Traditions are dangerous; doubly so in science. Traditions are unchanging; science is about change. This was the 4th International Colloquium on Carbohydrate Metabolism in Pregnancy and the Newborn to be held in Aberdeen, and by now the form is set. How much its content has changed is a matter of nice judgement and not under the control of the organizers. It is not within their power to bring news of revolution, if there has been no revolution. Certainly many of the speakers had kent faces from previous Aberdeen meetings, but so they would be at any meeting on diabetes anywhere in the world. The written proceedings of scientific conferences have purposes other than to record changes: sometimes they need to state a consensus. The 3rd Colloquium came to an agreement about the importance of prepregnancy recognition and control of abnormalities of carbohydrate metabolism. The 4th set out to examine what results it had achieved. Much of this book is taken up with follow-up studies of the applications of similar regimes in different parts of the world. Since the first Aberdeen meeting in 1973, progress in the manage ment of diabetic pregnancy has been slow and steady, but the change in the city and the society where the meetings took place has been fast.

The recent interest in the pharmacology of the skin and the treatment of its diseases has come about for two reasons. The first is a realisation that many aspects of pharmacology can be studied as easily in human skin, where they may be more relevant to human physiology and diseases, as in animal models. Examples of this are the action of various vasoactive agents and the isolation of mediators of inflammation after UV irradiation and antigen-induced dermatitis. The second reason is the fortuitous realisation that a pharmacological approach to the treatment of skin disease need not always await the full elucidation of etiology and mechanism. For example, whilst the argument continued unresolved as to whether the pilo-sebaceous infection which constitutes acne was due to a blocked duct or to a simple increase in sebum production, 13-cis-retinoic acid was found quite by chance totally to ablate the disease; again, whilst cyclosporin, fresh from its triumphs in organ transplantation, has been found able to suppress the rash of psoriasis, it has resuscitated the debate on etiology. We are therefore entering a new era in which the pharmacology and clinical pharmacology of skin are being studied as a fascinating new way of exploring questions of human physiology and pharmacology as well as an important step in the development and study of new drugs, use of which will improve disease control and at the same time help to define pathological mechanisms.

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."

In the decade since AIDS was first recognised the enormous and worldwide social and medical implications of this disease have been increasingly recognised. The exponential increase in the number of people infected with HIV has been paralleled by the written literature on the subject. When this book was initially conceived the question was why another book? It seemed to me at that time and since, that as HIV presented ever more complex problems, they were best solved when considered within a wider context, using basic principles of individual medical specialties and applying them. For this reason, all the chapter authors were experienced in a particular field and applied that knowledge to HIV. All the authors were working at the Middlesex Hospital in London when the AIDS services there were expanding to fill a need, from 2 beds in 1986 to two wards today. The authors were frontline staff looking after all aspects of HIV infection within a wider general medical context. Many are now consultants or senior lecturers. It is the aim of the book to provide an insight into HIV and AIDS as a overview for someone starting to work in this field or who sees such patients occasionally and requires some basic guidelines. For this reason the chapters are based predominantly on organ systems and are divided into sections covering the presenta tion, methods of investigation and treatment or action required of relevant conditions."

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."

The question facing anyone contemplating a book on low back pain is: Why write another book? It is certainly true that there are many books on this topic addressing a wide variety of audiences. Some books are all inclusive and scholarly in nature, others are personal descriptions of diagnostic and treat ment philosophies. This book is a combination of these two extremes. It represents our views on the low back problem, supported by scientific data. Most aspects on back pain presented in this book can be found in other texts. The organization of the material is unique, however. Our approach is to start by listening to and looking at the patient. It becomes apparent, then, that patients can be classified into one of the syn dromes described in chapters 4 through 13. We believe that this syndrome classification, which is quite simple to make clinically, will allow you to diagnose and treat your patients more effectively. To set the stage for the syndrome chapters the first three chapters of the book are generic to the remaining chapters. They reviewe the epidemiology, pathology, biomechan ics, etiologic theory, diagnostic methods, and treatment modalities applicable to the low back syndromes. They should be read before the syndrome chap ters. At the end of the book you will find four chapters that are specific to disease entities."

This volume contains papers presented at the First International Symposium on Mechanism and Treatment in Essential Hyperten sion, which was held on October 23 and 24, 1985 in Nagoya, Japan. The meeting was an official satellite symposium to the meeting of the Fifth International Symposium on Rats with Spon taneous Hypertension and Related Studies in Kyoto, October 20-22, 1985. The Nagoya symposium was made possible by offi cial grants from the city of Nagoya and Aichi Prefecture and the generous financial support of many companies. The aim of the symposium was to provide a forum for presen tation and discussion of recent advances in the area of essential hypertension, particularly with regard to calcium mechanisms in vasoconstriction and vasodilation in arterial vessels and the func tion of arterial smooth muscle. The role of calcium ions in the function of arterial smooth muscle has attracted a great deal of attention in the last two decades. The mode of action of calcium ions was revealed at the molecular level. The hypertension model of the spontaneously hypertensive rat has been widely utilized for research into the fundamental mechanisms of genetic hyperten sion, stroke, and cardiovascular disease as well as into therapeutic measures. New tools of calcium agonists and antagonists have become available to research into the mechanism, prevention, and treatment of essential hypertension at the molecular, subcellular, and cellular levels of arterial smooth muscle, at the organ level of arterial vessels, as well as at the total systemic level."

Designed to assist the physician in the application of computers in private medical practice, this comprehensive guide outlines where, why, and how this valuable tool can best be used. Integrating the mechanisms of computerization with the implications for health care, the authors draw on personal research and experience to describe models used effectively in the medical setting. Chapters cover administrative procedures, applications for marketing and quality assurance, and the link to an office-hospital application. Aslo included is information on software, hardware, database management, expert systems, artificial intelligence, and indications of future trends. This work will serve as an essential reference in meeting the ever-increasing medical information needs of the private practitioner.

The gratifYing response to the first edition of Tuberculosis has prompted this revision. There are many important changes incorporated into this edition, including the dramatic effect of AIDS on the incidence and clinical mani festations of mycobacterial infection, new developments in epidemiology and bacteriology, and thoroughly updated therapeutic recommendations and principles of prophylaxis. The chapters that deal with clinical manifestations of tuberculosis have also been updated and include important and clinically applicable information on manifestations of tuberculosis in both the normal and immunocomprom ised host. As with the first edition, it is hoped that this text will continue to represent a definitive resource for both the basic scientist and the clinician who deal with the prevention and treatment of mycobacterial infection. II Preface to the First Edition We have just witnessed the lOOth anniversary of Koch's discovery of the tubercle bacillus. This event did not end the centuries-long saga of tuber culosis, however; it was but one major step in the ongoing struggle to un derstand and combat this disease. Tuberculosis is very much with us today, and its clinical manifestations and principles of treatment must be understood by both the primary care physician and the specialist. This monograph covers all aspects of tuberculosis in a single volume. It is divided into three parts, covering, respectively, general considerations, clin ical manifestations, and atypical mycobacterial infection."

The need for greater international collaboration is becoming increas. ingly clear. Practically every nation or people has, in addition to its own characteristics and history, its own medical tradition. Methods and ways of thinking that are successfully established in one place may not be accepted in another for some time. The medical tradition and training in different countries can take quite different forms. What would our present knowledge be - Without the creative, spontaneous ideas and contributions from the romance countries? - Without the opportunity of research, as it is practised on a large scale in the USA, where so many young Europeans took their first steps in experimental science? - Without the conscientious clinical work done in Central Europe and the valuable experience gained there? - Without, finally, the sober and critical scientific approach, as fostered in the cool heads of Northern Europe for generations? None of these qualities is sufficient without the others, but together they are a source of strength. Ultimately, we hope, through sensible con centration of efforts (while maintaining variety), to overcome the lack of an integrated approach in experimental science and to prevent repetition of painful mistakes. In this regard, the first two ESKA congresses have brought us great advances."

Computer technology has impacted the practice of medicine in dramatic ways. Imaging techniques provide noninvasive tools which alter the diagnostic process. Sophisticated monitoring equipment presents new levels of detail for both patient management and research. In most of these technology applications, the com puter is embedded in the device; its presence is transparent to the user. There is also a growing number of applications in which the health care provider directly interacts with a computer. In many cases, these applications are limited to administrative functions, e.g., office practice management, location of hospital patients, appointments, and scheduling. Nevertheless, there also are instances of patient care functions such as results reporting, decision support, surveillance, and reminders. This series, Computers and Medicine, will focus upon the direct use of infor mation systems as it relates to the medical community. After twenty-five years of experimentation and experience, there are many tested applications which can be implemented economically using the current generation of computers. More over, the falling cost of computers suggests that there will be even more extensive use in the near future. Yet there is a gap between current practice and the state-of the-art."

HRT and Osteoporosis is a response to the increasing awareness among both the medical profession and the general public that ovarian failure is an important cause of osteoporosis and that much of the bone loss after the menopause can be prevented by oestrogen treatment. There is now an urgent need on the part of women, their doctors and those responsible for public health policy for practical guidance on such questions as the safety and acceptability of long-term treatment with sex hormones, the economic costs and benefits of such treatment, and the role of specialists and GPs in promoting and monitoring hormone replacement therapy. All these issues and more are considered here. The book comprehensively reviews current knowledge of the subject and gives recommendations for clinical practice and future research.

To the entomologist all insects have six legs; the layman tends to use the term "insect" to include the eight-legged spiders and mites. All these creatures are correctly classified as arthropods. Many thousands of the hundreds of thousands of recognised species of arthropods are found in the human environment-domestic, occupational and rec reational. Those species which are obligate parasites of man, the human scabies mite and the head and body lice, produce familiar clinical syndromes. They remain important in medical practice and have been the subject of a great deal of recent research. This is beginning to throw much light on the immunological mechanisms which largely determine the reactions of the host. Dr. Alexander has provided a detailed survey of this work. The wasps, bees, ants and other Hymenoptera which may sting man in self-defence can cause painful, even fatal reactions. The recent work on this important subject has also been thoroughly reviewed. Every dermatologist of experience will admit that he sees many patients in whom he makes a diagnosis of "insect bites," if he has the confidence to do so, or of "papular urticaria" or "prurigo" when he lacks such confidence, mainly because he is at a loss to know which arthropod is likely to be implicated. In his survey of the enormous literature in the entomological, public health and dermatology journals Dr. Alexander has provided an invaluable guide in which the solutions to these clinical mysteries can be sought."

The purpose of this particular NATO Advanced Study Institute is to contribute to the dissemination of advanced knowledge and the formation of contacts between scientists from different countries. The Institute is meant to have a substantial teaching component while also providing a forum for discussion at the highest level. The NATO Advanced Study Institute on Progress in Biomechanics was held July 10-21, 1978 in Ankara, Turkey and the Proceedings are presented in this volume. Sixty-four engineers, mechanicians, medical and biological scientists from fourteen countries attended. Prof. R.M. Kenedi of the University of Strathclyde, Glasgow, Scotland and Prof. W. Goldsmith of the University of California, Berkeley, USA were the other members of the Organizing Committee. As Director of the Institute, I wish to thank them for their assistance without which the Institute would not have taken place. Time will show whether the Institute has served its purpose; namely, exciting interdisciplinary communications and developing a lasting and productive link from which significant academic and technological advances might emerge.

The Oxford English Dictionary defines diagnosis as: 'Identification of a disease by careful investigation of its symptoms and history' . Regrettably, the value of the history in the diagnosis of disease often seems to be neglected in both undergraduate and postgraduate medical education. The considerable advances in medical technology have made it easy to carry out a multiplicity of tests. As a result, there is frequently an unfortunate tendency to rely on the results of tests before decisions are taken on diagnosis and treatment, even though such tests are often of limited value in the manage ment of the patients. This book is an attempt to redress the balance and place the proper emphasis on the diagnostic value of a well-taken and perspicacious history. The main purpose of the book is to show that most of the clinical problems encountered in daily practice can be dealt with effectively and satisfactorily on the basis of a good clinical history. This should be supplemented by a prob lem-orientated clinical examination, the primary function of which is either to confirm and amplify the diagnosis provided by the history, or to refute it."

Migraine is a debilitating disorder, it is essential that it is diagnosed accurately and swiftly in patients. This book covers, in-depth, the key diagnostic criteria and treatments that pediatricians and other primary care providers must be aware of in order to treat pediatric migraine effectively.

Written by an expert on the subject of pediatric migraine/headache
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
Concise but comprehensive"

Drawing on the expertise of a nationally recognized group of family practice educators affiliated with the University of California, Drs. Little and Midtling are able to present many specific examples on meeting the challenges of becoming a family physician. Also included are chapters that draw out the differences between inpatient and outpatient service, discuss the teaching of practice management, and touch on the impact of specialists in ethics and cross cultural communication on family practice teams. The concluding chapters examine how family physicians have survived in the "medical community," and examine the future of family practice.

This book is designed to be a physician's guide for those interested in diving and hyperbaric environments. It is not a detailed document for the erudite researcher; rather, it is a source of information for the scuba-diving physician who is searching for answers put to him by his fellow nonmedical divers. Following the publication of The Underwater Handbook: A Guide to Physiology and Performance for the Engineer there were frequent requests for a companion volume for the physician. This book is designed to fill the void. Production of the book has been supported by the Office of Naval Research and by the Bureau of Medicine and Surgery, Research and Development Command, under Navy Contract No. NOOOOI4-78-C-0604. Our heartfelt thanks go to the many authors without whose contributions the book could not have been produced. These articles are signed by the responsible authors, and the names a e also listed alphabetically in these preliminary pages. Every chapter was officially reviewed by at least one expert in the field covered and these reviewers are also listed on these pages. Our thanks go to them for their valuable assistance. We are grateful to Marthe Beckett Kent for editing Chapter III. Our thanks also go to Mrs. Carolyn Paddon for typing and retyping the manuscripts, and to Mrs. Catherine Coppola, who so expertly handled the many fiscal affairs.

The development of immunization has been one of the most striking features in the control of infectious disease in the twentieth century. This book takes into account the need for a simple, concise account of immunization procedures not only in the UK and USA but also in other countries, and to this end a special chapter on immunization in developing countries has been included. Following two introductory chapters, there are nine chapters on various diseases and the vaccines that have been developed to combat them. In each of these chapters, a short discussion of the epidemiology of the disease and the history of immunization against it is followed by a description of the vaccine, its efficacy, contraindications to its use and future developments. These are followed by four general chapters on vaccines for travel, vaccines for selective use, passive immunization and immunization in tropical environments and the book concludes with a chapter on the smallpox vaccination and one on new vaccines. The demand for this book follows the popularity of a series of articles on immunization which appeared in Update. These have been expanded and largely rewritten. I have drawn on many expert sources and have made an effort to provide a balanced and non-controversial opinion with a discussion of alternative procedures where indicated.

A fine team of state-of-the-art researcher/clinicians who know their fields, have contributed to the advancement of knowledge, and are in a position to judge what is truly important have here pooled their thoughts in a series of chapters on the cutting edges of gastroenterology. Four attributes render this volume superior to other update-oriented publications. The first striking feature, which is immediately evident upon scanning the table of contents, is the imaginative choice of subjects, ranging from trav eler's diarrhea and sexually transmitted GI infections through TPN and interventional endoscopy to geriatrics and iatrogenic disease. A second outstanding feature of this volume is its success in balanc ing basic pathophysiology with practical considerations of clinical man agement. This is achieved in the discussions of such diverse topics as acid-peptic diseases, infectious and other diarrheal syndromes, and hep atitis immunization. Throughout the book we are led smoothly from basic science principles to specific recommendations for diagnosis and therapy. This practical emphasis appears repeatedly and sometimes pro duces a delightful surprise, such as a chapter on radiology that is not tech nology-based but instead problem-oriented."

High blood pressure (BP) (with fats and smoking) is one of the three roots of cardio-cerebro-renovascular disease affecting up to 25% of the adult population. Hence, high blood pressure should be recognized and treated, to reduce any complications and prolong life, as noted by Michael Weber of the Veterans Administration Hospital in Long Beach, California. He further emphasizes the need for monitoring before one starts the treatment of high blood pressure. Indeed, he refers to the results of the Australian study on mild hypertension with a large percentage of placebo responders and rightly suggests that many people are treated who should not be because of 'white-coat-associated high blood pressure'. He also points to the lack of standardization of techniques for data analysis and of methods of BP measurement. Ambulatory monitoring under usual condi tions without concomitant recording of events does not allow even a qualitative assessment of the impact of varying stimuli, in weber's opinion."

Guide to Fitness After Fifty presents basic and applied research data, authoritative advice and tested techniques for professional workers who want to learn more about physical exercise, fitness and health for aging people and for all who seek to become more physically and mentally fit. The editors and contributors believe that physical activity and exercise following the pri ciples and practices utlined in this inter disciplinary volume can improve the health and quality of life by increasing en durance and cardiovascular fitness, strengthening the musculoskeletal system, im proving mobility, posture and appearance, and relaxing emotional tensions. Evidence at hand and discussed in this book demonstrates that properly prescribed physical activity or exercise can raise the level of physical fitness and health, both physical and mental, at any age, delay the ravages of aging, and prevent or reduce disability from musculoskeletal and circulatory disorders. Section I, Perspectives on Exercise and Aging, surveys the fundamental problems and relationships of exercise to aging and health and provides historical insights and philosophic perspectives on the significance and importance of physical fitness and exercise through the centuries and in contemporary society. Section II, Evaluation and Physiology of Exercise, presents objective scientific and medical evidence that reasonable improvement in fitness and other bodily func tions may be achieved by people of all ages who follow well designed exercise and relaxation routines for at least 30 minutes three or more times weekly."

Physicians in most developed countries are at a great disadvantage when confronted with geographic and tropical diseases. They may be faced with prevention for patients who are outward bound or with diagnosis and treatment on their return. The practitioners' difficulties relate to inade quate teaching in medical schools and to the infrequency with which they are confronted with these exotic diseases. It is quite surprising to realize the extent of travel by Americans to areas where the tropical diseases abound: in 1979 there were 3 million trips by U. S. residents to Central and South America and almost 1 million to Africa and Asia. I Further, the influx from the tropics to the United States in 1978 involved 4. 5 million visitors and more than half a million immigrants. I The single most danger ous ofthese infections is malaria, which is now averaging about 500 cases yearly in the United States; it is important to realize that infection with one species of this organism (Plasmodium falciparum) can be lethal within a few days of the onset of fever. Highly contagious infections such as the newly discovered and extremely lethal Lassa and Ebola fevers may be imported to our shores, plus cholera, antibiotic-resistant bacillary dys entery, and amebic dysentery and liver abscess. Chronic worm infections such as schistosomiasis, although rarely lethal, may have severe conse 2 quences such as paraplegia or hematemesis."

A concise summary of the most important medical and scientific topics concerning cardiovascular medicine in the primary care environment, this new edition of Cardiology in Family Practice has been updated with cutting-edge information and useful tips. Written in an easy-to-read format (background, diagnosis and disease management) and emphasizing practical techniques for evaluation and treatment, the authors explain the basic mechanisms underlying cardiovascular disease states and the treatment strategies that arise from them. Topics include stable angina, acute coronary syndromes, arrythmias, hypertension, pericardial and valvular diseases, and hyperlipidemia. New figures have been added to each chapter in this edition. This book is a must-have for primary care physicians who wish to keep up to date with the rapidly changing field of cardiology.