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 "First International Conference on Traditional Chinese Medicine: Science, Regulation and Globalization" was held from August 30 to September 2, 2000 at the University of Maryland at College Park, Maryland. There were approximately 250 participants from the Peoples Republic of China, Taiwan, Hong Kong and the United States. This objective of this conference was to promote international collaboration for the modernization of Traditional Chinese herbal medicines (TCM) and their introduction into the global health care system. It was mainly sponsored by the Ministry of Science and Technology of the People's Republic of China and the NllI National Center for Complementary and Alternative Medicine (NCCAM). It was organized by Dr. William Tai, then director of the Institute of Global Chinese Affairs at the University of Maryland and Dr. Yuan Lin, president of Marco Polo Technologies, Bethesda, MD. This conference was conceived by Dr. Tai two years earlier recognizing that this was an appropriate time and also the unique location of the University of Maryland. Today, there is a growing recognition of the of alternative medicine in modem societies and the rapid loss of importance knowledge about traditional methods for the treatment of the multitude of human illnesses found throughout the world. TCM has been in common use in China for thousands of years; and many of its formulations are well defined.

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."

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."

Blastomycosis remains the most enigmatic of human mycotic infections. The enigmas encompass the natural habitat of the etiologic agent, extent of exposure and subclinical infections in endemic areas, distribution of en demic foci throughout the world, inconsistency of serologic evaluation of infected patients, and varying response of such patients to standard treat ment regimens. In spite of diligent investigations by many competent investigators, we still do not know the ecological niche inhabited by the etiologic agent. We have many tantalizing clues but no definite answers. Nor do we know the extent of the endemic areas in the world for this disease. Skin testing, so useful in defining the distribution of histoplasmosis and coccidioidomycosis, has been of no value in mapping endemic areas for blastomycosis. Even the serologic evaluation of known cases of the disease has been too erratic in results to be useful as a diagnostic or prognostic procedure. The enigmas of blastomycosis go straight to the disease itself. There is an extensive literature on the debate concerning the presence and extent of subclinical infections. Case report series demonstrate that such transient infections do occur but, unlike other mycoses, the extent to which this phe nomenon is common in the general population still cannot be assessed. Even the diagnosis of established disease is a major clinical problem.

Selected as a Doody's Core Title for 2022! Essential for ob/gyn physicians, primary care physicians, and any health care provider working with pregnant or postpartum women, Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 12th Edition, puts must-know information at your fingertips in seconds. An easy A-to-Z format lists more than 1,400 of the most commonly prescribed drugs taken during pregnancy and lactation, with detailed monographs designed to provide the most essential information on possible effects on the mother, embryo, fetus, and nursing infant. Each templated monograph includes: Generic US name (trade names in index) Risk factors Pharmacologic class Pregnancy and breastfeeding recommendations Pregnancy, fetal risk, and breastfeeding summaries Updated references NEW in the 12th Edition: 100 new drugs, with thorough updates of all existing drugs Subheadings with each review for faster reference List of cross-referenced combination drugs List of drugs contraindicated in breastfeeding women List of drugs contraindicated in pregnancy List of drugs that affect human development Quarterly updates, available online, to keep you at the forefront of the field Greatly improved eBook searchability Enrich Your eBook Reading Experience Read directly on your preferred device(s), such as computer, tablet, or smartphone. Easily convert to audiobook, powering your content with natural language text-to-speech.

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.

Within the field of general medicine, the last two decades have seen the curative procedures increasingly supplemented by func tions that can be summed up under the heading of "preventive health care." There is a close link between this development and the changing morbidity pattern. In highly developed countries the morbidity rate attributable to infectious diseases has been much reduced, while the various types of arteriosclerosis, some tumorous conditions, and so-called functional syndromes have attained massive incidence rates. Systematic epidemiologic studies have yielded the concept of risk factors, i. e., certain exogenous and endogenous factors whose elimination, ideally, would make it possible to avoid the manifestation of an illness or to ensure it did not become mani fest until later in life or in a milder form. The socioeconomic and sociomedical significance of these aspects is considerable, as can be seen from all the statistics on the reasons for incapacity and early retirement and on the relative contributions of different ill nesses to total mortality. Effective avoidance of illnesses by primary prophylaxis (elimi nation of the causes of disease) or early detection of the symp toms of disease (secondary prophylaxis) leading to early treat ment would be a particularly significant step forward, since in the case of most of the conditions mentioned above only pallia tive forms of treatment are available, and none that have any cu rative effect."

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 biology of solid tumor metastasis has been the subject of significant scientific and clinical interest for years and while experimental evidence reveals that metastasis is not solely a random event, very little is known about the biology of metastasis originating from prostate cancer. This is in spite of the fact that the majority of prostate cancer patients die with metastatic lesions to the bone. Progress in understanding this most important aspect of prostate cancer has been hampered by the lack of suitable animal models and an inability to accurately quantify bone metastases and their responses to therapy. Over the past decade, scientists in Japan and the United States have steadily advanced our understanding of the cellular, molecular and immunologic biology of primary and disseminated prostate cancer. It is this body of new information, combined with advances in imaging techniques and prostate cancer tumor markers, that prompted the need for an in-depth assessment of bone metastasis of prostate cancer. Accordingly, on December 12, 1990, a group of basic and clinical investigators from Japan and the United States convened in Gotenba, Japan, to hold the first conference devoted solely to the basic biology and clinical aspects of bone metastases originating from prostate cancer. The cross-fertilization of ideas that was fostered through in-depth discussion of technological advances among various basic and clinical disciplines not only further advanced our understanding of prostate metastases to the bone, but suggested approaches for precise quantitative assessment of these lesions and their treatment.

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."

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.

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."

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.

Obesity in affluent countries continues to be a serious problem. When one runs an Obesity Clinic there appears to be an unending series of patients who need help. Our understanding of weight control has been advanced not only by the studies of obese patients but also by our investigation of the problems of weight gain in young women with anorexia nervosa. Just as among obese patients there is the group of 'efficient metabolizers' who can maintain their excessive weight with a calorie intake occasion ally as low as 600 kcal per day, so we have demonstrated that among anorexic women there are a few who may fail to gain normal weight with 3500 kcal per day. Some of the latter group may in fact develop T3 (tri-iodothyronine) thyrotoxicosis. One of the major unknown factors is still what determines when patients may be at these extremes. If we knew how to control these extremes we would like, for a time, to switch each to the opposite end of the spectrum. One factor which is becoming apparent from studying people in the machine which continually plots metabolic rate is that the metabolic response to food is a' major factor in determining a person's weight. In general terms there is a tendency for those who are below their ideal weight to have an increased metabolic response to food and those who are above ideal weight to have a reduced metabolic response to food."

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.

The original Beecham Manual for General Practice was produced by Dr Selwyn Carson, of Christchurch, New Zealand, whose objective was a set of instructions for patient care for his practice team. Beecham Research Laboratories published and distributed it. Dr Ed Gawthorn of Melbourne, Australia, edited an Australian version again published and distributed by Beecham Research Laboratories. We were invited to adapt the New Zealand and Australian editions for British readers -but we decided that we should produce an entirely new Manual. This was done and it was published and distributed to general practitioners by Beecham Research Laboratories. This latest edition has been revised and updated. The Manual is a ready reference on planned care of certain age groups and situations; specific procedures and emergencies; and clinical care in general practice of important conditions. We have intentionally adopted a concise didactic style that should be helpful for trainers, trainees and members of the practice team. We thank Beecham Research Laboratories, and especially Ed Stanford and Bill Burns, for their support and help over many years. John Fry (Editor) June 1982 viii Section A PLANNED CARE Family Planning A1 Discuss with the individual patient the advantages and disadvantages of all the methods. Keep in mind individual needs, wishes and religious beliefs. In Great Britain * 2.5 million women are registered with their G.P.'s for contraception. -100 per G.P. * 95% of G.P.'s provide contraceptive services.

Decision making is the physician's major activity. Every day, in doctors' offices throughout the world, patients describe their symptoms and com plaints while doctors perform examinations, order tests, and, on the basis of these data, decide what is wrong and what should be done. Although the process may appear routine-even to the physicians in volved-each step in the sequence requires skilled clinical judgment. Physicians must decide: which symptoms are important, whether any laboratory tests should be done, how the various items of clinical data should be combined, and, finally, which of several treatments (including doing nothing) is indicated. Although much of the information used in clinical decision making is objective, the physician's values (a belief that pain relief is more important than potential addiction to pain-killing drugs, for example) and subjectivity are as much a part of the clinical process as the objective findings of laboratory tests. In recent years, both physicians and psychologists have come to realize that patient management decisions are not only subjective but also prob abilistic (although this is not always acknowledged overtly). When doc tors argue that an operation is fairly safe because it has a mortality rate of only 1 %, they are at least implicitly admitting that the outcome of their decision is based on probability."

Herewe offer anew approach to understanding and managing common medical conditions. With the needs of our readers in mind we present clearer, more extensive and more expansive views on them. Traditional medical textbooks are wordy tomes with well worn patterns dealing in set order with 'causes, symptoms and signs, diagnosis and treatment'. They offer formal instant snapshots of diseases. We have devised an economic synoptic style, and we have endeavoured to give acomprehensive and an on-going long term movepicture ofeach condition and to relate this to the analysisofsymptoms and signs, to diagnostic assessment and to management and treatment. We have selected 22 important conditions and for eachhave followed the same sequence of questions and answers: * What is it? giving a brief summary of the current understanding of the nature of the condition. * Who gets it when? showing the age-sex distributions and influence ofother factors such as social class, international comparisons, andtheirlikelyfrequency ingeneralpractice and at the district general hospital. * What happens? analysing the significance of symptoms and signs, the likely course and outcome and how these influence care. * What to do? an appreciation of the nature and presentation of the condition, and their relevance to diagnosis and management.

ALLEN W. ROOT On November 11 and 12, 1988, a "Festschrift" was held to honor "our Chief;' Lewis A. Barness. Who is our Chief, and why was such an occasion held? I will not attempt to describe him in terms of his scientific and scholarly accomplish ments, which have spanned more than four decades. Rather, I will describe the characteristics of an individual whose concern for humanity has made him the quintessential role model for countless students, residents, and graduate pediatri cians around the world. The Chief's concern is manifested by his love for chil dren and his tireless efforts on their behalf, as well as his genuine affection for his colleagues, all of whom are also his friends. During the 2-day celebration, many of these friends had an opportunity to make comments which I believe capture portions of the essence of this remark able human being: Many of us are better persons because of our association with the "Chief . . .: ' Many of us have chosen pediatrics as a career as an unspoken act of tribute to him . . . . We love you and we thank you for making the world a better place to spend some time. (F. Oski) Lew fulfilled all our dreams . . . We all wish we could have done half so well. (R. Klein) Your] ever-present evidence of concern for your fellow man . . . it is the quality of car ing. (T."

Volume 5 of Contemporary Nephrology summarizes major advances in 15 different areas of nephrology. As in previous volumes the different chapters constitute up- of the discipline contributed by individuals dates in both basic and clinical aspects with in-depth expertise in their respective areas. We are grateful to the authors for their outstanding contributions to this fifth volume. Drs. Reuss and Cotton review in Chapter 1 new advances in our understanding of water transport in epithelial tissues responsive to antidiuretic hormone. In Chap- ters 2 and 3 Dr. Knox and Dr. Schoolwerth and their associates summarize respec- tively new information in the areas of renal hemodynamics and electrolyte excre- tion, and renal metabolism. Chapter 4, written by Drs. Laski and Kurtzman, updates recent developments in the regulation of acid-base balance in health and disease. Chapter 5, contributed by Drs. Sutton and Cameron, provides the reader with a detailed account of progress in the area of mineral metabolism. In Chapter 6, Dr. Campese examines the contribution of sodium, calcium, and neurogenic factors in the pathogenesis of essential hypertension. The immunological aspects of renal disease are clearly discussed by Dr. Couser in Chapter 7. New developments in this field are emphasized and should provide the reader with a clear understanding of the direction in which this field is moving. Drs. Humes and Messana (Chapter 8) discuss selected areas in which new developments have occurred in our understand- ing of acute renal failure and toxic nephropathy.

Primary care medicine is the new frontier in medicine. Every nation in the world has recognized the necessity to deliver personal and primary care to its people. This includes first-contact care, care based in a posi tive and caring personal relationship, care by a single healthcare pro vider for the majority of the patient's problems, coordination of all care by the patient's personal provider, advocacy for the patient by the pro vider, the provision of preventive care and psychosocial care, as well as care for episodes of acute and chronic illness. These facets of care work most effectively when they are embedded in a coherent integrated approach. The support for primary care derives from several significant trends. First, technologically based care costs have rocketed beyond reason or availability, occurring in the face of exploding populations and diminish ing real resources in many parts of the world, even in the wealthier nations. Simultaneously, the primary care disciplines-general internal medicine and pediatrics and family medicine-have matured significantly."

Infections of Leisure provides a thorough yet concise examination of the infectious risks and diseases of leisure time activity. Encompassing a wide range of medical and social interests, chapters provide practical, clinical guidelines for the diagnosis and management of various infectious risks in the garden, at the shore, on fresh water, on camping trips, traveling abroad, and on the farm. Additional chapters include up-to-date information on foodborne illnesses, and on animal-associated infections, with particular attention given to housepets. The rising prevalence of Lyme Disease, hepatitis and food poisoning make this volume vitally important. Family practitioners, internists, infectious disease specialists, pediatricians, and emergency room physicians will all benefit from the indispensable and practical information presented in this unique, groundbreaking volume.