bluuebunny/crossref_metadata_2025 huggingface dataset:
Fatigue
Authors: Chalder Trudie , Cella Matteo
Published: August 2018

Fatigue is a term used to describe an inability to sustain physical or mental effort. It should be distinguished from weakness, which is an inability to generate normal muscular strength. Fatigue is a natural signal to reduce or stop physical activity, but also a common subjective experience which may escalate to a significant health complaint as either a primary or a secondary (or supporting) symptom to an existing condition. Fatigue is the one of the commonest symptoms experienced by the general population. Approximately 25% of patients attending their GP complain of fatigue. However, only 10%–15% of these patients will receive a diagnosis of a physical cause for the fatigue. This chapter covers the differential diagnosis of fatigue, as well as key diagnostic tests, therapies, and prognosis.
Alcohol intoxication
Authors: Keshav Satish , Trivedi Palak
Published: August 2018

Alcohol intoxication occurs when the quantity of alcohol (ethanol) consumed exceeds one’s tolerance for the substance, with consequent impairment of the individual’s mental and physical functional status. Alcohol abuse is a broad term for general ill health (mental, social, and/or physical) resulting from the repetitive, compulsive, and uncontrolled consumption of alcoholic beverages. Manifestations of alcohol abuse include a failure to fulfil one’s responsibilities, resulting in loss of employment, personal relationships, or finances. Alcohol dependence is a condition which arises as a result of alcohol abuse and occurs when an individual continually uses alcohol despite significant areas of dysfunction, with evidence of physical dependence.

Alcohol withdrawal syndrome is the set of symptoms and physical signs observed when an individual reduces or abruptly stops alcohol consumption after prolonged periods of excessive intake; it is largely due to the development of a ‘hyperexcitable’ central nervous system. Delirium tremens is the most severe form of alcohol withdrawal; it manifests as altered mental status, hallucinations, and sympathetic overdrive, which may progress to cardiovascular collapse if left untreated.
Normal function of the cardiovascular system
Authors: Kalla Manish , Herring Neil
Published: August 2018

This chapter discusses normal function of the cardiovascular system, including cardiac physiology (the cardiac cycle, ECG, blood flow and heart sounds, control of cardiac output), vascular physiology (control of local blood flow, capillary transfer), integrated cardiovascular control,
Raynaud’s phenomenon
Authors: Sunmboye Kenny , Jeffery Rachel
Published: August 2018

Raynaud’s phenomenon is characterized by episodic digital ischaemia due to vasospasm causing closure of the small arteries and arterioles of the distal extremities, in response to cold exposure or emotional stimuli. This is manifested clinically by the sequential development of intense pallor of the fingers or toes, cyanosis, and rubor, following cold exposure and subsequent rewarming. These colour changes may be accompanied by paraesthesiae and other sensations, but pain is not usually a prominent feature. Raynaud’s phenomenon is separated into two categories: primary (idiopathic), called Raynaud’s disease; and secondary, called Raynaud’s phenomenon, which may be due to underlying disease or environmental associations.
Investigation in respiratory disease
Authors: Haldar Pranabashis
Published: August 2018

Investigation in respiratory disease may be broadly classified as (1) tests that aid with diagnosis; (2) tests that assess disease severity—these are usually measures of respiratory function and inform prognosis; and (3) tests that assess disease activity—these are usually non-invasive biomarkers, enabling serial measurement, and may inform therapy. One of the challenges of respiratory medicine is the limited spectrum of clinical expression associated with a diverse spectrum of pathologies. Clinical symptoms in respiratory medicine are often of poor specificity for securing a diagnosis or assessing disease severity. Investigations, therefore, necessarily form a critical part of assessment. The most appropriate choice of investigation is an important component of clinical decision-making that affects patient care and may be influenced by a number of different questions that the clinician will need to consider.
Tuberculosis
Authors: Haldar Pranabashis
Published: August 2018

Tuberculosis (TB) is an infectious disease caused by the bacterial organism Mycobacterium tuberculosis. In this context, reference to the word ‘disease’ is important, as TB implies Mycobacterium tuberculosis infection associated with symptoms. Approximately 10% of Mycobacterium tuberculosis infection is manifest as disease. In the large majority of cases, Mycobacterium tuberculosis infection is latent and defined by evidence of a measurable and significant cell-mediated immune response to mycobacterial antigens, in the absence of clinical or radiological evidence of disease. TB may be clinically classified further according to the site of disease. Miliary TB refers to systemic disease that may affect multiple organs.
Respiratory failure
Authors: Wise Matt , Barry Simon
Published: August 2018

Respiratory failure is a syndrome characterized by defective gas exchange due to inadequate function of the respiratory system. There is a failure to oxygenate blood (hypoxaemia) and/or eliminate carbon dioxide (hypercapnia). Hypoxaemia is defined as an arterial blood partial pressure of oxygen (PaO2) of <8 kPa, and hypercapnia as an arterial blood partial pressure of carbon dioxide (PaCO2) of >6 kPa. Respiratory failure is divided into two different types, conventionally referred to as type 1 and type 2. The distinction between these two is important because it emphasizes not only different their pathophysiological mechanisms and etiologies, but also different treatments. The preferred terminology and definitions are as follows: oxygenation failure (type I respiratory failure), PaO2 of <8 kPa; ventilation failure (type 2 respiratory failure), PaCO2 >6 kPa. Respiratory failure may be acute (onset over hours to days), or chronic (developing over months to years); alternatively, there may be an acute deterioration of a chronic state.
Pulmonary vasculitis
Authors: Sudhir Rajini
Published: August 2018

Pulmonary vasculitis comprises a heterogeneous group of disorders characterized by an inflammatory process damaging the vessel wall, leading to ischaemia and tissue necrosis. Wegener’s granulomatosis, Churg–Strauss syndrome, and microscopic polyangiitis are primary, small-vessel, necrotizing vasculitides linked by an overlapping clinicopathological picture and are referred to collectively as ANCA-associated systemic vasculitis. The European Vasculitis Study Group proposed a clinical staging system based on disease activity, to guide treatment.
ICU treatment of respiratory failure
Authors: Wise Matt , Frost Paul
Published: August 2018

Respiratory failure is a syndrome characterized by defective gas exchange due to inadequate function of the respiratory system. There is a failure to oxygenate blood (hypoxaemia) and/or eliminate carbon dioxide (hypercapnoea). Respiratory failure can develop over years when it is due to conditions such as kyphoscoliosis or motor neuron disease, or minutes in the case of an acute asthma attack or pneumothorax. In this context, respiratory failure is often called acute (e.g. asthma), chronic (e.g. kyphoscoliosis), or acute on chronic (kyphoscoliosis complicated by pneumonia). Chronic respiratory failure is characterized by compensatory mechanisms which aim to adjust the pH of the blood back to the normal physiological range and involve the retention of bicarbonate by the kidney. This topic covers the etiology of respiratory failure as well as signs, symptoms, diagnosis, investigations, prognosis, and treatment.
Urinary tract obstruction
Authors: Herrington William G. , Chakera Aron , O’Callaghan Christopher A.
Published: August 2018

The urinary tract can become obstructed by various disease processes, including tumours. Obstruction at any level of the urinary tract can impair the free flow of urine and may be partial or complete, and unilateral or bilateral. Bilateral obstruction usually occurs at the level of the bladder or lower. Retroperitoneal fibrosis and extrinsic compression of both ureters by a malignancy are exceptions. Children are affected by congenital vesicoureteric junction obstruction or pelvi-ureteric junction obstruction. Young adults suffer stone disease. The elderly are prone to urothelial cancers, and older men to bladder outflow obstruction. Retroperitoneal fibrosis is an inflammatory condition that typically affects men over 50 years of age. Diagnosis should be confirmed by biopsy to exclude a lymphoma or malignancy.
Renal replacement therapy
Authors: Herrington William G. , Chakera Aron , O’Callaghan Christopher A.
Published: August 2018

Renal replacement therapies provide a substitute for the function of normal kidneys. Options include haemofiltration, haemodialysis, peritoneal dialysis, and renal transplantation. Haemofiltration is only used in the acute setting. Endocrine functions of the kidney are replaced with erythropoietin and vitamin D therapy. This chapter provides an overview of renal replacement therapies.
Management of terminal care in renal disease
Authors: Herrington William G. , Chakera Aron , O’Callaghan Christopher A.
Published: August 2018

With the increasing age and burden of comorbidities experienced by patients with significant renal impairment in developed countries, many patients are deciding that they do not want renal replacement therapy or elect to withdraw from dialysis. In some countries, over 30% of deaths in dialysis-dependent patients are reported as being due to withdrawal from treatment. Several aspects of terminal care are unique in the context of renal impairment. These include the management of symptoms caused by the loss of normal kidney function, such as anaemia, oedema, and hyperphosphataemia, and also altered pharmacokinetics of medications that are renally cleared. This chapter reviews the terminal care of patients with end-stage renal disease.
Disorders of plasma sodium
Authors: Chakera Aron , Herrington William G. , O’Callaghan Christopher A.
Published: August 2018

The normal range for serum sodium levels in most laboratories is 135–145 mmol/l. Hyponatraemia is defined as a serum sodium concentration of <135 mmol/l (<120 mmol/l is severe), and hypernatraemia as a concentration >145 mmol/l. As sodium is the major extracellular electrolyte, and freely diffuses throughout the extracellular space, it plays a key role in regulating osmolarity. Hyponatraemia is almost always associated with a hyposmolar state, except for the rare circumstances when there are other osmotically active substances present at high levels (e.g. glucose). Given the relationship between sodium and water, accurate assessment of fluid balance is an integral part of determining the causes of hypo- or hypernatraemia. This chapter describes the clinical approach to patients with derangements of plasma sodium.
Diabetes mellitus
Authors: Shotliff Kevin
Published: August 2018

Diabetes mellitus, often referred to simply as diabetes, is a syndrome of disordered metabolism (insulin deficiency and/or insulin resistance) resulting in abnormally high blood glucose levels (hyperglycaemia). Currently, 2%–6% of the UK population have diabetes; worldwide, 189 million people were known to have diabetes in 2003 and this may reach 324 million by 2025. Type 1 diabetes is due to the destruction of insulin-producing pancreatic beta cells, and type 2 diabetes to combined insulin resistance and relative insulin deficiency. Other types of diabetes are also recognized. This topic reviews clinical features, diagnosis, and management of diabetes mellitus.
Normal gastrointestinal function
Authors: Keshav Satish , Kent Alexandra
Published: August 2018

The gastrointestinal (GI) system accomplishes the tasks of digestion, absorption of nutritional compounds, and removal of waste products. This is a complex process, involving the hollow GI tract and the hepatic, pancreatic, and biliary systems. Symptoms and signs of disease relate directly to the digestive and/or absorptive processes they interrupt. This chapter discusses normal GI function, following the progress of food through the GI tract. It starts with a brief introduction, which is followed by a section on the action of swallowing. It then discusses the anatomy and function of the oesophagus, the stomach, the duodenum, the jejunum, the ileum, the pancreas, the biliary tree, the colon, the rectum, and the anus.
Investigation in liver disease
Authors: Keshav Satish , Trivedi Palak
Published: August 2018

This chapter discusses investigations in liver disease, including blood tests (liver chemistry and liver function tests, alpha-fetoprotein, viral serology, antibodies and immunoglobulins), ascetic fluid analysis, imaging (hepatobiliary ultrasound, CT, MRI, endoscopic ultrasound), and liver biopsy.
Autoimmune hepatitis
Authors: Keshav Satish , Kent Alexandra
Published: August 2018

This chapter discusses autoimmune liver disease, including autoimmune hepatitis (AIH), primary biliary cholangitis, and primary sclerosing cholangitis. It explores definitions of the disease, etiology, typical symptoms, uncommon symptoms, demographics, natural history, complications, diagnostic approach and other diagnoses that should be considered, prognosis, and treatment.
The liver in systemic disease
Authors: Keshav Satish , Trivedi Palak
Published: August 2018

The liver may be involved in systemic diseases that primarily affect other organs. In most cases, the systemic disease should be treated effectively first. Circulatory disturbances can cause liver dysfunction by ischaemia (due to arterial hypoperfusion) and hepatic venous congestion. The liver is a key organ in sepsis, both as source of inflammatory mediators and as a victim of the inflammatory response. An oncological process may affect hepatic function in a number of ways. For example, tumours in and around the liver can affect function by directly reducing the volume of healthy, functioning tissue or by causing biliary obstruction, and portal venous infiltration or hypercoagulability may compromise the liver’s vascular supply. This chapter discusses the liver in systemic disease, including sections on etiology, symptoms, demographics, complications, diagnosis, and treatment.
Diagnosis in suspected neurological disease
Authors: Bäumer Dirk
Published: August 2018

It is not always clear that a symptom is due to a problem in the nervous system. Delirium, generalized weakness, and fatigue are frequently due to systemic illness. Transient loss of consciousness may have a neurological or cardiac cause. It is, therefore, important to keep an open mind before focusing on a primary neurological diagnosis in these presentations. The principles of the neurological method are described in this chapter, followed by its application in common clinical presentations.
Multiple sclerosis
Authors: Weir Andrew
Published: August 2018

Multiple sclerosis is an idiopathic inflammatory disorder of the CNS. The characteristic pathological feature is the occurrence of ‘plaques’: well-defined areas of myelin loss, with relative axonal preservation.
Neurological tumours
Authors: Elwell Christine , Sampson Kufre
Published: August 2018

Neurological tumours are categorized by the WHO as follows: neuroepithelial tumours (gliomas, oligodendrogliomas, ependymomas, pineal parenchymal tumours, medulloblastoma, neuronal and neuroglial tumours); cranial and paraspinal nerve tumours (schwannoma, neurofibromas); meningeal tumours (meningiomas); lymphomas; germ cell tumours (germinoma, teratoma); sellar region tumours (cranipharyngioma); and metastases. The tumours are classified according to grade. The WHO histological grading scheme used for astrocytomas is based on mitoses, nuclear pleomorphism, necrosis, and endothelial proliferation. WHO Grade I and Grade II tumours are low-grade tumours, and WHO Grade III and Grade IV tumours are high-grade tumours.
Palliative care in neurological disease
Authors: Acharya Bhavyang
Published: August 2018

This chapter focuses on the management of patients with terminal neurological disease. The definition of the term ‘terminal’ varies but could be used to describe a patient who is in the last 6–12 months of their life. Some people prefer to reserve this term for patients in the last days to weeks of their life.
Bullous disorders
Authors: Davies Emily
Published: August 2018

This chapter focuses on immunobullous diseases. The immunobullous disorders are a group of diseases in which pathogenic autoantibodies bind to target antigens either in desmosomes (intra-epidermal intracellular adhesion junctions) or in part of the basement membrane zone, resulting in loss of adhesion, and blister formation. This chapter will focus on pemphigus vulgaris, pemphigus foliaceus, bullous pemphigoid, linear IgA disease, chronic bullous disease of childhood, and dermatitis herpetiformis; it will also mention mucous membrane pemphigoid, pemphigoid gestationis, and epidermolysis bullosa acquisita.
Skin cancer
Authors: Matin Rubeta , McGregor Jane , Harwood Catherine
Published: August 2018

Skin cancer is very common in the UK, and its incidence is rising rapidly. There are two broad classes of primary skin cancer: non-melanoma and melanoma. Non-melanoma skin cancer is the commonest form (100 000 cases diagnosed annually in the UK), accounting for nine out of ten skin cancers and includes basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Cutaneous melanoma is less common (10 000 cases diagnosed in the UK annually) but confers a significantly worse prognosis and accounts for 75% of skin cancer related deaths. There are also a number of other, rarer, non-melanoma skin cancers (e.g. appendageal carcinomas, Merkel cell carcinoma, sarcomas, vascular malignancies, and cutaneous lymphomas); however, these account for less than 1% of all skin cancers in the UK and so will not be specifically discussed in this chapter. Cutaneous metastases can occur secondary to any internal cancer or, indeed, to skin cancer (e.g. melanoma). In most cases, cutaneous metastasis occurs after the diagnosis of a primary cancer and usually in late stages of the disease but, in some cases, it may be the first presentation, in which case it should prompt a thorough investigation for the primary malignancy.
Investigation in rheumatological disease
Authors: Jeffery Rachel , Nandi Pradip , Sunmboye Kenny
Published: August 2018

In suspected rheumatological disease, the findings on careful clinical assessment are crucial to the interpretation of test results. Investigation should not be used as a screening tool, but rather to clarify the differential diagnosis. In established disease, investigation is also be used to assess the extent and severity of organ involvement, establish prognosis and guide treatment choices.
Systemic lupus erythematosus
Authors: Yee Chee-Seng
Published: August 2018

Systemic lupus erythematosus is a chronic multisystem autoimmune inflammatory disorder of unknown etiology. Numerous abnormalities within the innate and adaptive immune system have been described. The hallmark of this disease is B-cell hyperactivity resulting in autoantibody production, abnormal T-cell function, impaired clearance of immune complexes (resulting in their deposition in tissues), complement activation, and defective cellular apoptosis. However, these abnormalities of the immune system are not uniform across patients or within the same patient at different stages of the disease, resulting in heterogeneity in its presentation and progress.
Crystal arthropathy
Authors: Doherty Michael
Published: August 2018

Three main crystals associate with arthritis: monosodium urate (MSU); calcium pyrophosphate, the usual cause of cartilage calcification (chondrocalcinosis); and basic calcium phosphates (BCP), including hydroxyapatite. Gout is a true crystal deposition disease caused by MSU. Calcium pyrophosphate crystal deposition (CPPD) is the umbrella term for calcium pyrophosphate deposition. Calcium pyrophosphate crystals cause inflammation in acute calcium pyrophosphate crystal arthritis and chronic calcium pyrophosphate crystal inflammatory arthritis. However, osteoarthritis (OA) commonly associates with calcium pyrophosphate (OA with CPPD) and BCP crystals and, in this context, it is unclear if the crystals are pathogenic.
Deficiency anaemias
Authors: Bunch Chris
Published: August 2018

This chapter addresses the diagnosis, investigation, and management of anaemia due to a deficiency in iron, vitamin B12, or folate. Erythropoiesis requires an adequate supply of iron for haem formation, as well as vitamin B12 and folic acid (folate) to support high levels of DNA synthesis, and a lack of any of these will result in anaemia. Iron-deficient anaemias are typically microcytic, while a deficiency in vitamin B12 or folate results in megaloblastic haemopoiesis and a macrocytic anaemia. Iron deficiency results from poor dietary iron intake, poor absorption, increased demands, blood loss, or combinations of these. The usual cause of severe vitamin B12 deficiency in Western countries is an autoimmune atrophic gastritis, in which there is a loss of gastric parietal cell numbers and an absence of intrinsic factor production, which effectively prevents vitamin B12 absorption. This is the classical pernicious anaemia, and it is often seen in association with other autoimmune disorders. Folate deficiency may result from poor diet, malabsorption, or when demand for folate is increased, for example, during pregnancy, or with increased haemopoiesis in haemolytic anaemias or myeloproliferative disorders.
Prothrombotic conditions
Authors: Alikhan Raza
Published: August 2018

The term thrombophilia is used to describe an individual who has a tendency to develop thrombosis. Arterial thrombosis is usually linked with classical risk factors such as age, smoking, hypertension, hyperlipidaemia, or diabetes; a thrombophilia assessment and workup is not usually considered in cases of arterial thrombosis. A clinically useful approach to the diagnosis and management of a patient with a venous thrombotic process is to categorize the disorder as either a primary (inherited) or secondary (acquired) hypercoagulable state. This topic addresses the diagnosis and management of prothrombotic conditions.
Chronic leukaemia
Authors: Bunch Chris
Published: August 2018

In the chronic leukaemias, leukaemogenesis occurs in two different cell types (and possibly even two different anatomical sites), leading to two very different forms of the disease: chronic myeloid leukaemia and chronic lymphocytic leukaemia. Chronic myeloid leukaemia is best thought of as a myeloproliferative disorder. It is a clonal disorder of the haematopoietic stem cell, leading to overproduction of the myeloid cells: neutrophils and their precursors, basophils and eosinophils. By contrast, chronic lymphocytic leukaemia can be viewed as a low-grade lymphoma. It is a clonal disorder of mature B-lymphocytes (possibly memory B-cells). This chapter reviews the causes, diagnosis, and management of these two forms of chronic leukaemia.
Terminal care in haematological disease
Authors: Nagarajan Chandramouli
Published: August 2018

Care of the terminally ill haematology patient presents a unique challenge, due to the complexity of treatment decisions in an era of newly developing therapeutic options, and the speed of change in patient’s condition from a potentially curable to a terminal phase. Terminal illness is defined as progressive disease for which curative treatment is neither possible nor appropriate and from which death is inevitable, although this may not be impending and the prognosis can vary from a few days to many months. The focus of this chapter is to try and bring together various palliative treatment options that should be made available to this cohort of patients with terminal disease.
Neutrophil abnormalities
Authors: Bhole Malini
Published: August 2018

Neutrophils are an important component of the innate immune system, forming the first line of defence against bacterial invasion. Abnormalities in either neutrophil numbers or function lead to immunodeficiency disorders affecting the innate immune system, with a predisposition towards developing serious and often life-threatening infections. Alterations in neutrophil numbers and function may also be noted secondary to systemic diseases, where they may act as markers for ongoing disease processes. Most of the primary neutrophil disorders discussed in this chapter will present in childhood. In adults, acquired neutropenia is the commonest neutrophil abnormality encountered in clinical practice, although, rarely, some primary neutrophil defects may present.
Antibody deficiencies
Authors: Bhole Malini
Published: August 2018

Antibody deficiencies comprise a heterogeneous group of disorders characterized by a failure of antibody production and recurrent infections. They result from inherited or acquired disorders that lead to abnormalities in the development, maturation, and/or function of B-lymphocytes. Impaired functioning of B-cells leads to decreased immunoglobulin production, which manifests clinically as an increased susceptibility to infection. This chapter addresses the causes, clinical features, diagnosis, and management of antibody deficiencies.
Combined T- and B-cell immunodeficiencies
Authors: Misbah Siraj
Published: August 2018

Combined defects in the functioning of T- lymphocytes and B-lymphocytes are predominantly disorders of childhood and are encompassed by the term ‘severe combined immunodeficiency’ (SCID). SCID comprises a heterogeneous group of inherited disorders characterized by fundamental defects in T-cell development, accompanied by severe impairment of B-cell function. Although SCID is largely a paediatric problem, prompt diagnosis followed by early haemopoietic stem cell transplantation has resulted in many adult survivors who are followed up by clinical immunologists. This chapter addresses the clinical features, diagnosis, and management of SCID.
Nature and demographics: Epidemiology of infective organisms
Authors: Lever Andrew , Coggle Sian
Published: August 2018

An infection is an interaction between a host and a parasitic microorganism, with the interaction being deleterious to the host. Its occurrence and outcome are a combination of the nature of the organism, the site at which it is found, and the competence of the host defensive (immune) system. There are around 1500 documented agents that are infectious for man. This chapter reviews the epidemiology of infective organisms.
Investigation in infection
Authors: Lalvani Ajit , Pareek Manish
Published: August 2018

Making a diagnosis in a patient with a suspected infection is dependent on obtaining a comprehensive history complemented by a thorough examination; these crucial elements narrow down the potential causative agent(s) and the organ systems affected, thereby guiding the clinician in undertaking appropriate investigations. This chapter reviews the investigation of suspected infectious disease.
Sepsis
Authors: Cooke Graham
Published: August 2018

Sepsis is a clinical syndrome defined by the presence of both infection and a systemic inflammatory response with or without organ damage. The pathogenesis of sepsis is complex and may differ according to the infecting microbe, the site of primary infection, and the host’s immunological and physiological status prior to infection. The term ‘systemic inflammatory response syndrome’ refers to the clinical manifestations of a dysregulated host immune response, while ‘bacteraemia’, in contrast, refers to the presence of viable organisms that can be cultured from blood.
Mycobacterial infection other than tuberculosis
Authors: Aston Stephen , Davies Geraint , Beeching Nick
Published: August 2018

Mycobacteria are aerobic bacilli with a lipid-rich cell wall and are widespread both in the environment and in animals. Many species within the genus cause disease in humans, most notably those of the Mycobacterium tuberculosis complex, which cause tuberculosis, and Mycobacterium leprae, the causative agent of leprosy. Several other species, termed non-tuberculous mycobacteria, can cause chronic cutaneous, pulmonary, and disseminated infections. This chapter will briefly review infection with non-tuberculous mycobacteria and Mycobacterium leprae.
Protozoal infection: Malaria
Authors: Beeching Nick , Goodwin Lynsey , Peters Joanna
Published: August 2018

Malaria is a devastating protozoal infection that affects more than 200 million people worldwide each year, killing up to a million. Five species of Plasmodium are recognized causes of human disease: Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale, Plasmodium malariae, and Plasmodium knowlesi.
Cancers related to infection
Authors: Ajzensztejn Daniel
Published: August 2018

The development of a cancer is often complex and multifactorial. Environmental factors such as smoking, diet, asbestos exposure, and sun exposure are important causes of cancer, with smoking alone responsible for 25%–30% of cancers. Up to 10% of cancers have a genetic component. Infectious agents are implicated in the development of approximately 15% of cancers. Viruses, bacteria, and parasites can all cause cancers. Cervical and hepatocellular carcinoma are the two commonest cancers related to infections.
Vitamin deficiencies
Authors: Silva Aminda De , Saunders J. A. , Stroud M. A.
Published: August 2018

Vitamins are organic compounds required by the body in small amounts to perform specific cellular functions. Nine vitamins (thiamine (vitamin B1), riboflavin (vitamin B2), pyridoxine (vitamin B6), cyanocobalamin (vitamin B12), niacin (nicotinic acid; vitamin B3), pantothenic acid (vitamin B5), biotin (vitamin B7; vitamin H), folic acid (folate; vitamin B9), and ascorbic acid (vitamin C)) are water soluble, while four (vitamins A, D, E, and K) are fat soluble. The importance of vitamins was first appreciated through recognition of their clinical deficiency state. However, this approach has led to the concept that the primary purpose of a vitamin is to prevent the associated clinical deficiency state and, consequently, unless patients exhibit signs of a specific clinical deficiency state, they are thought to be replete in the corresponding vitamin. This is a misunderstanding. In reality, most vitamins have many different functions which are incompletely understood, and impaired biochemical function and even functional problems affecting metabolic, immunological, or cognitive status can occur with marginal vitamin depletion long before overt clinical deficiency becomes evident. A high index of suspicion is thus essential in all patients who have malnutrition or malabsorption, to ensure that levels that might compromise health, resistance to disease, and recovery from injury or illness are not left untreated.
Screening for cardiovascular disease
Authors: Banerjee Amitava , Asrress Kaleab
Published: August 2018

Screening involves testing asymptomatic individuals who have risk factors, or individuals who are in the early stages of a disease, in order to decide whether further investigation, clinical intervention, or treatment is warranted. Therefore, screening is classically a primary prevention strategy which aims to capture disease early in its course, but it can also involve secondary prevention in individuals with established disease. In the words of Geoffrey Rose, screening is a ‘population’ strategy. Examples of screening programmes are blood pressure monitoring in primary care to screen for hypertension, and ultrasound examination to screen for abdominal aortic aneurysm. The effectiveness and feasibility of screening are influenced by several factors. First, the diagnostic accuracy of the screening test in question is crucial. For example, exercise ECG testing, although widely used, is not recommended in investigation of chest pain in current National Institute for Health and Care Excellence guidelines, due to its low sensitivity and specificity in the detection of coronary artery disease. Moreover, exercise ECG testing has even lower diagnostic accuracy in asymptomatic patients with coronary artery disease. Second, physical and financial resources influence the decision to screen. For example, the cost and the effectiveness of CT coronary angiography and other new imaging modalities to assess coronary vasculature must be weighed against the cost of existing investigations (e.g. coronary angiography) and the need for new equipment and staff training and recruitment. Finally, the safety of the investigation is an important factor, and patient preferences and physician preferences should be taken into consideration. However, while non-invasive screening examinations are preferable from the point of view of patients and clinicians, sometimes invasive screening tests may be required at a later stage in order to give a definitive diagnosis (e.g. pressure wire studies to measure fractional flow reserve in a coronary artery). The WHO’s principles of screening, first formulated in 1968, are still very relevant today. Decision analysis has led to ‘pathways’ which guide investigation and treatment within screening programmes. There is increasing recognition that there are shared risk factors and shared preventive and treatment strategies for vascular disease, regardless of arterial territory. The concept of ‘vascular medicine’ has gained credence, leading to opportunistic screening in other vascular territories if an individual presents with disease in one territory. For example, post-myocardial infarction patients have higher incidence of cerebrovascular and peripheral arterial disease, so carotid duplex scanning and measurement of the ankle–brachial pressure index may be valid screening approaches for arterial disease in other territories.
Screening for cancer
Authors: Grant Warren , Scott-Brown Martin
Published: August 2018

The aim in cancer screening is not just to prevent the incidence of disease or diagnose it in an early stage but, most importantly, to reduce mortality. Designing screening programmes leads to challenging questions. Effective cancer screening programmes require a centralized organization to coordinate implementation, robust statistical evidence of benefit, and extensive cost and resource planning for the inevitable increase in use of diagnostic and treatment services. This chapter explores screening for cancer and malignancy, including the aims of cancer screening; the history of cancer screening; cancers that are suitable for screening; breast cancer screening; cervical cancer screening; and bowel cancer screening. It also discusses strategies for ensuring a useful screening test, and potential biases.
Endocrine investigation, nursing, and dietetics
Authors: Turner Helen E. , Eastell Richard , Grossman Ashley
Published: August 2018

This chapter documents laboratory procedures in testing and diagnosing endocrine disorders. The diagnosis and monitoring of endocrine disorders depend largely on measurements of circulating hormones and growth factors. These measurements can often be made using serum or urine. This chapter also describes the role of endocrine specialist nurses and includes information on dynamic tests, somatostatin analogue treatment, patient education, patient support, and societies and meetings designed for endocrinology clinicians. In addition, the chapter describes dietetic and dietary assessments for disorders such as amenorrhoea, hypoglycaemia, and polycystic ovary syndrome (commonly abbreviated as PCOS).
Speedy reference
Authors: Turner Helen E. , Eastell Richard , Grossman Ashley
Published: August 2018

This chapter is a quick-reference tool for clinicians, for those moments in the clinic when time is very short and a rapid answer to a query is needed. It aims to provide rapid, practical and easily accessible algorithm/guidelines for common clinical scenarios.
Up-and-Over Snare Technique for the Difficult Contralateral Gate Access
Authors: Kahn S. Lowell
Published: August 2018

The use of two- and three-piece modular aortic stent grafts requires proper catheterization of the contralateral gate. This step can be readily accomplished with appropriate pre- and intraprocedural planning. In some cases, catheterization can be challenging. This chapter describes a bailout technique when the conventional use of a catheter and wire fails or is unlikely to succeed within a timely interval. An Amplatz Gooseneck snare (ev3 Endovascular Inc., Plymouth, MN) or EN Snare (Merit Medical Systems Inc. South Jordan, UT) may be employed to grasp a Glidewire (Terumo Medical Corp., Somerset, NJ) that is threaded through a reverse curve catheter (e.g., Sos 1/2) over the bifurcation and brought below the contralateral gate. In so doing, cannulation of the contralateral gate is readily achieved.
Use of a Buddy Wire to Facilitate Contralateral Gate Catheterization During Endovascular Aortic Aneurysm Repair
Authors: Kahn S. Lowell
Published: August 2018

Catheterization of the contralateral gate during endovascular aortic aneurysm repair is typically of little difficulty. However, on occasion it proves challenging. With the exception of grafts such as Nellix (Endologix Inc., Irvine, CA), which utilizes parallel stents with polymer endobags, and those that employ a unibody concept, such as the AFX (Endologix Inc., Irvine, CA), all modular grafts require this step. A difficult catheterization can often be facilitated by using different catheters, such as the Cobra, Van Schie (Cook Medical Inc., Bloomington, IN), or Sos (AngioDynamics Inc., Latham, NY) designs. Alternatively, a wire advanced up and over through the contralateral gate from the ipsilateral side can be snared allowing catheterization of the gate. This chapter describes a simple alternative buddy wire technique that facilitates rapid contralateral gate catheterization.
Obtaining True Lumen Access in Aortic Dissections with Iliac Extension
Authors: Parikh Roshni A. , Williams David M.
Published: August 2018

Aortic dissection resulting in lower extremity ischemia is an emergent condition requiring urgent endovascular treatment of the aorta and iliofemoral arteries to restore blood flow to the lower extremities. This chapter describes the management, applications, challenges, and potential complications when obtaining bilateral true lumen access during the urgent endovascular treatment of lower extremity ischemia after an aortic dissection. Most interventions require retrograde access to the true lumen; however, if one of the common femoral arteries is dissected, then retrograde access can be a challenge. Utilizing the contralateral true lumen, retrograde access can be confidently obtained through the true lumen of a dissected artery. This chapter illustrates the steps involved in successfully obtaining bilateral retrograde access to the common femoral arteries when these challenging cases arise.
Alternative Subintimal Entry and True Lumen Re-entry Techniques
Authors: Kahn S. Lowell
Published: August 2018

Subintimal arterial revascularization has a high technical success rate, but requires the ability to navigate between different planes/lumens of the arterial wall. While most failures are attributable to the inability to re-enter the true lumen distal to the occlusion, there are times where entering the subintimal lumen can be challenging as well. This chapter describes alternative strategies for both entering and exiting the subintimal plane during lower extremity revascularization.
Techniques for Traversing Difficult Aortic Bifurcations and Aortobifemoral Grafts
Authors: Kahn S. Lowell
Published: August 2018

Contralateral extremity interventions are a mainstay of endovascular therapy for the lower extremity. The retrograde common femoral arterial access for contralateral infrainguinal interventions remains one of the most common access sites. Traversing the aortic bifurcation for an up-and-over approach is readily accomplished with little difficulty, but sharp angulation, severe calcification, iliac occlusive disease, kissing common iliac stents, and surgical or endovascular bifurcations can make this challenging or impossible. This chapter describes multiple techniques to transverse the difficult aortic bifurcations.
Proximal Arterial Occlusion During Treatment of Pelvic High-Flow Arteriovenous Malformations
Authors: Parikh Roshni A. , Williams David M.
Published: August 2018

Pelvic arteriovenous malformations (AVMs) are a cause of significant morbidity. Surgical management of AVMs poses a risk of massive intraoperative hemorrhage, surrounding organ injury, and incomplete removal of the nidus. Unfortunately, treatment is associated with high recurrence rates. Endovascular treatment is the preferred method of treatment; however, the high-flow nature of these lesions poses a challenge, risking nontarget treatment. It is important to provide adequate proximal arterial occlusion before injecting the sclerosant. This chapter outlines the steps involved in creating temporary stasis proximally within an arterial feeder to extend the contact time between the sclerosant and the recipient vessel wall while simultaneously accessing the arterial feeder more distally to deliver the sclerosant.
Reverse Deployment of the Gore Excluder Contralateral Iliac Limbs for Central Venous Occlusive Disease
Authors: Kahn S. Lowell
Published: August 2018

Central venous occlusive disease is a common finding, especially in the dialysis population. The incidence of central venous occlusions is increasing, largely because of the expanded use of central venous catheters and pacer wires in the growing dialysis population. The clinical sequelae of central venous occlusions are highly variable and depend on the site of occlusion, the presence of collaterals, and the presence of an arteriovenous (AV) fistula on the affected side. Many patients have occult disease, but often the disease presents with failure of the AV access and swelling of the involved extremity, breast, neck, and face. Rarely, a pleural effusion may be present. This chapter discusses the use of Gore Excluder iliac limbs for some large central venous occlusions.
Endovascular Snaring Technique for Shortening of Central Venous Port Catheters in Children
Authors: Zahra Mahmoud , Krishnamurthy Ganesh
Published: August 2018

Implanted venous ports in children are commonly placed by pediatric interventional radiologists, primarily through the internal jugular vein to allow long-term delivery of intravenous access. The ideal location of the catheter tip is the junction of the superior vena cava and right atrium. High catheter tip positions may result in failure of the port catheter due to venous thrombosis, catheter occlusion, or fibrin sheath formation, whereas low catheter tip positions may cause catheter occlusion, cardiac arrhythmias, or perforation. This chapter describes indications, contraindications, equipment, techniques, and complications of the endovascular snaring technique of central venous port tip revision in children.
Femoral Retrieval of Conical Filters
Authors: Patel Mikin V. , Zangan Steven
Published: August 2018

Inferior vena cava (IVC) filters are a safe, effective treatment option for the prevention of pulmonary embolism in patients who either have contraindication to or fail anticoagulation. However, filters pose long-term risks, such as IVC thrombosis, deep vein thrombosis, penetration of the IVC wall, filter fracture, and filter migration. IVC filters should be retrieved once the indication for placement has passed. However, cervical access frequently becomes compromised. This chapter reviews strategies for retrieving IVC filters from a femoral approach. Various techniques are discussed, including snaring the filter struts and the use of bilateral femoral sheaths to recapture the IVC filter.
Transradial Access Technique
Authors: Sanders Kyle , Miller Craig , Yamada Ricardo , Guimaraes Marcelo
Published: August 2018

Transradial access (TRA) competency can be rapidly achieved by the experienced interventionist. Statistically significant reductions in bleeding and other access site complications have been shown in randomized and meta-analysis studies when comparing TRA to both brachial and femoral artery access. Despite accumulating data, vascular interventional radiologists have been hesitant to adopt TRA for a variety of reasons. However, TRA offers distal dual blood supply, easily achievable hemostasis, and no adjacent critical structures. Other advantages of TRA are safer endovascular approach concomitant with earlier ambulation, improved patient comfort, decreased length of stay, as well as potential for cost savings. This chapter discusses the TRA technique, applications, challenges, and potential complications.
Techniques for Forming Large Reverse Curve Catheters
Authors: Kahn S. Lowell
Published: August 2018

Reverse curve catheters facilitate catheterization of vessels angled oppositely from the point of access. Most commonly, they are used to access caudally angulated vessels from a femoral approach. An array of these catheters exists, and their utilization greatly expands the options for intervention from any single access. Once formed, the catheters are gently advanced forward until their tip engages the vessel of interest, typically confirmed with an injection of contrast under live fluoroscopy. Engagement of the vessel is then performed by advancing a guidewire into the vessel of interest and retracting the catheter to seat the tip more distally within the vessel, providing a stable access. This chapter reviews four techniques for forming large reverse curve catheters.
Suprahepatic Catheter Placement for Hydrodissection
Authors: Gasparetto Alessandro , Angle John Fritz
Published: August 2018

Heat injuries of adjacent organs need to be considered when radiofrequency and microwave ablation procedures of hepatocellular carcinoma or hepatic metastases are performed, especially when the target lesion is in a subcapsular portion of the liver. Hydrodissection can be performed prior to radiofrequency or microwave ablation procedures in which the target lesion is in a subcapsular portion of the liver and adjacent to another structure, particularly the diaphragm. This technique creates a fluid layer thick enough to separate the nearby structures from the target lesion in the liver, providing thermal insulation around the ablation area. Moreover, if fluid (rather than CO2) is used, it improves the sonic window when the target lesion is not visible or only partially visible due to overlapping bowel, lung, or ribs.
Taming Cryoablation for Lung Tumors
Authors: Bansal Anshuman , Abtin Fereidoun
Published: August 2018

This chapter details the indications, uses, and techniques of using percutaneous cryoablation to treat lung tumors. The chapter reviews the role of ablative therapy for primary lung cancers as well as metastatic disease to the lung. It reviews the basic physical principles of cryoablation and the advantages of percutaneous cryoablation compared to other percutaneous heat-based ablative modalities. Patient selection criteria and post-ablation follow-up protocols are discussed. The chapter reviews procedural considerations, including choice of anesthesia, patient positioning, probe trajectory, and post-procedural recovery. It also details techniques that can be used to minimize and treat complications as well as tips for treating more challenging lesions.