with medical ethics and duty to take responsibility for your health. And if you're out of luck if your illness is particularly severe course, or if no clear diagnosis, if not help more or less standard methods of treatment - if the doctor refers to a specialist - for help and advice. He (your doctor) as it refracts through the prism of the expert advice of own knowledge about you, your lifestyle, about your physical capabilities, as your other diseases. And not a narrow specialist and your doctor with you makes the decisions. He remains fully responsible for you.
Most diseases, fortunately, takes a standard, the methods of treatment are not a mystery.
And competent, diligent, constantly watching over her qualifications, balanced and material security practitioner can quite without the help of anyone and to treat stomach ulcers, and neurosis, and angina, and diabetes, and prostatitis, and pyelonephritis, and ...
We can not make a What can Viagra doctor a balanced and financially secure. We can only supposed to help all doctors at once: to share the heavy burden of responsibility and bring a measure of this same responsibility in line with wages.
Narrow specialists - the elite of medicine! Super pros who know a lot right, but something - a very, very good. So it should be.
Narrow specialist - is an evolution of generalists, when the general practitioner after many years of work, having experience and knowledge of people, becoming a specialist in a small area of medicine. So it should be.
One can not become a specialist one year after graduating from medical school. In theory - you can not.
You can not become a neurosurgeon or a heart surgeon, without going through the school of general surgery. In theory - you can not.
Can not be Venereologists or an allergist, not having learned to treat infectious diseases, bronchitis and acute respiratory disease. In theory - you can not.
Narrow specialists may not be much. It is too difficult, responsible and honorable - to be a specialist. Herewith a specialist!
What a pity that it is only in theory ...