Children with life-threatening and terminal illnesses- and their families- require a unique kind of care to meet a wide variety of needs. This book, now in its third edition, provides an authoritative source for the many people involved in the care of dying children. Written by leading authorities in pediatrics and palliative medicine, this comprehensive resource emphasizes practical topics and covers the entire range of issues related to the hospice care from psychological stress to pain and symptom management. The text has been fully updated and includes an international perspective chapter and a chapter written cy Children's Hospice International with detailed all-inclusive care plans.

Proceedings of the Third International Symposium on Frontiers in Biomedical Polymers including Polymer Therapeutics: From Laboratory to Clinical Practice, held May 23-27, 1999, in Shiga, Japan. This book focuses on the progress and unique discoveries in the interdisciplinary scientific and technological area of biomedical application of polymers. The topics include polymeric materials for biomedical and pharmaceutical applications, as well as polymeric materials in therapeutics.

t Heinz Red! and Gunther Sch!ag Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria The word "sepsis" derives from the Greek meaning decay or rottenness. Tradition ally this term has been used to describe the process of infection accompanied by the host's systemic inflammatory response. Based on that understanding, previous clin ical studies have been designed to include only patients with positive blood cultures [1, 2]. However, the frequent occurrence of a septic response without the demon stration of microorganisms in the circulation has led to a new definition and under standing of sepsis, mainly as the systemic response of the host to an often unde tectable microbiological or non-microbiological process [3]. The general consensus is that cytokines are central to the inflammatory response, particularly in sepsis. It is now known that not only Gram-negative but also Gram positive, viral, and fungal infections initiate the complex cascades of cytokine release. Probably the most important aspect of bacterial action is the release of toxic bacterial products. In particular endotoxin from Gram-negative bacteria (see chap ter by Schade) and super antigens (see chapter by Neumann and Holzmann), as well as pore-forming toxins [4] from Gram-positive bacteria, induce cytokine formation. The importance of this cytokine release is evident from both diagnostic and thera peutic (mostly experimental) studies, and the action of cytokines may be the key to our understanding of the pathophysiology of the sepsis syndrome.

The Update compiles the most recent developments in experimental and clinical research and practice in one comprehensive reference book. The chapters are written by well recognized experts in the field of intensive care and emergency medicine. It is addressed to everyone involved in internal medicine, anesthesia, surgery, pediatrics, intensive care and emergency medicine.

The purpose of this book is to focus attention on recent developments in steroid and sterol hormone action. Many authors have generously contributed to the book. As a result, there is a great diversity of opinion A majority of the chapters deal with steroid or sterol hormone receptors. This is not meant to imply that receptor-mediated mechanisms are the sole or even the most important mechanisms by which steroid hormones act in the cell. There is wealth of evidence showing that other, non-receptor events, are important also. Steroid hormone recep tor research and the study of nuclear events mediated by steroids are presently the most intensely studied aspects of sterol hormone action and our selection of topics reflects this trend. We have also included chapters on vitamin 0 sterols and thyroid hormone in the book, as there is pood evidence that these hormones act in a manner similar to other classical steroids. 1 IMMUNOCHARACTERIZATION OF THE NUCLEAR ACCEPTOR SITES FOR THE AVIAN OVIDUCT PROGESTERONE RECEPTOR A. GOLDBERGER, M. HORTON, T. C. SPELSBERG Department of Biochemistry and Molecular Biology, Mayo Clinic and Mayo Graduate School of Medicine, Rochester, MN 55905 INTRODUCTION It is well known that steroid hormones, certain vitamins and sterols, enter target cells and bind to specific protein receptors in the cyto plasm or nucleus (1-4). This binding is saturable, high affinity, and steroid specific."

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.

Lippincott (R) Connect Featured Title Purchase the new print edition of this Lippincott (R) Connect title includes access to the digital version of the book, plus related materials such as videos and multiple-choice Q&A and self-assessments. This updated ninth edition of the leading medical physical examination pocket guide available today provides concise, authoritative guidance on how to perform the patient interview, physical examination, and other core assessments. This trusted pocket-sized reference includes fully illustrated, step-by-step techniques, retaining the easy-to-follow two-column format that correlates examination techniques on the left and abnormalities (clearly indicated in red) with differential diagnoses on the right. Now featuring an enhanced design, new content, and new student-friendly learning aids, Bates' Pocket Guide to Physical Examination and History Taking, Ninth Edition, is the ideal quick-reference resource for today's medical, PA, pharmacy, and nursing students. NEW! Expanded Unit 1 provides an overview of the components of the patient encounter and helps you ensure the most effective information-gathering and decision-making approaches. NEW! Algorithms provide helpful starting approaches for patients with common presenting symptoms. UPDATED! Restructured Regional Exam chapters enhance your understanding of overview material, examination techniques, and health promotion and counseling considerations. UPDATED! Photographs, illustrations, and references reinforce key content based on the latest evidence-based information. UPDATED! Text boxes are numbered to provide quick access to important summaries of clinical conditions and tips for challenging examination techniques. Detailed, highly illustrated tables of abnormal conditions display examination and clinical information in an easy-to-find, quick-reference format. Lippincott (R) Connect features: Full access to the digital version of the book with the ability to highlight and take notes on key passages for a more personal, efficient study experience. Carefully curated resources, such as interactive diagrams, audio and video tutorials, and self-assessment, all designed to facilitate further comprehension. Lippincott (R) Connect also allows users to create Study Collections to further personalize the study experience. With Study Collections you can: Pool content from books across your entire library into self-created Study Collections based on discipline, procedure, organ, concept or other topics. Display related text passages, video clips and self-assessment questions from each book (if available) for efficient absorption of material. Annotate and highlight key content for easy access later. Navigate seamlessly between book chapters, sections, self-assessments, notes and highlights in a single view/page.

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.

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.

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.

The inaugural volume of the 50 Studies series, 50 Studies Every Doctor Should Know presents key studies that have shaped the practice of medicine. Selected using a rigorous methodology, the studies cover topics ranging from dieting to cardiovascular disease, insomnia to obstetrics. For each study, a concise summary is presented with an emphasis on the results and limitations of the study, and its implications for practice. Brief information on other relevant studies is provided, and an illustrative clinical case concludes each review. A section of review questions and answers is included at the back of the book to ensure that readers take away the key messages from each study. For this new edition, the contents were reorganized to include ten new studies, and the references, guidelines, and implications of existing studies were thoroughly updated. This book is a must-read for health care professionals and anyone who wants to learn more about the data behind clinical practice.

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.

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

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.

An Exciting New Approach to Regaining Health Without Surgery!

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Fibroid tumors, while usually benign, can swell a woman's uterus to the size of a basketball, frequently causing heavy menstrual bleeding, cramping, bladder infections, and even infertility. Most doctors recommend surgery as the only answer. Now this innovative holistic program brings new hope for a surgery-free life to millions of American women.

Dr. Allan Warshowsky combines traditional Western medicine and holistic science to cure not just the fibroid condition but also the underlying imbalances and systemic dysfunctions that can cause fibroids. With an exciting program of diet, exercise, supplements, herbs, and mind/spirit work, Dr. Warshowsky shows fibroid sufferers how to become the strong, healthy women they deserve to be.

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.

Medically unexplained somatic symptoms are problematic in psychiatry, primary care settings, and other clinical areas. The burden they impose on health-care systems constitutes a significant public health problem. At the international symposium "Rethinking Somatoform Disorders," this problem was addressed by specialists working in somatoform disorders, psychiatric nosology, epidemiology, and biological and cross-cultural psychiatry. The meeting was the third of the Keio University International Symposia for Life Sciences and Medicine, in collaboration with the World Health Organization and the World Psychiatric Association.

One of the fascinations of psychiatry is that it is amenable to many different approaches. In seeking to account for mental disorder, for example, it is pos sible to explore the meaning and significance of symptoms in the psychody namic sense, to examine the social determinants of illness, or to adopt an es sentially biological viewpoint in investigating links between physiological and psychological dysfunction .. As a clinical discipline it may be practiced in the community, in the specialized clinic or hospital, or shoulder-to-shoulder with other medical practitioners in the general hospital. This richness and diversity are at once a strength and a weakness, attracting practitioners with a wide range of talents and interests, yet sometimes leading to polarizations and false an titheses. The so-called "medical model" of psychiatry has come under a good deal of attack, and deservedly so when claiming an exclusive provenance over all types and aspects of mental disorder. What cannot be gainsaid, however, is the central role of medicine in relation to many parts of the field, and the success in terms of understanding and therapy that has resulted from medicine's in volvement. Nor can it be doubted, after the most cursory acquaintance with the physically or mentally ill, that the relationship between these two forms of suffering is often so close and so mutually reinforcing that distinctions are drawn somewhat arbitrarily. This last is perhaps the cardinal reason for the alliance between medicine and psychiatry."