In the previous two volumes of this series, we presented classic problems in internal medicine as illustrated by actual cases cared for in our institution. It has been gratifying for us to see the interest that these volumes have generated with students and trainees. We remain committed to the case method of instruction, and believe that there is no better method to learn medicine than to have an individual patient problem as the basis for study of pathophysiology, natural history, diagnosis and management. We hope that our readers find this third volume as enjoyable and instructive as the editors found it. Juan M. Bowen, MD Ernest L. Mazzaferri, MD, FACP xiii Acknowledgement The editors are grateful to Jeff Smith and Jenny Riegler for their unflagging professionalism and patience. xiv Contents Case 1 Mitral Regurgitation - Chronic Versus Acute: Implications for Timing of Surgery * . * * * . . * . . . . . * . . . . . . . . . . . 1 Harisios Boudoulas, MD Charles F. Wooley, MD Advances and diagnostic imaging in a surgical technique have changed the approach to mitral valve regurgitation. This chapter provides an expert's perspective. Case 2 Cystic Fibrosis in Adults .. * ************ 36 Andrew Libertin, MD John S. Heintz, MD As children with cystic fibrosis grow into adulthood, the internist assumes a greater role in their care. Case 3 Thrombotic Thrombocytopenic Purpura . . . . . . . . . . 51 . . . Donald E. Thornton, MD Earl N. Metz, MD, FACP Patients with ITP continue to present difficulties in diagnosis and management. Two experts discuss the current approach to ITP.

Research over the years has demonstrated that free radicals mediated oxidative stress lies at the helm of almost all patho-physiological phenomena. These findings emphasize on the need to understand the underlying molecular mechanism(s) and their critical role in the pathogenesis. This book aims to focus on these areas to provide readers a comprehensive outlook about the major redox sensitive pathways and networks involved in various disease conditions. In the first chapter of the book, basic information about the oxidative stress, its generation, its biomarkers and its role in body are discussed. In the next three chapters, the role of oxidative stress in various pathologies ranging from neurological disorders, to cardiovascular diseases, cancers, metabolic diseases and ageing have been described. Chapter 5 cumulatively describes the most important molecular signaling pathways that are affected by reactive oxygen species (ROS). These are the mechanisms which are common denominators in various pathological states. In the next part of the book, various antioxidant strategies to target and mitigate ROS have been discussed with details on the mechanisms. Selenium, being the research focus and interest of the authors for years, the role of selenium as an antioxidant as part of selenoproteins has been included in the book. Finally, the book culminates with authors' perspective on the future of the redox biology field. Throughout the book, efforts have been made to use simplified language and suitable figures for ease to understand the contents. Although the authors have tried to touch on all the different aspects of oxidative stress in detail, the fact that it is a continuously growing field with updates coming every day, there might be some areas which might not be described in depth. This book is designed for students, young scientists to get acquainted with the redox biology. Overall, this book is a reference to understand the redox regulation of cellular signaling pathways involved in pathogenesis.

This book covers both molecular and clinical aspects of Fragile X Syndrome (FXS) and premutation disorders so that new targeted treatments can be understood by clinicians and parents. It covers all premutation disorders including FXTAS, FXPOI and FXAND problems. The main focus is to help clinicians to give the best care possible to patients with FXS and to understand a multidisciplinary treatment approach. Underserved populations such as babies and toddlers with FXS and mothers with the full mutation are highlighted, including the treatments that can be beneficial to them. This book also discuss fragile X associated disorders as they impact the family whose proband has FXS. A highlight of this book is the international perspective on how different cultures deal with FXS and targeted treatments.

The scope for improving health care using stem cell therapies is thrilling, but has considerable technical challenges and methodological constraints that need to be addressed. Keeping with the tradition of Humana Press to bring these developments to the forefront in a timely manner, this book presents scientific advances in stem cell methods for a wider use by novice and expert scientists, through the series of Methods in Molecular Biology.

This is a basic book on evidence-based medicine (EBM). It starts with an introduction to the topic. It outlines the relationship between EBM and research and quality of care. Then it goes on to cover the most commonly used modules of EBM, i.e. therapy, diagnosis, prognosis and meta-analysis. Each module starts with an introduction to fundamental concepts, and description of the related research process, and then follows the critical appraisal of related type of research article. At the end, it covers the different systems of grading of level of evidence and strength of recommendations. The book also has three examples of critical appraisal on diagnosis, therapy, and meta-analysis.

Although breast-feeding has long been associated with lowered infant morbid- ity and mortality from infectious disease, until relatively recently little was known regarding the individual components of human milk aside from their nutritive func- tions and the presence of secretory antibodies. Over the last 40 years, and especially over the last decade, evidence has been growing that human milk contains a large number of materials that are bioactive and that are not found in artificially formu- latedinfantdiets. Disparatelinesofresearcharecurrentlyproducingsurprisinglylong listsofnewlyrecognizedhumanmilkcomponents-antimicrobialsand immunomod- ulators, includinganti-inflammatoryagents, antioxidants, cytokines, andhormones- with biological activities that relate to pathogenesis, inflammation, development, metabolic regulation, and other functions. The sum of all of these biologically active milk components may account for the strong protection that human milk affords nursing infants. Strictly speaking, most components of human milk could be considered bioac- tive, since nutrients are bioactive by definition. A major emphasis of this book, how- ever, is on defining what is known about components of human milk that inhibit common pathogens of the infant, those that have hormonal and/or cytokine activity, those that have immunomodulatory and/or anti-inflammatory activity, xenobiotics, and nutrients that are uniquely essential to early development. The topic of bioactive substances in human milk was explored in depth at the th 8 International Conference of the International Society for Research on Human Milk and Lactation (ISRHML) held at Plymouth, Massachusetts, October 25-29, 1997. This book contains the proceedings of that conference.

Human Biochemistry, Second Edition provides a comprehensive, pragmatic introduction to biochemistry as it relates to human development and disease. Here, Gerald Litwack, award-wining researcher and longtime teacher, discusses the biochemical aspects of organ systems and tissue, cells, proteins, enzymes, insulins and sugars, lipids, nucleic acids, amino acids, polypeptides, steroids, and vitamins and nutrition, among other topics. Fully updated to address recent advances, the new edition features fresh discussions on hypothalamic releasing hormones, DNA editing with CRISPR, new functions of cellular prions, plant-based diet and nutrition, and much more. Grounded in problem-driven learning, this new edition features clinical case studies, applications, chapter summaries, and review-based questions that translate basic biochemistry into clinical practice, thus empowering active clinicians, students and researchers.

The metabolic syndrome is a common syndrome affecting about 20 % of the adult population in Europe, and probably the prevalence is of the same magnitude in other industrialised countries worldwide. It is mainly caused by western lifestyle resulting in abdominal obesity, but also a genetic predisposition plays a role. This syndrome, which is linked to leisure lifestyle and overeating/obesity, can develop into type 2 diabetes, cardiovascular disease and cancer. Therefore, proper treatment and prevention are heavily needed. This book discusses lifestyle intervention and treatment, specifically with pharmacological compounds, in order to formulate a strategy for treating the metabolic syndrome in the daily clinic.

Arachidonic acid (AA) and other 20 or 22-carbon polyunsaturated fatty acids (PUFAs) are precursors of lipid mediators of inflammation known as eicosanoids. These mediators are critical in disease processes and in regulating normal cell function. Remodeling is important in maintaining homeostasis and in regulating cell function by dictating how PUFAs are converted to lipid mediators of inflammation. Thus, PUFA remodeling is a critical process in the biosynthesis of a multitude of mediators, and understanding this process will unravel better therapeutic targets for controlling inflammatory diseases such as asthma and Alzheimer s disease.
AA metabolism is described in an integrated context linking the remodeling processes with the biosynthesis of mediators and diseases. By following the movement of the substrate (AA), the volume describes how upstream biosynthetic pathways influence the formation of lipid mediators of inflammation, showing the metabolic interrelationship between all AA-derived mediators."

The complement system, first described more than a century ago, was for many years the ugly duckling of the immunology world, but no more. Complement in recent years has blossomed into a fascinating and fast moving field of immediate relevance to clinical scientists in fields as diverse as transplantation biology, virology, and inflammation. Despite its emergence from the shadows, complement retains an unwarranted reputation for being "difficult." This impression derives in large part from the superficially complicated nomenclature, a relic of the long and tortuous process of unraveling the system, of naming components in order of discovery rather than in a syst- atic manner. Once the barrier of nomenclature has been surmounted, then the true simplicity of the system becomes apparent. Complement comprises an activation system and a cytolytic system. The former has diverged to focus on complement to distinct targets-bacteria, - mune complexes, and others-so that texts now describe three activation pa- ways, closely related to one another, but each with some unique features. The cytolytic pathway is the same regardless of the activation process and kills cells by creating pores in the membrane. Complement plays an important role in killing bacteria and is essential for the proper handling of immune complexes. Problems occur when complement is activated in an inappropriate manner-the potent inflammation-inducing products of the cascade then cause unwanted tissue damage and destruction.

From explanations of the roles of hormones to detailed descriptions of testing options and treatment choices, this book is a guide to male hormones: What they do, what goes wrong, and what can be done about it. Testosterone levels begin to decline in men at the age of 30. But, as this book shows, men can take steps to normalize hormone levels. With the twin goals of education and empowerment, two naturopaths explain the roles of male hormones and why decreasing testosterone levels affect body and mind. His Change of Life: Male Menopause and Healthy Aging with Testosterone offers detailed descriptions of testing options and, most importantly, specific treatment choices offered by both allopathic and alternative models that will enable men of all ages to live life to the fullest. Symptoms the authors address include night sweats, reduced flexibility, loss of muscle mass, low sex drive, and high blood pressure. Solutions they explain include stress management, exercise, nutrition, dietary supplements, and androgen replacement therapy. Conventional treatments are also covered, as are potential side effects of actions men may take. The authors detail which actions are safe to take on your own, and which need the supervision of a medical expert. 14 tables and graphs explain the main points of each chapter A list of endnote references appears at the end of every chapter

Tiefgehende Analyse von Sarkopenie in der Gerontologie. Die Erkrankung ist noch immer wenig erforscht, hat jedoch weitreichende Auswirkungen in dem Fachgebiet. Von Sarkopenie sind altere Manner und Frauen betroffen. Im klinischen Kontext spielt die Krankheit, die erst 2016 formal in die Internationale Klassifikation von Krankheiten aufgenommen wurde, weiterhin eine ungeordnete Rolle. Die gesundheitlichen und finanziellen Folgen koennen fur eine Gesellschaft immens sein, wenn keine einheitlichen und effektiven Verfahren umgesetzt werden, um die Erkrankung zu erkennen und zu behandeln. In der uberarbeiteten und erweiterten 2. Auflage von Sarcopenia erhalten Geriatern und weitere Experten aus dem Gesundheitssektor einen UEberblick uber diese kaum erforschte und wenig erkannte Erkrankung. Die Herausgeber sind namhafte Experten und betrachten die Epidemiologie und Diagnose der Sarkopenie, Behandlungsoptionen und moegliche Praventionsstrategien. Die acht neuen Kapitel bauen auf dem vorhandenen Wissensstand auf und liefern neue Erkenntnisse, u. a. zu Biomarkern bei Sakropenie und den Auswirkungen auf das Gesundheitswesen. Diese wichtige Publikation - definiert Sarkopenie und erlautert die klinische Relevanz. - prasentiert die jungsten wissenschaftlichen Erkenntnisse. - beleuchtet Behandlungsoptionen. - erlautert Praventionsstrategien. - zeigt die Bedeutung von Sarkopenie im Gesundheitswesen. - enthalt acht neue Kapitel, u. a. zu dem klinischen Management der Erkrankung, zu Biomarkern und zu den finanziellen Folgen. Die 2. Auflage von Sarcopenia ist ein bahnbrechendes und wichtiges neues Referenzwerk fur Kliniker und weitere Experten in der Geriatrie, Altenpflege und Altenheimen und der Fachrichtungen Ernahrung, Onkologie, Endokrinologie, Chirurgie, Sportmedizin sowie einer Vielzahl von Fachgebieten.

Applied Anatomy for Clinical Procedures at a Glance is a concise resource combining high-quality images and step-by-step instructions to provide expert guidance on the major core training pathways in medicine, surgery and anaesthesia. Written by an experienced team of Foundation Training programme directors and clinical skills examiners, this unique revision and learning guide aligns with training pathways rather than anatomical area to support Foundation doctors and core trainees master these vital clinical procedures. Succinct yet thorough descriptions of each procedure include photographs of surface anatomy, line diagrams of the anatomy, instructions on the procedural techniques, and practical tips for performing the procedures safely whilst minimising risks of complications. All major aspects of Foundation procedures and Core training in applied anatomy are covered, including catheterisation, ECGs, central venous cannulation, basic suturing and anastomotic techniques, endotracheal intubation, epidural injection and spinal injection, defibrillation, and many others. Helps Foundation doctors and Core trainees apply their medical school knowledge in clinical settings Explains the common anatomical pitfalls of invasive clinical procedures Features practice questions on anatomy and clinical aspects to aid in preparing for clinical skills examinations Includes sections on aftercare and on specific equipment, including manometers and underwater seals Applied Anatomy for Clinical Procedures at a Glance is ideal for Foundation doctors and Core trainees, as well as medical students, physician's assistants and surgical scrub practitioners.

Accessible, visually stimulating guide to clinical neuroanatomy, striking the perfect balance between regional and functional content Essential Clinical Neuroanatomy, 2nd Edition discusses the anatomy of the nervous system from the clinical perspective in easy-to-understand language, providing descriptions of the sensory, motor, and integration systems within the nervous system. Illustrations are included throughout in the clinical view using the axial radiologic standard of computed tomography and magnetic resonance imaging. To enable seamless reader comprehension, the text includes case studies, study questions, boxes of interest to highlight the clinically relevant neuroanatomy, learning objectives, an outline of each chapter’s material to be covered, multiple choice questions, and further reading resources. Essential Clinical Neuroanatomy, 2nd Edition contains information on: Topics important to clinical medicine, but often neglected in other neuroanatomy texts, such as trauma, infection, and congenital considerations Includes recent reviews and references with a focus on the cortical chapter and the imaging chapter where there is significant ongoing research Two new chapters on the peripheral and autonomic nervous systems Use of imaging studies used in clinical neuroanatomy, including how to evaluate these images Neuroanatomy of the central nervous system, covering an overview of the nervous system, blood vessels, meninges, and ventricles, neurodevelopment, the spinal cord, brain stem, cerebellum and cortex Sensory, motor, and integration systems, covering the visual system, auditory and vestibular system, olfaction and taste, central motor control, the limbic system and cortical integration Essential Clinical Neuroanatomy, 2nd Edition is the perfect resource for medical and health science students taking a course on neuroanatomy and as an on-going companion during those first steps in clinical practice. The text is also useful for those reviewing neuroanatomy for major licensing or competency examinations (National Board of Medical Examiners (NBME) United States Medical Licensure Exams (USMLE).

Encyclopedia of Respiratory Medicine, Second Edition, Six Volume Set explores the key processes of lung diseases and their diagnosis and management. The book dissects the molecular and cellular biology, physiology and immunology that underpin normal lung function, along with the aberrations that occur in respiratory diseases, from common disorders such as asthma and COPD to rarer lung diseases such as cystic fibrosis, interstitial lung diseases and pulmonary hypertension. Written in at a time when the globe is in the grip of respiratory pandemic, lung disease has never been so prominent in the public and political conscious. This new edition will provide new researchers in respiratory medicine with a solid foundation in unfamiliar topics and will update more experienced researchers seeking to step outside their core areas of research to put their work into a broader context.

Here is the first book to respond to the growing movement towards clinical simulations in health care education. It provides all of the guidance needed to make an informed decision about whether to begin using patient simulators . describes how to develop and operate a simulation center . and discusses how to design educational and assessment simulations that reflect specific educational curricula. Features the expertise of three authorities who have extensive experience in working with the University of Louisville School of Medicine's Dr. John M. and Dorothy Paris Simulation Center-one of the leading medical simulation centers in the world. Explains the value of simulation for a variety of healthcare disciplines and discusses which types of simulations are most relevant for each field. Discusses the resources (space, personnel, equipment) needed to establish a simulation program. Evaluates the specific simulation products that are currently available. Details the "nuts and bolts" of preparing relevant "patients" and scenarios. Describes applications for assessment, certification, and re-certification. Presents an overview of future trends in simulation (such as virtual reality simulations) and discusses issues related to planning for simulation center growth. With 29 additional contributors.

Evidence for the efficacy of behavioral approaches to the treatment and management of physical illness is mounting, as is the evidence for behavioral interventions for psychological disorders. A pressing question that remains is how to effectively treat co-morbid physical and psychological illnesses. Diseases co-occur more often than not, and the co-occurrence of physical and psychological illnesses is associated with greater impairment and healthcare costs. Unfortunately, the treatment literature has traditionally been disease-specific, with fewer insights and discoveries regarding the underlying processes of co-morbid physical and psychological illnesses, and even fewer of approaches to treatment.Research on co-morbidities between physical and psychological illnesses has focused primarily on depression. Quite extensive literatures describe the negative impact of depression on type 2 diabetes, cardiovascular disease, cancer, obesity, pain, and other physical illnesses. More recently, higher rates of physical illness have been documented in individuals with bipolar disorder, anxiety disorders, schizophrenia, and impulse control disorders. Studies emanating from the National Comorbidity Survey-Replication (NCS-R), the only U.S. population-based database that includes diagnostic information on all DSM-IV psychological disorders, have revealed strong links between a number of physical and psychological illnesses. These data draw attention to the prevalence of physical and psychological co-morbidities at the population level, which has stimulated research on the biobehavioral mechanisms of those co-morbidities, with the goal of developing and improving treatment approaches. As this area of research grows, practical resources are needed for clinicians and researchers who encounter individuals with co-morbid physical and psychological illnesses in their work. This book is the first to provide a comprehensive overview of psychological co-morbidities of physical illness, biological and behavioral mechanisms of those co-morbidities, and implications for treatment. Each chapter focuses on a physical condition, such as obesity, type 2 diabetes, HIV infection, tobacco dependence, cardiovascular disease, cancer, asthma, pain, irritable bowel syndrome, autoimmune disorders, and obstetric/gynecological conditions. Chapters are structured to cover 1) the epidemiology of the most prevalent co-morbid psychological disorders within that physical condition (e.g., depression and other mood disorders, anxiety disorders, psychotic disorders, impulse control disorders, and eating disorders; 2) biobehavioral mechanisms of the co-morbidity; 3) a review of the behavioral treatment literature including evidence-based practice guidelines (where available); and 4) treatment considerations including issues of stepped care, evidence-based treatment decisions, treatment sequencing, treatment blending, treatment interactions, and contraindications. Content is guided by available research evidence and relevant theoretical models, and it is presented in such a way as to inform clinical practice, identify important gaps in the research literature, and provide directions for future research. The book serves as a tool for clinicians and researchers who work in the area of behavioral medicine in medical, academic, and/or training settings. Patients with psychological and medical co-morbidities may be encountered by clinicians working in either mental health or medical settings, where the presenting problem could be either the psychological disorder or the medical disorder. As such, assessment and treatment issues are discussed from both perspectives. For the clinician, the book reviews brief assessment tools, provides practical summaries of the treatment outcome literature and treatment considerations (e.g., treatment sequencing, contraindications), and includes treatment decision hierarchies that help the clinician incorporate each facet of evidence-based decisions (the evidence, patient characteristics, and their own expertise). For the researcher, the book brings together the literature for the medical and psychological disorder, highlighting still unanswered research questions relevant to the co-morbidity. Literature relevant to the underlying biobehavioral mechanisms of the co-morbidity as well as treatment are summarized. While a vast literature exists for the treatment of these disorders in isolation, one important purpose of this book is to bring together this literature to uncover specific areas in need of future study that will further our understanding of why different disorders co-occur and the best ways to treat them when they do.

This is the second and updated version of the Textbook of Allergy for the Clinician. It is a unique book in the field of allergy. The uniqueness lies in the international character of the book with contributors representing both the East and West. This book represents the diversity of issues affecting patients in the specialty of allergy, asthma & immunology. There is some discussion of the basic mechanisms involved and extensive elaboration for the clinicians. This book will appeal to medical students, residents and fellows undergoing training as well as consultants in academic and clinical practice settings. The color plates, especially in the section on Aerobiology, will help in the interaction between the patient and consultant in identifying the plant or flora which is the causative factor. The differences and similarities between the Eastern and Western approaches in the practice of the specialty are being addressed for the first time in a book.

Psychiatry Algorithms for Primary Care is a practical, quick reference guide to psychiatric assessment and mental healthcare in general practice. Providing algorithms informed by evidence-based guidelines, this easy-to-use resource helps busy medical and healthcare professionals quickly assess mental health problems, make informed treatment decisions, and understand when referrals to specialist mental health services are appropriate. Drawing from their extensive experience in general practice and psychiatry, the authors provide clear and authoritative guidance on a wide range of common psychiatric disorders, complex scenarios, and special considerations. Unique visual management algorithms define assessment, diagnosis, investigations and management for each condition, including Bipolar Affective Disorder, Psychosis, Depression, Dementia, and Attention Deficit Hyperactivity Disorder. Up-to-date information on medication choices and counselling strategies is found throughout the text. Designed for informing swift clinical decisions in demanding primary care settings, this indispensable reference guide: Conforms to the diagnostic criteria in the current edition of the World Health Organization's International Classification of Diseases Contains algorithms informed by the Royal College of General Practitioners (RCGP), Royal College of Psychiatrists (RCPsych), and the National Institute for Health and Care Excellence (NICE) guidelines Explores common complaints that can suggest psychological or psychiatric disorders, such as insomnia and fatigue Outlines special mental health considerations related to children, intellectual disability, autism, the elderly, and pregnancy Includes appendices covering commonly prescribed drugs and physical examinations for patients with severe mental illness Features numerous self-assessment questions and links to online reference tools for General Practitioners Psychiatry Algorithms for Primary Care is a much-needed resource for medical students and trainees, physicians and healthcare professionals in general practice, nurse practitioners, and practitioners in other fields such as urgent care and emergency medicine.