bluuebunny/crossref_metadata_2025 huggingface dataset:
Male Sexuality and its Problems
Authors: Barrett Peter
Published: November 2023

Men are supposed to think about sex a lot and, if that is the case, purchases of this book may be made on the merits or otherwise of this chapter while the purchaser is perusing it in the bookshop. We think you will have made a good decision. Men often find it difficult to talk to GPs about their sexual problems, and GPs in turn fear that sexual counselling may take more time than is available. The author discusses normal and abnormal male sexual function, and uses case histories to illustrate specific approaches that GPs may find useful. He deals with both psychological and physical causes of sexual problems; the latter may well be underestimated and need to be considered. The chapter deals mostly with heterosexual problems as little seems to be known in the medical world about the sexual problems of homosexual men.
Sexually Transmitted Diseases
Authors: Kinghorn George
Published: November 2023

Genito-urinary medicine (GUM) has become a more prominent specialty over the last 20 years, and general practitioners are more likely to work with genito-urinary physicians as our patients increasingly acquire sexually transmitted diseases (STDs). GPs have not traditionally been involved bypatients who suspect a venereal origin to their symptoms. Our lack of expertise in the field has, in part, contributed to patients bypassing us. However, the changing epidemiology of STDs, the changing role of the GU clinics, and health education means that general practice will be increasingly involved in the management of the more chronic conditions. This chapter provides an introduction to the common STDs and their management.
Nucleosomes and lupus nephritis
Authors: Berden Jo H M
Published: November 2023

Renal involvement is one of the most serious complications of systemic lupus erythematosus (SLE).1 It has a major impact on morbidity and mortality. The incidence of renal disease in SLE varies with the criteria used to define renal involvement and the selection of the patients. Using clinical parameters, the incidence varies from 45 to 75 per cent, but it is reasonable to assume that, on average, two-thirds of the patients with well-documented SLE will develop renal symptoms during their disease course. However, if renal tissue from SLE patients is analyzed using immunofluorescence and or electron microscopy, abnormalities are found in almost all cases, regardless of the presence or absence of clinical symptoms. Like the disease itself, lupus nephritis is highly variable in its clinical presentation, ranging from mild proteinuria to a rapidly progressive course leading to renal insufficiency within days.
Renal vascular involvement in SLE
Authors: Appel Gerald B
Published: November 2023

A number of different histopathologic lesions of the renal vasculature may be involved in systemic lupus erythematosus (SLE). Each lesion may have a unique pathogenesis and may lead to either trivial or major clinical consequences. Moreover, the treatment for the vascular lesions in SLE varies depending upon the nature and the severity of the renal lesions present.
End-stage renal disease in the patient with SLE
Authors: Nossent JC
Published: November 2023

The possibility of renal failure—here defined as a reduction in glomerular filtration, that necessitates the initiation of renal replacement therapy—is a risk that approximately half of all patients with severe lupus nephritis (and their physicians) will have to contemplate at least once in their disease course.
Creating a coherent story in family therapy
Authors: Byng-Hall John
Published: November 2023

In the first session Sara, aged six, was the first to speak. She sat up very straight, looked me in the eye, and said ‘I killed my brother’. The ‘A’ family, who had originated from South America, had been referred after a second cot death. Sara had been sleeping between her parents, and was found lying on top of her dead brother. It was the ultimate dreaded catastrophe another dead baby. Lightning does strike twice after all. Since then, the mother, Anna, had become reluctant to let the family out of her sight, and was largely housebound. Carlos aged eight was feeling very constrained and was running off, and father, Mario, had been coming in late at night, much to mother’s dismay. In addition there was a new baby, Zeta, aged four months, who everyone was watching like a hawk day and night.
The rehabilitation of rehabilitation: a narrative approach to psychosis*
Authors: Roberts Glenn
Published: November 2023

It is a common view that where an action is incomprehensible or peculiarly destructive, whether publicly or privately, the person must be mad and sometimes they are. As a result of being found thus, the distressed man described above was deported to Austria instead of being charged for his actions. Where, the story continues, ‘as far as anyone knows he is still at large never having been heard of or see again’ (Gamboni, 1997).
Aetiology: causal and meaningful connections
Authors: Dickenson Donna , Fulford Bill (Kwm)
Published: November 2023

There is a widespread belief that the problems with psychiatric diagnosis we encountered in the last two chapters will be resolved once we have a better picture of the underlying causes of mental disorder in the brain. The cases described in this chapter all show, in different ways, that this belief — the belief that ‘brain trumps mind’ — is mistaken in principle and may be abusive in practice.
Putting theory into practice: a sample teaching seminar
Authors: Dickenson Donna , Fulford Bill (Kwm)
Published: November 2023

One of the general themes running through the cases described in Chapters 3-8 of this book has been the extent to which legitimately different ethical per spectives may bear on clinical problems in psychiatry. We have reflected this in the open nature of our discussions of these cases. Thus we have not prescribed ethical ‘solutions’ but, rather, have highlighted the issues, indicated relevant guidance, and reviewed alternative strategies. Those committed to a particular ideological point of view may find this approach unsatisfactory. It is important that such points of view are respected in psychiatry: there must be room for an Islamic ethic, a Christian ethic, a humanist ethic, and so on. But if there is an ethic guiding this book, it is of valuing diversity, of making room for individual perspectives within a framework of mutual respect. Everyone has their ethical sticking points, of course.
Paediatrics
Authors: Round Jonathan
Published: November 2023

In our new Key Questions Answered series, Paediatrics KQA has been to help the clinical medicine student learn and revise their paediatrics. Designed to be used on its own for revision and additional learning, this book can also be used to complement the Paediatrics: Understanding Child Health (An Oxford Core Text). Taking an integrative approach, this book covers the undergraduate medical curriculum and the Diploma of Child Health, giving a broad base of questions both knowledge based and data-interpretive and reasoning, and has full answers which contain additional learning points. There are more than 200 key questions testing both knowledge, data interpretation and reasoning skills. It also includes a section on how to approach MCQs: For example; commonly this means something is often encountered or its association is not a surprise. Rarely here the association is well-recognised but uncommon.
Nature of growth
Authors: Sinclair David , Dangerfield Peter
Published: November 2023

Growth as a concept is familiar to us all. As living organisms, we have all grown, and think we can speak from the experience. Parents set great store on seeing how their children are growing, and many readers may well remember being stood up against a convenient door or wall to be measured by their mothers. Nevertheless, not many parents understand the biological processes taking place in the child they are measuring which are causing it to grow bigger, or how their own child’s progress can be related to that of other children. The fact that growth is such a commonplace experience affecting all living things has perhaps hindered proper investigation of the factors involved, and it is only within the last 20 years or so that scientists have begun to understand the complex processes involved.
Growth in height and weight
Authors: Sinclair David , Dangerfield Peter
Published: November 2023

The human ovum measures about 100 µ,m in diameter, and is just visible to the naked eye. At birth, a baby is about 50 cm (20 in) long-roughly 5000 times as long as the ovum. Further growth in height after birth may take the adult to a height of (say) 175 cm (5 ft 9 in)-three and a half times the length of the baby. The process of growth is not uniform in human throughout life. Each region and part of the body can be shown to have its own growth rate and this can vary according to age as well.
Changes in shape and posture
Authors: Sinclair David , Dangerfield Peter
Published: November 2023

Just as the whole body grows at a varying rate from birth to maturity, so its component parts have their own rates of growth, which also change with age, although not necessarily synchronously. This leads to changes in bodily propor tions. Occasionally, the relationship between the size of one part and the size of another, or between the size of one part and the whole body, can be described by a straight regression line; this argues that the relative growth rates of the two parts remain constant, and also that the difference between the two rates is established early in development.
Old age
Authors: Sinclair David , Dangerfield Peter
Published: November 2023

Today, the increased standards of living and associated improvements and advances in medical care are resulting in more people living longer so that the proportion of the population in the older age groups is increasing, sometimes rapidly. Age-related changes occur in the body and more and more health affecting problems can arise. Because of this, it is helpful to divide the older age groups into three groups in a widely used classification which regards those aged 60-74 as ‘young old’, those aged 75 and over as ‘old old’, and those aged 90 or over as ‘oldest old’.
Homophobia: covert and overt
Authors: West D J
Published: November 2023

Homosexual males are vulnerable to assault, including sexual assault, by men who despise them for their deviant sexuality. The label homo phobia is commonly used by supporters of the right to be gay (homophiles) to describe any condemnation of homosexual activity, especially when it takes the form of verbal or physical ‘gay bashing’. A phobia is an intense, irrational fear, a pathological reaction supposedly engendered by intra-psychic conflict. To regard everyone who considers homosexual practice immoral or socially undesirable, as suffering from a ‘phobia’ is scarcely sensible, although some theorists, supported by little evidence, suggest that all opponents of homosexuality are reacting against their own suppressed homosexual tendencies.
Acute vascular access
Authors: Farrell John , Abraham K A , Walshe J J
Published: November 2023

The development of the Quinton-Scribner shunt in 1960 signalled a new era in haemodialysis as it made repeated, adequate vascular access possible for the first time. Complications such as clotting and infections, however, soon caused this approach to fall out of favour. In recent years, percutaneous large-vein catheterization, using the Seidinger technique, has become the preferred method for immediate and/or temporary access to the circulation.
Pathophysiology of access failure
Authors: Davies Mark G , Huynh Tam T T , Hagen Per Otto
Published: November 2023

Autogenous arteriovenous fistulas remain the preferred conduit for dialysis access. Most patients will require a prosthetic bridge at some point due to lack of a suitable vein. Polytetrafluoroethylene (PTFE) is now the most commonly used prosthetic graft and is widely accepted because it is flexible, porous, easy to handle, puncture and revise, and resists infection better than Dacron.
Surgical considerations in vascular access
Authors: Nicholson Michael L , Murphy Gavin J
Published: November 2023

Repeated haemodialysis only became feasible with the introduction of the external arteriovenous shunt described by Quinton, Dillard and Scribner in 1960. This procedure opened up a new era in the treatment of end-stage renal failure despite the fact that external shunts were prone to infection and thrombosis. These problems wrere largely solved by the introduction of the Brescia-Cimino internal radiocephalic arteriovenous fistula (AVF) in 1966. This operation has been so successful that it remains the first-choice procedure for vascular access some 30 years after its inception. Autogenous vein would appear to have many advantages over prosthetic graft materials and European vascular access surgeons tend to exhaust every available autogenous vein before considering prosthetic materials. In stark contrast to this, it is common practice in the USA to use prosthetic grafts as primary AV conduits.
Options for restoration of thrombosed vascular access: surgery
Authors: Henry Mitchell L
Published: November 2023

Vascular access for hemodialysis continues to be literally the ‘life blood’ of the end-stage renal disease (ESRD) patient. As such, planning of new access, sur¬veillance of graft function, and intervention of the failing graft are very import¬ ant issues to these patients. While a number of newer, ‘less invasive’ approaches have been described recently, the gold standard still remains a function of sur¬gical therapy. Ultimately, a complex interplay between nephrologist, surgeon, interventional radiologist, and patient may allow for an optimal approach to the vascular access.
The National Kidney Foundation’s Dialysis Outcome Quality Initiative (NKF-DOQI)
Authors: Schwab Steve K
Published: November 2023

In the United States in 1995, the National Kidney Foundation’s Dialysis Outcome Q!:iality Initiative (NKF-DOQ[) was established, supported by an edu¬cational grant from Amgen.1 The primary objective of the NKF-DOQ[ was to improve patient outcomes and survival by providing recommendations for optimal clinical practices, thereby increasing the efficiency of patient care and positively impacting patient outcome. The National Kidney Foundation identified four key areas where variability in practice patterns would lend themselves to the development of evidence-based guidelines.
Hormone replacement therapy and ischaemic heart disease in postmenopausal women
Authors: Kardos Attila , Casadei Barbara
Published: November 2023

Cardiovascular disease (CVD) is the main cause of death and disability in women in Western societies (Eaker et al. 1993). The mortality from ischaemic heart disease (IHD) in women, as compared with that in age-matched men, is low before the menopause, whereafter it gradually rises towards that of men (Sans et al. 1997). In addition, the risk of IHD is increased in ovariectomized women as compared with age-matched menstruating women. These sex-related differences have generally been attributed to the impact of female sex hormones (Christiansen 1997). During the past 15 years several investigators have evaluated the relationship between oestrogen replacement therapy and the risk of CVD in postmenopausal women. A recent meta-analysis of published studies showed that oestrogen treatment is associated with approximately 50% reduction in risk (relative risk: 0.56, 95% CI 0.50—0.61) of CVD in postmenopausal women (Stampfer and Colditz 1991). The mechanisms by which hormone replacement therapy (HR T) reduces the risk of IHD are incompletely understood; however, they include beneficial effects on plasma lipids and lipoprotein levels, insulin sensitivity, body fat distribution, coagulation, fibrinolysis, and endothelial function itself. Moreover, oestrogens act directly on blood vessels through both endothelium-dependent and endothelium-independent mechanisms.
Alternative treatments for the menopause
Authors: Brockie Janet
Published: November 2023

About 80% of menopausal women will experience troublesome symptoms, and for some women these will severely affect their quality of life. Postmenopausal women are at an ever-increasing risk of cardiovascular disease, osteoporosis, and Alzheimer’s disease. There is good evidence that hormone replacement therapy (HRT) plays a valuable role in the alleviation of these symptoms and in preventing the long-term consequences of the menopause. However, only 17% of women aged between 40—65 years-the years of greatest symptomatology—will commence HRT. Continuation of therapy is poor: 31% will have discontinued HRT by one year and 74% before three years of therapy is completed. Many women are not continuing HR T for long enough to achieve symptom control and few are gaining any of the long-term benefits of treatment. Few women actually commence HR T for its long-term benefits (Hope and Rees 1995).
Polygenic and multifactorial inheritance
Authors: Young Ian D
Published: November 2023

In previous chapters, attention has focused on risk calculation in single gene disorders. In this chapter, we shall consider how to approach the difficult task of estimating risks for the large number of human characteristics and diseases which clearly have an underlying genetic component but which do not conform to any obvious pattern of straightforward Mendelian inheritance. There are, for example, many human characteristics which are probably determined by the interaction of many genes acting in concert, with each contributing in a small additive way to the overall phenotype. A characteristic which is determined in this way is said to show polygenic inheritance. Similarly, there are many diseases which show familial clustering with incidence figures in close relatives which are considerably less than would be expected if the conditions in question were caused by single genes, whether recessively or dominantly inherited.
Oxford Dictionary Of Medical Quotations
Authors: Mcdonald Peter
Published: November 2023

The Oxford Dictionary of Medical Quotations presents a wonderfully entertaining and eclectic range of quotations covering all aspects of medicine through the ages. It couples profound statements from famous scientists with witty one-liners from the likes of Woody Allen and Spike Milligan. Packed with hundreds of quotations, it is a book that anyone in the medical profession, or with an interest in health, will find an invaluable source of reference and considerable entertainment.
Anxiety
Authors: Flint Alastair J
Published: November 2023

Anxiety disorders are a heterogeneous group of conditions that fall into the following categories: phobic disorders (agoraphobia, social phobia, specific phobia), panic disorder, generalized anxiety disorder, obsessive–compulsive disorder, and post- traumatic stress disorder. This chapter reviews the clinical characteristics, risk factors, prevalence, and incidence of anxiety disorders in later life. It also discusses the relationship between anxiety and other conditions, specifically depression, dementia, delirium, and physical illness and drugs.
Somatoform disorders in late life
Authors: Melding Pamela S , Armstrong Louise
Published: November 2023

Of all the psychiatric disorders, the somatoform disorders seem to attract more negative attitudes from health professionals than other mental illnesses. Somatization and hypochondriasis are seen in all aspects of medical care of older people and are a challenge for the liaison psychiatrist. The phenomena can vary from transient symptoms under stress, to a lifelong coping style, to a disabling disorder. The phenomena are manifest in illness behaviour, a concept that has attracted wide- spread controversy as to whether it is a clinical entity or an ‘idiom of distress’. The phenomena have many potential meanings for the patient–environment relationship and these are explored in this chapter.
Non-biological therapies
Authors: Payne Julia , Wilson Ken
Published: November 2023

In this chapter, we will describe the evidence for non-biological treatments in older patients with mental health problems, with reference to their possible use in non- psychiatric settings. The first part of the chapter reviews the literature concerning formal psychotherapeutic interventions. In the second part, we examine the literature concerning less structured psychosocial, supportive, and other interventions. In this part, we also explore the role of non-drug interventions in the context of specific clinical situations. Lastly, we review aspects of the literature concerning family and domestic issues.
A legal perspective on issues in geriatric liaison psychiatry
Authors: Bouchier Hanneke
Published: November 2023

Obtaining the consent of patients with psychiatric disorders to medical or surgical treatment will often involve an assessment of competency to consent. In the absence of legal mental capacity, the attending medical practitioner should make enquiries about whether a substituted authority exists. This may include advanced directives, a living will, or the appointment of a welfare guardian by the patient. It may require an application to the Court for appointment of a welfare guardian or for the Court’s authorization for the procedure. Alternatively, medical intervention may be justified because of necessity. This does not require an emergency. The circumstances and standards of care applicable is determined by the Bolam test. Where a patient in a medical or surgical ward requires possible psychiatric treatment, local mental health statutes will usually outline the processes for preliminary assessment and treatment of the patient, and these do not require the consent of the patient. The statutory provisions in mental health statutes restrict the all-important principle of autonomy and are for that reason interpreted narrowly by the Courts.
Researching complementary therapies in cancer care
Authors: Rees Rebecca
Published: November 2023

Rebecca Rees worked for five years promoting research and audit with the independent charity, the Research Council for Complementary Medicine. She is now working on synthesizing research findings in the fields of health promotion and education at the Institute of Education’s Evidence-informed Policy and Practice Information and Co-ordinating Centre.
A new chance in life
Authors: Baldwin Edward
Published: November 2023

Sally Baldwin, after being diagnosed with breast cancer, combined orthodox and complementary treatments and went to the Gerson Clinic in Mexico. She is involved in setting up The Speedwell Trust, an integrated health advisory service in Oxford, to offer hope and help to the seriously ill. Sally’s husband, Edward, is principal spokesman for complementary medicine in the House of Lords, and has served on the Research Council for Complementary Medicine and as Chair of the British Acupuncture Accreditation Board.
Providing complementary therapies in a cancer hospital
Authors: Young Judy , Howells Nest
Published: November 2023

Judy Young qualified as a radiotherapy radiographer in 1967 and continued to treat cancer patients until 1989 when she undertook a further training in psychotherapy and counselling. In 1993 she was involved in setting up the Lynda Jackson Macmillan Centre for Cancer Support and Information at Mount Vernon Hospital where she now works as Director of Services and head of the counselling team.
Guiding patients through the maze
Authors: Zollman Catherine
Published: November 2023

Catherine Zollman graduated in 1989 from Oxford University and the Royal Free Hospital School of Medicine, London, where she developed an interest in holistic medicine by becoming a member, and then a trustee, of the British Holistic Medical Association. During her training in medical oncology, palliative care, and then general practice, she worked at the Bristol Cancer Help Centre and the Hammersmith Hospital Oncology Department, and was on the executive committee of the British Psycho-Oncology Society. Between 1996 and 1999 she was part-time director of medical education with the Research Council for Complementary Medicine, where she was involved in educating conventional healthcare professionals about complementary medicine and was co-author of an ABC of Complementary Medicine, published in journal (1999) and book (2000) form by the British Medical Journal.
Gastrointestinal tract
Authors: Fortune Farida
Published: November 2023

The basic function of gastrointestinal tract is to convert food into a form in which it may be absorbed. Material unsuitable for absorption passes out as faeces about 24–36 h after ingestion.
The nervous system
Authors: Fortune Farida
Published: November 2023

The dental surgeon is frequently faced with patients presenting with complaint sarising from the nervous system. The commonest is pain of dental origin. However, the nature of the pain may be vague and pain of non-dental origin may be present but be interpreted as dental pain, resulting in the unnecessary extraction of sound teeth.
Eyes and ears, taste and smell
Authors: Fortune Farida
Published: November 2023

The dentist must be able to recognize and advise whether a referral to a specialist is urgent or routine, but should always err on the side of caution. Examination of thecon junctiva may give clues to the underlying pathology.
Rheumatology
Authors: Fortune Farida
Published: November 2023

Systemic lupus erythematosus is a multisystem disorder occurring mainly inyoung women (female: male ratio 9 : 1). It is characterized by flares and remissions. Onset is between the ages of 15 and 45 years.
Liver disease
Authors: Fortune Farida
Published: November 2023

The liver plays a major role in the general metabolism of the body. Any acute or chronic liver disease will result in abnormalities of biochemical function. Derangement of liver function has consequences for the provision of dental care of patients. Both metabolism and detoxification of drugs are dependent on effective enzyme systems, while tooth extraction and wound healing are dependent on production of clotting factors and protein metabolism.
Disability
Authors: Fortune Farida
Published: November 2023

People with disabilities are very disadvantaged in many societies. They are fre- quently treated with prejudice and discrimination. The British Social Attitudes Survey 1998 looked at predjudice against disabled people in employment which showed these attitudes still prevail.
Care of the elderly and children
Authors: Fortune Farida
Published: November 2023

The ageing process is complicated and not completely understood. The body becomes mature around the age of 18 years after which ageing begins. The body replaces and repairs tissue constantly but with ageing this slows down and become less consistent as well as less precise. The process is progressive and irreversible.
Description of society
Authors: Taylor Ross J , Smith Blair H , Teijlingen Edwin R van
Published: November 2023

for example, education and defence. Thus, a Cabinet decision to provide more money to train more customs officers could mean that less money is made available to reduce the waiting list for people with hip operations.
An epidemiological picture of society
Authors: Taylor Ross J , Smith Blair H , Teijlingen Edwin R van
Published: November 2023

individuals with lung cancer with those of people without; a major association between cigarette smoking and lung cancer was found. However, showing that an association exists is not the same as saying that the risk factor caused the disease. There may be many other explanations for an association, although in the case of smoking few would now dispute that smoking causes lung cancer and many other diseases. Epidemiological data need to be interpreted carefully, especially when used to inform clinical and public health decisions.
Social influences on health
Authors: Taylor Ross J , Smith Blair H , Teijlingen Edwin R van
Published: November 2023

One of the main recent overviews in the field of health and inequality in Britain was the 1980 Black Report (Townsend & Davidson, 1982). This listed four possible explanations for the differences between social class and health. These four explanations—artefact, materialistic, social selection, and cultural/behavioural—are summarized below.
Health promotion
Authors: Taylor Ross J , Smith Blair H , Teijlingen Edwin R van
Published: November 2023

support for the development of projects through local health promotion departments that might develop activities at youth centres with individual young people—an individual approach to health promotion. Given the diversity of communities in the UK population local activities will need to reflect religious, cultural and gender differences on attitudes to sex amongst teenagers.
Chronic illness
Authors: Taylor Ross J , Smith Blair H , Teijlingen Edwin R van
Published: November 2023

A chronic disease is one that continues for a relatively long time, or is so frequently recurring or relapsing, that its effects on health are virtually continuous (Fig. 15.1). The epidemiology of chronic illness is not straightforward. The incidence (i.e. number of new cases) may be difficult to assess as the onset is often insidious or not obvious. In many examples there is a spectrum of disease activity and the point at which one is classified as a case is arbitrary, often depending upon individual ‘symptom thresholds’, or other cultural or medical factors. The prevalence (i.e. number of existing cases) may be difficult to assess as the disease may follow a variable course, including changes in severity, remission (i.e. temporary abatement), relapse, recovery, and recurrence. Nonetheless, it is important to have some indicators of both incidence and prevalence to inform both consulting room discussions and health service planning. In general, as opposed to acute diseases, chronic diseases have a low incidence and a relatively high prevalence (See also Chapter 3.).
Physical impairment, disability, and handicap
Authors: Taylor Ross J , Smith Blair H , Teijlingen Edwin R van
Published: November 2023

Criteria for disability exist in a variety of settings throughout society where rights and benefits are being considered. Doctors are often asked whether one of their patients ‘qualifies’ as someone with a disability. The fairness of these rules is a matter of public interest and debate and you might like to consider the role of the doctor in this exercise.
Psychological problems in the community
Authors: Taylor Ross J , Smith Blair H , Teijlingen Edwin R van
Published: November 2023

health (smoking and poor diet) and social processes. These last are unclear in their precise mechanisms, but are likely to be closely linked to social setting or family group. Mild to moderate degrees of learning difficulty arise more often in families exposed to socio-economic hardships. These families may suffer the multiple handicaps of poor nutrition, overcrowding, unemployment, alcohol and substance abuse, and possibly inherited causes of learning difficulty. The term ‘intergenerational cycles of disadvantage’ was coined to describe families affected in this way.
Growing up with haemophilia
Authors: Jones Peter
Published: November 2023

Haemophilia is not a disease. Children are born with it. If the parents know that there is a family history of haemophilia, then their sons can be diagnosed in the womb, or at birth. When there is no family history, severe haemophilia usually presents itself in the first year of life. Less severe forms may come to light at any time. People with very mild haemophilia may only be diagnosed when they are well into adult life and have bled for longer than usual after an operation or dental extraction.
What to use: therapeutic materials
Authors: Jones Peter
Published: November 2023

Recombinant, bioengineered clotting factors are now available for the treatment of some patients in most developed countries. However, they are in short supply and most of the materials used in the treatment of bleeding disorders in the world are still derived from human blood. This is provided by either voluntary or paid donors and is collected by a transfusion service that may be local or national. In several countries, including the United Kingdom, the donors receive no payment for their generosity. In other countries, most especially in the United States, donors are paid modest amounts for their blood plasma, which is then processed by one of the commercial companies.
Inhibitors
Authors: Jones Peter
Published: November 2023

Inhibitors are not the end of the world! People who develop inhibitors to clotting factors can nowadays enjoy good and productive lives, and even major surgery is possible in special circumstances.

What are inhibitors? In coagulation they are substances that ‘inhibit’ the actions of dotting factors. To do this an inhibitor attacks the relevant clotting factor directly. In the process, the clotting activity of the factor suffers. When inhibitor attack is strong, the effect can be marked. When it is weak, much of the activity may be left and the dotting process survives relatively intact.
Towards a career: education and employment
Authors: Jones Peter
Published: November 2023

The vital importance of providing the child with haemophilia or a related disorder with a good education cannot be overstressed. His or her future happiness and prosperity may depend on the choice of a satisfying career in keeping with any limitations imposed by the bleeding disorder. This often means brain rather than brawn, and jobs needing brain mean open competition with unaffected children and the passing of examinations.
The use of plain radiography
Authors: Renton Peter
Published: November 2023

From its infancy, diagnostic imaging was largely concerned with musculoskeletal disease. Foreign bodies, fractures, tumours, and infections were amongst the earliest lesions shown by the new technique. The inherent contrast between cortical bone and soft tissue made imaging possible even when very long exposure times were necessary and the image quality often poor.
Magnetic resonance imaging in rheumatic disease
Authors: Peterfy Charles G
Published: November 2023

The past 30 years have seen extraordinary advances in medical imaging, and innovations, such as computerized tomography (CT), real-time ultrasonography, and magnetic resonance imaging (MRI), have dramatically changed the way in which clinicians in most medical disciplines diagnose disease and manage their patients. Surprisingly, however, rheumatology has benefited relatively little from these innovations thus far, and continues to rely almost exclusively on conventional radiography for imaging evaluation of patients with arthritis, despite the widely acknowledged limitations of this imaging modality.
Localized pain in the upper limb
Authors: Grainger Andrew J , Griffiths Ian D
Published: November 2023

The development of a local musculoskeletal problem, as opposed to a generalized or polyarticular disorder, presents a wide range of diagnostic possibilities, including more serious conditions such as infection or neoplasia. In practice clinicians tend to request imaging for various reasons: they are uncertain as to the diagnosis, or they may be relatively confident of the diagnosis but require additional information to either confirm or refute their impression, or, if the diagnosis has been established, sequential imaging is helpful in monitoring the response to therapy.
Multiple peripheral joint swelling
Authors: Conaghan Philip , Karim Zunaid , Green Mike , McGonagle Dennis , Emery Paul
Published: November 2023

The evaluation of the patient with multiple peripheral joint symptoms is an extremely common problem for rheumatologists, in terms of both early appropriate diagnosis of rheumatoid arthritis (RA) and assessing effective treatment response. The last decade has seen a steady improvement in the range and availability of imaging modalities to help the clinician. In particular, advances in non-ionizing radiation techniques such as magnetic resonance imaging (MRI) and ultrasonography (US) have brought these tools to the stage where they may soon be considered in diagnostic criteria for inflammatory arthritides, as well as changing views on the accuracy of clinical assessment of disease activity (see below).
Spinal pain
Authors: Shipley Michael , Renton Peter
Published: November 2023

Low back pain affects some 80–85 per cent of the population in the Western world at some time in their lives. The pain may be short-lived and mild, so many episodes go unreported to a medical practitioner. Help may come from a pharmacist, a physiotherapist, or an osteopath. Once spinal pain presents to a doctor, the outlook is less good. Although such episodes are often self-limiting, others may follow over subsequent years.
Imaging in systemic vasculitides
Authors: Rutgers Abraham , van der Werf Tsjip , Jan Boeve Willem , Kallenberg Cees G M , Tervaert Jan Willem Cohen
Published: November 2023

Vasculitis is a condition characterized by inflammation of blood vessels. This can lead to microscopic as well as macroscopic damage to the vascular wall and ischaemic damage to the organs supplied by these vessels. Vessel wall aneurysm, stenosis, or occlusion with thrombosis can be macroscopic characteristics. Microscopically, there can be evidence of immune cell infiltration, intimal proliferation, fibrinoid necrosis, thrombus formation, and loss of vessel wall integrity leading to erythrocyte and fibrin extravasation. Clinical manifestations depend on the localization, magnitude, and type of vessels involved.
Diarrhea, malabsorption
Authors: Mercadante Sebastiano
Published: November 2023

Diarrhea is an abnormal looseness of the stools (increased liquidity or decreased consistency), and occurs when the intestine does not complete the absorption of electrolytes and water from the luminal content. Diarrhea is usually accompanied by an abnormal increase in daily stool weight. Patients often have associated symptoms of abdominal pain, urge to defecate, perianal discomfort, and fecal incontinence (1).

Diarrhea is a common complication in the oncologic population, and occurs in 5%–10% of patients with advanced cancer (2–4). The consequences of diarrhea can be troublesome, and include loss of water, electrolytes, albumin, failure to reach nutritional goals, declining immune function, risk of bedsores, or systemic infection. Diarrhea also causes additional work for the nursing staff or family who have to prevent maceration and bedsores. Moreover, loss of comfort and dignity have to be considered (5).
Enteric fistulae
Authors: Gemlo Brett
Published: November 2023

Enteric fistulae represent an especially difficult clinical challenge for clinicians caring for patients with malignant as well as benign disease, and result in significant morbidity and mortality (1). Patients with inflammatory bowel disease commonly present with enteroentero and enterocutaneous fistulae, and other patients who have suffered post-operative complications such as anastomotic leak or unrecognized enterotomies can fistulize and be challenging to manage, but are beyond the scope of this chapter. We will concentrate on the evaluation, diagnosis, and treatment of fistulae in patients with underlying malignancies that have resulted in the development and perpetuation of those fistulae.
The principles of assessment
Authors: Bowden Reed , Jackson Neil
Published: November 2023

It may come as a surprise to a young doctor entering general practice today to learn that well within living memory it was possible for a man—it was usually a man—to qualify as a doctor one day and start work in a practice the next day, alone and unsupervised. The only assessment beyond finals was the loyalty and affection, or otherwise, of his patients.
Renal failure as an immunodeficiency state
Authors: Vanholder R , Dhondt A
Published: November 2023

Infection, however, remains the factor which affects the largest number of patients. Dysfunction of the host defence mechanisms has major clinical and socioeconomic implications. Life expectancy, hospitalization rate and duration, and treatment costs may all be adversely affected since the application of expensive and prolonged courses of antibiotics, vasopressors, haemodynamic monitoring, and ventilation may be necessary.
Hepatitis C in end-stage renal disease
Authors: Natov Svetlozar N , Pereira Brian J G
Published: November 2023

Hepatitis C virus (HCV) is a small spherical virus, 40-60 nm in size, with a lipid envelope and a single-stranded RNA. The virus exhibits structural and sequence homology with the Flavivirideae family—human flaviviruses and animal pestiviruses—and therefore is considered to be a member of this family. The viral genome containing approximately 9400 nucleotides is organized in a long reading frame coding for a 3000- amino-acid polyprotein bracketed at the ends by two non-coding regions (NCR) in 5’ and 3’ terminus (5’ NCR and 3’ NCR respectively). The 5’ end of the genome encodes the major structural proteins and is described as the structural region of the viral genome.
Management of renal disease in patients with human immunodeficiency virus infection
Authors: Rao T K Sreepada
Published: November 2023

The expansion of human immunodeficiency virus (HIV) infection worldwide has led to an increase in the recognition of both the spectrum and the number of patients developing renal diseases. In HIV-infected patients, renal damage can result both as a direct consequence of viral-mediated glomerular/tubular/interstitial injury, and indirectly from the wide systemic derangements induced in the host by the virus, as well as from the therapeutic agents employed in their treatment. Furthermore, well-defined intrinsic primary renal diseases can also occur in patients with prior HIV infection. In addition, patients receiving renal replacement therapy may acquire HIV infection through various routes.
Living with Germs
Authors: Playfair John
Published: November 2023

The word germ is defined as ‘a microbe that causes disease’. The vast majority of microbes do not infect us at all: it is pathogens that make us ill. These include bacteria, viruses, protozoa, fungi, worms, and prions. Living with Germs not only looks at all of these in detail, but also at the defence mechanisms by which we come to terms with them, whether by eliminating them, stopping them from eliminating us, or simply learning to live with them. This is the first book to look at the subject of immunology in a relevant and approachable style. Using anecdotal and autobiographical material, John Playfair has produced a lively, well-written, and up-to-date look at immunology. Timely and topical, this will appeal to all those who want to know the facts behind the ‘germ’ scare stories.
Introduction: Living with Germs
Authors: Playfair John
Published: November 2023

No – not living with Germans, as my French wife thought she heard me say when I told her I was planning this book! My topic was to be biological, not sociological.

However, when I came to think about it, the relationship between those two great but very different nations did remind me a little of the uneasy but mainly peaceful coexistence of the biological species with which our planet is crowded. The dogs that half-heartedly chase our two cats if they escape into the road, or the pigeons and squirrels that forage together in our local park, may not be the best of friends, but they don’t spend their entire time trying to kill each other. Except where you have two species directly competing for food or space, or when one of them is the other’s favourite meal, ‘live and let live’ seems to be Nature’s general rule.
The pathogens
Authors: Playfair John
Published: November 2023

Opinions still differ as to exactly how life on earth started, but there is clear fossil evidence that about 3.5 billion years ago, only 1 billion years after the earth itself was formed, single-celled organisms remarkably like today’s bacteria were already abundant – and they were certainly not parasites, because there was nothing larger around for them to be a parasite of! It was another 2 billion years before the appearance of the new type of cell required for the evolution of larger animals and plants. Strange and wonderful creatures have come and gone since – ammonites, trilobites, dinosaurs, the mammoth, the sabre-toothed tiger – but the bacteria are still there, so evidently the design of that single cell was a pretty good one.
Sharpening the focus: the new immune system
Authors: Playfair John
Published: November 2023

The phenomena of antibody formation, immunological memory, and the success of vaccines were well known before 1900, yet it was another half century before it was realized that they were all due to the properties of lymphocytes. Up to then the favourite theory was that lymphocytes were the ‘stem’ cells that gave rise to all the other blood cells – one of the classic wrong ideas of the twentieth century. It was not until the elegant experiments of James Gowans in Oxford (1959) that the lymphocyte took its rightful place as the cell of adaptive immunity.
Getting ill
Authors: Playfair John
Published: November 2023

Up to this point the emphasis has been on pathogens – what they are like, how we try to combat them, how they fight back – but not much has been said about pathology. Some people might think of pathology purely in terms of post-mortems and the coroner’s inquest, but in reality it covers everything that makes you feel ill. Illness implies symptoms, which mean tissue damage or at least some loss of normal function somewhere, and that is pathology. A pathogen is by definition a parasite that induces pathology – makes you ill.
Immunodeficiency
Authors: Playfair John
Published: November 2023

If there were people who had never thought much about immunodeficiency, or indeed about immunity at all, the AIDS epidemic must have opened their eyes. For immunologists, it was a nightmare come true. Here as we watched, fascinated and horrified, was the proof of all the things we had been teaching our rather bored students for years – that you needed T lymphocytes to control tuberculosis, that there were parasites that only became pathogenic when immunity failed, that one animal’s harmless parasite could be another’s deadly pathogen, that one infection could influence another, that vaccines were not always straightforward to make. It was all true!
Controlling pathogens
Authors: Playfair John
Published: November 2023

We are the only animals that have actively altered the balance between ourselves and our pathogens. Admittedly there are reports of chimpanzees eating the right parts of the right plants to get rid of their worm infections, but that is a far cry from draining swamps, building hospitals, designing vaccines, and synthesizing antibiotics. Nowadays, even when a totally new infectious disease appears, the experience and the techniques are in place to identify the pathogen and work out how best to control it – drugs, a vaccine, or simple public health measures. This may of course take time, but our overall success can be measured by human life expectancy – in the developed world, more than twice what it was a century and a half ago, when infectious disease accounted for about half of all deaths (the figure now is about 5%).
Introduction: Living with Germs
Authors: Playfair John
Published: November 2023

Open almost any newspaper nowadays and you will probably be greeted by a headline about the imminent arrival of mutant killer bird flu, or the ever-rising toll from AIDS or tuberculosis, the spread of West Nile virus, the reappearance of polio or SARS, an outbreak of Lassa fever, the failure of yet another malaria vaccine, or a death in hospital from a superbug resistant to all antibiotics. You could be forgiven for concluding that our planet swarms with all kinds of germs and microbes invisible to the eye and that their one aim is to wipe us all out. The first conclusion is undoubtedly true, but fortunately the second is not, and this book is an attempt to explain why.