Transcript Treatments, Procedures, and Devices (cont.)

Unlocking Medical Terminology
Second Edition
CHAPTER
11
Blood and the
Lymphatic System
Unlocking Medical Terminology, Second Edition
Bruce Wingerd
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Learning Objectives
After completing this chapter, you will be
able to:
– Define and spell the word parts used to create
medical terms for blood and the lymphatic
system
– Identify the organs of blood and the lymphatic
system and describe their structure and
function
Unlocking Medical Terminology, Second Edition
Bruce Wingerd
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Learning Objectives (cont.)
After completing this chapter, you will be
able to:
– Define common medical terms used for blood
and the lymphatic system
– Break down and define common medical
terms used for symptoms, diseases,
disorders, procedures, treatments, and
devices for blood and the lymphatic system
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Bruce Wingerd
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Blood and the Lymphatics
• Blood is normally found only in the
cardiovascular system, and its primary
function is transport
• Another type of fluid, known as lymph,
also transports substances throughout the
body and is found in the lymphatic vessels
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Bruce Wingerd
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Blood and the Lymphatics (cont.)
• The two fluids are intertwined because
lymph is formed from blood and because
blood and lymph both carry white blood
cells
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Bruce Wingerd
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Prefixes
•
•
•
•
•
•
ana- = up, toward, apart
homo- = same
iso- = equal
macro- = large
micro- = small
pro- = before
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Combining Forms
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•
•
•
•
aden/o = gland
aut/o = self
bacteri/o = bacteria
blast/o = germ, bud, developing cell
chromat/o = color
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Combining Forms (cont.)
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•
•
•
erythr/o = red
fung/o = fungus
hem/o, hemat/o = blood
immun/o = exempt; immunity
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Combining Forms (cont.)
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•
•
•
leuk/o = white
lymph/o = clear water, fluid
mon/o = one
myel/o = bone marrow (also means spinal
cord, medulla, myelin)
• nucle/o = kernel, nucleus
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Combining Forms (cont.)
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•
•
•
•
path/o = disease
plas/o = change
poikil/o = irregular
septic/o = putrefying
splen/o = spleen
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Combining Forms (cont.)
• staphyl/o = grape-like clusters;
Staphylococcus
• strept/o = twisted or gnarled;
Streptococcus
• therm/o = heat
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Combining Forms (cont.)
•
•
•
•
thromb/o = clot
thym/o = wart-like; thymus gland
tox/o, toxic/o = poison
vir/o = virus
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Suffixes
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•
•
•
•
-crit = to separate
-cyte = cell
-emia, -hemia = condition of blood
-globin = globe-like protein
-lysis = to dissolve, loosen
-osis = condition of
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Suffixes (cont.)
• -penia = abnormal reduction in number,
deficiency
• -pexy = surgical fixation, suspension
• -phil, -philia = loving, affinity for
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Suffixes (cont.)
•
•
•
•
-phylaxis = protection
-poiesis = formation
-stasis = standing still
-therapy = treatment
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Anatomy and Physiology
• Some of the circulating blood does not
return to the bloodstream but returns to
the lymphatic vessels instead
• The lymphatic vessels channel the fluid,
known as lymph, back into the
cardiovascular system
• Before the lymph reaches the
cardiovascular system it passes through
numerous lymphatic organs
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Bruce Wingerd
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Anatomy and Physiology (cont.)
• The lymphatic organs contain millions of
white blood cells that filter the lymph by
removing bacteria and other unwanted
materials
• The white blood cells are the functional
components of the immune response that
serve to defend against viruses, bacteria,
protozoa, fungi, and nonliving substances
that may cause disease
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Blood
• The blood transports materials throughout
the body via the cardiovascular system
• It consists of a watery fluid and a
combination of several types of formed
elements that are suspended in the fluid
• The fluid part of the blood is called plasma
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Figure 11.1 A blood smear
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Blood (cont.)
• Plasma is slightly thicker than water and is
thickened by the presence of dissolved
proteins
• These proteins give plasma a yellow color
• One of these proteins, fibrinogen, begins
the blood clotting process
• The removal of fibrinogen from a blood
sample produces serum
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Bruce Wingerd
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Blood (cont.)
• The formed elements that are carried
along in the plasma current include three
types
– Red blood cells (RBCs)
– White blood cells (WBCs)
– Platelets
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Red Blood Cells
• Also called erythrocytes
• The most abundant cells, numbering about
4,200,000 to 6,200,000 per cc in adults
• Are produced from precursor cells, called
stem cells, in the red bone marrow during
the process known as hematopoiesis
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Red Blood Cells (cont.)
• Each cell is filled with the protein
hemoglobin
– Contains iron
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Figure 11.2 Hematopoiesis
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Figure 11.3 Red blood cells
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Platelets
• Platelets or thrombocytes are the second
most abundant formed elements in blood
• Smaller than RBCs, they range between
150,000 and 360,000 cells per cc of blood
• Prevent fluid loss that would otherwise
follow an injury by releasing proteins in a
process, known as coagulation, which
results in the formation of blood clots
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Figure 11.4 Saturated red blood cells Source: Custom Medical Stock Photo, Inc.
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Figure 11.5 A blood clot
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White Blood Cells
• Also called leukocytes, they are the fewest
cells in a normal sample of blood
• Role is to protect the body from infectious
microorganisms and other foreign,
unwanted materials
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Bruce Wingerd
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White Blood Cells (cont.)
• Several types of WBCs exist in the blood
– Eosinophils
– Basophils
– Lymphocytes
 T cells and B cells
– Neutrophils
– Monocytes
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The Lymphatic System
• Closely related to the blood and its
circulation
• Plays a key role in protecting the body
against infection
• Includes a series of vessels that carry a
fluid through the body
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Bruce Wingerd
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The Lymphatic System (cont.)
• This fluid, known as lymph, flows in a oneway direction toward the heart, rather than
in a circulatory loop
• Lymph originates when interstitial fluid
finds its way into lymphatic capillaries
• The lymph then flows into larger lymphatic
vessels which are similar in structure to
veins and often course alongside them
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Bruce Wingerd
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The Lymphatic System (cont.)
• The lymphatic vessels deliver lymph into
larger channels called lymphatic trunks
• The largest lymphatic trunk is known as
the thoracic duct
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Figure 11.6 Macrophage
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The Lymphatic System (cont.)
• As lymph flows through the lymphatic
vessels, it is channeled through small
organs called lymph nodes
• The lymph nodes contain millions of
WBCs that remove foreign materials from
the lymph as it passes through them
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Bruce Wingerd
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The Lymphatic System (cont.)
• Other organs of the lymphatic system that
protect against infection include the
– Spleen, thymus gland, tonsils, and lymphatic
nodules
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The Immune Response
• The human body is continuously exposed
to harmful substances, such as
– Pathogenic microorganisms, poisonous
molecules, foreign particles, and dying or
diseased cells
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The Immune Response (cont.)
• Pathogenic microorganisms, or
pathogens, are disease-causing agents
that include
– Viruses, bacteria, fungi, protozoans, and
worm-like organisms
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Figure 11.7 The lymphatic system
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The Immune Response (cont.)
• Pathogens may cause harm by destroying
cells or releasing poisonous substances
that interfere with the cell function
– These harmful substances are called toxins
• Pathogens, toxins, and other harmful
particles can severely disrupt health if left
unchecked by the body’s defenses
• An immunological disease resulting from a
pathogen is called an infection
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Word Roots
•
•
•
•
•
•
bacteri = bacteria
cyt = cell
erythr = red
hem,hemat = blood
immun = exempt, immunity
lymph = clear water or fluid
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Bruce Wingerd
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Word Roots (cont.)
•
•
•
•
path = disease
thromb = clot
thym = wart-like, thymus gland
tox = poison
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Bruce Wingerd
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Figure 11.8 Pathogens
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Other Important Terms
•
•
•
•
•
•
•
•
Antibody
Antigen
Basophil
B cell
Blood clot
Coagulation
Fibrinogen
Neutrophil
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•
•
•
•
•
•
•
•
Phagocytosis
Plasma
Platelets
Serum
Spleen
T cell
Thoracic duct
Tonsils
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Medical Terms
• Hematology
– The general field of medicine focusing on
blood-related disease
• Hematologist or hematopathologist
– A physician specializing in the treatment of
diseases associated with the blood
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Medical Terms (cont.)
• Immunology
– The field of medicine that focuses on
immunological diseases
– Sub-disciplines include virology, bacteriology,
and toxicology
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Symptoms and Signs
• Anisocytosis
– Presence of red blood cells of unequal size
• Bacteremia
– Presence of bacteria in the bloodstream
• Erythropenia
– Abnormally reduced number of red blood cells
• Hemolysis
– Rupture of the red blood cell membrane
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Symptoms and Signs (cont.)
• Hemorrhage
– Loss of blood from the circulation
• Macrocytosis
– Abnormally large-sized red blood cells
• Poikilocytosis
– Large, irregularly-shaped red blood cells
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Symptoms and Signs (cont.)
• Polycythemia
– Abnormal increase in the number of
erythrocytes in the blood
• Splenomegaly
– Abnormal enlargement of the spleen
• Toxemia
– Presence of toxins in the bloodstream
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Diseases and Disorders
• AIDS
– The acronym for acquired immune deficiency
syndrome. AIDS is caused by the human
immunodeficiency virus (HIV), which disables
the immune response by destroying mainly
helper T cells (needed for activation of B
cells); the loss of immune function allows
opportunistic infections to proliferate and
eventually cause death
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Figure 11.9 HIV
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Diseases and Disorders (cont.)
• Allergy
– A response to an allergen, which is an antigen
that produces a hypersensitivity reaction that
includes immediate inflammation but does not
elicit other immune responses; allergies are of
many types, the most common of which are
allergic rhinitis (hay fever) that affects the
mucous membranes of the nasal cavity and
throat, and allergic dermatitis, which affects
the skin where it has made contact with the
allergen
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Figure 11.10 Results from an allergy skin test
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Diseases and Disorders (cont.)
• Anaphylaxis
– An immediate reaction to an antigen that
includes rapid inflammation and system-wide
smooth muscle contractions
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Diseases and Disorders (cont.)
• Anemia
– A reduced ability of red blood cells to deliver
oxygen to tissues; common forms of anemia
include aplastic anemia, iron deficiency
anemia, sickle cell anemia, and pernicious
anemia
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Diseases and Disorders (cont.)
• Aplastic anemia
– Anemia characterized by the failure of red
bone marrow to produce red blood cells
• Autoimmune disorder
– Any one of several diseases that are caused
by a person’s own immune response attacking
otherwise healthy tissues, including
rheumatoid arthritis, systemic lupus
erythematosus, and multiple sclerosis
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Diseases and Disorders (cont.)
• Botulism
– A form of poisoning caused by the ingestion of
food contaminated with the toxin produced by
the bacterium Clostridium botulinum
• Diphtheria
– A disease caused by a bacterium and its toxin,
resulting in inflammation of mucous
membranes primarily in the mouth and throat
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Figure 11.11 Diphtheria
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Diseases and Disorders (cont.)
• Dyscrasia
– a general term for an abnormal condition of
the blood
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Diseases and Disorders (cont.)
• Erythroblastosis fetalis
– A blood disorder resulting from incompatibility
between a fetus with Rh positive blood and its
mother with Rh negative blood, which causes
the destruction of fetal red blood cells, and
requires blood transfusions to save the fetus;
also known as Rh mismatch or hemolytic
disease of newborn
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Diseases and Disorders (cont.)
• Fungemia
– A fungal infection distributed by way of the
bloodstream
• Gas gangrene
– The infection of a wound caused by various
anaerobic bacteria that produces a
fermentation gas, necrosis, and septicemia
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Diseases and Disorders (cont.)
• Hemochromatosis
– Inherited disorder that results in an excessive
accumulation of iron deposits in the body
• Hemophilia
– An inherited bleeding disorder that results from
defective clotting proteins involved in blood
coagulation
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Diseases and Disorders (cont.)
• Hodgkin’s disease
– Cancer of lymphatic tissue, characterized by the
progressive enlargement of lymph nodes, fatigue,
and deficiency of the immune response
• Immunodeficiency
– A condition resulting from a defective immune
response
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Diseases and Disorders (cont.)
• Immunosuppression
– Reduction of an immune response caused by
disease or, in the case of organ transplants,
by the use of chemical, pharmacologic,
physical, or immunologic agents
• Infection
– A multiplication of disease-causing
microorganisms
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Diseases and Disorders (cont.)
• Inflammation
– A swelling of body tissue caused by the
movement of the plasma into the extracellular
space to produce edema, or fluid
accumulation in tissue; symptoms include
swelling, redness, heat, and pain
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Figure 11.12 Reaction against infection
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Figure 11.13 Inflammation Source: Phototake NYC
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Diseases and Disorders (cont.)
• Influenza
– A viral disease characterized by a temporary
inflammation of mucous membranes and
fever; commonly called “the flu,” it is highly
contagious and the virus is capable of
mutating to escape detection by B and T
memory cells
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Diseases and Disorders (cont.)
• Iron deficiency anemia
– Anemia that is caused by a lack of iron, which
results in smaller red blood cells containing
deficient levels of hemoglobin
• Leukemia
– Cancer of the red bone marrow, which is the
blood-forming tissue
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Figure 11.14 Leukemia Source: Getty Images, Inc./Stone Allstock
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Diseases and Disorders (cont.)
• Lymphadenitis
– Inflammation of the lymph nodes
• Lymphadenopathy
– Literally, disease of the lymph nodes; this
general term is often applied to a syndrome,
lymphadenopathy syndrome (LAS), which is a
persistent swelling of the lymph nodes that
often precedes the onset of AIDS
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Diseases and Disorders (cont.)
• Lymphoma
– A tumor originating in lymphatic tissue
• Malaria
– A disease caused by a parasitic protozoan
that infects red blood cells, which is carried by
anopheles mosquitoes; it is characterized by
periodic fevers and fatigue
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Figure 11.15 Malaria Source: Photo Researchers, Inc.
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Diseases and Disorders (cont.)
• Mononucleosis
– A viral disease characterized by enlarged
lymph nodes, an increase in number of
mononuclear blood cells (monocytes and
lymphocytes), sore throat, and fatigue
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Figure 11.16 Mononucleosis
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Diseases and Disorders (cont.)
• Myelodysplasia
– Bone marrow disorder characterized by the
proliferation of abnormal stem cells, which
usually develops into a form of leukemia
• Nosocomial infections
– A disorder, usually bacterial infections,
contracted during a hospital stay; often due to
antibiotic-resistant strains of Staphylococcus
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Diseases and Disorders (cont.)
• Pernicious anemia
– Anemia caused by an inadequate supply of
folic acid (vitamin B12), resulting in red blood
cells that are large, varied in shape, and
reduced in number
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Diseases and Disorders (cont.)
• Plague
– Any infectious disease of wide prevalence or
excessive mortality; it also refers specifically to
an acute infectious disease caused by the
bacterium Yersinia pestis, characterized by
high fever, skin eruptions, internal
hemorrhage, and pneumonia, also called
bubonic plague
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Diseases and Disorders (cont.)
• Septicemia
– A systemic disease caused by the presence of
bacteria and their toxins in the circulating
blood; a person suffering from this is referred
to as septic
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Diseases and Disorders (cont.)
• Rabies
– A bacterial infection spread from the mouth of
an infected animal, usually by way of a bite;
the bacterium produces a neurotoxin that acts
on the central nervous system and is highly
fatal
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Diseases and Disorders (cont.)
• Sickle cell anemia
– An inherited, chronic anemia that is
characterized by defective hemoglobin that
causes red blood cells to become misshapen
(sickle-shaped), resulting in drowsiness, leg
ulcerations, fever, joint and abdominal pain,
and thrombosis
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Figure 11.17 Sickle cell anemia
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Figure 11.17(continued) Sickle cell anemia
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Diseases and Disorders (cont.)
• Staphylococcemia
– The presence of Staphylococci bacteria in the
blood, which is the literal meaning of the term;
commonly called a staph infection, it is a
frequent complication to normal healing and
also the most common cause of food
poisoning, skin inflammation, osteomyelitus,
and nosocomial infections
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Diseases and Disorders (cont.)
• Tetanus
– A disease caused by a powerful neurotoxin
released by the common bacterium
Clostridium tetani; the toxin acts upon the
central nervous system to cause convulsions
and paralysis
• Thymoma
– A tumor originating in the thymus gland
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HIV
• Viruses combine with a host cell using
their receptor molecules as “landing gear”
and inject virus RNA inside the host cell
• Once in the host cell, the viral RNA
redirects cell functions to make copies of
the virus
• Soon after new viruses are produced they
leave the host cell and infect other cells
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HIV (cont.)
• The host cell is then damaged or killed
• HIV viral particles may lie dormant for
years and once they are activated they are
capable of killing many types of cells
• HIV prefers helper T cells, although it
attacks other cells
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HIV (cont.)
• Helper T cells have a CD-4 receptor,
which HIV is able to form a chemical bond
with to gain entry into the cell
• When HIV enters the body, it usually
infects helper T cells and causes flu-like
symptoms
• The symptoms are caused by the body’s
immune response effort to remove the
virus
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HIV (cont.)
• The body is usually not able to completely
eliminate the virus
• The surviving HIV particles enter a period
of dormancy in which there is no active
reproduction of the virus for about 6
months, although the time may vary
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HIV (cont.)
• Following the dormant phase, HIV begins
its reproductive phase and invades
primarily helper T cells and destroys them
to produce new viruses
• HIV’s reproductive phase destroys 60-90%
of the helper T cells in the body
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HIV (cont.)
• The destruction of helper T cells results in
a suppression of cell-mediated immunity,
followed by the rise of opportunistic
infections
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Bruce Wingerd
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HIV (cont.)
• There is a long list of opportunistic
infections that arise; the most deadly are
fungal lung infections caused by
Pneumocystis carinii that produces
pneumonia, a lymphoma of the brain, and
tuberculosis
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Bruce Wingerd
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HIV (cont.)
• Other less deadly diseases that are
nonetheless painful and difficult to treat
include
– A skin cancer called Kaposi’s sarcoma
– A protozoan infection called toxoplasmosis
– Anorexia caused by bacterial infection of the
digestive tract
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Bruce Wingerd
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HIV (cont.)
• Other less deadly diseases that are
nonetheless painful and difficult to treat
include
– Squamous cell carcinoma
– Infection by Herpes viruses types 1 and 2
– Candidiasis
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Bruce Wingerd
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Treatments, Procedures, and
Devices
• Antibiotic
– A therapeutic treatment in which a substance
with known toxicity to bacteria, which may be
obtained from a mold or from other bacteria, is
administered; it is effective only against
bacteria, many types of which are capable of
developing resistance, especially when
antibiotics are not administered properly
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Bruce Wingerd
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Treatments, Procedures, and
Devices (cont.)
• Anticoagulant
– A chemical agent that reduces the clotting
process
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Bruce Wingerd
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Treatments, Procedures, and
Devices (cont.)
• Antiretroviral therapy
– Application of drugs to battle against a class of
viruses that tend to mutate quickly, known as
retroviruses, of which HIV is a member; also
known as combination therapy, the drugs form
a cocktail that includes nucleoside analog
reverse transcriptase inhibitors and protease
inhibitors, all of which block HIV replication by
a variety of means
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Bruce Wingerd
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Treatments, Procedures, and
Devices (cont.)
• Attenuation
– A process in which pathogens are rendered
less virulent prior to their incorporation into a
vaccine preparation
• Autologous transfusion
– Transfusion of blood donated by a patient for
personal use; this is a common procedure
before a surgery to avoid potential
incompatibility or contamination
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Bruce Wingerd
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Treatments, Procedures, and
Devices (cont.)
• Bacteriology
– The field of science and medicine focused on
the study of bacteria and prevention of
bacterial diseases; one who specializes in this
field is a bacteriologist
• Blood chemistry
– A test or series of tests on plasma to measure
the levels of particular components
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Bruce Wingerd
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Treatments, Procedures, and
Devices (cont.)
• Blood culture
– A test to determine infection in the blood by
placing a blood sample on a nutritive media in
an effort to grow populations of bacteria for
analysis
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Bruce Wingerd
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Treatments, Procedures, and
Devices (cont.)
• Blood transfusion
– Introduction of blood, blood products, or blood
substitute into a patient’s circulation to restore
blood volume to normal levels; the two main
types of blood transfusions are autologous
transfusions and homologous transfusions
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Bruce Wingerd
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Figure 11.18 Blood transfusion Source: Getty Images Inc./Image Bank
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Bruce Wingerd
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Treatments, Procedures, and
Devices (cont.)
• Coagulation time
– A timed blood test to determine the time
required for a blood clot to form; one type of
this test, called prothrombin time (PT),
measures the time required for prothrombin, a
precursor protein, to form thrombin. It is often
used to monitor anticlotting therapy. Another
type is partial thromboplastin time (PTT),
which is used to evaluate clotting ability
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Bruce Wingerd
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Treatments, Procedures, and
Devices (cont.)
• Complete blood count
– A common laboratory blood test that provides
diagnostic information about a patient’s
general health; abbreviated CBC, it includes
several more specific tests, including
hematrocrit, hemoglobin, red blood count, and
white blood count
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Bruce Wingerd
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Treatments, Procedures, and
Devices (cont.)
• Differential count
– Microscopic count of the number of each type
of white blood cell using a stained blood
smear
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Bruce Wingerd
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Treatments, Procedures, and
Devices (cont.)
• Erythrocyte sedimentation rate
– A timed test to measure the rate at which red
blood cells fall through a volume of plasma to
provide information on their hemoglobin
content; abbreviated ESR, it is commonly
used to evaluate nonspecific systemic
inflammation
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Bruce Wingerd
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Treatments, Procedures, and
Devices (cont.)
• Hematocrit
– A test that measures the percentage of red
blood cells in a volume of blood; abbreviated
HCT or Hct, it is obtained from centrifuging a
sample of blood to separate blood cells
• Hematology
– The general field of medicine focusing on
blood-related disease; one who specializes in
this field is a hematologist
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Bruce Wingerd
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Treatments, Procedures, and
Devices (cont.)
• Hemoglobin
– A test that measures the level of hemoglobin
in red blood cells; abbreviated HGB or Hgb
• Hemostasis
– Stoppage of bleeding
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Bruce Wingerd
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Treatments, Procedures, and
Devices (cont.)
• Homologous transfusion
– Transfusion of blood that is voluntarily donated
by another person, it requires blood type
matching, known as crossmatching, to prevent
incompatibility
• Immunization
– A procedure that provides immunity against a
particular antigen
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Bruce Wingerd
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Figure 11.19 Immunization with a vaccine Source: PhotoEdit
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Bruce Wingerd
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Treatments, Procedures, and
Devices (cont.)
• Immunology
– The study concerned with immunity and
allergy
• Immunotherapy
– Used in the treatment of infectious disease, it
is the use of agents to activate or strengthen
the immune response
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Bruce Wingerd
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Treatments, Procedures, and
Devices (cont.)
• Lymph node dissection
– Removal of lymph nodes for pathological
study to assist in a diagnosis; also known as
lymph node biopsy
• Lymphadenectomy
– Excision of a lymph node
• Lymphadenography
– The process of x-ray photography of the lymph
nodes following injection of a contrast medium
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Bruce Wingerd
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Treatments, Procedures, and
Devices (cont.)
• Lymphadenotomy
– Incision into a lymph node
• Lymphangiography
– The process of x-ray photography of lymphatic
vessels following injection of a contrast
medium; it produces an x-ray recording called
a lymphangiogram
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Bruce Wingerd
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Treatments, Procedures, and
Devices (cont.)
• Pheresis
– Removal of donor’s blood, which is then
separated into blood components, with one
portion retained for use and the remainder
returned to the donor
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Bruce Wingerd
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Treatments, Procedures, and
Devices (cont.)
• Platelet count
– Calculation of the number of platelets in the
blood
• Prophylaxis
– Any treatment that tends to prevent the onset
of an infection or other type of disease
• Red blood count
– Measures the number of red blood cells per
cubic centimeter (cc)
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Bruce Wingerd
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Treatments, Procedures, and
Devices (cont.)
• Splenectomy
– Excision of the spleen
• Splenopexy
– Surgical fixation of the spleen
• Thrombolysis
– The process of dissolving a blood clot
• Thymectomy
– Excision of the thymus gland
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Bruce Wingerd
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Treatments, Procedures, and
Devices (cont.)
• Toxicology
– Focuses on the study and treatment of toxins
and the diseases they cause
• Vaccination
– The inoculation of a culture that has reduced
virulence as a means of providing a cure or a
prophylaxis
Unlocking Medical Terminology, Second Edition
Bruce Wingerd
Copyright ©2011 by Pearson Education, Inc.
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Treatments, Procedures, and
Devices (cont.)
• Vaccine
– Any preparation used to activate an immune
response
• Virology
– Focuses on the study of viruses and the
diseases they cause
• White blood count
– Measures the number of white blood cells per
cubic centimeter
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Bruce Wingerd
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Abbreviations
•
•
•
•
•
•
•
AIDS
CBC
ESR
HCT, Hct
HGB, Hgb
HIV
INR
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Bruce Wingerd
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Abbreviations (cont.)
•
•
•
•
•
•
•
LAS
PCP
PLT
PT
PTT
RBC
WBC
Unlocking Medical Terminology, Second Edition
Bruce Wingerd
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