This book has been written to provide general practitioners with an easy to read, easy to consult guide, to aid in the management of the large majority of practice emer gencies. Each presenting problem is approached logically with telephone assessment and advice followed by the assessment and management necessary when the patient is seen. The emphasis is on practical primary care with discussion of differential diagnosis only taken as far as is needed for deciding the best immediate course of action. Words are kept to a minimum though tables are liberally used to summarise useful information. For each situation the final management advice is highlighted by being presented within a heavily lined box. Our guiding principles for emergency care, which this book naturally reflects, are: (1) Visit first - argue or educate later. (2) If in doubt - see the patient. To use this book for ready reference by the telephone, in the car, or at the bedside: (i) If the patient is a child, look at the contents list at the beginning of chapter 4 and then turn to the relevant pages. (ii) If the patient is an adult, first decide the system involved then look at the contents list at the beginning of the appropriate chapter before turning to the relevant pages."

International researchers summarize the current understanding of peptic disease and trace the development of a novel new drug for peptic disease therapy-sucralfate. Contributors present laboratory research along side data from clinical trials as well as from the practice of medicine. Articles discuss the history of sucralfate's development, mechanisms of action, clinical efficacy, and future directions for research. This volume will be of interest to scientists and clinicians working in gastroenterology and gastrointestinal physiology.

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.

Cells have evolved multiple strategies to adapt the composItIon and quality of their protein equipment to needs imposed by changing conditions within the organism. Extracellular stimuli that inform cells about such needs are hormones, cytokines and neurotransmitters, which bind to specific cell surface receptors. Inside the cell, secondary signals are then produced which, ultimately, initiate the expression of proteins giving novel functional properties to the stimulated cells. This process can be controlled at a transcriptional, posttranscriptional, translational or posttranslational level. Extensive research over the past fifteen years has shown that transcriptional regulation is probably the most impor- tant strategy used to control the production of new proteins in response to hormonal signals. At the level of gene transcription, the initiation of mRNA synthesis is most frequently used to govern gene expression. The key elements controlling transcription initiation in eukaryotes are acti- vator proteins (transactivators) that bind in a sequence-specific manner to short DNA sequences in the proximity of genes. The activator binding sites are elements oflarger control units, called promoters and enhancers, which bind many distinct proteins that may synergize or negatively cooperative with the activators. The de novo binding of an activator to DNA or, if already bound to DNA, its functional activation is what ultimately turns on a high-level expression of genes. In this second volume of Inducible Gene Expression, leading scientists in the field review eight eukaryotic transactivators that allow cells to respond to hormonal stimuli by the expression of new proteins.

The philosophy of this NATO Advanced Research Workshop and the monograph it has yielded is that if you put a small number of very talented and creative scientists of different backgrounds and documented accomplishments together in a cloistered place for a few days to consider a very important and timely topic, many new ideas will be generated. The keynote of this conference was the Future. By this we mean the expected future developments of highly reliable sequential quantitative measurements of atherosclerotic plaque size and components in living human subjects. Some of the best minds and the most experienced and talented individuals at the leading edges of imaging of arteries were involved; some of the best scientists and students of the atherosclerotic plaque and its components participated; and some of the leading investigators of the cell biology or, as we call it in the USA, the pathobiology of atherosclerosis, contributed important new information. All of these individuals were actively involved in the conference and each obviously had carefully prepared and was able to communicate effectively.

Most of us spend at least two-thirds of our lives either sitting or standing. It is somewhat surprising, therefore, to find not a single book devoted to disorders caused by derangements of the normal physiological adjustments to changes in posture. In fact, until very recently, medical students have not even been advised to measure the blood pressure and heart rate in the upright posture as part of the routine physical examination. Although Bradbury and Eggleston first described orthostatic hypotension as a consequence of autonomic insufficiency in 1925, interest in orthostatic disorders has been slow to develop in the subsequent years. It is well known that the change from recumbency to the standing posture stimulates neurological, endocrine, and cardiovascular adjustments that ensure maintenance of a normal circulation despite the effects of gravitational forces. The mechanisms of these physiological responses to orthostasis have been stud ied by many investigators. Some of the defects to which antigravitational com pensatory mechanisms are subject, such as postural hypotension resulting from autonomic failure, have been studied intensively and have become part of the general knowledge of most medical practitioners. Other orthostatic disorders such as various other postural abnormalities of blood pressure control, and orthostatic edema-have received far less attention and have been unable to compete with the more dramatic and life-threatening ailments of humankind for a place in our standard medical texts. These disorders often give rise to distressing symptoms and may lead to severe impairment of health.

The understanding of pain has undergone extraordinary development over the last 25 years. Half of all medical visits are initiated because of pain. The need for all clinicians and trainees to have a foundational knowledge of pain has become more critically important than ever. Not surprisingly, most books on pain medicine are almost all written by "pain management doctors," physicians who've trained in "pain medicine" and devote their lives to treating pain. However, the burden of pain extends to all doctors, not just those who treat it every day. Managing Pain: Essentials of Diagnosis and Treatment offers a fundamental guide on the diagnosis and therapy of frequently encountered pain conditions for non-pain physicians and clinicians. Written using easily-accessible language, this book first reviews the basics of opioids and other therapies, including psychotherapy and complementary modalities. The second part of the book presents clinically-relevant cases chosen to reflect those conditions most frequently encountered by primary care providers. Edited by world-renowned experts in pain medicine, with many chapters written by non-pain physicians who are experts in their respective specialties, Managing Pain: Essentials of Diagnosis and Treatment is a useful guide for the non-pain-trained healthcare provider who is on the frontlines treating chronic pain.

This monograph is intended to compile the lectures presented at the 4th Annual Symposium "Cardiac Surgery:1992" held at the Frenchman's Reef Beach Resort, St. Thomas, US Virgin Islands, November 7-10, 1991. This symposium was organized by the Division of Cardiothoracic Surgery and the School of Cardiovascular Perfusion, Cooper Hospital/University Medical Center, Camden, New Jersey and sponsored by the University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School at Camden, Philadelphia Academy of Cardiovascular Perfusion and the American Society of Extracorporeal Technology -Region II. The symposium was devoted to cardiothoracic surgeons, cardiologists, cardiovascular perfusionists, and nurses involved in the management of the cardiac surgical patient. Therefore, the context of the book represents the multidisciplinary nature of cardiac surgery at its present level of development. The contributors to this book have critically examined their experience and discussed controversial issues regarding cardiac pathophysiology, surgical indications, operative techniques, and long term care and outcome. The co-editors wish to express their gratitude for the contributors' efforts in the production of this manuscript. We would also like to thank the members of the Organizing Committee, Jane V. Stewart MSN, RN, CCRN, Roger A. Vertrees BA, CCP, Rosemary Volosin, MSN, RN, Rosemary Morrone and Paul R. Cappola BS, CCP, who have greatly contributed to the success of the symposium."

The topics in this book represent the presentations given at the Fifth Annual Meeting entitled "Cardiac Surgery: Current Issues" held at the Frenchman's Reef Beach Resort, St. Thomas, U.S. Virgin Islands, November 18-20, 1993. This symposium was sponsored by the Division of Cardiothoracic Surgery, the School of Cardiovascular Perfusion and the Department of Nursing Education and Quality Assurance of Cooper Hospital/University Medical Center, the University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Camden, New Jersey, as well as the Academy of Medicine of New Jersey. Chapter authors were charged with the task of writing brief overviews of major issues related to the field of cardiac surgery. The book is specifically tailored to the needs of cardiothoracic surgeons, cardiovascular perfusion ists, allied health professionals and nursing personnel involved in all phases of caring for the cardiac surgical patient. Although intended as a reference source with emphasis on up-dated approaches applied in cardiac surgery, it is hoped that the discussion of these topiCS will compliment other texts and manuscripts. Obviously, a book of this length cannot cover the whole multidisciplinary and complex field of cardiac surgery. However, co-editors are certain that the annual appearance of this text will highlight comprehensive, new and Interesting approaches to the field of cardiac surgery."

This volume is the third in the Contemporary Geriatric Medicine series. As in previous volumes, information is presented in the form of easy-to read essays to bring the reader up to date on state-of-the-art develop ments in the area of geriatric medicine. Once again, a system approach is utilized. In addition, several new topics-including alcoholism, throm boembolic disease, and decubitus ulcer management-have been intro duced to enhance this volume's usefulness to the busy clinician and student. Each chapter is not meant to be an exhaustive review of all topics in the field, but rather to focus on issues currently receiving a great deal of attention. Our goal continues to be to create an exciting approach to contemporary issues in geriatric medicine. The editors are once again appreciative for having been given the opportunity to develop this series. Appreciation is also expressed to our professional colleagues, families, and administrative assistants, who have enabled this volume to reach fruition. As in the past, we thank, most of all, our elderly patients for providing the inspiration and impetus to improve our knowledge and understanding of the health care needs of the elderly. Steven R. Gambert, M.D. V alhalla, New York ix Contents Chapter 1 Geriatric Cardiology and Blood Pressure 1 Edmund H. Duthie, Jr., and Michael H. Keelan, Jr."

A solution to the protein folding problem has eluded researchers for more than 30 years. The stakes are high. Such a solution will make 40,000 more tertiary structures available for immediate study by translating the DNA sequence information in the sequence databases into three-dimensional protein structures. This translation will be indispensable for the analy sis of results from the Human Genome Project, de novo protein design, and many other areas of biotechnological research. Finally, an in-depth study of the rules of protein folding should provide vital clues to the protein fold ing process. The search for these rules is therefore an important objective for theoretical molecular biology. Both experimental and theoretical ap proaches have been used in the search for a solution, with many promising results but no general solution. In recent years, there has been an exponen tial increase in the power of computers. This has triggered an incredible outburst of theoretical approaches to solving the protein folding problem ranging from molecular dynamics-based studies of proteins in solution to the actual prediction of protein structures from first principles. This volume attempts to present a concise overview of these advances. Adrian Roitberg and Ron Elber describe the locally enhanced sam pling/simulated annealing conformational search algorithm (Chapter 1), which is potentially useful for the rapid conformational search of larger molecular systems."

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.

Why another series on infectious disease? The question is a fair one in view of the proliferation of monographs, texts, and periodicals on the vast subject of infectious disease. The goal of this series is to provide an additional service to the clinician in the form of clinical information not usually assembled in one convenient volume. One type of monograph presented in this series will cover a specific infection, detailing microbiologic, research and clinical aspects. It is hoped that such a compilation will be helpful in both its thoroughness and breadth to the clinician interested in this particular problem. The other type of monograph that this series will provide will discuss a clinical presentation that comprises many possible specific etiologies. Volumes in the series will be multiauthored, giving us the opportunity to invite authorities in each specific area to contribute their expertise and experience. Regular revisions are planned so that each volume will remain as current as it is thorough. We hope that our goals are met and that the present series of mono graphs establishes its own identifiable and valuable niche in the growing compendium of resource material available to the clinician. Preface to the Second Edition Since the first edition of Infectious Mononucleosis was published, we have seen exciting advances in our understanding of this disease."

DDDDDDDDDDDD Effective management logically follows accurate diagnosis. Such logic often is difficult to apply in practice. Absolute diagnostic accuracy may not be possible, particularly in the field of primary care, when management has to be on analysis of symptoms and on knowledge of the individual patient and family. This series follows that on Problems in Practice which was concerned more with diagnosis in the widest sense and this series deals more definitively with general care and specific treatment of symptoms and diseases. Good management must include knowledge of the nature, course and outcome of the conditions, as well as prominent clinical features and assess ment and investigations, but the emphasis is on what to do best for the patient. Family medical practitioners have particular difficulties and advantages in their work. Because they often work in professional isolation in the com munity and deal with relatively small numbers of near-normal patients their experience with the more serious and more rare conditions is restricted. They find it difficult to remain up-to-date with medical advances and even more difficult to decide on the suitability and application of new and rela tively untried methods compared with those that are 'old' and well proven. Their advantages are that because of long-term continuous care for their patients they have come to know them and their families well and are able to become familiar with the more common and less serious diseases of their communities."

This book has been designed, as its title implies, as a practical book for medical practitioners, although it should be of interest to medical students and nutritionists. It attempts to provide essential information about this important group of substances rather than be an all embracing monograph on the subject. For this reason biochemical and physiological considera tions have been kept to a minimum, and aspects of animal disorders and animal husbandry have not been considered. The material is often presented in a rather dogmatic fashion and, with rare exceptions, references are not included since this makes reading more difficult. The exceptions, where references are provided, are the therapeutic claims, and the series of recent studies which have indicated that vitamin deficiencies are still widely present among certain groups of the population of many industrially developed countries. To add to this reference list there is a reading list which has been selected to give key books, reviews with extensive bibliography and important articles over the past 10 years. From this reading list it is possible to trace most of the literature on the vitamins since they were first described over half a century ago."

In their second year in medical school, students begin to learn about the differences between "disease" and "illness." In their studies of pathology they learn to understand disease as pertubations of molecular biological events. And we clinicians can show disease to them by our scans, lay it out even on our genetic scrolls, and sometimes even point out the errant nucleotide. Disease satisfies them and us; at Yale, lectures on the gastrointestinal tract run from achalasia to proctitis. There is, alas, little mention of functional bowel disease or of the irritable or spastic colon, for that is not easy to show on hard copy. Functional bowel disease represents "illness," the response of the person to distress, to food, to the environment, and to the existential problems of living. In real life such matters are most important. Richard Cabot first found out at the Massachusetts General Hospital almost a century ago that 50% of the patients attending the outpatient clinic had "functional" complaints. The figure had grown to over 80% when the very same question was reexamined 60 years later.

The contributions to this volume were presented at a Symposium entitled "Current Topics in Muscle and Nonmuscle Motility" held in Dallas 19-21 November 1980 under the auspices of the A. Webb Roberts Center for Con tinuing Education, Baylor University Medical Center Dallas, and the Univer sity of Texas Health Science Center at Dallas. This very useful opportunity for a group of active investigators in motility to meet and discuss their latest findings was made possible in part by the income from an endowment fund established by a generous gift from Dr. Albert P. D'Errico in the Baylor University Medical Center. Dr. D'Errico was the first formally-trained neurosurgeon to practice in the Dallas area, the first Chief of Neurological Surgery, and a member of the Medical Board of the Baylor University Medi cal Center Dallas (1947 -1964). The income from this fund is used to promote the dissemination of up-to-date information in the Neurosciences, to provide intellectual stimulation, to add to the fund of knowledge, and improve the skills of neurosurgeons, neurologists, internists, and others in specialized fields of medicine. We are all indebted for this generous gift that made this enriching educational experience possible. We are also grateful for support the Symposium received from Electron Microscopy Sciences, Forma Scien tific, J. E. O. L. USA, Inc. , Ladd Research Industries, M. J. O. Diatome Co. , Or ganon Co. , Upjohn Co. , G. D. Searle & Co. , and Smith, Kline and French. Robert M.

During the past five years there has been a reawakening of interest in the psychotherapy of patients with medical disorders characterized as psychosomatic. For three decades, psychoanalysis and psychoanalytic psychotherapy were used extensively to treat and study psychosomatic disorders. Early in the 1960s, interest in this approach to these conditions faded, and the .Psychosomatic Service. in most hospitals became the .Consultation Liaison Service. (Lipowski, 1967). The recent focus of biofeedback on psychosomatic conditions provides a new technique with which the physician or psychiatrist may treat these patients (Rickles, 1981). In addition, the successful application of biofeedback training to a variety of complaints such as those presented in this volume has heralded the addition of biofeedback to the treatment modalities used for medical complaints. Frequently, psychological factors can still be seen; for example, when biofeedback treatment may require lifestyle changes on the part of the patient, the exploration of secondary gains or resistances before the disorder can be success fully treated, and the establishment of rapport and empathy which is so important for truly effective biofeedback training. Aside from certain psychological dimensions that are always present in biofeed back training, in this case biofeedback is being used in a primarily medical setting for primarily medical complaints."

In the last two years, a wealth of new information has accumulated regarding both clinical and research aspects of health care for the elderly. Although many controversial issues have been resolved, many still remain. Volume 2 of Contemporary Geriatric Medicine is once again dedicated to the clinician who cares for the elderly on a continuing basis. Although, for the most part, general topics first introduced in Volume 1 have been retained, all infor mation in this volume is new and represents the current state of the art. In addi tion, several new topics-including falls, interpretation of laboratory data, and oral health care-have been introduced to enhance this volume's usefulness to the busy clinician. Through these easy-to-read essays, we attempt once again to keep the non geriatrician abreast of the current state of the art regarding the special needs and problems of the elderly. Each chapter is not meant to be an exhaustive review of all topics in the field, but rather to focus on issues receiving a great deal of atten tion. Our goal is to create an exciting approach to contemporary issues in gerIatric medicine."

Few diagnostic methods in Cardiology have heralded such revolutionary developments as the introduction of coronary arteriography. When, in the early 1960's, Dr. F. Mason Sones demonstrated that visualization of the coronary anatomy in living humans was not only feasible but sufficiently safe and reliable to be used as a clinical tool in the evaluation of patients with known or suspected ischemic heart disease, the thus far somewhat neglected area of coronary circulation became the focus of interest. Naturally, for a considerable period of time a great deal of emphasis was placed upon coronary anatomy. Simple relations between narrowing lesions, impediment to flow, and prognosis were assumed to exist. Spectacular results of surgical coronary revascularization seemed to confirm this concept. Gradually it has become evident that the pathophysiology of coronary artery disease is considerably more complex. Diagnostic methods were introduced to assess and quantify exercise-induced myocardial ischemia. At first, these tests were used mainly to achieve a more discriminative selection of candidates for coronary arteriography and the coronary arteriogram remained the gold standard. Currently, these techniques have evolved to the point where they provide valuable functional and metabolic information. They have become powerful independent tools in clinical investigations and evaluation of individual patients.

This book is written for medical students and house officers working on the wards, in the intensive care unit, and in the emergency room. It is intended for use by all whose work involves the daily evaluation and management of medical emergencies. The material is a compilation of information gained from our personal experiences in clinical practice, from participation in professional meet ings and conferences, and from searching the medical literature. The introductory chapters in Part I form a foundation that is devel oped in the subsequent parts where specific topics are discussed. When possible, we have simplified complex approaches to diagnosis and man agement by formulating algorithms and handy reference tables. Since this is a handbook and not a textbook, we have limited our discussion of pathogenesis and pathophysiology in order to concentrate on practical aspects and specific details that are useful in the diagnosis and management of pulmonary emergencies. Our aim is to alert young physicians to common pulmonary emergencies and guide them through their initial management."

The Fourth International Congress of Peritoneal Dialysis was held in Venice, Italy, June 29 to July 2, 1987. By this time peritoneal dialysis had emerged as a treatment for a substantial fraction of patients with end-stage renal disease and countless numbers of patients with acute renal failure. This treatment is now practiced worldwide and is the life-sustaining treatment for about 40,000 patients with chronic renal failure, representing 15 to 20% of dialysis therapy in about 1000 centers. It is not surprising, therefore, that the number of health professionals engaged in the investigation and the application of the treatment has also grown exponen tially. The First International Symposium on Peritoneal Dialysis, organized by Dr. A. Treviiio-Be cerra in Chapala, Mexico, in 1978, brought together a group of pioneers when continuous ambulatory peritoneal dialysis was in its infancy. In 1981, Dr. G. M. Gahl chaired the Second Symposium, in West Berlin, when the technique and professional interest were growing con siderably. By 1984, when Dr. 1. F. Winchester and I organized the Third Symposium, the pre sented papers exceeded 100 and there were about 1000 attendees. At that time, it was deemed appropriate to form a more organized group and the International Society for Peritoneal Dialy sis was founded. One of the first actions of the Society was to choose from among several applicants Dr."

As 'seasoned campaigners' we offer our readers more than 60 joint practice years of commonsense experience on children and their prob lems. Child care is a large and fascinating part of general family practice. More than any other discipline it is a mix of understanding the wide range of normal and abnormal development, of skilful diagnosis and treatment of treatable conditions, of long-term care for handicapped children, and of organizing and carrying out prevention. F or all this and more the physician has to rely on sound knowledge and understanding of the child, parents, family, social and community conditions, available services and the likely natural history of the condition - and to dispense all this with humanity, sense and sensi bility. We have divided the book logically into 6 sections: (I) Factual background. (2) Universal problems of behaviour and development. (3) Common clinical disorders, so frequent and yet often so dif ficult to manage. (4) Social, family and community factors that create and influ ence many problems of childhood. (5) How to use available services and resources with discrimina tion and sensitivity. (6) The importance of understanding and managing the whole child. We have no single group of readers in mind. We hope that our views will be appreciated, for example, by parents, nurses, health visitors, general practitioners, community physicians and paedia tricians - in fact all who care for children."

Starting in 1986, the European School of Oncology has expanded its activities in postgraduate teaching, which consisted mainly of traditional disease-orientated courses, by promoting new educational initiatives. One of these is the cloister seminars, short meetings intended for highly qualified oncologists and dealing with specific, controversial aspects of clinical practice and research. Another is the institution of permanent study groups, also called task forces, where a limited number of leading experts are invited to meet once a year with the aim of defining the state of the art and possibly reaching a consensus on developments and treatment in specific fields of oncology. This series of ESO Monographs was designed with the specific purpose of disseminating the results of the most interesting of the seminars and study groups, and providing concise and updated reviews of the subjects discussed. It wa& decided to keep the layout very simple in order to keep costs to a minimum and make the monographs available in the shortest possible time, thus overcoming a common problem in medical literature: that of the material being outdated even before publication.

The literature of medicine continues to expand at a remarkable pace. The number of papers and monographs published has increased dramatically in the past five years. Nowhere has this increase been as dramatic as in the field of acute and chronic hepatitis. Why then should there be still another book? Despite the sheer volume of words published, it is still difficult to find in anyone volume a compilation of all of the most significant work. Most mono graphs have considered either chronic or acute hepatitis, not both. Few works have addressed both the clinician and the basic scientist. This book addresses both of these audiences and considers both of these diseases. It was designed to provide an authoritative but concise assessment of our changing concepts of acute and chronic hepatitis. It covers what is currently known and, based on the most convincing research, believed about these diseases. To fulfill this ambitious goal, only authors with international reputations in their fields of expertise were invited to contribute. In the evolution of our current thoughts on the pathogenesis and manage ment of acute and chronic hepatitis, our ideas have changed several times. This book presents the facts as they are known today and, in areas where all the facts are not established, presents the well-founded opinions of those considered to be authorities. The authors present established and usually confirmed data and do not deal extensively with areas of speculation or unconfirmed material."