"Infection in the Compromised Host" has become a classic chapter in textbooks devoted to infectious diseases and internal medicine. The numbers of compromised hosts are increasing in the era of modem medicine because of our expanded capabilities to deal with difficult diseases, especially neoplasms. As a consequence, microbiologic complications related to the intensive care administered to these patients are increasing as well. Under these circum stances, not only does the underlying illness create conditions favorable for the development of unusual infections, but often the therapy contributes to the acquisition of potential pathogens that turn into agents responsible for severe and frequently fatal disease. Granulocytopenia and immunosuppression have been the two key fac tors in predisposing patients with cancer and other serious diseases to severe bacterial infections. Colonization by hospital-acquired pathogens and breaks in the anatomic barriers-as a result of disease or medical intervention-have contributed to the high incidence of infectious diseases in these patients. Although there is some overlap between the types of infection in granulocytopenic and immunosuppressed hosts, each ofthese clinical entities has distinctive features thatjustify considering them separately, reserving the term immunocompromised hosts only when refer ring to patients who are predisposed to opportunistic infections. For about two decades, infections in granulocytopenic patients have attracted the atten tion of clinicians because they represent a model for the study of antimicrobial drugs in hosts deprived of an essential element of defense against bacterial infection, that is, an adequate number of normally functioning granulocytes.

A pioneering guide for the management of tics and habit disorders Managing Tic and Habit Disorders: A Cognitive Psychophysiological Approach with Acceptance Strategies is a complete client and therapist program for dealing with tics and habit disorders. Groundbreaking and evidence-based, it considers tics and habit disorders as part of the same spectrum and focuses on the personal processes that are activated prior to a tic and habit rather than the tic or habit itself. By drawing on acceptance and mindfulness strategies to achieve mental and physical flexibility in preparing action, individuals can release unnecessary tension, expend less effort and ultimately establish control over their tic or habit. The authors explain how to identify the contexts of thoughts, feelings and activities that precede tic or habit onset, understand how self-talk and language can trigger tic onset, and move beyond unhelpful ways of dealing with emotions - particularly in taking thoughts about emotions literally. They also explore how individuals can plan action more smoothly by drawing on existing skills and strengths, and overcome shame by becoming less self-critical and more self-compassionate. They conclude with material on maintaining gains, developing new goals, and creating a more confident and controlled lifestyle. Managing Tic and Habit Disorders is a thoughtful and timely guide for those suffering from this sometimes all-consuming disorder, and the professionals who set out to help them.

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."

Prepare for success in today's fast-paced, collaborative healthcare environment! Offering expert perspectives from a variety of primary care and nurse practitioners, Primary Care: A Collaborative Practice, 5th Edition helps you diagnose, treat, and manage hundreds of adult disorders. Care recommendations indicate when to consult with physicians or specialists, and when to refer patients to an emergency facility. This edition includes six new chapters, a fresh new design, the latest evidence-based guidelines, and a new emphasis on clinical reasoning. Combining academic and clinical expertise, an author team led by Terry Mahan Buttaro shows NPs how to provide effective, truly interdisciplinary health care. UNIQUE! A collaborative perspective promotes seamless continuity of care, with chapters written by NPs, physicians, PAs, and other primary care providers. Comprehensive, evidence-based content covers every major disorder of adults seen in the outpatient office setting, reflects today's best practices, and includes the knowledge you need for the NP/DNP level of practice. A consistent format in each chapter is used to describe disorders, facilitating easier learning and quick clinical reference. Diagnostics and Differential Diagnosis boxes provide a quick reference for diagnosing disorders and making care management decisions. Complementary and alternative therapies are addressed where supported by solid research evidence. Referral icons highlight situations calling for specialist referral or emergency referral. NEW chapters cover topics including transitional care, risk management, LGBTQ patient care, bullous pemphigoid, pulmonary embolism, and dysphagia. NEW! An emphasis on clinical reasoning helps you develop skills in diagnosis and treatment, with coverage moving away from pathophysiology and toward diagnostic reasoning and disease management - including pharmacologic management. NEW focus on interdisciplinary care underscores the importance of interprofessional education and practice, and includes Interdisciplinary Management features. UPDATED chapters reflect the latest literature and evidence-based treatment guidelines, including new content on the Affordable Care Act as well as new coverage of patient satisfaction metrics, quality metrics, value-based purchasing, pharmacogenetics/genomics, and teen pregnancy and abnormal pregnancy. NEW quick-reference features make it easier to locate important information, through colorful section tabs, bulleted summaries, additional algorithms, a more logical table of contents, an Index to Standardized Treatment Guidelines, and a Reference to Common Laboratory Values.

In the front material of this book both a foreword and a preface appear. What the content of a preface should be is well understood. It is the author's retrospective account of intent, of the labors to accomplish that intent, and of the content of the book that resulted. What a foreword should be is less obvious. Most properly, it is perhaps the brief testimony of one who knows the accomplishments of the author and the scope of the field and who may direct readers to the book. On some basis, the writer is assumed to have earned the right to undertake such a task. To undertake the writing of a foreword for so considerable a researcher, teacher, and scholar as Alfred Evans can be seen not only as an honor but also as a daunting one. My first thought, in truth, is that this wine needs no blush and that no foreword is needed. As John Rodman Paul Professor of Epidemiology at Yale, Alfred Evans has an established reputation in the field of causality. We have learned from his insights about the evolution of causal thinking as epidemiology passed from the era of the germ theory into that of the search for causes of chronic noncontagious diseases. It was he who drew attention to the effect of specific context in that evolution.

The fifth edition of this bestselling Oxford Medical Handbook is now even better than ever, with the inclusion of three new chapters on day case surgery, remote and rural surgery, and emergency surgery. It has been thoroughly revised with the latest guidelines, management algorithms, and guidance on decision-making.Now with the editorial team expanded to include four new associate editors, this new edition provides an accessible pocket reference for surgical trainees, medical students, and all those involved in the care of the surgical patient. It is thoroughly comprehensive, without sacrificing the clear, concise, and quick-reference style the Oxford Medical Handbooks are known for. It provides surgically relevant anatomy and physiology, quick reference symbols, key diagrams, and a focus on evidence-based practice with key references throughout. This essential guide will ensure you have the information you need at your fingertips.

Since its launch in 1998 the European Society for Intravenous Anaesthesia (EuroSIVA) has come a long way in providing educational material and supporting the research and clinical application of intravenous anaesthesia. After the first two annual meetings held in Barcelona and Amsterdam in 1998 and 1999, three other successful meetings took place in Vienna, Gothenburg and Nice in 2000, 2001 and 2002. Next to these main meetings, starting in the year 2000, a smaller winter meeting has been organised every last week of January in Crans Montana, Switzerland. Both the main summer and the winter meetings breathe the same atmosphere of sharing the latest on intravenous anaesthesia research in the presence of a friendly environment and good company. Since the first meetings the educational tools of EuroSIVA have increased in quantity and technical quality allowing digital slide and video presentation along with the use of the computer simulation program TIVAtrainer during the speaker sessions and the workshops. Furthermore, EuroSIVA now exploits a website www. eurosiva. org that allows for continuous exchange of information on intravenous anaesthesia, the TIVAtrainer, the EuroSIVA meetings and online registration for these meetings. The EuroSIVA is currently engaged in friendly contacts with the Asian Oceanic Society for Intravenous Anaesthesia (AOSIVA), the United Kingdom Society for Intravenous Anaesthesia (UKSIVA), the Korean Society for Intravenous Anaesthesia (KSIVA), the European Society of Anaesthesiology (ESA) and the International Society for Applied Pharmacology (ISAP).

The availability of analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) sold over-the-counter (OTC) to the public without prescription has become an issue of major concern in recent years. The problem has been highlighted in the UK, USA and other countries because of the continuing high rates of cases of poisoning and the influence of switching from prescription-only status for many NSAIDs to OTC sale brought about, in a large part, by governments and health maintenance organisations (especially in the USA) anxious to save on costs of these drugs. Concern in the UK about poisoning from paracetamol and the appreciable morbidity and mortality from aspirin was such that a major review was initiated in 1996 by the UK government's Medicines Control Agency (MCA). Doubtless, many other governments have also undertaken reviews of the safety issues concerning OTC analgesics and NSAIDs. In the UK the situation has culminated in the decision announced in August 1997, as this book was going to press, that the number of tablets/capsules of the solid dosage forms of paracetamol and aspirin would be limited for sale OTe. This decision was essentially based on the need to limit the unit quantity of these drugs so as to reduce the likelihood of poisoning with paracetamol and the development of gastrointestinal and other more serious side-effects from aspirin. Time. will tell whether these new regulations will influence the occurrence of these adverse events.

At the Sixth Wiggers Bernard Conference, a group of scientists from various disciplines discussed new findings relating to nitric oxide synthase inhibitor in shock, sepsis, and organ failure. Dedicated to the presentation and discussion of both positive and negative findings related to the use of NOS inhibitors, the meeting served as a forum for issues relating to specific and non-specific inhibitors, as well as the role of nitric oxide-oxygen radical interactions. Both experimental and clinical data were presented in the trauma and sepsis field.

This collection of contributions on the subject of the neural mechanisms of sensorimotor control resulted from a conference held in Cairns, Australia, September 3-6, 2001. While the three of us were attending the International Union of Physiological Sciences (IUPS) Congress in St Petersburg, Russia, in 1997, we discussed the implications of the next Congress being awarded to New Zealand. We agreed to organise a satellite to this congress in an area of mutual interest -the neuroscience of movement and sensation. Australia has a long-standing and enviable reputation in the field of neural mechanisms of sensorimotor control. Arguably this reached its peak with the award of a Nobel Prize to Sir John Eccles in 1963 for his work on synaptic transmission in the central nervous system. Since that time, the subject of neuroscience has progressed considerably. One advance is the exploitation of knowledge acquired from animal experiments to studies on conscious human subjects. In this development, Australians have achieved international prominence, particularly in the areas of kinaesthesia and movement control. This bias is evident in the choice of subject matter for the conference and, subsequently, this book. It was also decided to assign a whole section to muscle mechanics, a subject that is often left out altogether from conferences on motor control. Cairns is a lovely city and September is a good time to visit it.

In this book, the discussion of the normal and pathological aspects of anxiety is critically examined. A chapter on the molecular basis of anxiety is included, outlining the potential of such approach in the discovery of novel effective pharmacological interventions. The face validity, predictability and usefulness of animal models in the design of valid new efficacious products are discussed. Separate chapters dedicated to each particular type of anxiety such as generalized anxiety disorder, social phobia, posttraumatic stress disorder, panic and obsessive-compulive disorder are included. This book should be of benefit to psychiatrists, clinical psychologists, general practitioners, nurses, students and all those engaged in neuropsychiatric research.

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.

This volume contains the proceedings of the ninth "Colloque medecine et recherche" of the Fondation IPSEN devoted to research on Alzheimer's disease. This symposium was held in Lyon on June 21, 1993, on the topic, "Amyloid Protein Precursors in Development, Aging and Alzheimer's Disease". The choice of this venue and of this particular subject was not a matter of chance. As far as the history of medicine and neurology is concerned, Lyon is doubtless one of the most famous cities in France and the F ondation IPSEN had to organize one of its meetings in this city which has been regarded for centuries as a major crossroads. Regarding the topic, the amyloid story is at the center of the debate in the field of Alzheimer's studies. For nearly 10 years, "alzheimerology" has more or less been intertwined with "amyloidology". The purification and the sequencing of the beta/ A4 peptide in amyloid congophilic angiopathy (Glenner and Wong 1984) and in Alzheimer's disease (Masters et al. 1985) were the first steps toward the numerous successes realised in the last few years. The discovery of the amyloid precursor protein (APP), the localisation of its gene on chromosome 21 and the sequencing of its cDNA in 1987 (Kang et al. 1987; Goldgaber et al. 1987; Robakis et al.

"Methods in Pulmonary Research" presents a comprehensive review of methods used to study physiology and the cell biology of the lung. The book covers the entire range of techniques from those that require cell cultures to those using in vivo experimental models. Up-to-date techniques such as intravital microscopy are presented. Yet standard methods such as classical short circuit techniques used to study tracheal transport are fully covered. This book will be extremely useful for all who work in pulmonary research, yet need a practical guide to incorporate other established methods into their research programs. Thus the book will prove to be a valuable resource for cell biologists who wish to use organs in their research programs as well biological scientists who are moving their research programs into more cell related phenomena.

xii a second edition might be in order, and readily agreed. Although the basic principles remain the same, discussions with analysts, laboratory supervisors, and managers indicated many areas where improve ments could be made. For example, new chapters have been added on sampling and quality assurance; laboratory facilities and quality assurance; and auditing for quality assurance. Very little of the first edition has been discarded, but many topics have been expanded considerably. The chapter on computers has been completely rewritten in view of the rapid changes in that field. The chapter in the first edition on planning and organizing for quality assurance has been split into two chapters, one on planning for quality assurance and the other on organizing and establishing a quality assurance program, and new material on mandated quality assurance programs has been combined with the material on laboratory accreditation. Numerous examples, especially those involving mathematical calculations, have been added at the suggestion of some readers. In short, this edition is very nearly a new book, and I can only hope it is as well received as the first edition. CHAPTER 1 Quality, Quality Control, and Quality Assurance One of the strongest trends in modem society is the continuing ev olution from a manufacturing to a service-oriented economy."

A detailed description of a new approach to perceptual analysis and processing of medical images is given. Instead of traditional pattern recognition a new method of image analysis is presented, based on a syntactic description of the shapes selected on the image and graph-grammar parsing algorithms. This method of "Image Understanding" can be found as a model of mans' cognitive image understanding processes. The usefulness for the automatic understanding of the merit of medical images is demonstrated as well as the ability for giving useful diagnostic descriptions of the illnesses. As an application, the production of a content-based, automatically generated index for arranging and for searching medical images in multimedia medical databases is presented.

The chapters of this book report cutting-edge research on molecular events in adiposity and type 2 diabetes, thus opening the way for innovative drug-based therapeutic strategies. It addresses all those who wish to keep in touch with recent developments in the field.

As little as 30 years ago, cardiovascular research at Bayer was just a small sideline with in an environment dominated by chemotherapy research, and only 15 years ago, Bayer's pharmaceutical business was confined to European and Latin Ameri can countries, with sales in cardiovascular pharmaceuticals close to zero. It goes without saying that Adalat has changed the company as a whole in its research, development, and marketing, both in Germany and, most importantly, world wide. In research and development, Adalat has led the way in to new areas such as hypertension, acute neurology, dementia, atherosclerosis, and heart failure. In pharmacology, Adalat was present at the dawning of the second phar macological revolution, which started out from whole animal models and progres sed, via in vitro screening and pharmacological research on the DHP receptor, down to the molecular level with the cloning of calcium-channel proteins. Having followed the Adalat story closely in its early years as a bench scientist, let me take this opportunity to thank the inventors, the scientists, and the investigators who have helped to tap the broad potential of calcium-channel blockade with dihyd ropyridines in general and Adalat in particular. But, success should not obscure our vision. There is no reason for us to rest on our laurels: it will take true innovations in cardiovascular research to top the gold standard set by Adalat. Let us take up the challenge.

HOW DO I USE THIS BOOK? This book is organized to answer specific questions about the metabolic and nutritional problems of critically ill patients. Thc questions are listed under five chapter headings in the Contents. Each question is self-contained with its own charts, tables, and references, although, in some instances, you may be referred to another section of the book for additional information. A detailed subject outline appears on the first page of each chapter, and there is an index for cross-reference to specific subjects. A metabolic support plan and accompanying metabolic and nutritional worksheet are locatcd in the Appendix. This plan pro vides the best estimates available for predicting the metabolic requirements of patients, and outlines approaches to feeding the hospitalized patient which will satisfy these nutritional needs. Clin ical cases are presented in this section to help you get started using the support plan. This volume is a handbook organized for frequent use - place the appropriate tables and nomograms on the bulletin board of the intensive care unit or in your office for convenient reference. Use the metabolic and nutritional support plan and establish the habit of assessing the metabolic requirements of your patients. Refer to the references cited to explore in further detail specific questions or areas of interest. By applying our knowledge of the metabolic and nutritional alterations which occur following disease, we can improve our care of the critically ill."

This was an important Symposium in a rapidly developing field of interest. It was designed to draw attention to areas which have been neglected in standard hepatology textbooks and to review areas of controversy. It was also meant to help bridge the communication gap between hepatologists'caring for children and adults as well as between some areas of clinical and basic research. The Symposium was a substantial success. Unfortunately two of the twenty participants did not deliver a manuscript. The result is a publication which is late and which is not as complete as it should be. For this lateness and incompleteness the editors apolo gize most sincerely--especially to those participants who delivered their manuscripts on time but even to those who delivered their manu scripts late. perhaps the most noteworthy feature of this publication is the fact that material presented in May 1980 is by no means out of date. Apart from the section on Viral Hepatitis, one of the most rapidly evolving fields of medicine, the context of the Symposium remains disturbingly current. The neglect continues, the controversies remain. We hope that this publication will help draw investigators into liver research, provide a useful point of reference for. those in the field and stand as a monument to editors past, present and future, who have chased, are chasing and will chase manuscripts in vain."

In this new volume, Dr. Gregory Fanelli, of the Geisinger Medical Center and a reknowned expert on knee injuries, provides orthopaedic surgeons with an unprecedented review of the most recent and advanced knowledge needed to successfully diagnosis and treat PCL injuries. This comprehensive and practical volume covers everything from biomechanics and anatomy, evaluation and non-operative treatment to the latest surgical treatments of PCL injuries using arthroscopy, grafts and synthetic ligament substitutes. In addition, contributions from such well-known specialists as Drs. M. Malek, Roger Larson and Fred Flandery make this an essential text for every orthopaedic surgeon.

Although a strikingly modem account of multiple (disseminated) sclerosis was given by Charcot more than one hundred years ago, we are still not sure of the precise nature of the disease, still less of any precise mode of management. Even diagnosis is at best 'probable'. This collection of essays examines the particular difficulties which beset the problem and have mili tated against the solution-problems of data collection and evaluation; clinical and biochemical vagaries and unanswered questions ; laboratory test prediction of the disease, etc. Experts in their fields have set out the difficulties and way forward as ther see them, and there must necessarily be overlap or contradictions which underline our lack of knowledge. Clearly no attempt can be made to cover more than a very few aspects of the problem (a further volume is planned to review other areas not covered here, in particular the relationship between multiple sclerosis and experimental allergic encephalo myelitis)-but it is hoped that the 'softness' of much of the data we have to work upon will become appan!~nt. It is intended that this volume should clearly differ from the large number of monographs and reports of symposia dedicated to multiple sclerosis in bringing out the shortcomings of our approaches, and in some respects our naivities rather than our individual brilliancies.

Clinical biomechanics is a rapidly changing field with an increasingly wide appeal. While the core subjects of biomechanics remain the behavior of bones, joints, ligaments, and muscles, this book focuses on more clinical aspects such as artificial joints, tissue transplantations, and the effects of disease on biomechanical properties. Also featured are special studies of the hand, spine, vascular system, and the analysis of three-dimensional motion.
Based on the 20th Annual Meeting of the Japanese Society for Clinical Biomechanics and Related Research, this book provides an overview of the subject as well as describing many exciting new concepts and innovative methods for analyzing biomechanical systems. It should appeal across a wide spectrum of professions, proving indispensable to everyone from orthopedic surgeons to engineers with an interest in biology.