The secretion of bioactive products by tumors of the gastroenteropancreatic system results in the development of watery diarrhea that can lead to death in a very short period if not brought under control. Even if the consequences are less dramatic, the patients' ability to lead a normal daily life is seriously impaired, and they may become severely depressed. SandostatinR alleviates the condition by inhibiting peptide release, and its long duration of action makes it an effective and rational adjunct to therapy at all stages. Last year a consensus Round Table Meeting was held in Scottsdale, Arizona, to discuss the optimal use of SandostatinR in this indication. These guidelines offer the results of clinical research and the dosage recommendations arising from them, together with a critical summary of the points of view presented.

This volume comes from manuscriptscontributed by invited speakers to the NATO AdvancedStudyInstitute on Biopolymers, which was held in Izmir, during August 27th - September 5th, 1984. Many more detailshave been added to the manuscripts as a resultof the interchange of ideas during the symposium. This book includes 16 papers which were originallypresented at the meeting by some of the world'sforemostinvestigators. In this volume, the existing basic knowledgeacross the wholefieldof polymericbiomaterials is reviewed.Classification, structure, composition, synthesis, modification and fabrication of these novel materialsis included in detail. Fundamental phenomena involved in the interactionof polymers with the biological environmentand resultingresponses of blood and tissue components are discussed. Modification of polymers physically, chemicallyor biochemically, in order to improve their biocompatibility is included. Selected applications of polymeric biomaterialsin Medicine, Dentistry, Biotechnology, Pharmacology and otherrelated fieldsarealsocovered. We stronglyhope thatthis book will be agreatcontribution to the rapidly expanding field of biomaterialsand willhelp to stimulate an even more excitingfuturefor th is field. ErhanPiskin AllanS. Hoffman VI ACKNOWLEDGEMENTS NATO Advanced Study Institute on "Biopolymers" was held in Izmir during August 27th - September 5th, 1984. I would like to ex press my deepest appreciation and gratitude to NATO Scientific Affairs Division, that our meeting has been accepted as a NATO ASI, and has been supported by their programmes. I wish to thank also to all the other supporting firms and organizations, especially to Hacettepe University and Turkish Scientific and Technical Research Council."

Why yet another book on clinical diagnosis? The profusion ofmedical text booksfor studentsand young postgraduates is known to all ofus, and so also is the time-consuming and frequently frus- trating search in these books for the relevant facts we need, so often sub- merged in a mass of information which we do not really require. The traditional textbook that most clinicians have used in their training may well be written in the leisurely, discursive and unstructured style much loved by our teachers of old, but perhaps out of place in modern medical education where knowledge is so rapidly expanding and time available for its assimi- lation rapidly contracting. It iswith these considerationsinmindthat wefelt itwould beusefulto pro- vide a clear, concise, easily readable and well-illustrated book on the essen- tials of clinical diagnosis. Each chapter deals with a medical problem commonly encountered in dailyclinicalpracticeand beginswith alistofthepossiblecausesand apracti- cal perspective of their prevalence in general practice and in hospital prac- tice; the age distribution and the clinicalsignificanceofthe various disorders is also pointed out. The majorpartofthe chapter isconcernedwith thediag- nostic approach to the particular problem and emphasizes the importance of symptomsand signsin reachingthecorrectdiagnosis, as well asthe value and limitation of the investigational approach to the diagnosis. The book emphasizes the fundamental clinical skills ofhistory-taking and clinicalexamination in diagnosis, so frequently and mistakenlysubordinated to the investigational approach which is often disappointing in the limited diagnostic help which it does provide.

Clinicians spend their working lives making decisions. such decisions are usually made in interlocking streams rather than in the discrete circumscribed contexts so beloved of scientists. When the clinician encounters a patient a complex interactive process is initiated in which the clinician searches his memory to match the symptoms and signs indicated by the patient with the complex disease models which he carries in his head. He then makes choices about further questions or tests in order to clarify his understanding of the patient's problem and to formulate a management or treatment plan. In recent years there has been increasing interest in how clinicians make such decisions and a realization that decision-making in clinical medicine is virtually the same as that in many other professional contexts. The scientific study and formal teaching of clinical decision-making is a relatively young discipline. Less than 20 books have so far appeared which take explicit account of the theoretical and experimental decision-making literature in medicine and other related disciplines. This book is a distinctive and important contribution to this growing field. It combines a comprehensive critical analysis of a wide range of relevant philo sophical, statistical, psychological and medical literature with an interesting set of experimental observations of primary care physicians. Dr. Ridderikhoff shows great erudition and wide command of a large reference literature. Dr. Ridderikhoff takes a firmly descriptive rather than prescriptive viewpoint on understanding clinical decision-making."

This volume contains the proceedings of the XVth North American Testis Workshop, held in Louisville, Kentucky, April 7 to 10, 1999, to describe current advances in testis biology. The first two chapters provide a useful historical perspective of testis physiology and formulate compelling research questions about important aspects of sperm formation and function. This prologue sets the scene for the remainder of the volume that follows a logical progression, as the title implies, from stem cell to cell function, but that is necessarily preceded by sex determination, the quintessential requirement for there being a testis in the first place. The program for this XVth Testis Workshop evolved from recommenda tions of the scientific committee and their advice on the selection of invited speakers. The XVth Testis Workshop has a strong comparative flavor with contributions on worms (Caenorhabditis), flies (Drosophila), and chickens, which are models that permit and thereby reveal the power of genetic analy ses of the molecular mechanisms involved in spermatogenesis. A glimpse into the future is provided with information from EST, protein, and genome databases that already have an impact on progress in our understanding of the male germ cell. Although there is heavy emphasis in these chapters on cellular and molecular e, Yents, database mining and translational profiling relevant to testis function and dysfunction and assisted reproduction tech nologies are not overlooked."

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.

An ever greater number of our contemporaries will reach a very much greater age than their ancestors. Longevity is one of the most fertile fields for paradoxes: it is clear that the same causes do not produce the same effects at the age of ten and at the age of one hundred! On the subject of longevity, the "recipe book" is far from having been written. Nevertheless, the Fondation IPSEN has chosen a few of these paradoxes to discuss and try and explain them.

Pelvic pain in the female patient is common in gynaecological practice, but the specialties of general surgery, urology and orthopaedics provide a significant number of patients and problems. These patients may suffer a multitude of symptoms, and only careful analysis and investigation of each individual problem by the doctor concerned will lead to correct diagnosis and management. The subject matter of this book lies in the practice of many specialties, and all are combined here in a coherent whole. This emphasises the close collaboration necessary between family practitioners, junior hospital staff and consultants. The authors are consultants who work together in a busy district general hospital, and their experience and collaboration is evident in the approach to the diagnosis and management of pelvic pain in the female. Emphasis is laid on the careful evaluation of history and examination and the correct interpretation of diagnostic investigations. Full details of radiology, ultrasound scanning, endoscopy, peritoneoscopy and bacteriological investigation are given. Full consultation between members of staff who have special experience in these investigative procedures is of paramount importance. Details of treatment for relief of pain are important to all doctors concerned with this aspect of clinical management. and this section will be of particular value. The blending of these specialties allows full consideration of the problems affecting the patients. Careful management leads to better treatment for the patient and better satisfaction for the doctor.

This monograph is essentially the outcome of corporate endeavour on the part of members of the Committee on Public Education of the International Union against Cancer, from the decision taken in September 1963, via a lengthy and arduous rework ing of the first draft in Philadelphia in 1964 to its final editorial meeting in September 1965. In between there has been a continuous exchange of ideas, suggestions, advice and material for inclusion. Nevertheless, as chairman I should be remiss if I did not acknowledge the Committee's indebtedness to Mr. MICHAEL S. GOOD STADT, formerly of the University of Manchester, who worked with me in Manchester and undertook the painstaking search of sources of published information and compiled the draft on which this monograph is based. If there are omissions from the bibliography, it is not for want of industry in seeking them out: our difficulty has been to obtain original material from certain sources. We hope that the material assembled here will both offer useful guidance to those engaged in public education about cancer and provide a baseline from which future research in this neglected field may stem. Committee on Public Education International Union Against Cancer Chairman: JOHN WAKEFIELD, U. K. Members: Dr F. DE AMESTI, Chile, Mr. A. J. BROWN, Australia, Dr. J. COURTIAL, France, Mr. T. CRAMER, Denmark, Dr. L. MEINSMA, The Netherlands, Dr. R. A. MUSTARD, Canada, Dr. L. V. ORLOVSKY, U. S. S. R. , Dr. J. C.

There is now widespread recognition that emotional problems, to say nothing of the interactions of emotions with other manifestations of illness and disease, constitute a substantial component of all human suffering. For too long the pro vision of medical care has been restricted to the physical aspects of that suffer ing while the psychological aspects have been shunned. Whether through igno rance about the nature of emotional illness and its clinical management, or through uncertainty about the legitimacy of their ministrations, physicians and many other health professionals have left the care of psychiatric problems to psychiatrists and other mental health professionals. For a variety of reasons this strategy is no longer feasible and substantial changes are required. The extent of the needs, the nature of the presenting problems, the ex pectations of the patients, the prohibitive costs of alternative approaches, and the lack of trained mental health professionals make it imperative that general health workers learn to cope with the psychological and behavioral health prob lems of their patients. There are no other alternatives if the realities of comtem porary suffering, limited resources and psychobiological knowledge are accepted. It is to the pragmatic knowledge base for this essential component of contemporary health care that this book makes a seminal contribution. Dr."

Cells have evolved multiple strategies to adapt the composition and quality of their protein equipment to needs imposed by changes in intra- and extracellular conditions. The appearance of pro teins transmit ting novel functional properties to cells can be controlled at a transcrip tional, posttranscriptional, translational or posttranslational level. Extensive research over the past 15 years has shown that transcriptional regulation is used as the predominant strategy to control the production of new proteins in response to extracellular stimuli. At the level of gene transcription, the initiation ofmRNA synthesis is used most frequently to govern gene expression. The key elements controlling transcription initiation in eukaryotes are activator proteins (transactivators) that bind in a sequence-specific manner to short DNA sequences in the of genes. The activator binding sites are elements of larger proximity control units, ca lied promoters and enhancers, which bind many distinct proteins. These may synergize or negatively cooperate with the activators. The do novo binding of an activator to DNA or, if already bound to DNA, its functional activation is what ultimately turns on a high-level expression of genes. The activity of transactivators is controlled by signalling pathways and, in some cases, transactivators actively partici pate in signal transduction by moving from the cytoplasm into the nuc1eus. In this first volume of Inducible Gene Expression, leading scientists in the field review six eukaryotic transactivators that allow cells to respond to various extracellular stimuli by the expression of new proteins."

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 as in animal models, where they may be more relevant to human physiology and disease. 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 aetiology and mechanism. For example, whilst the argument continued un resolved 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 aetiology. 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 for the development and study of new drugs, use of which will improve disease control and at the same time help to define pathological mechanisms.

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"

Following an introduction to the philosophical and theoreti- cal background of traditional Chinese medicine, the dia- gnostic system is presented: the Chinese system of channels and functional organs, the significance of pointsand point categories, methods of needling and moxibustion. There is a chapter on treatment based on western diagnosis.

In psichiatria dell infanzia e dell adolescenza il primo contatto con il paziente riveste una grande importanza clinica e puo far risparmiare tempo e risorse. Una consultazione ambulatoriale ben condotta permette di giungere a un ipotesi diagnostica rigorosa, orientando invii per approfondimenti e presa in carico; in alcuni casi, puo acquisire carattere terapeutico.

Questo volume guida il clinico, anche quando lavora da solo, verso una formulazione diagnostica il piu possibile precisa ed esauriente. Il libro illustra uno schema di procedura clinica che integra le diverse prospettive proprie del campo in un otticaevolutiva, esaminando la metodologia del colloquio, le tecniche per la valutazione cognitiva, neuropsicologica e psicopatologica, i contatti con genitori e scuola.

Questo testo e rivolto a neuropsichiatri infantili, pediatri, psichiatri e agli specializzandi in tali discipline; piu in generale, puo essere di interesse per chiunque abbia contatti con pazienti in eta evolutiva.

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.

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."

Since the apoE4 allele is a risk factor or susceptibility gene in late-onset familial and sporadic AD, the mechanism of disease expression may involve metabolic effects that are isoform specific. Isoform-specific interactions of apoE therefore become critical in the mechanism of AD pathogenesis. Detailed characterization of the binding of the apoE isoforms with proteins and peptides relevant to the pathology of the disease may be critical in understanding disease pathogenesis. These critical isoform-specific interactions of apoE may involve interactions with proteins and pep tides in the defining neuropathologic lesions of the disease, the neurofibrillary tangle and senile plaque. Other possible critical isoform-specific interactions include the mechanism of internalization, intracellular trafficking, and subsequent metabolism. In addition, differential post-translational modifications of apoE isoforms may determine differences in metabolism contributing to the pathogenesis of the disease. Oxidation of apoE may confer several isoform-specific, biochemically distinct properties. Since {3A peptide binds apoE in the lipoprotein binding domain of the protein and not in the receptor-binding domain, apoE could target bound {3A4 peptide to neurons via the LRP receptor. Internalization of the apoEI {3A peptide complex into the cell, by the same route as the apoE-containing lipoproteins, would result in incorporation into primary lysosomes and pH dependent dissociation. The demonstration of apoE in the cytoplasm of neurons, with isoform-specific interactions of apoE with the microtubule-binding protein tau demonstrated in vitro, suggest additional, testable hypotheses of disease pathogenesis.

Based on the Commonwealth Harvard Alcohol Research and Teaching Program, this clinically oriented work is designed to give internists and primary care practitioners the knowledge and skills necessary to recognize and care for patients with alcoholism.

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.

This essential handbook for sports medicine clinicians combines resources from various United States and International Olympic Committee sporting guidelines; national and international youth, scholastic, collegiate, and professional associations; and real-world experience to provide the most up to date and relevant information needed to fulfill coverage duties for sporting events. Easy to read, concise, and complete, this guide is a one-stop reference for sideline medical coverage of nearly fifty sports. Geared for live event coverage, chapters deliver quick hit specifics designed for in-the-moment use on the field.The book opens with a review of general coverage concepts applicable to most sports along with chapters dedicated to overriding medical concerns including emergency management, nutrition and hydration, adaptive sports considerations, and doping in sports, among other key topics. The core of the book focuses on coverage details for individual sports, organized by contact level and presented in a templated format for quick identification. Each sport-focused chapter describes its history, governing organizations, participants, rules and regulations, equipment, medical coverage logistics, medical emergencies, and common injuries. A dedicated "Medical Bag" for every sport outlines the necessary items providers should have at hand for managing emergencies and common injuries. This essential handbook belongs in every sports bag and will serve as a ready resource for clinicians and sideline personnel covering sporting events at any level. Key Features: Handy reference for on-field, sideline, or event sports coverage - with digital access for mobile use on most devices Current guidelines for almost 50 sports, including information specific to the disabled athlete when applicable Every chapter contains sport-specific information on emergencies and common injuries What's in your bag? Highlights medical bag essentials by sport, so you're always prepared Includes general chapters on clinician role, traveling with a team, pre-participation exams, medicolegal and ethical concerns, and approach to signature medical emergencies in sports

This fourth edition of Common Diseases comes just over 10 years after the first. There has been change and counterchange in the primary health care (PHC) field. One change has been the tendency to replace 'general practice' by 'PHC'. Vocational training has become compulsory. With larger group practices have come formalized teams and teamwork, increasing con cern with the business side of general practice and attempts to achieve best values for money and maximal profits. On the clinical side there have been enthusiasms for prevention, early diagnosis, anticipatory care, screening and quality initiatives. As a counterchange it is necessary to remind ourselves that the real essence of general practice, PHC, or whatever title we give it, is 'personal doctoring' of people as individuals in family units. All the changes mentioned will achieve less than expected without good continuing doctor/ patient personal care. But even this is not enough. Good general practice demands a sound knowledge of the nature of disease in the community. Not only are traditional diagnostic and therapeutic skills necessary, but also application of an understanding of the frequency and distribution of the diseases and an awareness of their likely natural history - their course and outcome."

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."

My conviction is that the matters addressed in this volume are of transcendental importance if we are to face up to the challenges of the 1990s and beyond. How, for instance, are we to cope with a truly ecological approach to public health and all its concomitant changes of risk groups worldwide unless there is a full appre ciation of the popUlation perspective throughout the health establishment? The global village has achieved a measure of interdependence requiring recognition by all concerned with the health of both individuals and communities that there is an urgent need to share our knowledge and deploy our resources in the best interests of people everywhere. The history of public health initiatives, the origins of epidemiology, and the tragic separation-virtually a divorce--of public health from medicine recounted in the chapters that follow argue strongly for an early rapprochement. Health professionals who complement each other's knowledge and skills can be reunited through their common reliance on epidemiology as a major fundamental science for the entire health enterprise. Henceforth, epidemiology should be ranked in importance with cellular and molecular biology, immunology, and the social and systems sciences; all are essential if we are to cope with the vast array of diseases and disorders that face us in both the developed and developing worlds. We need more first-rate laboratory scientists, clinicians, nurses, aides, village health work ers, and managers committed to serving the public."

Decoding the significance of proteinuria as an indicator of severity or prognosis in kidney disease is a stimulating challenge to students and practitioners of nephrology. Sir Richard Bright in 1827 associated pro with the disease that bears his name. In the subsequent more teinuria than a century and a half, however, the meaning of the linkage between proteinuria and renal disease remains elusive. Proteinuria is discovered on routine urinalysis in about 10 million Americans, most of whom express no symptoms of kidney disease, each year. From the studies of Robinson (updated in these pages), we know that proteinuria, per se, can be present for 20 years without change in re nal function, as described in orthostatic proteinuria. By contrast, pro teinuria may be the harbinger of swift kidney destruction, rarely cul minating in clinical collapse, a syndrome typifying "malignant proteinuria" as detailed herein by Avram. Although proteinuria is ubiquitous, an orderly management strategy for rational handling of proteinuria of less than nephrotic range is lack ing. Separation of tubular proteinuria and transient proteinuria of fever is now possible routinely. This book provides a record of the contribu tions of investigators and clinicians whose work forms the substrate for production of understanding and, ultimately, marching orders for prac titioners seeking optimized management for their proteinuric patients."