bluuebunny/crossref_metadata_2025 huggingface dataset:
Time and Space: the framework of the world
Authors: Cutting J
Published: November 2023

The two most widely quoted pre-Socratic philosophers, Heraclitus and Parmenides, are celebrated for their opposing aphorisms about time. Heraclitus’ aphorism You cannot step twice into the same river, for fresh waters are ever flowing in upon you is regarded as a statement about the reality of change and time’s primary role in the scheme of things. Parmenides’ aphorism There remains only one way that being exists ... it is indestructible, entire, unshakeable and everlasting: it never was and it never will be, since it is all of it together present in the Now is considered to have expressed the opposite point of view. Parmenides and Zeno, through his paradoxes, are held to have believed that only the enduring is real, and that time, motion, and change are unreal.
Emotion, Will, and Action
Authors: Cutting J
Published: November 2023

The two main issues to be considered are the nature of emotion and its categorization. There are numerous reviews of theories of the nature of emotion. Those by Hillman (1960) and Lyons (1980) are particularly good, the former because of its comprehensiveness, and the latter for its clear exposition of the critical issues. Many theories are intrinsically unsound because they blur a whole number of matters, conflating, for example, the effect that an emotion might have on someone’s life situation, various levels of hypothetical causes of emotion (psychological, physiological, anatomical), and various metaphorical interpretations of emotion (energy, symbol, force).
The historical development of nutritional concepts
Authors: Bender David A , Bender Arnold E
Published: November 2023

If one distinguishes between nutrition-the study of foods in relation to the living organism-and dietetics-recommendations for treatment of disorders by dietary change-then dietetics has the longer history. Among the writings of Hippocrates (460-360 BC) is the injunction ‘Let your food be your medicine, and your only medicine be your food.’
World food supplies and protein-energy malnutrition
Authors: Bender David A , Bender Arnold E
Published: November 2023

The term protein-energy malnutrition (pem or pcm, protein-calorie malnutrition) is used to mean an inadequate intake of· total food to meet energy and protein requirements. In fact the problem is one of energy shortage, not protein deficiency. As shown in Table 10.12, most dietary staples provide at least enough protein to meet requirements if enough can be eaten to meet energy needs. Three distinct types of protein-energy malnutrition can be defined.
Vitamin D, calcium and phosphorus
Authors: Bender David A , Bender Arnold E
Published: November 2023

Vitamin D is not strictly a vitamin; it is a hormone which is synthesized in the skin non-enzymically in UV light. Nevertheless, where sunlight exposure is inadequate a dietary source of preformed vitamin is essential, and deficiency (rickets in children, osteomalacia in adults, see section 14.4) is, or has been, a major problem of public health in northern latitudes. The function of the active metabolite of vitamin D (see section 14.3.2) is in the regulation of calcium homeostasis and the uptake of calcium into tissues. It is therefore appropriate to consider vitamin D and calcium nutrition together; since the major body pool of phosphate is as calcium phosphates in the skeleton, requirements for phosphorus are closely related to those for calcium.
Vitamin C (ascorbic acid)
Authors: Bender David A , Bender Arnold E
Published: November 2023

Vitamin C is a vitamin for only a limited number of vertebrate species: man and the other primates, the guinea pig, bats, the passeriform birds and most fishes. Insects and invertebrates are incapable of ascorbate synthesis. Ascorbate is synthesised as an intermediate in the gulonolactone pathway of glucose metabolism; in those vertebrate species for which ascorbate is a vitamin, one enzyme of the pathway, gulonolactone oxidase (EC 1.11.3.8), is absent.
Food processing
Authors: Bender David A , Bender Arnold E
Published: November 2023

Man the hunter-gatherer lived on what he could find-molluscs, fish, seals, wild grain, nuts, berries, tubers, leaves, insects and their grubs, birds and their eggs, and such animals as were available. He roamed from one area to another seeking and hunting food and had no need to store it; storage became necessary between harvests only when people settled in one place and cultivated crops and herded animals. The first crops were wheat and barley; grains have been found in Palestine dating from 8000 BC. The wild variety of wheat was Emmer wheat from which the range of modem varieties was developed. Bread made from wheat has been dated around 5000 BC in the Nile Valley (2000 BC in England). Domestication of animals dates back to 8000 BC for cows, 6000 BC for sheep, goats and swine.
The face
Authors: Birnholz J C
Published: November 2023

An important trend in the continuing technical development of ultrasound imaging has been the progression from low resolution, composite, static views to highly detailed, high-speed imaging. Clinical sophistication has progressed in concert. In fetal scanning, the diagnosis or exclusion of structural abnormalities has been consolidated, and progress has been made in monitoring physiologic and behavioural dynamics. Study of the fetal face exemplifies these trends. It has been possible to depict the face clearly for the past decade with improved fidelity for the last five years using techniques for noise reduction (Birnholz 1991) (Plate 1). Some recent textbook chapters express the opinion that viewing the face, routinely, is a curiosity without practical value; other authors have focused upon the diagnosis of (major) facial anomalies (McGahan et al. 1990) or described appearances with some forms of aneuploidy. This article will address the clinical potential of holistic pattern recognition of the face itself.
Case studies: recent curriculum designs
Authors: Towle Angela , Jolly Brian
Published: November 2023

In this brief chapter we look at some curricula and changes and how they fit into the schemes described in Chapter 2.1. Although many curricula world-wide have undergone recent modification, we confine ourselves here to short descriptions, inevitably over¬ simplified, of established and large scale changes, that are well reported and relatively permanent. Unfortunately, none are UK-based.A new Faculty of Medicine was established at McMaster University in 1965. Intense early discussions among the ‘founding fathers’ in the late 1960s led to a fundamental decision: to try methods of education, research, health services partnerships, and organizational arrangements that represented clear alternatives to the North American norm prevailing at that time (Spaulding 1991). These goals are still arguably unique in their comprehensiveness. The planners decided that the curriculum would control the structure of the school for both teaching and research. Hence departments were large and multidisciplinary, but did not necessarily encompass every discipline.
The patient’s perspective: a challenge for medical education
Authors: Neuberger Julia
Published: November 2023

When the public examines the way young doctors are trained, they gasp in admiration at the hours students and house officers put in on the wards. They see a medical student going through her preclinical and clinical training, spending some of the time on the wards on the ‘firm’ of a senior doctor, a consultant, who is often treated like God. It often seems that on the impression that student makes on that consultant, her future reputation rests. If she wants to please, then she must imitate the behaviour of that consultant. She must act as the apprentice, learn from the man on the job, stay silent very often, and then practise in the same way.
Service-based learning in hospital medicine: integrating patient care and training in the early postgraduate years
Authors: Grant Janet
Published: November 2023

BackgroundPostgraduate medical education is based in clinical practice. That is a given that everyone accepts. Our own research work (Grant and Marsden 1988, 1992; Grant et al. 1989) has provided the evidence and it has been replicated many times by other workers.However, the advent in British hospital medicine of partial shift systems can deter the regular presence, as a group, of junior doctors in either service or teaching contexts. It also can mean that doctors no longer get the opportunity to follow a patient through from admission to diagnosis and treatment. They can have a partial view of a patient’s current history and its resolution. Added to this, patients themselves are staying in hospital for shorter periods, as increased throughput per bed becomes a management criterion. Clinical experience thus decreases with decreasing times in in-patient stay. A shortened overall period of training does not add any comfort to the observer of this picture.
The psychology of pain
Authors: Coniam S W , Diamond A W
Published: November 2023

Pain is felt as potential or actual tissue damage. As a result when we feel pain, or someone describes a pain to us, we seek its physical origin. If a physical origin can be found we accept the pain as real pain. If a cause cannot be found, or the intensity of the sensation seems greater than it should be, then a ‘supratentorial’ element is thought to have been added. In other words, the pain is in the mind or psychological.
Nerve blocks of the lower limb
Authors: Peutrell J M
Published: November 2023

The sciatic nerve (L4-S3) leaves the pelvis through the greater sciatic foramen accompanied by the posterior cutaneous nerve of the thigh and then passes beneath piriformis. In the buttock it lies half-way between the greater trochanter and the ischial tuberosity covered by gluteus maximus.
Subarachnoid anaesthesia in children
Authors: Peutrell J M
Published: November 2023

Subarachnoid anaesthesia has been used in children since the early part of this century but is no longer popular because:the duration of analgesia produced by a single injection of local anaesthetic is short and insufficient for postoperative pain control;general anaesthesia is usually used in children. Subarachnoid block is indicated:(l) to provide prolonged analgesia using intrathecal opioids in older children having major surgery (see p. 223)
Why is pain control a problem?
Authors: Park Gilbert , Fulton Barbara , Senthuran Siva
Published: November 2023

Numerous studies of hospital patients have confirmed that acute pain is often inadequately managed. Patients of all ages experience considerable pain during their hospital admissions, despite the widespread availability of drugs and techniques to relieve pain. The reasons for ineffective pain control in hospitals have been a source of much speculation and study. Some of the major reasons which have been considered follow.
Inflammation and non-steroidal anti-inflammatory drugs
Authors: Park Gilbert , Fulton Barbara , Senthuran Siva
Published: November 2023

Though the initial pain of injury is due to traumatic activation of nociceptors, the persistence of pain at the site of injury is caused by inflammatory mediators released by damaged tissue as well as increased spinal cord sensitivity to nerve impulses from the damaged area. Peripheral mechanisms of inflammatory pain revolve around the localized sensitization of nociceptors by prostaglandins and leukotrienes. These prostaglandins and leukotrienes increase the pain response to other chemical mediators such as histamine and bradykinin, which are released in response to cell damage from trauma. The characteristic signs of inflammation are described as ‘rubor, dolor, and tumor’ —erythema, pain, and swelling—and result from the effects of these mediators on peripheral vessels. These substances produce vasodilatation (rubor), nociception (resulting in pain), and increased capillary permeability (resulting in swelling).
An introduction to epidural and spinal analgesia
Authors: Park Gilbert , Fulton Barbara , Senthuran Siva
Published: November 2023

Epidurals and spinals are techniques of blocking pain transmission at nerve root and spinal cord level. Though both techniques offer good pain relief, there are a number of important differences between the techniques which need to be appreciated as these affect how the patient is managed. The differences are listed in Table 14.L Epidurals involve the placement of a catheter through a needle inserted in the epidural space just outside the dura mater. Through this catheter, continuous infusions of analgesic agents can be given. In spinals, a fine needle is inserted from the skin through the dura and arachnoid mater into the subarachnoid space to enable injection of the analgesic agents directly into the cerebrospinal fluid.
Antiemetic drugs
Authors: Park Gilbert , Fulton Barbara , Senthuran Siva
Published: November 2023

Nausea and vomiting are frequent and distressing complications after surgery. In some patients they will occur after a minor body-surface operation associated with a brief general anaesthetic without opioids being used. In other patients their frequency, duration, and severity appear to be related to the magnitude of the procedure, type of anaesthesia, and consequent method of analgesia. Nausea and vomiting are particularly common after gastrointestinal surgery, as a result of postoperative gastrointestinal dysfunction. They may also be an unwanted effect of the drugs that are used to control the pain. Some patients are particularly prone to vomiting and suitable reassurance and support may be important in these patients. Vomiting occurs more often in females than males and is more common in the young than in the elderly.
Early recognition of the critically ill child
Authors: Morton N S
Published: November 2023

It is as important that people working with children are able to recognize the early signs of failure of the respiratory, circulatory and central nervous systems as it is for them to be able to treat cardiac arrest in children (see Chapter 3). This is because the outcome from established paediatric cardiorespiratory arrest is so poor. It is particularly important to prevent progression to cardio respiratory arrest whenever possible and, unfortunately, the compressed time scale of deterioration in children is often not appreciated. Decompensation can occur in seconds in the seriously ill child.
Resuscitation of infants and children
Authors: Cullen P M
Published: November 2023

Each year in the United kingdom, approximately 7500 children die. About 50% will die in the first month of life, and a further 20% by the age of 1 year (Table 3.1). The causes of death vary with age.1 In the neonatal period, birth asphyxia, congenital abnormalities, and factors associated with preterm birth such as respiratory distress syndrome, periventricular haemorrhage, and sepsis are the main killers. In infants less than 1 year, sudden infant death syndrome (SIDS) is the most common cause of death, followed by congenital abnormalities and infections. After l year trauma is the most frequent cause of death, and remains so well into adult life. Neoplasms are also an important cause of death in older children (Table 3.2).
Monitoring techniques in paediatric intensive care
Authors: Robson M
Published: November 2023

Monitoring the paediatric patient relies on the same basic equipment and underlying physical principles as in adult practice. However, differences are present particularly in relation to their size, physiology and underlying medi cal conditions (persistent fetal circulation, congenital heart defects) which are important in interpreting values and positioning of monitoring lines.
Accidents and poisonings
Authors: Modell Michael , Mughal Zulf , Boyd Robert
Published: November 2023

Childhood accidents are the commonest cause of death between the ages of 1 and 15. It has been estimated that 20 per cent of all paediatric admissions to hospital are due to accidents, and one out of six children will attend an Accident and Emergency Department each year (Polnay and Hull 1993). The risk of accidents in different environments varies according to age: toddlers and preschool children are at greater risk at home, while school age children are more likely to be injured at school during games and sports, and, more importantly, on the roads as pedestrians. Boys outnumber girls by a ratio of 3:2. Children from economically deprived backgrounds have a higher death rate from accidents. Poor housing, such as high rise flats, poor access to nearby parks or play areas, overcrowding and lack of money to buy safety equipment (such as fire guards) contribute, as do more intangible social factors. Stressful situations such as parental depression, marital discord, or family illness increase the risk of childhood accidents. The various preventive measures appear to be having an effect as the rate of accidental death is declining.
Allergy and asthma
Authors: Modell Michael , Mughal Zulf , Boyd Robert
Published: November 2023

Even though atopic disease in one form or another probably affects more than 10 per cent of the population, most GPs do not greet the suggestion that allergy may be the cause of a child’s persistent catarrh, prolonged diarrhoea, or hyperactivity with much enthusiasm, and neither do we. It is a difficult hypothesis to prove, and treatment by, for example, dietary manipulation, is difficult to sustain, may be hazardous, and can lead to an obsessive attitude to the child’s upbringing. However, allergy can sometimes be relevant to a wide range of diseases such as asthma, hay fever, eczema, perennial rhinitis, chronic conjunctivitis, urticaria, and failure to thrive with vomiting or diarrhoea.
Surgical problems
Authors: Modell Michael , Mughal Zulf , Boyd Robert
Published: November 2023

An organic cause for recurrent abdominal pain is only found in under 10 per cent of affected children, a problem discussed in Chapter 19. Here we consider quite another issue, acute abdominal pain occurring without a previous history. Most affected children will have unimportant illness; a few will be starting the weary round of recurrent abdominal pain; an important small minority will have a serious organic cause. In these, other symptoms are almost always present and give a clue to the diagnosis. After babyhood, the common causes are gastro-enteritis, with colicky pain, vomiting, and watery diarrhoea (p. 207); perhaps dietary indiscretion; and pain associated with upper respiratory tract infection. This latter in its severe form, ‘mesenteric adenitis’, may cause moderately severe abdominal tenderness which tends to have moved on re-examination. At operation enlarged mesenteric lymph nodes are found.
Professional Education for General Practice
Authors: Havelock Peter , Hasler John , Flew Richard , Mcintyre Donald , Schofield Theo , Toby John
Published: November 2023

Vocational training for general practice has been tremendously successful over the past two decades, but the need became apparent at the beginning of the 1990s for revision of the education of GP trainers already experienced in setting up a training practice, who were demanding a fresh, more detailed consideration of the educational aspects of vocational training. The authors of Professional Education for General Practice comprise general practitioners from training practices, regional advisers in primary care, and an expert in adult education. They describe the history of vocational training and examine the educational requirements of adult learners, then go on to discuss particular aspects of curriculum design, assessment, teaching methods, trainer-trainee relationships, and evaluation, followed by an appraisal of what changes are needed in training for general practice in the future. Throughout the preparation of the book the authors worked closely with general practice trainers and trainees as well as their educators, thus ensuring that the book is completely appropriate for these groups. This book is essential for everyone involved in teaching GP trainers as well as for the trainers themselves, and will be of interest to doctors training in primary care.
Pathology of rapidly progressive glomerulonephritis
Authors: Ferrario Franco , Rastaldi Waria Pia
Published: November 2023

Rapidly progressive glomerulonephritis (RPGN) is the name given to a syndrome characterized clinically by an acute rapid deterioration of renal function, and morphologically by widespread formation of circumferential extracapillary proliferation, generally involving more than 50% of glomeruli (Neild et al. 1983; Baldwin et al. 1987; Couser 1988). Many types of glomerulonephritis can present with crescent formation and renal failure, including both primary glomerular diseases and systemic diseases with glomerular involvement. Consequently, definition of RPGN has been difficult and the terminology and classification criteria have varied over the years, as a result of different approaches to the disease based on mainly clinical, pathological, or immunological components.
Anti-glomcrular basement membrane disease
Authors: Turner A Neil , Rees Andrew J
Published: November 2023

Ernest Goodpasture reported a single patient with lung haemorrhage and rapidly progressive glomerulonephritis (RPGN) while on leave from his residency at the Massachusetts General Hospital as a pathologist at the Chelsea Naval Hospital (Goodpasture 1919). In retrospect, the patient probably had systemic vasculitis. Goodpasture went on to become a pioneer in developing culture techniques for pathogenic viruses, but his name has remained attached to anti-GBM disease since it was applied by Stanton and Tange (Stanton and Tange 1958). Subsequently, it has become apparent that systemic vasculitis is a more common cause of lung haemorrhage and RPGN than anti-GBM disease, and it has become necessary to distinguish that syndrome (Goodpasture’s syndrome) from anti-GBM disease (Goodpasture’s disease), as his name is now firmly associated with the rarer, but better understood, disorder.
Crescentic nephritis secondary to infection, systemic disease and other glomerulopathies
Authors: Cameron J S1ewart
Published: November 2023

Since crescents occur when breaks in glomerular capillaries allow leakage of cells and plasma proteins into Bowman’s space (Chapter 1-3), it is not surprising that occasional crescents have been described in most chronic renal diseases, including some that do not primarily affect the glomerulus. Widespread crescent formation, however, requires active and specific attack on glomerular capillaries; predictably, this can occur in a variety of settings (Table 9.1). Today, crescentic nephritis is categorized using a variety of clinical, morphological, immunohistological, and serological criteria. None of the systems are entirely satisfactory; largely because crescent formation is the result of a disease, rather than a disease in itself.
The family attachment scheme at Queen’s University, Belfast
Authors: McGlade Kieran
Published: November 2023

The scheme, which evolved over several years, was originally squeezed into students’ spare time and facilitated by volunteer general practitioner tutor:,. It is essentially about learning how families and individuals perceive, understand, and manage their own health. The scheme arose out of a belief that medical students would benefit from very early and continuing exposure to patients and that there was a need to provide them with experience of how the practice of medicine works in the community. In recent years, formal curriculum time has been wrested from the basic medical science course to provide one tutorial per term with a GP tutor over the first two years of the medical curriculum. Students are still expected to visit patients in their own time. A lecture course entitled ‘Lifestyle and health’ takes place at the end of second year and draws on the experience the students have from this family attachment course. With the current reconstruction of the medical curriculum at Queen’s, as in many other universities, the family attachment scheme is now a key component and will act as a resource to several other curricular themes.
Audit projects
Authors: Blackie Dominic , Campion Peter
Published: November 2023

The audit cycle, like the citric acid cycle, is critically important to health and, potentially, just as stupefyingly dull to learn. However, there is one crucial difference: the Krebs’ cycle happens whether it is understood or not, unlike the audit cycle, which depends on doctors having the necessary knowledge, skills, and attitudes (Marinker 1990). The almost universal ignorance among clinicians of the details of Krebs’ work--despite the time devoted to it in the classical curriculum-is largely irrelevant. On the other hand, the reluctance among clinicians of all disciplines to pursue rigorous and relevant clinical audit, despite, for general practitioners, contractmil obligation and financial incentives, is arguably detrimental to patient care.
Student-completed records of learning
Authors: Bradley Colin
Published: November 2023

The idea of students completing a contemporaneous record of their clinical experience is certainly not new. The idea of a so-called ‘log diary’ is a common feature of many undergraduate and postgraduate courses in medical disciplines. However, not all such documents arc the same nor, indeed, do they even share a common purpose or set of purposes. Often, they fail to exploit the greatest potential of a student completed record of experience which is to act as a stimulus to reflection on experience that is central to the whole concept of experiential learning and is claimed to be particularly important in the development of professionals (Baud 1985; SchiÖin 1987).
Principles of assessment
Authors: Holsgrove Gareth
Published: November 2023

The major principles of assessment can be summarized under three interrelated headings: reliability, validity, and feasibility. Although they are very important, they are so frequently ignored that even some experienced examiners may be unfamiliar with them. Each acquires a special meaning in the context of educational assessment so this chapter sets out to describe some of the key points in lay terms. Reliability is concerned with the accuracy with which the assessment is made. Among the things which might affect accuracy is the extent to which different examiners marking the same piece of work would independently award similar marks. This is known as inter-rater reliability. It is of no importance in computer-marked examinations (e.g. multiple choice questions, MCQs), but may be a major source of unreliability in essay questions and, notoriously, in viva voce examinations and selection interviews.
Assessing knowledge
Authors: Holsgrove Gareth
Published: November 2023

A recurrent theme in this section has been that the style and outcome of summative assessment is a major determinant of students’ learning behaviour. This is especially true in medical education, which is traditionally highly competitive both in student selection and in the many examinations that the students will take, especially if the assessment is norm-referenced. Assessors should be concerned to know the students’ achievements in relation to agreed criteria, the curriculum objectives, and, in particular, whether they satisfy the criteria for safe and competent practise. The rank order of their marks is of little interest, particularly when the confidence intervals determined by measures of the reliability of the examination prove that the rank order may be unreliable anyway.
Resuscitation and acute treatment of brain injuries (traumatic and atraumatic)
Authors: Ratcliffe Jane
Published: November 2023

The aim of this chapter is to provide an overview of the principles of management and to emphasize the importance of adequate initial resuscitation and the optimization of cardiovascular parameters, to reduce the incidence of secondary brain injury. Although there are different mechanisms of acute brain injury with very different outcomes, the initial management and goals of treatment are the same.
The impact of brain injury on the family
Authors: Demellweek Colin , O’Leary Audrey
Published: November 2023

When a child suffers a brain injury (BI), other family members are likely to be affected and, indeed, such an injury has been referred to as being a family affair (Lezak 1988). Family members may be there when the injury occurs or be called to the hospital afterwards, and even quite a mild head injury (HI) appears to cause parents anxiety. In more severe cases, the child may be in a coma and family members may spend long, uncertain hours at the child’s bedside, disrupting family routines. If and when the child emerges from the coma he may, for example, be unable to walk or talk. A lengthy rehabilitation process may then begin, again requiring family members to spend long periods of time in the hospital and suspend or defer other activities.
Prevention of brain injury
Authors: Gregg Jackie , Appleton Richard
Published: November 2023

The number of patients with serious disability or death from brain injuries is not likely to decrease solely because of better medical care. Prevention is the only cure. This chapter will focus on the prevention of traumatic brain injury i.e. head injuries, but will also discuss the importance of preventative measures in non-traumatic injuries.
The urinary tract
Authors: Smith Francis W , Gemmell Howard G
Published: November 2023

The study of the urinary tract may be divided into the demonstration of the anatomy and the study of its function. The anatomy of the kidneys, ureters, and bladder is best displayed using diagnostic ultrasound and/or intravenous urography (IVU). Functional information, as well as the gross anatomy, are obtained by radionuclide renography and renal imaging using a gamma camera and computer. Renography is the method of monitoring the arrival, uptake, and elimination of a radiopharmaceutical by the kidneys to give an assessment of individual renal function. Renal imaging produces static images of the urinary tract.
The historical context
Authors: Heather Nick , Robertson Ian
Published: November 2023

Writing in 1773, Dr Johnson lamented the passing of the good old days ‘when all the decent people in Lichfield got drunk and every night and was not thought the worse of’ . Presumably such nostalgia already reflected the emergence of a more welldisciplined and sober age but, even so, on a night in 1782, James Boswell, Johnson’s faithful companion and biographer, was found dead drunk in a London gutter.
The wrist
Authors: Wardrope Jim. , English Bryan
Published: November 2023

The area of the wrist comprises a complex series of joints including the distal radioulnar joint.The joints are highly mobile and dependent on strong ligaments for stability. “ TraumaFractures of the scaphoid are one of the commonest missed diagnoses in A&E practice. Be reluctant to label an injury as due to ‘wrist sprain’ in a young patient with pain or swelling in the wrist after a fall or other significant injury. Such patients require senior review within 14 days.Falls on the hand in a child may result in fractures anywhere along the limb and these may be difficult to localize and diagnose. Seek senior review of a child not using a limb.Ligament injury may cause significant long-term disability.
The chest
Authors: Wardrope Jim. , English Bryan
Published: November 2023

In a patient presenting after a blow to the ribs perform a full respiratory examination.If the blow is to the lower ribs examine the abdomen.Perform a chest X-ray if there is any shortness of breath, raised respiratory rate, or chest signs.Those patients with chronic chest disease require extra care as the pain from a minor rib injury may precipitate respiratory failure.In a patient returning with chest problems after injury perform a chest X-ray.
Cardiovascular System
Authors: Harvey CJ , Roberts HRS , Shaw PJ
Published: November 2023

This 67-year-old man presented with a 4-hour history of central chest pain radiating to the back. His electrocardiogram (ECG) was diagnostic of an acute myocardial infarction. What is the diagnosis and how would you confirm it? The chest radiograph shows gross widening of the mediastinum and enlargement of the aortic contour. Other radiological features that may be present are tracheal and oesophageal displacement and a shift medially in the position of a calcified aortic rim by more than 6 mm from the aortic border. The cardiac silhouette may appear enlarged due to a haemopericardium or aortic regurgitation. Pleural effusion, an extrapleural apical fluid cap, and paramediastinal widening are other well recognized features. The chest radiograph may be normal. The diagnosis may be confirmed by contrast enhanced CT (Fig. 42a, arrow demonstrating a dissection of the descending aorta), MRI, aortography, or transoesophageal echocardiography.
Musculoskeletal
Authors: Harvey CJ , Roberts HRS , Shaw PJ
Published: November 2023

This 20-year-old man presented with a painful left shoulder. What is the most likely diagnosis? There is an aggressive lytic process affecting the left humeral head with cortical destruction and a Codman’s triangle type periosteal reaction. The glenoid is not involved. The distal extent of the bony involvement is ill-defined (‘wide zone of transition’) indicative of an aggressive process.
Rheumatology and orthopaedics
Authors: Round Jonathan
Published: November 2023

True. The spine should be straight when viewed from behind but should deviate in the anterior—posterior (AP) plane at the neck, chest, and in the lumbar region (known as the cervical, thoracic, and lumbar lordoses). Scoliosis is an abnormal lateral deviation and kyphosis deviation in the anterior-posterior direction.
Dermatology
Authors: Round Jonathan
Published: November 2023

There are several very common conditions peculiar to paediatrics in this subspeciality. Rashes and blemishes are also a particular focus of concern by the parents and a common cause of consultation.
Non-diabetic renal disease in type 2 diabetes
Authors: Rychlik Ivan , Fliser Danilo , Ritz Eberhard
Published: November 2023

Renal disease is particularly common in the elderly. According to Feest et al. the frequency of end-stage renal disease (ESRD) is about 85 times more common in this group (i.e. 500/million in those aged 70-79 years compared to 6/million in those aged< 19 years).1 It is in this elderly population that type 2 diabetes also tends to occur. Therefore, it can be predicted that some patients with diabetes will have another primary chronic renal disease. How often this occurs has remained controversial. From 1960 to 1963, Ditscherlein in former East Berlin collected a total of 400 consecutive diabetic patients who had come to autopsy.2 He found glomerulosclerosis in 45.3% including nodular glomerulosclerosis in 23.3%. As to additional or superimposed renal disease, it is of note that pyelonephritis was diagnosed in 30%. However, this figure must be viewed with circumspection in view of the criteria then used for the diagnosis. Of note, however, is the finding that papillary necrosis was found in no less than 10.5% of the diabetic versus 0.7% in the non-diabetic population.
Risk factors for the progression of renal disease in type 2 diabetes
Authors: Bilous R W
Published: November 2023

The factors that affect progression of nephropathy in type 2 diabetes are less well characterized than for type l and there are several reasons for this. Historically, it was believed that fewer patients with type 2 diabetes developed nephropathy, and that proteinuria in these patients had a relatively benign prognosis compared to insulin dependent diabetic patients. Carefully controlled prospective studies have refuted both of these concepts; the cumulative incidence of proteinuria in type 2 diabetes is very similar to type l in Europid patients at around 25% after 20 years known duration of diabetes.
Extrarenal complications of the type 2 diabetic patient with diabetic nephropathy
Authors: Raz ltamar , Wexler Isaiah D
Published: November 2023

Diabetic nephropathy (DN) is a frequent complication of type 2 diabetes as well as a major cause of end-stage renal disease. The predicted natural course of type 2 diabetes is worse for patients with DN even in those with only asymptomatic proteinuria. The poor outcome is related to both renal dysfunction and the extrarenal complications of type 2 diabetes (see Table 11.1).
Kidney transplantation
Authors: Frei Ulrich
Published: November 2023

Since the first successful kidney transplants in twins more than 40 years ago, kidney transplantation has become an integral part in the treatment of end-stage renal disease (ESRD) in most of the developed countries around the world. Several important steps have been necessary to expand kidney transplantation from an experimental procedure into a widely practiced therapeutic option in such a way that it has become the most successful modality of renal replacement therapy.
Multi-organ transplantation
Authors: Frei Ulrich
Published: November 2023

In most patients, renal transplantation has to deal with a primary disease of the kidney. However, there are a number of clinical situations in which kidney failure is either a consequence of an extra-renal systemic disease or the cause for the failure of an other organ. The latter may happen simultaneously or sequentially. Therefore, there is a need for a simultaneous multi-organ transplant or the transplantation of different organs in sequence. In these cases, the rarely easy decision has to be made whether it is justified to use two precious organs, which might save the lives of two recipients, for one case with a sometimes open success. When reviewing the literature, it is obvious that multi-organ transplants have never been evaluated in a prospective manner, except for combined kidney-pancreas transplantation in some rare instances. Most available data consist of collected case histories. Nevertheless, it is now possible to draw some conclusions and to give advice on how to deal with these rare circumstances.
Optimal renal replacement therapy in elderly patients
Authors: Jacobs Claude , Mignon Françoise
Published: November 2023

No universal consensus currently prevails for the definition of elderly people. A 65-year age-limit is widely recognized in many countries for designating people as such on social, professional, or administrative grounds. In many persons, old age can not be strictly identified with civil age, as an elderly condition is also largely a state of mind. Similar difficulties and complications of dialysis treatments can be encountered in patients aged 40 or 75 years depending on their individual past history, presence of co-morbid diseases, and social environment.
The diagnosis of pregnancy
Authors: Neuberg Roger
Published: November 2023

It is very important to be able to diagnose pregnancy correctly. A woman will usually wish to have her suspicions, hopes, or fears confirmed one way or another as soon as possible. To assure a woman that she is not pregnant when in fact she is, or vice versa, can cause a considerable amount of distress and does not do a great deal to enhance a doctor’s reputation. In the majority of cases the diagnosis of pregnancy is a simple matter, being based upon an assessment of symptoms and signs backed up by special investigations.
Labour and delivery
Authors: Neuberg Roger
Published: November 2023

Although this may not be apparent to the woman and her partner, the labour ward must be regarded potentially as an intensive care area. Every pregnancy has the potential for producing a sudden and unexpected emergency.
Abnormal labour
Authors: Neuberg Roger
Published: November 2023

Labour is precipitate if delivery occurs within 4 hours of the onset of regular contractions. The risks are that delivery does not always occur in the safest environment and may take place before medical help arrives. There is risk of trauma to both the baby and the mother.
Towards the genetic basis of Rett syndrome
Authors: Clarke Angus , Schanen, Carolyn , Anvret Maria
Published: November 2023

In Andreas Rett’s original description of the condition was the key observation that all affected individuals were female (Rett 1966a,b, 1977). Almost all definite cases of Rett syndrome (RS) described since have been female. It is this observation, together with the (almost complete) concordance of monozygotic female twins for the disorder, that has led so many investigators to conclude that RS must be genetic in origin although almost all cases are sporadic. The most convincing reports of males with RS have been of boys with mosaic or complete Klinefelter syndrome (Vorsanova et al. 1996; Schwartzman et al. 1999).
The role of genetic and environmental factors in brain development: development of the central monoaminergic nervous system
Authors: Segawa Masaya
Published: November 2023

The MA neurons in the brainstem, namely the noradrenalin (NA), serotonin (SHT) and dopamine (DA) neurons, project their axons to various areas of the brain including the neocortex. There is regional specialization of innervation and.
The monoamine hypothesis in Rett syndrome
Authors: Nomura Yoshiko , Segawa Masaya
Published: November 2023

Rett syndrome (RS) is a unique neurodevelopmental condition predominantly affecting females and presenting with characteristic symptoms and signs. It is caused by mutation in the gene encoding X-linked methyl-CpG-binding protein 2 (MeCP2) (Amir et al. 1999) but its pathophysiology still remains to be clarified.
The Structure And Function Of Tendons
Authors: Benjamin Michael
Published: November 2023

A tendon is generally a dense fibrous connective tissue that links a muscle to a bone and thus extends from its myotendinous junction to its enthesis (i.e. the bony attachment site). However, some tendons (e.g. the intermediate tendons of omohyoid and digastric and the tendinous intersections of rectus abdominis) simply link one muscle belly to another. Depending on the fibre arrangements in the muscle, tendons can extend into the muscle belly as tendinous septa. Such an arrangement is generally characteristic of the more powerful, multipennate muscles (e.g. deltoid) that have a short range of action.
Local Injections For Soft Tissue Lesions
Authors: Speed Cathy
Published: November 2023

Injections of corticosteroids into articular and extraarticular structures began soon after their introduction for the treatment of rheumatoid arthritis in the 1950s. They rapidly became one of the most commonly utilized treatment approaches in the management of soft tissue disorders, in particular, chronic tendon lesions, and have remained so ever since. Corticosteroid injections have little or no role to play in most acute injuries nor in the management of ligament or muscle injuries and offer no advantage over dry needling in myofascial pain. Hence their use in chronic tendinopathies and in cases of bursitis will form the focus of this chapter.
Acute Neck Pain and ‘Whiplash’
Authors: O’Gradaigh Donncha , Hazleman Brian
Published: November 2023

Neck pain, though almost as common as low back pain and presenting the same difficulties in diagnosis and management, has received considerably less research attention, and the precise anatomical structures responsible and the most appropriate management remain unclear in most cases. This chapter will concentrate on conditions in which a rheumatologist’s opinion is typically sought by general practitioners or others working in primary care, such as physiotherapists and sports physicians. Neck pain resulting from whiplash injuries is particularly relevant in this context. While various authors have suggested that whiplash-associated disorder is exclusively a somatization disorder, driven by psychosocial factors and compensation claims, the disorder is discussed here in the context of the available evidence in rheumatology and orthopaedic literature.
Acute spinal pain
Authors: Fairbank Jeremy
Published: November 2023

Back pain is so common as to be an almost universal affliction. Ennui or professed ignorance rapidly overwhelms all but a dedicated few of doctors when confronted with this complaint. However, it is a symptom that can be analysed by careful listening and a knowledge of the fascinating complexity of the spine and pain mechanisms. This chapter gives an account of ‘acute’ low back pain, although the definitions of ‘acute’ have been stretched, since many acute problems become chronic in this field. Back pain heads the list of condition-related health costs. In 1998 the estimated total health cost of back pain in the United Kingdom was £1632 million (of which a third was contributed by the patient) and employment-related costs were £10,668 million.(1) These costs relate to both acute and chronic back pain.
The shoulder
Authors: Speed Cathy
Published: November 2023

Shoulder complaints cause significant pain and disability in the general population and represent a major burden upon the economy due to the cost of health care, lost earnings, and social security payments. Shoulder pain has a point prevalence of 7–21 per cent of adults in the community(1,2) and is the second most common acute musculoskeletal complaint presenting to primary care, with only back pain presenting more frequently. In the United Kingdom 1 per cent of adults over the age of 45 present to their general practitioner with a new episode of shoulder pain annually.(3)
The Wrist and Hand
Authors: Dalton Seamus
Published: November 2023

The anatomy of the wrist and hand is complex but it is this that provides the upper limb with its unique capacity for fine motor function and ability to obtain information from the surrounding environment. Not only is the hand our conduit for almost all upper limb function, but it also assists in communication and expression. The hand comprises 19 bones, 17 articulations, and 19 muscles, as well as the numerous tendons activated by muscles in the forearm. The risk of injury, both acute and overuse, is high. Many of these injuries resolve with no lasting loss of function but significant impairment may result from acute or chronic soft tissue disorders and early diagnosis is important. The aim of this chapter is to present the common and some of the more unusual soft tissue disorders of the wrist and hand. Fractures and dislocations are not discussed but the more common carpal instability patterns arising from ligamentous injuries are reviewed.
The Ankle
Authors: Speed Cathy , Robinson Andrew
Published: November 2023

Soft tissue injuries of the ankle are among the most common soft tissue injuries and their consequences are frequently underestimated. The numerous ligamentous bands, the 11 major tendons that cross the joint, and other local soft tissue structures are prone to both acute and overuse injuries due to the significant forces imposed upon the region. The stability of the ankle joint is vital to normal function but is frequently compromised through injury.
The Foot
Authors: Speed Cathy , Robinson Andrew
Published: November 2023

The anatomy of the foot is closely linked to its diverse functions, in particular, support, stability, flexibility, propulsion, acceleration, deceleration, and the provision of sensory information. This is achieved through a series of arches and chains formed by bones and soft tissues. These allow the foot to transform from a rigid and stable unit to a flexible system. The foot can be divided into three regions: the hindfoot; midfoot; and forefoot (Fig. 1). Inevitably, the function of each region is affected by the others.
Myofascial Pain Syndromes
Authors: Cummings Mike
Published: November 2023

Somatic pain is likely to be the most prevalent cause of pain in the general population—it is certainly a common reason for extended absence from work. The prime environmental aetiological factors are probably degeneration and abuse of the musculoskeletal system, and it should be no surprise that the areas which suffer most are those exposed to the greatest loads and activity over time—the articular surfaces of weight-bearing joints and the postural muscles of the limb girdles and axial skeleton.