bluuebunny/crossref_metadata_2025 huggingface dataset:
Seasonal variation
Authors: Little Julian , Elwood Mark
Published: November 2023

Seasonal variation in the frequencies of congenital malformations is of interest as it may indicate the potential action of environmental agents such as climate, dietary factors, or infections. Historically, the evident seasonality of congenital cataract (Gregg 1941) led to the demonstration of an infectious aetiology associating this defect with maternal rubella infection in early pregnancy. Seasonality in the prevalence at birth of anencephalus and spina bifida has been long recognized (McKeown and Record 1951), but much inconsistency and marked secular changes and geographical variation in seasonality of these malformations has been observed. Observations of seasonal variation in the occurrence of neural tube defects have led to a number of hypotheses. One suggested explanation is that the seasonal variation in births is secondary to seasonal variation in the spontaneous abortion rate of fetuses with anomalies (Leck and Record 1966). If an association between neural tube defects and season were due to seasonal factors acting in the periconceptional period rather than influencing the length of gestation, these effects might be postulated as acting at two levels—direct and indirect.
Smoking and Hormone-related disorders in the Nurses’ Health Study
Authors: Stampfer Meir J , Colditz Graham A , London Stephanie J , Chute Christopher G , Rosner Bernard , Willett Walter C , Hennekens Charles H , Speizer Frank E
Published: November 2023

Cigarette smoking alters levels of oestrogens and other hormones, and could therefore affect the incidence of disorders thought to be hormonally related. This issue is addressed in the Nurses ‘ Health Study. A cohort of 121 700 nurses was established in 1976, and followed through biennial questionnaires. In 1976, 34.4 per cent of the cohort were current smokers, a proportion very similar to the general US population of women. Smokers had a dose-related earlier menopause than non-smokers, independent of leanness. Cigarette smoking was an important risk factor for both stroke and coronary heart disease, with a pronounced dose effect. Even one to four cigarettes per day led to a relative risk of coronary heart disease of 2.4 (95 per cent confidence interval 1.1-1.5). Approximately half the cases of fatal coronary disease and nonfatal myocardial infarctions were attributable to cigarette smoking. These effects were not materially altered by menopausal status or use of postmenopausal hormones. Smokers who currently used oral contraceptives had a relative risk of coronary heart disease of 5.0 (confidence intervals 2. 7-9.0) compared to non-smoking women who never used them. No effect of past use of oral contraception was observed on risk of cardiovascular diseases in both pre- and post-menopausal women. There was a strong protective effect of post-menopausal oestrogen use for coronary disease that was similar in both smokers and non-smokers. No material association was found between smoking and colorectal cancer, breast cancer, endometrial cancer, or fractures.
Smoking and prostatic hypertrophy
Authors: Morrison Alan S
Published: November 2023

Hospitalization and surgery for urinary obstruction from prostatic hypertrophy (PH) is a major public health problem. PH ranks among the most common discharge diagnoses for men 65 years of age and older who are admitted to short-stay hospitals. The probability that a 40-year-old man will have an operation for PH, if he lives to age 80, has been estimated as 10 per cent to 30 per cent (Lytton et al. 1968; Glynn et al. 1985). Furthermore, PH may be a risk factor for prostatic cancer (Hutchison 1976).
Cigarette smoking and cancer of the breast
Authors: MacMahon Brian
Published: November 2023

All known published data on the possibility of an association between cigarette smoking and risk of breast cancer have been reviewed. Summary odds ratios and confidence intervals have been calculated for various types of study. The summary odds ratio was significantly below 1.0 only for the category of case-control studies in which controls were hospital patients including patients with diseases related to smoking. This finding is predictable on a priori grounds. Excluding this category other case-control studies gave an odds ratio of 1.12 with confidence limits 1.06 to 1.19. Cohort studies also gave an odds ratio slightly, though significantly, higher than 1.0-1.14 with confidence interval 1.02-1.2 7. There was no indication of effect modification by menopausal status. It is concluded that breast cancer risk is not reduced among cigarette smokers. The very small, though significant, elevation of risk in smokers is unexplained.
The effect of smoking on hormone levels in vivo and steroid hormone biosynthesis in vitro
Authors: Canick Jacob A , Barbieri Robert L
Published: November 2023

Cigarette smoking appears to be associated with alterations in oestrogen-related metabolic and disease processes, perhaps through a decrease in the levels of active hormones (Baron 1984). Such a decrease could be accomplished through mechanisms involving diminished rates of oestrogen biosynthesis or increased rates of metabolism, or both.
Oestrogen 2-hydroxylation in rat and human liver
Authors: Back David , Ball Simon , Forrester Lesley , Wolf Roland
Published: November 2023

Hydroxylation at C-2 effectively terminates the peripheral activity of oestradiol. There is evidence that cigarette smoking increases the rate of 2-hydroxylation of oestradiol by induction of cytochrome P450. However in recent years it has become evident that there are multiple forms (isozymes) of the P450 haemoprotein. This reviews attempts to define more closely the enzymatic catalysts of oestradiol 2-hydroxylation. Data from studies using purified rat liver isozymes show that oestradiol is metabolized by both forms of cytochrome P450 that are phenobarbitone and 3-methylcholanthrene inducible; in contrast the related contraceptive steroid ethinyloestradiol is metabolized only by phenobarbitone inducible isozymes. In human liver there is a weak correlation between oestradiol and ethinyloestradiol 2-hydroxylase activity and differential immunoinhibition is seen with antibodies raised against specific isozymes. Oestradiol appears to be metabolized by a protein within the P450/A family. As proteins within the family are induced by cigarette smoke this may explain changes in 2-hydroxylation rates in smokers.
Determination of the rules—definitions and concepts
Authors: Ellencweig Avi Yacar
Published: November 2023

Though it is complicated to investigate a health system, it is even more complicated to investigate and compare among health systems. In the preface, we discussed the importance of comparing health systems. As Victor Sidel (1981) put it, the comparative analysis of health systems is done to improve one’s understanding of one’s own systems and to learn from experience gained abroad. Such comparisons give us a broad perspective and enable us to pose questions that could not be answered by data from a single region or from a single country. For example, if only one country is examined, there is no way of evaluating the pros and cons of different methods for reimbursing physicians. The methods of several countries should be studied to discern the effects of various economic conditions or the influence of different perceptions of the physician’s role. In addition, comparative evaluation allows us to understand the characteristics of the organization of health services, as some variables and their effects can be studied only by comparing different countries or regions. For instance, the so-called benefits of universal health coverage should be carefully evaluated in more than one health system. This is because these benefits probably depend on the particular organizational structures prevailing in each country, as well as on the culture and the economy. What may be considered advantageous in one health system can easily be disadvantageous in another.
The process of health care delivery—direct and indirect determinants
Authors: Ellencweig Avi Yacar
Published: November 2023

Though the goal of health systems is to improve the health status of the population, outcomes are frequently forgotten due to the complex and turbulent process of care. Only a few sceptics, like Illich (1977), have dared to question the role of hospitals, for example, in shaping health status. As Illich put it, it is possible that instead of improving health, hospitals may rather sustain ‘iatrogenesis’. By ‘iatrogenesis’ Illich means the production of disease and sickness by the hospital system itself. Yet, for most people in modern societies, Illich’s view is unacceptable. Though hospitals and other health services are only means to improve the ends—which are the health of the population - the use of health services is so generally acceptable in modern societies that justifying the ends is no longer required.
Demand and consumption
Authors: Cohen David R , Henderson John B
Published: November 2023

Section 3.2.1 explained that a demand curve normally slopes downward from left to right, reflecting the fact that when price is high a smaller quantity of the good is demanded than when price is low. Economists are also concerned with how responsive demand is to price changes and use the concept of elasticity to measure this. The demand for a good is said to be ‘price elastic’ if proportionately small changes in price cause proportionately large changes in demand and ‘price inelastic’ if the opposite is true. For example, if a 20 per cent rise in price causes a 10 per cent fall in the quantity demanded (price elasticity of - 0.5), then demand is said to be inelastic. If a 10 per cent rise in price causes a 20 per cent fall in the quantity demanded (price elasticity of - 2.0), then demand is said to be elastic. In these examples the negative signs indicate that price and demand move in opposite directions.
Overview
Authors: Frankel Stephen
Published: November 2023

Community health workers (CHWs) have achieved much in many countries at different times, but the frequent disappointment with the outcome of CHW programmes is often attributed to inadequacies in the CHW concept, or even laid at the door of the CHWs themselves. This debate is a sterile one. There is no longer any place for discussion of whether CHW s can be key actors in achieving adequate health care. The question is how to achieve their potential. With this in mind, the contributors to this book have sought to provide an overview of the situation in their countries, by documenting experiences and offering informed observations on the way forward as they see it. The chapters represent a wide-ranging analysis of the achievements and difficulties of CHWs in Africa, South America, Asia, and Indonesia, and it is hoped that such a broad approach will contribute significantly to an understanding of the present position and an appreciation of future requirements. This introductory chapter seeks to synthesize some of the conclusions to be drawn from the vast literature which has accumulated on the implementation of CHW programmes throughout the world. The CHW provides an ideal bridge between the community and the health sector. However, experience in numerous countries has demonstrated that top priority must be given to understanding and tackling the problems raised by attempting to achieve this bridging function in practice. CHWs are variously regarded as extenders of health services and agents for educational and developmental change (Walt 1990). If they are to be more than an ‘extra pair of hands’ or an ‘additional element’, however welcome, then countries must show themselves more committed to structural change than has hitherto been apparent (Ramprasad 1988).
Community health workers in Nepal
Authors: Mcconnell Claudia , Taylor Mary
Published: November 2023

Community health worker (CHW) programmes have been implemented in a variety of ways, both prior to and following the 1978 Alma-Ata Declaration. In Nepal, the first training programme was initiated in 1979. Community Health Leaders were selected to improve the coverage of government health services, particularly in rural areas. Following a series of reviews in the 1980s a new programme for training Community Health Volunteers was implemented in 1988. In contrast to past efforts, this programme focuses on the training 0f rural village women with the aim of addressing maternal and child health (MCH) problems. It is similar in design and content to many other programmes around the world.
Italy
Authors: Paci Pierella , Wagstaff Adam
Published: November 2023

Prior to the reforms in the late 1970s public health care in Italy was financed largely through employment-based sickness funds and provided mainly by non-profit organizations.1 In 1975 coverage against inpatient care costs was increased from 95 per cent to 100 per cent when responsibility for public hospital services was transferred to the state. In 1978 the government created a national health service—the Servizio Sanitario Nazionale (SSN)— and cover for ambulatory care and medical goods was increased to 100 per cent. The SSN was to be financed eventually out of general taxation, although it was accepted that in the short term there would be some reliance on earnings-related health-specific social insurance contributions as under the old sickness fund system. In contrast to the British National Health Service (NHS), it was accepted that the private sector would play a part in the provision of SSN-financed health care.
The Netherlands
Authors: Doorslaer Eddy Van , Wagstaff Adam , Janssen Richard
Published: November 2023

In the Netherlands—as in many other European countries—equity concerns have always been an important motivation for government intervention in the way health care services are financed and delivered.1 Despite a long tradition of government intervention in health care, the uneasy coexistence of a public and private insurance sector has continued to foster political debate concerning radical reforms. In particular, the persistent and pronounced medical consumption differentials (see van Vliet and van de Ven 1985) and the alleged lack of financial solidarity between the publicly and the privately insured have often been cited as sufficient reasons for concern about the equity characteristics of the system.
United Kingdom
Authors: O’Donnell Owen , Propper, Carol , Upward Richard
Published: November 2023

This chapter presents evidence on departures from equity in the finance and delivery of health care in the UK. Following the methodology proposed in this volume, we examine equity in the finance and the delivery of health care separately and thus do not examine the net redistributive impact of the UK health care system. On the finance side, we review the progressivity of the finance of health care in the UK. Since health care in the UK is primarily financed from taxation, the analysis is predominantly an assessment of the progressivity of general taxation. On the delivery side, we examine the extent to which the allocation of health care in Britain is consistent with the National Health Service (NHS) policy objective of ‘equal treatment for equal need’. Previous studies of this issue in the UK have yielded contradictory results. Le Grand (1978), using data from the 1972 General Household Survey, found evidence of substantial inequity in favour of the middle classes. Collins and Klein (1980), using data from the same survey but for a later year (1974), could find no evidence of inequity. We have argued elsewhere that, in part, these conclusions may reflect methodological differences between the studies (O’Donnell and Propper 1991 a).
Health, health expenditures, and equity
Authors: Culyer A J
Published: November 2023

What motivates studies dealing with the interpersonal (or interfamily, interhousehold, interclass) distribution of income, wealth, health, and so on? They seem usually to have been undertaken so as to enable judgements to be made (by either their authors or their readers) of the ‘fairness’, ‘justice’, or ‘equity’ of such distributions with respect to some benchmark distribution (which need not, of course, be an equal distribution). It seems reasonable to ask two fundamental questions to do with their motivation. The first is: ‘What is the ethical theory that underlies the study?’ This issue is examined elsewhere in the present volume by Alan Williams (Chapter 16) and I shall not examine it further here other than to note that, because there is more than one ‘ideology’ serving as justi¬ fication (e.g., utilitarian, desert-based, Rawlsian) it would be in general helpful (although no doubt rather complicated) if studies were to be so conducted as to enable equity judgements to be made from a variety of viewpoints or ideologies (rather than that only of the authors-if they have one). When one is confident of there being a consensus amongst the trageted readership, this desideratum is less compelling, of course. The second question is: ‘Why study the distribution of whatever entity it is that has been studied?’ In the case of the present volume, there are two entities-health care expenditures on the one hand, and health care payments on the other. In this section I shall explore some reasons why it may be interesting to examine the distribution of health expenditures. That of payments will be discussed subsequently.
Equity and health care policy: the American experience
Authors: Davis Karen
Published: November 2023

The US is the only major industrialized nation without a national health plan that assures universal access to health care services. Rather, it has a mixed public-private approach to the financing of health care services. Public programmes finance health care for elderly, disabled, and some groups of poor people. Employers voluntarily provide private health insurance to the majority of workers and their dependents.
Equity in the distribution of health care: the British debate
Authors: Grand Julian Le
Published: November 2023

In 1978, I published an article in Economica on the distribution of public expenditure on health care in England and Wales (Le Grand 1978). The article compared the distribution of illness with the distribution of public expenditure and arrived at the conclusion that, once the distribution of illness was taken into account, the distribution of public spending favoured the higher social groups. In other words, contrary to its stated intentions, the British National Health Service (NHS) was not providing equity in at least one interpretation of that term, equal treatment for equal need. Rather, it was providing more treatment per person ill for the better-off.
Wound dressings
Authors: Thomas S , Leigh I M
Published: November 2023

For centuries, man has applied a variety of substances to his wounds to stem bleeding, ease pain, or provide protection for newly formed tissue. Many of these agents were simple absorbents that were used to remove exudate and produce a dry wound, an essential prerequisite for rapid and uneventful healing - or so it was believed. It was not until the work of George Winter, in the early 1960s, that this view was chal lenged and the advantages of moist wound healing finally became recognized.
Decentralization
Authors: Collins Charles
Published: November 2023

There can be few ideals more dear to the proclamations of politicians and health managers alike than that of decentralization. It is quite clear that the policy formulation and implementation of PHC cannot be conducted through a centralized bureaucratic machinery in a top-down fashion. There are, however, some important issues surrounding decentralization. In this chapter we shall face up to and try to answer a number of challenging questions.
Strengthening district management
Authors: Collins Charles
Published: November 2023

This book has been building up to this point—the district and its management. In Chapters 2 and 3, the relevance of decentralization to the PHC strategy was highlighted along with the importance of developing managerial capacity at both the central and district level. Chapters 4-6, concentrated on developing management and organizations from a national perspective. We should now focus on the district level in this and the next chapter. Firstly, the basic and often recognized characteristics of the district health system will be identified. This will be followed by a checklist of issues for the formulation and implementation of a district health management strengthening programme (HMSP). Secondly, and in the next chapter, we shall examine the scope for district management strengthening in three areas—planning, community participation, and human resources.
Making choices
Authors: Furedi Ann
Published: November 2023

The decision to end a pregnancy occurs in an entirely different emotional context to that of ‘trying for a child’. Terminating a pregnancy is not the same as never having started it.
Considering adoption
Authors: Furedi Ann
Published: November 2023

Adoption is the least common solution to unplanned pregnancy nowadays, probably because it involves all the stresses of pregnancy and labour but with none of the joys of motherhood after the birth. The claim that today adoption is seen as the least socially acceptable solution to unplanned pregnancy is probably true. A study of the attitudes of single mothers conducted in the late 19 70s showed that of 36 unmarried, pregnant young women, only one said she would choose adoption, while 18 dismissed adoption immediately as in tolerable. Abortion, single parenting, or getting married were, by far, the preferred choices. Today, it is probably even less acceptable to most women. In 1991 just 1 ll 5 babies under one year old were adopted. When this figure is compared to the 12 641 adoption orders granted in respect of babies under one year old in 1968, it is clear how attitudes to adoption have altered.
Prevention for individuals and the ‘high-risk’ strategy
Authors: Rose Geoffrey
Published: November 2023

Illness is a personal and not a collective event: it happens to individuals, and statistics mislead by presenting only the totals. According to recent World Health Organization reports, covering 56 of the world’s populations, annual deaths from lung cancer numbered 471434 (nearly all preventable). What this really means is that there werw 1+1+1+1 ... etc. individuals, each of whom suffered severe personal distress. The objective of preventive medicine is the avoidance of a series of individual misfortunes, and so it is natural to believe that preventive action should be targeted on the individuals at risk.
An overview of the treatment of functional somatic symptoms
Authors: Sharpe Michael , Bass Christopher , Mayou Richard
Published: November 2023

In this chapter we offer an overview of the treatment of patients with functional somatic symptoms with the aim of providing an introduction and context for the chapters that follow. We discuss where patients should be treated, who should treat them, and how they should be treated. A review of the different forms of therapy available is preceeded by a consideration of non-specific aspects of treatment. The chapter concludes with an outline of practical management.
The patient with medically unexplained symptoms: making the initial psychiatric contact
Authors: House Allan
Published: November 2023

Dr House points out that the patient’s initial contact with a psychiatrist has to be very carefully managed. He stresses the importance of eliciting the patient’s attitudes to psychiatric referral, as well as exploring the beliefs and assumptions that influence each patient’s understanding of his or her illness.

The importance of acknowledging the reality of the patient’s physical symptoms during the assessment interview is emphasized, as is the need for a flexible, empathic style of interviewing. In tandem with the ‘illness history’ Dr House encourages the adoption of a developmental approach, during which those experiences that might lead the patient to express distress in somatic terms are explored. Finally, the key role of family attitudes and beliefs is described and the importance of interviewing family members emphasized.
Chronic pelvic pain
Authors: Glover Lesley , Pearce Shirley
Published: November 2023

In this chapter Drs Glover and Pearce begin by describing the prevalence of pelvic pain and the associated cost to health services. An aetiological model of pelvic pain is outlined in which pathophysiological processes in the pelvis (which include abnormal venous congestion) interact with psychological factors to produce the sensation of pelvic pain. A preoccupation with disease explanations for the pain, increased attention to the somatic sensations, and the acquisition of ‘pain behaviours’, may all then act to perpetuate a syndrome of chronic pelvic pain.
The management of patients with functional somatic symptoms in the general hospital
Authors: Bass Christopher , Sharpe Michael , Mayou Richard
Published: November 2023

In this chapter we propose that patients with functional somatic symptoms are best managed by a combination of improvements in routine care by medical and surgical teams and greater provision of specialist care by psychiatrists and clinical psychologists. These improvements would, however, require better training for all those involved. Although some initial increase in resources would be required, significant savings from the reduction of the inappropriate and ineffective use of existing hospital and primary care resources could be expected. Both clinical experience and evaluative research suggest opportunities for improved outcomes for many patients.
Alternative and complementary treatments
Authors: Bass Christopher , Mayou Richard
Published: November 2023

The two forms of non-conventional medicine, complementary, and alternative treatment are described and the reasons patients consult non-orthodox practitioners are outlined. It is suggested that the increased interest in non-conventional therapies is in part a consequence of dissatisfaction with orthodox medicine and, by implication, the training of doctors.

The efficacy of alternative treatments is reviewed and the evidence for most but not all therapies is found to be unconvincing. For example, some of the manipulative therapies may be effective but others such as iridology and reflexology appear to be useless.
Psoriatic arthritis and spondylitis: a clinical approach
Authors: Espinoza L R , Cuellar M L
Published: November 2023

Psoriatic arthritis (PsA) can be defined as a chronic inflammatory disorder affecting the musculoskeletal system in psoriatic patients. This definition encompasses a broad spectrum of clinical articular manifestations, including monoarthritis, distal interphalangeal inflammatory joint involvement, asymmetric and symmetric polyarthritis, and axial or spondylitic involvement (Espinoza et al. 1992a).
The eye in spondyloarthritis
Authors: Rosenbaum James T
Published: November 2023

Many internists tend to be intimidated by having to evaluate eye disease and, conversely, many ophthalmologists are daunted by the differential diagnosis of systemic illness. Consequently, a knowledge of the ocular manifestations of reactive arthritis and ankylosing spondylitis requires either an exceptional rheumatologist or an exceptional ophthalmologist. The eye is commonly involved in spondyloarthropathy and is vital with regard to both theoretical and therapeutic considerations. This chapter reviews the clinical manifestations of this eye disease, its treatment, and its possible aetiology.
Mechanisms of arthritis associated with chronic intestinal inflammation
Authors: Bocker Ulrich , Sartor R Balfour
Published: November 2023

Peripheral arthritis and spondylarthritides are part of a characteristic spectrum of systemic inflammation which accompanies numerous forms of clinical and experimental intestinal inflammatory disorders (Table 14.1) (Sartor and Lichtman 1994). These extraintestinal manifestations, which include arthritis, hepatobiliary inflammation, erythema nodosum, pyoderma gangrenosum, and uveitis, occur in approximately 20-30% of patients with Crohn’s disease, ulcerative colitis, and jejunoileal bypass for obesity (Lichtman and Sartor 1994), but are relatively infrequent in the other clinical conditions listed in Table 14.1.
Neurological disorders with a pigmentary retinopathy
Authors: Baraitser Michael
Published: November 2023

Abstract: Strictly speaking, Bardet-Biedl is separate from Laurence-Moon syndrome. The difference is that patients with Laurence-Moon syndrome are spastic, thin, and do not have polydactyly. Both conditions present with retinal dystrophy, mental handicap, and hypogenitalism. Bardet-Biedl syndrome the commoner of the two, is variable in its manifestations. Seventy per cent of cases have polydactyly which, when present, might only affect one limb. Syndactyly and brachydactyly are very common (Green et al., 1989).
Myoclonus and myoclonic epilepsy
Authors: Baraitser Michael
Published: November 2023

Myoclonic epilepsy is different from myoclonus and the EEG is helpful in differentiating between the two Myoclonus is defined as a brief contraction of a muscle or a group of muscles. It might be. Benign and barely perceptible; Severe, causing a sudden fall; Atypical, as in Lennox-Gastau syndrome.
Muscle disease
Authors: Baraitser Michael
Published: November 2023

Dystrophinopathies: Duchenne muscular dystrophy; Becker muscular dystrophy; Congenital muscular dystrophy: Fukuyama muscular dystrophy; occidental type with white matter disease on CT (merosin or alpha-2 laminin deficiency) occidental type with normal scan or white matter disease (merosin positive); HARD; muscle-eye-brain disease; Limb-girdle muscular dystrophy: LGMDlA autosomal dominant; LGMD2A 15q15 calpain 3 related; LGMD2B 2p13; LGMD2C 13q12
Myotonias/carnitine deficiency
Authors: Baraitser Michael
Published: November 2023

From the genetic viewpoint, diagnosis and counselling have became much easier. It is no longer needed to do routine EMG and a slit lamp examination to determine who is affected or possibly a gene carrier. Myotonic dystrophy is a condition with unstable CTG repeat.
Structural Imaging Findings and Macroscopic Pathology
Authors: Hopkins Richard , Lewis Shon
Published: November 2023

From its inception as dementia praecox over a hundred years ago, schizophrenia was considered to be a disorder of the brain (Kraepelin, 1896). There were numerous early attempts to isolate the presumed macroscopic and microscopic pathology (e.g. Alzheimer, 1897; Southard, 1915), mainly inspired by concurrent successes in the neuropathology of general paralysis of the insane. However, research was unable consistently to replicate findings, considerably hindered as it was by a lack of operationalised diagnostic criteria, problems with the selection of brains for analysis, postmortem artefacts, and inadequate controls (see Chapter 14). The diagnostic non-specificity of findings, and the absence of an overall hypothesis also hampered the development of a consensus view.
Hippocampal Pathology
Authors: Arnold Steven E
Published: November 2023

The hippocampal formation has been a region of extensive clinical investigation in schiz ophrenia and also the most commonly studied region in postmortem research (Shapiro, 1993; Arnold and Trojanowski, 1996). There are a number of reasons to justify this. Clinicians have long noted similarities between the symptoms of schizophrenia and those of the schizophrenia-like organic psychoses associated with temporal lobe epilepsy, temporal lobe tumors, and cerebrovascular lesions, herpes encephalitis, and neurodegenerative diseases such as Alzheimer’s disease and frontotemporal degenerative dementias which have particular predilections for the hippocampal region (Davison, 1983). In addition, early clinical neurobiological investigators described enlarged temporal horns in schizophrenia using pneumoencepholgraphy (Jacobi and Winkler, 1929) while electroencephalographers frequently reported abnormal recordings from temporal electrodes (Ellingson, 1954).
Synaptic Pathology
Authors: Honer William G , Young, Clint , Falkai Peter
Published: November 2023

Synapses are a defining characteristic of neurons, and pathology at these sites is proposed to be a mechanism for psychiatric disorders. Studies of neurotransmitters and receptors provide one perspective on synaptic pathophysiology in schizophrenia, however there are other equally informative, complementary approaches to investigate synaptic abnormalities in the disorder. In the past decade, molecular elements of the synaptic complex, both pre and postsynaptic, have been defined in considerable detail. The aims of this chapter are to assess critically the techniques available to study synapses in the human brain, and evaluate the evidence for synaptic pathology in schizophrenia from morphological and molecular vantage points. We conclude with a brief discussion of its potential origins and functional implications.
Cerebral Asymmetry
Authors: Roberts Gareth W , Harrison Paul J
Published: November 2023

Investigation of human brain lateralization began in earnest following Broca’s (1861) report of language distm-bance resulting from injury to the left hemisphere (see Harris (1999) for historical review). Proposals that cerebral asymmetry is relevant to insanitsy can be traced back to Wigan (1844), Crichton Browne (1879), and, more explicitly, to the neuropathol ogist Southard (1915) who stated “the atrophies and aplasias [of schizophrenia], when focal, show a tendency to occur in the left cerebral hemisphere.” Despite these prescient statements, and the stimulus provided by Flor-Henry’s (1969) report that schizophrenia was associated with left-sided foci in temporal lobe epilepsy, it is only in the past 20 years or so that the question has been investigated in any detail. Although no unequivocal answer can be yet given, this chapter reviews a range of evidence which suggests that the neuropathology of schizophrenia is asymmetrical, and considers the implications this has for the nature of the disorder. First, however, we discuss the normal anatomical cerebral asymmetries, since it need not be schizophrenia per se which is lateralized, but rather that the disorder affects these asymmetries.
Initial management of life-threatening wounds
Authors: Wardrope Jim , Edhouse June A
Published: November 2023

In the United Kingdom only 4 per cent of serious injury is due to penetrating trauma. However, all penetrating wounds of the trunk, neck, and face presenting to the A&E department must be regarded as serious. The size and appearance of the skin wound does not give a reliable indication of the severity of the deep damage.
Surgical techniques of wound care
Authors: Wardrope Jim , Edhouse June A
Published: November 2023

Give yourself the best possible operating conditions. Ensure adequate anaesthesia. Wound cleaning is THE most important part of wound care. Examine the wound closely to exclude foreign bodies or damage to deep structures. Consider the best method of wound closure— primary suture in most wounds.
Special types of wounds
Authors: Wardrope Jim , Edhouse June A
Published: November 2023

The commonest penetrating wounds in A&E practice are those of the limbs, especially the hands and feet. Sharp shards of glass, cutting tools, drills, and nails often cause such wounds. These deep, penetrating wounds may enter joints or tendon sheaths, and severe infections may result.
Psychological factors and cancer progression: involvement of neuroimmune pathways and future directions for laboratory research
Authors: Garssen B , Goodkin K
Published: November 2023

Psychological factors may exert their influence on tumour processes through various pathways. One possible pathway is through an effect on health behaviour, and will be discussed in the next chapter. Another more studied, but not necessarily more likely, pathway is via changes in the endocrine and immune systems, and is discussed in this chapter (see also reviews in 1–6). The influence on the immune system can be exerted along two roads. One is directly via the nervous system; the second is through nervous system modulation of the endocrine system, which in tum can regulate immunological activities. In some types of cancer, especially breast cancer and endometrial cancer, tumour growth can also be influenced by hormone levels, which represent a more direct, potential pathway for the effect of psychological factors.
The Urinary Sediment In The Main Diseases Of The Urinary Tract
Authors: Fogazzi Giovanni B , Ponticelli Claudio , Ritz Eberhard
Published: November 2023

Clinical presentation. Minimal change disease (MCD) is mainly a disease of children even though it may also occur in adults. It is characterized by full-blown nephrotic syndrome, i.e. severe proteinuria without hypertension, haematuria or renal failure. Slowly progressing impairment of renal function and appearance of hypertension are exceptional.
Resuscitation
Authors: Currie David G , Ritchie Ewan , Stott Stephen
Published: November 2023

Resuscitation of the head-injured patient is the responsibility of the A&E department, and on no account should a patient be transferred to a specialist unit before resuscitation is complete and the patient stabilized. Hypotension and hypoxia on arrival at Neurosurgery are associated with very high mortality rates. Patients should not be removed from the resuscitation room (e. g. for X-rays) until resuscitation is complete: this may necessitate the use of portable X-ray equipment.
Anaesthesia in head injuries
Authors: Currie David G , Ritchie Ewan , Stott Stephen
Published: November 2023

The anaesthetist is a key member of the team involved in the care of the head-injured patient. The anaesthetist is involved in the transfer of head- injured patients both within the hospital and between hospitals, in the resuscitation of the patient and in anaesthesia for surgical procedures. A thorough understanding of the pathology, physiology, and pharmacology of anaesthetic drugs is required for the safe conduct of these tasks.
The disturbed head-injured patient
Authors: Currie David G , Ritchie Ewan , Stott Stephen
Published: November 2023

Disturbed behaviour is common after head injuries when there is some degree of altered consciousness. Inspection of the Glasgow Coma Scale (See Box 1.3) will show that a minor degree of altered consciousness results in ‘confusion’ even although the patient remains ambulant and able to obey commands. A further deterioration in consciousness results in a verbal response described as ‘inappropriate words’. This commonly means that the patient is abusive and uses offensive language. This is usually a transient phenomenon requiring little active intervention but it is of the greatest importance that those responsible for dealing with head-injured patients realize that this behaviour indicates altered consciousness and not simply antisocial behaviour or drunkenness.
Introduction to Clinical Genetics
Authors: Mohammed Shehla
Published: November 2023

This introductory chapter aims to provide some basic information about human genetics, the nature of genetic counselling and to highlight some of the issues and dilemmas that may arise following the diagnosis of a genetic disorder in a family.
Dysmorphic Syndromes With Renal Involvement
Authors: Young Ian D
Published: November 2023

The human kidney is an extremely sophisticated organ which represents the end-point of a long and complicated evolutionary process. Its formation requires the successful coordinated orchestration of a complex series of developmental steps including cellular migration, proliferation, differentiation, and polarization.
Wilms Tumour and the Wilms Tumour Predisposition Syndromes
Authors: Grundy Richard
Published: November 2023

The molecular genetics of Wilma tumour (WT) has turned out to be far more complex and interesting than originally envisaged (Knudson and Strong 1972). It is now clear that at least six separate genetic loci and loss of genomic imprinting are involved in the predisposition, development, and progression of this fascinating tumour. Wilma tumour is the most common primary renal tumour of childhood affecting approximately 1 in 10,000 children (Birch and Breslow 1995).
Gene Therapy in Renal Disease
Authors: Saggar-Malik Anand K
Published: November 2023

Molecular biological intervention therapy has come of age and generates tremendous excitement. Gene therapy has the distinct potential to treat disease at the most fundamental level. However, therapy of renal diseases is at present still too immature for clinical application and significant barriers remain before successful organ-specific molecular therapy can be applied to the kidney.
Gene Therapy for Renal Cancer
Authors: Gough Michael J , Vile Richard G
Published: November 2023

This chapter looks at the basic principles of gene therapy in the kidney and in particular the potential for the treatment of renal malignancies. Despite greater understanding of the molecular mechanisms of renal cancer, there remains a pressing need for a novel therapy (Marshall et al. 1997).
The Macrophage Second edition
Authors: Burke Bernard , Lewis Claire E
Published: November 2023

The field of macrophage research has grown enormously since publication of the first edition of this book. The Macrophage, Second Edition provides a unique, comprehensive review of the current scientific knowledge of the multifaceted role of this important and intriguing cell in health and disease. In 16 chapters, written by experts in the field, it covers the basic biology and diverse functions of macrophages in specific diseases and the complex interactions between macrophages and other cells. Ranging from their role in the defence against pathogens, their role as hosts for pathogens (including HIV), their complex roles in diseases such as arthritis and cancer, and their potential for use in novel gene therapy approaches to disease treatment, the book gives an up to the minute account of active macrophage research. The editors have included a broad range of topics that will appeal not only to immunologists and cell biologists but will also be of interest to those working in the specific disease areas covered.
Macrophages in parasitic infection
Authors: Vray B
Published: November 2023

Due to their widespread distribution in vertebrate host tissues and cavities, macrophages are among the first cells to encounter and then to combat invading microorganisms. However, in their non-activated (or resting state) and also in their primed state, they can act as ‘host cells’ of these microorganisms. Various ligand–receptor systems are involved in recognition/adhesion systems. For instance, fibronectin (FN) is a plasmatic dimeric multifunctional glycoprotein binding many microorganisms to their host cells. Macrophages and some parasites express both receptors for carbohydrate residues and glycoconjugates which serve as ligands so that double receptor–ligand systems modulate parasite–macrophage binding as shown by various in vitro experiments using lectins or sugars. In addition, opsonins [complement (C) or specific antibodies] also contribute to recognition/adhesion systems. As a result, protozoan parasites can invade macrophages through various parasite and macrophage molecules.
5-HT1B and 5-HT1D receptor immunoreactivity co-localizes with sensory neurotransmitters in the human trigeminal ganglion
Authors: Hou Mingyan , Kanje Martin , Tajti Janos , Uddman Rolf , Edvinsson Lars
Published: November 2023

In human intracranial vessels, antimigraine drugs cause vasoconstriction via 5-HT1B receptors. In vivo studies in animals have shown that triptans inhibit peripheral responses evoked by trigeminal stimulation. These responses are sensitive to blockade by calcitonin gene-related peptide (CGRP) receptor agonists and neurokinin 1 (NK1) receptor antagonists, respectively. Triptans and NK1 receptor antagonists also inhibit nociceptive transmission within the trigeminal nucleus caudalis and prevent the activation of second-order sensory neurons in this nucleus, probably through a similar mechanism.
Encapsulation of sumatriptan does not delay its absorption
Authors: Milton K Ashley , Kleinermans D , Scott N , Cooper J D H
Published: November 2023

Encapsulation is a standard method of maintaining the blinding of study treatments when it is not feasible to obtain placebo for use as a comparator drug. However, encapsulation can potentially change the dissolution characteristics of a marketed tablet; therefore, in vitro dissolution testing is required. In addition, the decreased in vitro dissolution of ‘stressed’ encapsulated sumatriptan (i.e. a tablet stored for long periods) is a potential indicator of reduced bioavailability.
.Sumatriptan: looking back and looking forward
Authors: Mansbach Hank
Published: November 2023

The sumatriptan revolution in migraine therapy began 10 years ago when the introduction of sumatriptan brought, for the first time, to the majority of patients prompt migraine relief that facilitates rapid resumption of normal daily activities. In the decade since sumatriptan was introduced, hundreds of studies have reinforced its consistent efficacy, its rapid onset and long duration of action, its tolerability, and its pharmacoeconomic advantages. The utility of sumatriptan has been shown to extend to menstrual migraine, cluster headache, and the treatment of non-migraine headaches in patients with a previous diagnosis of migraine.
Frovatriptan— simplifying clinical practice in migraine
Authors: Keywood Charlotte
Published: November 2023

The triptans have revolutionized the acute treatment of migraine, and are widely acknowledged to have improved the quality of life for migraine sufferers throughout the world. As a class, the triptans are highly effective, however, there are ongoing concerns about safety and tolerability and the potential for adverse drug interactions. Frovatriptan is a new triptan that has been specifcally designed to overcome some of the disadvantages associated with earlier agents.
Overuse of new 5-Ht agonists (zolmitriptan and naratriptan) in migraine patients: clinical features
Authors: Lantéri-Minet M , Alchaar H , Coullet P , Chatel M
Published: November 2023

Inappropriate use of headache medication may contribute to the development to chronic daily headache. Potentially, each component contained in analgesics or drugs used for the treatment of migraine attacks probably could induce chronic daily headache. Triptans can also lead to drug-induced headache. Triptan-induced headache is not defined by the International Headache Society (IHS) classification which was published before sumatriptan was marketed in Europe and the United States. However, the occurrence of overuse in migraine patients treated by sumatriptan has been clearly demonstrated by pharmacoepidemiological studies (see review in ref. 1).
Regulation of PTH secretion and synthesis and of parathyroid cell proliferation
Authors: Silver Justin , Kilav Rachel , Sela-Brown Alin , Naveh-Many Tally
Published: November 2023

The regulation of PTH production is of great interest to nephrologists because its abnormal activity is such a frequent complication in patients with chronic renal failure. Chronic renal failure is usually associated with a large increase in serum PTH, secondary hyperparathyroidism, although sometimes there is an inappropriate decrease in serum PTH that is a feature of dialysis patients with adynamic bone disease. There is therefore an intense interest in understanding how the parathyroid (PT) is regulated, in order to devise effective treatment strategies. This review will summarize experimental data that may provide some light in understanding the regulation of the PT.