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.

Amid the ongoing changes in how health care is administered and financed, prevention-oriented care is a critical and cost-effective method for improving population health through primary care. As the key figure in promoting patients' health and prevention of disease, the primary care provider can play a major role in patient engagement, self-management, and behavior change. Prevention Practice in Primary Care systematically explores state-of-the-art practical approaches to effective prevention in primary care. Guided by theory and evidence, the book reviews approaches to risk factor identification and modification for the major causes of mortality in adulthood, including cancer, stroke, and cardiovascular disease. Topical coverage in this book includes: * the practical applications of genomics and proteomics to personalizing prevention * transformative approaches to practice change, including the patient-centered medical home, academic detailing, and practice facilitation * Engaging self-management and behavior change using counseling tools (goal setting, assessing the stage of change, motivational interviewing, and the five A's) Prevention Practice in Primary Care is a vital, practical guidebook for the implementation of evidence-based prevention to improve patient health. Brief, simple summaries and innovative content make it book a valuable reference for busy practitioners and students alike.

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."

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.

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."

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.

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.

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.

One million people in the United States suffer from systemic lupus erythematosus (SLE or lupus), a chronic autoimmune disease that is potentially debilitating and sometimes fatal as the immune system attacks the body's cells and tissue, resulting in inflammation and tissue damage. SLE can affect any part of the body, but most often damages the heart, joints, skin, lungs, blood vessels, liver, kidneys and nervous system. The course of the disease is unpredictable, with periods of illness alternating with remission. It can be treated symptomatically, mainly with corticosteroids and immunosuppressants, though there is currently no cure. The symptoms of lupus vary widely, come and go unpredictably, and often mimic or are mistaken for other illnesses. As a result, patients present with varied symptoms to different practitioners and diagnosis can be elusive, with patients sometimes suffering unexplained symptoms and untreated lupus for years. Hence, a practical guide to the diagnosis and treatment of lupus is a valuable resource to an array of clinicians and may help expedite earlier diagnosis and better patient care. Part of the Oxford American Rheumatology Library, this concise, authoritative pocketbook describes the pathophysiology of lupus, diagnostic strategies and tools, and current and emerging therapeutic options, focusing on direct clinical applications for busy healthcare professionals. With 20 new tables and the most up-to-date information on the diagnosis, treatment and management of the condition, this second edition fulfills a need for a concise, practical guide to Lupus for clinicians that distills the principal features of this complicated, often misunderstood disorder.

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.

Compact, hand-carried ultrasound devices are revolutionizing how healthcare providers practice medicine in nearly every specialty. The 2nd Edition of this award-winning text features all-new chapters, a greatly expanded video library, and new review questions to keep you fully up to date with the latest technology and its applications. Access to this product, which may be at the discretion of your institution, is up to 3 years of online and perpetual offline access. Elsevier reserves the right to restrict or remove access due to changes in product portfolio or other market conditions. Provides comprehensive guidance for any specialty on the latest point-of-care ultrasound applications for physicians and other health care providers. Helps you interpret findings with a peer-reviewed, online video library with more than 1,000 ultrasound videos of normal and pathologic findings. These videos are complemented by anatomical illustrations and text descriptions to maximize learning. Offers new online resources, including over 120 clinical cases and 350 review questions in every chapter. Features fully updated content throughout, plus all-new chapters on hemodynamics, transesophageal echocardiography, transcranial Doppler ultrasound, pediatrics, neonatology, and 2nd/3rd trimester pregnancy. Shares the knowledge and expertise of expert contributors who are internationally recognized faculty from more than 60 institutions. Recipient of British Medical Association's President's Choice Award and Highly Commended in Internal Medicine at the BMA Medical Book Awards 2015 (first edition). Enhanced eBook version included with purchase gives you access to all the text, figures, videos, cases, review questions, and references while on the go.

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.

This book covers a wide range of disorders such as atrial fibrillation, artificial heart valves, deep vein thrombosis, pulmonary embolism and stroke. Handbook of Oral Anticoagulation aims to provide an accessible overview of the exciting new developments in this field. Incorporating numerous quick-reference tables and figures and fully referenced throughout to key papers and the latest reviews, it will be a useful resource for all healthcare professionals involved in thromboprophylaxis.

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.

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.

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 . . . . . . . . . . . . . ."

Written by world-renowned experts in COPD A refresher for GPs and hospital doctors with practical diagnostic and treatment advice Reviews clinical developments and guidelines, and places them into everyday clinical practice Stresses the importance of early intervention, therapies and patient education Managing COPD is an in-depth guide on the management of patients with COPD concentrating on the impact of COPD on a patient as well as how healthcare professionals can intervene and educate the patient at an early stage and thereby slow the onset of severe symptoms. This book has been designed to increase physician awareness of the pathological processes involved in the aetiology of COPD which underpins effective disease management.

Amenorrhea: A Case-Based Clinical Guide is a comprehensive review of the current knowledge regarding normal female reproductive physiology. Replete with interesting case vignettes and providing diagnostic algorithms and therapeutic strategies for amenorrhea, Amenorrhea: A Case-Based Clinical Guide is divided into three sections. The first section is composed of two chapters that provide a thorough review of basic science and clinical knowledge about the organ systems responsible for normal physiology of the menstrual cycle. The second section includes discussion about menstrual cycle disruption as it relates to hypothalamic-pituitary dysfunction, surgical and natural menopause, genetic defects, premature ovarian failure/insufficiency and the effects of caloric excess and restriction. The third section offers an update on the physiological effects of prolonged amenorrhea induced surgically or by hypothalamic dysfunction and also includes an original chapter that focuses solely on the impact of race and ethnicity on the prevalence and diagnosis of amenorrhea. Amenorrhea: A Case-Based Clinical Guide brings together chapters from renowned experts who offer state-of-the-art, clinically useful information in a case-based, reader-friendly fashion. This title will be a welcome addition to the bookshelves of all clinicians who practice in women's health settings.

The New Contract which came into force on April 1st 1990 includes proposals for the provision of minor surgery services by the General Practitioner. The aim of this book is to assist those doctors undertaking minor surgery in their Practices. It is intended to present a practical, clear and concise text. This is accompanied by easy to follow illustrations. The contents of the book are governed by two considerations. Firstly, it covers only those procedures which are safe for the patient. Secondly, it only includes minor surgery which it is possible for the ordinary General Practitioner in a busy practice to undertake. Vll Chapter One The Advantages of Minor Surgery in General Practice Minor Surgery:- Despite this descriptive term, no surgery can be considered "minor" no matter where it is carried out! It requires a knowledge of anatomy and basic surgical principles. There must be an understanding of the procedures and technical skills required. Careful planning is needed at all stages. Arrangements must also be made to deal with any complications and disasters which may occur. Having stated these provisos, however, surgical procedures can and should be an important part of general practice within the British National Health Service (NHS). There are many advantages to be gained, both for patient and doctor, when minor surgery is undertaken by the general practitioner.

North American Parasitic Zoonoses provides a concise and useful review of essential information about parasitic zoonotic diseases. North American Parasitic Zoonoses, volume six of "World Class Parasites", is written for researchers, students, veterinarians, physicians and scholars who enjoy reading research that has a major impact on human health, or agricultural productivity, and against which we have no satisfactory defense. It is intended to supplement more formal texts that cover taxonomy, life cycles, morphology, vector distribution, symptoms and treatment. It integrates vector, pathogen and host biology and celebrates the diversity of approach that comprises modern parasitological research.

Depression und Demenz sind mit Abstand die hAufigsten psychiatrischen StArungen in der zweiten LebenshAlfte. Laut umfangreicher Untersuchungen der Weltgesundheitsorganisation beeintrAchtigen beide Erkrankungen in fundamentaler Weise und sogar stArker als fast alle kArperlichen Erkrankungen die LebensqualitAt der Betroffenen. Der HAufigkeit und der Schwere dieser Erkrankungen wird jedoch wegen unzureichendem diagnostischen und therapeutischen Hintergrundwissen nicht immer ausreichend Rechnung getragen. Das beklagte diagnostische und therapeutische Defizit fA1/4r Depressionen und Demenzen bei alten Menschen ist ein gesundheitspolitisch brisanter und nicht tolerierbarer Missstand. Dieses Buch hilft deshalb A"rzten, Psychologen und allen anderen interessierten Berufsgruppen, die richtigen diagnostischen und therapeutischen Entscheidungen zu treffen.