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.

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."

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."

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."

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.

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.

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."

Prevention of disease and injury, including early identification of risks and disease and optimal control of potentially debilitating or fatal complications of chronic conditions, is the area of clinical medicine that holds the greatest promise for improving human health. Each year a long list of major, but potentially preventable health problems exacts a terrible human and financial toll. These problems urgently need our attention, especially as major advances in curative medicine become more complex and costly. Prevention of disease and injury may well be the central health issue of our time, an issue of vital concern to every quarter of our society. Now is a very good time to promote prevention. Citizens and some social groups are increasingly aware of and interested in health and fitness issues. There is great enthusiasm about-even obsession with-health, and we are seeing an astonishing proliferation of health publications and media presentations for laymen, fitness and weight control cen ters, exercise programs, health food stores, disease support groups, health education programs, and do-it-yourself diagnostic kits. All of this betokens an increased health consciousness on the part of public and perhaps signals greater individual accountability for health."

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."

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.

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."

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."

Having the privilege of editing the English language version of this book I have found the detailed thought, explanation and step-by-step instruction that this book provides most refreshing and stimulating. There are few publications indeed that provide a completely reliable companion to bedside and out-patient instruction for the medical student - and even fewer that enhance the established physician's techniques. Medical skills in the art and science of patient examination are normally learnt experimentally - time, personal instruction and constant repetition are necessary for them to be acquired. Even then it must be admitted by many that there are some techniques that are never fully understood, properly learnt or correctly concluded - and these errors are liable to a lifetime's repetition. This volume with its excellent photographs and illustrations takes the reader clearly and incontrovertibly step-by-step through every detail of all the procedures necessary for the standard forms of examination of a patient. It is a companion for every student and doctor who wishes to learn fully and completely these necessary skills and to improve the ones they already have. Dr Alexander D. G. Gunn, Director, University Health Service, Reading, Berks, UK 1982 Preface to the Dutch edition The idea of writing this book coincided almost them a superficial acquaintance with five or six exactly with the establishment of a 'skills 'fashions' and proficiency in none of them.

This book is addressed to all professionals concerned with the health care of children. It is, first and foremost, a teaching tool. It can be used for class discussion or case conferences with medical students or residents, nurses, and other staff in pediatrics or family medicine. It can also be used for self-teaching or continuing education by those already in practice. No one who reads this book is a beginner at moral reasoning. However, many may well be beginners at discussions that focus sharply on the ethical issues in medicine and introduce philosophical analysis. The goal is to clarify, conceptualize, and guide reasoning in order to come to conclusions that can be defended with good reasons. Case studies provide the most successful method of teaching medical ethics, posing the issues as they arise in real-life situations. The cases in this book are brief and rather skeletal in nature. This is partly to deflect the natural curiosity of those who are driven to seek more and more medical details, hoping thus to resolve the ethical issues or avoid them entirely. It also allows the reader to concentrate on one ethical issue at a time. In real life, of course, the hard questions arise often several at a time, embedded in a rich and complex medical and psychosocial background. As one must learn to walk before one can run, so it is wise to practice on cases where the key issue is highlighted.

Respect for persons, beneficence, and justice are the principles that collectively form the ethical basis of human research . These three principles find expression in "Community-Based Participatory Research for Improved Mental Healthcare, " or CBPR a systematic approach for engaging specially-defined groups of people in a process of inquiry and social change. In the Community-Based Participatory Research, a panel of renowned authors provide a step-by-step approach for conducting CBPR, providing all the conceptual and methodological guidelines needed to implement this important and extremely fruitful research approach. As early career investigators use this mode of collaborative inquiry in the service of society, an exciting and entirely new capacity for ethically sound and more rigorous and consequential science can be built. An indispensable resource that will be of great interest to researchers from a wide array of disciplines, the "Community-Based Participatory Research for Improved Mental Healthcare" is a major addition to the literature and certain to become the gold standard reference in the field."

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

Headache pain is widespread: 70% of Americans report suffering from headaches; 12% of those experience migraine pain. Aiming to supply clinicians with the information they need to care for headache patients, this second edition covers the most current information on headache classification, diagnostic procedures, and the treatment and management of chronic headache pain, including botulinum toxin for headache and zolmitriptan. The author discusses all common headache conditions: migraine, chronic migraine, status migraine, cluster and related headaches, tension headaches, sinus headaches, cervicogenic headaches, secondary headaches, and neuralgias. Part of the Oxford American Pain Library, this concise handbook aims to provide clinicians with practical information about the diagnosis and management of headache patients. Treating migraine and headache care holistically, the author includes a thorough review of both pharmacological medicines, such as anticonvulsants, antidepressants, and triptans as well as non-pharmacological alternatives, such as botanical remedies, acupuncture, and behavioral therapy. The book concludes with a collection of representative cases to help the physician integrate factual knowledge with evidence from real-life clinical situations. Compact and affordable, this volume is accessible, fact-filled, readable, and clinically pertinent.

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

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 Sclera is the definitive text on the diagnosis and treatment of scleral diseases, with in-depth chapters on non-infectious scleritis, infectious sclertitis, non-inflammatory diseases of the sclera, and systemic implications of scleral disease. Basic physiology, anatomy, and biochemistry are addressed as well. Written for the ophthalmologist, the revised and updated new edition of The Sclera contains the most current information available on newer characterizations of the composition of the sclera, immune derangements of it, and success in medical and surgical treatment of the inflammatory diseases of the sclera.

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 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.