Here, Erich H. Loewy expands on his earlier book Textbook of Medical Ethics (1989) offering healthcare workers and students a new perspective on ethical practice. Textbook of Healthcare Ethics focuses on the social conditions in which medical practice occurs and how ethical healthcare decisions involves nurses, social workers, psychologists, technicians, and patients as well as physicians. This thoroughly revised and expanded edition addresses historical and theoretical underpinnings and practical concerns. A series of case studies serve as a guideline for further discussion. The text examines provocative issues such as organ donation, care of the terminally ill, abortion, HIV-positive healthcare professionals, physician-assisted suicide, and experimentation with fetal tissue. This is an ideal book for all members of the healthcare team as well as students and residents in any discipline of medicine.

This book is based on the proceedings of the fourth Medical Microcomputer Workshop held at the Middlesex Hospital Medical School on 3-5 September 1986. The workshop was attended by clinicians and computer scientists with an interest in applying computer technology to current medical practice. The problems ranged from audit and patient management through to the more complex applications of data analysis obtained from current diagnos tic techniques. The choice of microcomputers has never been greater with low cost making them readily available. A single microcomputer has limita tions in clinical practice and the use of networks for multi-user tasks has expanded its capability but increased the complexity both in terms of hardware and the software needed to run it. Although comprehensive commercial packages are available, none of these are entirely suitable for medical applications without modification. Many of the chapters presented in this book describe the problems encountered and the solutions achieved by configuring and modifying applications software.

This volume provides a history of Eosinophilic Esophagitis (EoE), a basic understanding of the physiology of the eosinophil, and a current understanding of the pathophysiology and genetics of EoE. The emphasis is on clinical applications including presenting symptoms, diagnosis and treatment options for patients with EoE. Written by both pediatric and adult experts in the fields of gastroenterology, allergy and pathology, this volume includes the most up to date information. Providing practical information useful in the treatment of patients, this book will be of great value to gastroenterologists, allergists, pathologists, medical residents, fellows, internists, and general practitioners who treat patients with eosinophilic esophagitis.

Gastric secretions contain hydrogen ions at a concentration that is more than one million times higher than their intracellular concentration. This phenomenal gradient as well as the demonstrated ability of gastric juice to digest tissues has motivated clinicians and investigators alike to emphasize acid secretion and acid ablation in studying the pathogenesis and therapy of peptic ulcer disease. Conse quently, over the past 150 years, we have made considerable progress in under standing the mechanisms and regulation of acid secretion by the stomach. Not surprisingly, therapy for both peptic disease and mucosal injury has also been predominantly directed at either neutralizing acid or suppressing its production. During the past 10 years, attention has been focused on factors other than acid in the genesis and therapy of ulcer disease. Work done worldwide demon strated that acid hypersecretion is not a common event in peptic ulcer disease. Therefore, we began realizing that factors other than acid secretion may be important in the genesis of ulcer disease or in gastroduodenal mucosal damage. In addition, new physiological information has established that the gas troduodenal mucosa is normally protected by a complex series of events includ ing mucus and bicarbonate secretion, cell renewal, surface mucosal restitution, and preservation of the microvasculature and mucosal proliferative zone.

One of the major advances in the understanding of the mechanism of action of hormones, neurotransmitters and drugs had arisen from the hypothesis that the physiological or pharmacological responses are trig gered by their interaction with specific cell compo nents, termed receptors. However, the presence of receptors has been inferred from indirect data, and only recently has it been possible to study the kinetics of the interaction between drug and receptors directly, through the so called "binding technique. " This NATO-ASI on "Principles and Methods in Receptor Binding" was devoted mainly to the following aspects of the study of receptors: the principles underlying the use of the binding technique; the mathematical models necessary to interpret binding data; the application of binding methods to specific receptors; and, finally, a few selected examples of coupling between receptors and physiological re sponses. In the chapters of this book, special interest is devoted to the analysis of the simplest models for the interaction of receptors with their ligands (either hormones or neurotransmitters or drugs). The graphical techniques used to analyze the data from binding exper iments are extensively discussed, together with the statistics that have to be used in binding analysis. Moreover, the basic concepts to analyze binding data using a personal computer are presented. v vi PREFACE The factors which should be considered when setting up a binding assay (such as choice of ligand and incubation conditions, preparation of tissue, termina tion of incubation) are discussed."

This work, Essential Endocrinology: A Primer for Nonspecialists, is written with dual purposes in mind: first, to provide a framework of basic endocrinology and diabetology to the medical student, and second, to provide a quick, con cise, and handy "guide" to the junior residents in their early years of training who wish to obtain a working knowledge about endocrine disorders that affect their patients. One of the outstanding advantages of being a teacher of en docrinology to students and junior residents is that it bestows a perspective from a unique vantage point. Books written for the junior members of our profession have suffered from extremes of caliber, ranging from excellence beyond their comprehension to insufferable mediocrity. Textbooks in en docrinology that are simple enough to cover the principles of that speciality and yet comprehensive enough without treading into controversial quicksand are few and far between. This book is aimed at filling that gap and is written with no other criterion than simplifying a complex subject matter. From this touchstone, the work has never really departed. A decade of experience as a teacher and physician in the field of endo crinologyhas impressed on me that the process of "simplification" rests on four basic principles: an understanding of endocrine concepts, the application of these concepts to the understanding of diseases, the transference of knowl edge to clinical situations, and the integration of the patient with the labo ratory, the ultimate testing ground where clinical diagnoses stand or fall."

This book describes key knowledge concepts, skills and up-to-date algorithms pertaining to common emergencies that can take place in a pediatric office, including: seizures, anaphylaxis and shock, and diabetic ketoacidosis. The authors supported by peer review from top specialists in Pediatric Emergency Medicine at the Baylor College of Medicine offer the first comprehensive educational resource on pediatric office emergency preparedness devoted exclusively to the practicing primary care health care provider and his/her team. During emergencies, providers and their staff are called on to work efficiently as a "code-team" which is a source of considerable apprehension for many primary care pediatricians. This unique reference guide contains a wealth of information and resources in a compact and practical form. It presents the most important knowledge, skills, office resources and team interactions required by practitioners to successfully treat pediatric emergencies in the office.

As we move into the 21st century it is becoming increasingly difficult to offer appropriate introductory clinical experiences for medical students. Many schools offer clinical experiences in the first year of medical school, when the learner has little background in the traditions and origins of the doctor-patient interaction. Others begin this process in the second year, after a professional language base has been established, but concise educational materials are scarce that integrate the meaning of the privileged clinical encounter with the process and content of interviewing and examining patients. In the tertiary hospitals, where most medical schools are based, the educators must provide an orienta tion to the clinical encounter, an intensely personal experience, in the midst of glittering technological marvels that easily distract both the novice physician and the wizened teacher. Understanding the context and historical basis for the privilege of interviewing and examining another person about intimate matters relating to health and disease is essential to this process. Considering these factors, this textbook is written to assist medical educators and medical students involved in early clinical training. As the demand for "high-tech" medicine has accelerated, so has the public concern over the loss of "high-touch" or compassionate, humane interactions with physicians. Physicians are perceived as more concerned with readouts from machines and fiberoptic views of the patient than with understanding and car ing about the people we have labeled as patients."

The NATO-Advanced Research Workshop "Esterases, Lipases and Phospholipases: From Structure to Clinical Significance" was held at the University of Bordeaux II, France from 22nd- 24th September 1993 under the Directorship of Professor Michel Clerc of the University of Bordeaux II. The meeting was organised by Hugues Chap (INSERM U 326, Toulouse, France), Georges Ferard (University of Strasbourg, France), Wolfgang Junge (University of Kiel, Germany) and Michael Mackness (University of Manchester, UK). In recent years it has become increasingly apparent that hydrolytic enzymes of the esterase, lipase and phospholipase type play central roles in the pathophysiology of many human diseases. The purpose of this NATO-ARW was to bring together experts (both clinical and scientific) in all three interrelated fields to review the current basic and clinical position and discuss future developments particularly with respect to future research aimed at determining the basic biochemical lesion involving hydrolytic enzymes involved in human disease and the use of these enzymes in diagnosis. As well as formal lectures from established researchers, the meeting also involved a number of lively round-table discussions on future developments and presentations from younger research workers, all of which are recorded in this Proceedings and which contribute to the success of the meeting.

The intent of this book is to provide a practical approach to the recognition and therapy of selected outpatient problems faced by the internist, family practi tioner, house officer, physician's assistant, and nurse. The topics selected were based on problems often encountered by clinicians in the outpatient setting, as well as by the interests of the authors. No attempt was made to write an all encompassing textbook of infectious disease. We want to thank Dr. John Czachor, infectious disease fellow, Saint Vin cent Hospital, for his contributions to two chapters: mononucleosis and mono nucleosislike syndromes and selective laboratory studies. We want to thank Suzanne Hedstrom and Sharon Budzyna for typing and preparing the manuscript. Finally, we would like to give special recognition to our wives, Brenda, Roberta, and Bonnie, for their support during the preparation of this book. Richard A. Gleckman Nelson M. Gantz Richard B. Brown Worcester and Springfield v Contents 1 Immunization in Adults Richard B. Brown Definitions and Principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Immunization in Special Clinical Situations . . . . . . . . . . . . . . . . 5 Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 College Students and Military Recruits . . . . . . . . . . . . . . . . . 6 Health Care Personnel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Travelers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Vaccines of Especial Use to Travelers . . . . . . . . . . . . . . . . . . . . 7 Typhoid Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Yellow Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Cholera. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Japanese B Encephalitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Immune Serum Globulin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Strategies for Use of Other Commonly Employed Vaccines in Specific Clinical Situations . . . . . . . . . . . . . . . 9 Tetanus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Rabies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Pneumococcal Vaccine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Viral Influenza . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Hepatitis B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 vii viii CONTENTS 2 Infectious Disease Problems for the Traveler Richard B."

Throughout the world, scientists and the general with environmental illness. Part II presents an over public are concerned about the adverse effects of view of chemical and physical agents commonly toxic agents found in contaminated air, water, food, found in contaminated air, water, food, and soil. and soil. In the past, attention has focused on haz The problem of hazardous wastes is also discussed. ards originating in the workplace. As a consequence, Part III characterizes the body's defense against occupational medicine has become a well-recognized such exposure. Defenses at the portals of entry are and established clinical discipline. Much less atten discussed, with emphasis placed on the role of tion has been paid to nonoccupational hazards. There nutrition. Detoxication and immunologic defense is a growing awareness, however, of the dangers of mechanisms are described. Part IV indicates the exposure to toxic chemical and physical agents in importance of and provides instruction on the the homes, community, and general environment, method of including occupational and environmen especially for the fetus, the infant, the very young, tal factors in the routine medical history. The role of the elderly, and the chronically ill, those most sus enhanced susceptibility as a factor in an individual's ceptible. Environmental medicine, fOCUSing on the response to toxic exposure is discussed."

In the previous two volumes of this series, we presented classic problems in internal medicine as illustrated by actual cases cared for in our institution. It has been gratifying for us to see the interest that these volumes have generated with students and trainees. We remain committed to the case method of instruction, and believe that there is no better method to learn medicine than to have an individual patient problem as the basis for study of pathophysiology, natural history, diagnosis and management. We hope that our readers find this third volume as enjoyable and instructive as the editors found it. Juan M. Bowen, MD Ernest L. Mazzaferri, MD, FACP xiii Acknowledgement The editors are grateful to Jeff Smith and Jenny Riegler for their unflagging professionalism and patience. xiv Contents Case 1 Mitral Regurgitation - Chronic Versus Acute: Implications for Timing of Surgery * . * * * . . * . . . . . * . . . . . . . . . . . 1 Harisios Boudoulas, MD Charles F. Wooley, MD Advances and diagnostic imaging in a surgical technique have changed the approach to mitral valve regurgitation. This chapter provides an expert's perspective. Case 2 Cystic Fibrosis in Adults .. * ************ 36 Andrew Libertin, MD John S. Heintz, MD As children with cystic fibrosis grow into adulthood, the internist assumes a greater role in their care. Case 3 Thrombotic Thrombocytopenic Purpura . . . . . . . . . . 51 . . . Donald E. Thornton, MD Earl N. Metz, MD, FACP Patients with ITP continue to present difficulties in diagnosis and management. Two experts discuss the current approach to ITP.

Fundamentals of Clinical Practice, Second Edition presents medical students with a comprehensive guide to the social ramifications of a physician's work, and more experienced practitioners with the tools to augment their own patient-centered techniques.

One of the fascinations of psychiatry is that it is amenable to many different approaches. In seeking to account for mental disorder, for example, it is pos sible to explore the meaning and significance of symptoms in the psychody namic sense, to examine the social determinants of illness, or to adopt an es sentially biological viewpoint in investigating links between physiological and psychological dysfunction .. As a clinical discipline it may be practiced in the community, in the specialized clinic or hospital, or shoulder-to-shoulder with other medical practitioners in the general hospital. This richness and diversity are at once a strength and a weakness, attracting practitioners with a wide range of talents and interests, yet sometimes leading to polarizations and false an titheses. The so-called "medical model" of psychiatry has come under a good deal of attack, and deservedly so when claiming an exclusive provenance over all types and aspects of mental disorder. What cannot be gainsaid, however, is the central role of medicine in relation to many parts of the field, and the success in terms of understanding and therapy that has resulted from medicine's in volvement. Nor can it be doubted, after the most cursory acquaintance with the physically or mentally ill, that the relationship between these two forms of suffering is often so close and so mutually reinforcing that distinctions are drawn somewhat arbitrarily. This last is perhaps the cardinal reason for the alliance between medicine and psychiatry."

Although there are a number of excellent current reviews on one or another aspect of cytomegalovirus, the last comprehensive treatment of this subject was that of Krech et al. (197la). In view of the amazing advances in the virological, epidemiologic, and clinical knowledge of cytomegaloviruses, an up-to-date book is needed. Such a work should cover many areas of expertise and a voluminous technical literature. Each area might have been reviewed and analyzed by workers more expert than myself. However, I have embarked on the entire venture alone in order to attain unity and continuity in this book, characteristics that are not easily achieved in the more popular multiauthored works. I have tried to review the Iiterature and provide a critical summary for each area discussed. To do this, I provide as much of the primary data of the relevant works as needed and not just the qualitative conclusions. Inevitably, the flow of the narrative may be interrupted by dry facts and figures. However, such information is essential to make this a meaningful reference work. But for those not interested in such details, I have provided at what I hope are crucial points critiques and summaries. This book is not an exhaustive review of all the literature. This is probably no Ionger possible or even desirable. By selection, however, one runs the risk of having missed or ignored important papers. I am keenly aware of this, and I wish to apologize for such oversight, if that is possible.

Minorities and Cancer broadly surveys the problem of cancer in minority communities. Leading epidemiologists discuss cancer incidence and mortality in minority populations, including black Americans, Hispanics, American Indians, and Asian Americans. Major sections review cancer prevention and detection programs available to the private practice physician and the community, research findings on cancer in minority groups, and cancer treatment. The final chapters summarize the problem and its possible solutions as perceived by leaders at the American Cancer Society, the National Cancer Institute, the Office of Minority Health Affairs of the Department of Health and Human Services, and Meharry Medical College, a leading minority medical school in the United States.

Prepare for success in today's fast-paced, collaborative healthcare environment! Offering expert perspectives from a variety of primary care and nurse practitioners, Primary Care: A Collaborative Practice, 5th Edition helps you diagnose, treat, and manage hundreds of adult disorders. Care recommendations indicate when to consult with physicians or specialists, and when to refer patients to an emergency facility. This edition includes six new chapters, a fresh new design, the latest evidence-based guidelines, and a new emphasis on clinical reasoning. Combining academic and clinical expertise, an author team led by Terry Mahan Buttaro shows NPs how to provide effective, truly interdisciplinary health care. UNIQUE! A collaborative perspective promotes seamless continuity of care, with chapters written by NPs, physicians, PAs, and other primary care providers. Comprehensive, evidence-based content covers every major disorder of adults seen in the outpatient office setting, reflects today's best practices, and includes the knowledge you need for the NP/DNP level of practice. A consistent format in each chapter is used to describe disorders, facilitating easier learning and quick clinical reference. Diagnostics and Differential Diagnosis boxes provide a quick reference for diagnosing disorders and making care management decisions. Complementary and alternative therapies are addressed where supported by solid research evidence. Referral icons highlight situations calling for specialist referral or emergency referral. NEW chapters cover topics including transitional care, risk management, LGBTQ patient care, bullous pemphigoid, pulmonary embolism, and dysphagia. NEW! An emphasis on clinical reasoning helps you develop skills in diagnosis and treatment, with coverage moving away from pathophysiology and toward diagnostic reasoning and disease management - including pharmacologic management. NEW focus on interdisciplinary care underscores the importance of interprofessional education and practice, and includes Interdisciplinary Management features. UPDATED chapters reflect the latest literature and evidence-based treatment guidelines, including new content on the Affordable Care Act as well as new coverage of patient satisfaction metrics, quality metrics, value-based purchasing, pharmacogenetics/genomics, and teen pregnancy and abnormal pregnancy. NEW quick-reference features make it easier to locate important information, through colorful section tabs, bulleted summaries, additional algorithms, a more logical table of contents, an Index to Standardized Treatment Guidelines, and a Reference to Common Laboratory Values.

Systemic Method Mark B. Mengel, M. D. , M. P. H. Learning Objectives 3 The Biomedical Model 6 A New Framework: The Systemic Patient-Centered Method 9 Physician Roles Patient Roles 22 Patient-Centered Clinical Decision-Making Data Base Responding to Patient Cues Constructing a Mutually Agreeable Plan The Systemic Patient-Centered Method: Other Concerns Changing Larger Systems Ethics of the Systemic Patient-Centered Method Efficacy of the Systemic Patient-Centered Method 32 Safety of the Systemic Patient-Centered Method Conclusion Cases for Discussion Recommended Readings XV 36 34 32 32 31 30 30 27 25 23 16 10 Patient-Centered The 1: Chapter !iiiii!i !ili !iil !i!i !iii !iii iiii !iiiii!i !iii !iil !iii!ii! !i!i!iiiiiii !i!i !i!i!iil ii!i !i!i !iii iiii!iiiiiii !ill !i!i!iii !iii !i!i !i!ilili!iii iiii !iil i!ii iili iii! i!ii ii!i i!ii iiii iiil iiiiiii! iiii iiiiii!iiiiiiiiiii!iiii!iiii iiii iiii ii!i iiiiii!i!i!iiiiiiiii !iii iiii iiiiiiiiii!i iiiiiiiiiiii iiiiiiii iiiiiiiiiiiiii!i iiii iiii iiiiiiii iiiiiiil iii!iiii iii! iiii iiii i!i! ilil iiii iiii iiii iiii iiii iiii iiii iiiiiiii iiii!iiiiiii iiii !iiiiiii iiii iiiiii!i iiii !iii !iiii!iii!i ii!i ii!i iiil iiii !i!i!iiiii!i!ill iiiiiiii! i!i iiii iili ii!i iiiiii!i iliiii!i iili iiiiiiiiiiililil iiii iiil ilil iliiiiiiiiiiiiii ilii ilii iiii iiii iiii iiii iiii iiiiiiii ilil i!il iiil iiii ii ii iiiiiiii iiiiiiii iiii !i !i!i !i!i !i!i !i!i !i!i !i!i !i!i !i!i !ill !i!i !i!iii!iii!i !i!i !i!i !!ii !iil !iii !iii !iii !i!i iiiiiiiiiiiiiiiiiiiiii!iii!i ililili! iii iiii iiii iiiil iii iiiil iiii iiii iiii xvi Part II.

Motility is a fundamental property of living systems, from the cytoplasmic streaming of unicellular organisms to the most highly differentiated and devel oped contractile system of higher organisms, striated muscle. Research on var ious aspects of motile systems in muscle and undifferentiated or non muscle cells has been developing at an ever more rapid pace in the laboratories of investiga tors with a wide variety of backgrounds using methodologies varying from me chanics to the most sophisticated physical measurements. Significant contri butions to our understanding of motility are coming from the disciplines of cell biology, biochemistry, pharmacology, molecular biology, biophysics, and physiology. The findings have relevance not only to basic scientists but to clinicians in such diverse fields as cardiology and neurology and to scientists in the more traditional physical sciences. Cell and Muscle Motility is a new multivolume series of essays by distinguished research workers in various fields whose work has a common thread of dealing with one aspect or another of motility. The essays are meant to focus on topics of current interest, to be critical rather than exhaustive, and to indicate the current trends of research efforts. The series is intended to foster an interchange of concepts among various workers in the field and to serve as a reference for students and workers who wish to familiarize themselves with the most current progress in motility.

The book opens with a summary on the main theories representative of human error, such as: "Bad Apples Theory", "Normal Accident Theories" and "High Reliability Organizations Theory". Following this, the authors define mistakes in the diagnostic process, identifying their major causes and suggesting several principles for optimal, bias-free diagnoses. Evidence is presented which supports the idea that the Common Assessment Framework is a total quality management tool that public organizations can use for free for their self-assessment, aiming to improving their administrative capacity and services without having to ask for support from external sources. An analytical exploration of patient advocacy related to patient safety and the concept of a "Theory-Practice-Ethics gap" is presented, reinforcing the importance of their synonymous relationship for trustworthy healthcare practices. The concluding chapter proposes that inline fluid warming devices must employ the safest technology to ensure patients are not exposed to additional risks during the active warming of infused fluids.

A successful seientific career requires constant effort on the part of the seientist. If such a career is to be achieved by seientists in developing countries where the faeilities are not easily available, even more dedication is required. Dr. K. M. Sivanandaiah, having completed a successful career in the field of peptide chemistry, is such a seientist. Being weIl aware of the limited research facilities available in India, we are extraordinarily appreciative of Professor Sivanandaiah's dedication to the advancement of science. As a Professor of Chemistry and, until his retirement in 1992, the Head of the Department of Studies in Chemistry at Bangalore University, India, he not only devoted much of his time to his students, teaching basic organic chemistry, but was also able to contribute to the field of peptide chemistry. After completing 25 years of service at Central College, Bangalore, where he was admired as an outstanding teacher, Professor Sivanandaiah is still active in research. He is now Professor Emeritus and continues to contribute to the field of peptides. As former students of Professor Sivanandaiah, we felt that publishing a book containing articles related to the design, synthesis, conformation, and biological activity of peptides and written by eminent scientists in the field of peptide research would be a fitting tribute to his role in the field of bioorganic chemistry.

Read with two objectives: first, to acquaint yourself with the current knowledge of a subject and the steps by which it has been reached; and secondly, and more important, read to understand and analyze your cases. William Osler, The Student Life What follows is a collection of cases-or more aptly, the stories of our patients and friends who have been seen at The Ohio State University Hospitals where our faculty have provided their care and about whom this volume is written. Today many fear that our patients are being moved from center stage while we are being distracted by the technology of medicine. This volume was written with patients in mind. The idea is that the most intriguing questions and the most rewarding answers begin and end at the bedside. This is a story of our patients, told by expert clinicians and spiced with commentary along the way. This volume in no way at tempts to be comprehensive. Instead, it is like the practice of medicine, scattered, somewhat disjointed, while at the same time intensely personal and focused upon whatever problem the patient brings to us. The discussions are not so much about disease entities as they are about patients with problem." The two are uniquely dif ferent. For instance, when the physician suspects hepatitis, not every imaginable cause can be actively investigated. Instead, tests and procedures are discriminate ly chosen, a part of medicine that is still more art than science."

This volume provides in a conveniently accessible package a comprehensive collection of accurate and timely information on the management of patients with diarrhea, both in pediatric age and in the adult. As medical knowledge has recently expanded in this area, this volume is full of new practical, clinically useful material for the busy clinician. Illustrations are emphasized to permit rapid acquisition of practical information that is not readily available in the major texts. Each chapter is concise, concentrating on "clinical pearls," and new advances in diagnostic and therapeutic technology. Each chapter discusses the relative costs of diagnostic and therapeutic options to permit financial considerations to be taken into account in the decision making process. Additional unique features include, summaries of key points, recommendations, and indications for requesting GI subspecialty consultation. Providing a comprehensive but practical overview of the issues surrounding the diarrheal diseases, this volume will prove of great value and utility to gastroenterologists, surgeons, internists, primary care physicians.

Oncology has developed as a subspecialty of medicine with unique and often complex clinical problems. This handbook ofhematologic and oncologic emer gencies provides a compact, concise, yet comprehensive guide to the manage ment of a variety of difficult clinical situations. The authors of the various chapters are all clinicians with experience in the management of these difficult patients. Their efforts provide insight and a ready source of practical infor mation which lends itself to use in the clinic and in the inpatient ward. The authors sincerely hope that this handbook will be of service to house officers and fellows alike, as they develop skills in the management of the emergent problems of patients with hematologic and other neoplasms. Janice P. Dutcher Peter H. Wiernik Bronx, New York;; Contents 1. Syndrome of Inappropriate Antidiuretic Hormone Secretion and Hyponatremia . . . . . . . . . . . . . . . . . . . . . . . . 000 . . . . . . . . . . . Stuart L. Marcus, M.D., Ph.D., and Joachim Z. Fuks, M.D. 1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2. Mechanisms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 3. Etiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 4. Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 5. Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 2. Acute Tumor Lysis Syndrome: Prevention and Management . . 9 Stuart L. Marcus, M.D., Ph.D., and Avi I. Einz;ig, M.D. 1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 2. Risk Factors for the Development of Azotemia in Acute Tumor Lysis Syndrome........................................... 10 3. Metabolic Abnormalities That Occur during Acute Tumor Lysis Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 . . . . . . . . . . . . . . 4. Prevention of Acute Tumor Lysis Syndrome: Management prior to Beginning Chemotherapy . . . . . . . . . . . . . . . . . . . . . . . . . 13 . . . . . . . . . . 5. Posttreatment Management: Indications for Dialysis . . . . . . . . . . 14 . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 . . . . . . . . . . . . . ."