bluuebunny/crossref_metadata_2025 huggingface dataset:
Pathophysiology of amyloidogenesis
Authors: Campistol Josep M , Cohen Alan S
Published: October 2023

The term ‘amyloidosis’ describes a group of diseases characterized by extracellular deposition of a fibrillar protein, amyloid, with a -pleated sheet conformation (Cohen 1967; Glenner et al. 1970). The growing mass of amyloid fibrils associates with plasma and extracellular matrix proteins and proteoglycans to form amyloid deposits. The amyloid deposits bind Congo red stain and give a green birefringence in polarized light, which is the most common histological criterion used for the presence of amyloid deposits in tissues (Cooper 1974). Characteristic fibrils of 7-10 nm diameter with a random twist are seen using electron microscopy, and a -pleated sheet configuration is viewed with X-ray crystallography (Cohen and Calkins 1959). Amyloid fibrils are known to be highly insoluble under physiological conditions and resistant to normal degradative processes in vivo, and therefore when they deposit within the physiological environment of the cell, thereby replacing normal tissue constituents, the function of the affected organ is often disturbed (Glenner 1980).
Various clinical types of amyloidosis
Authors: Hawkins P N , Tan, S Y , Pepys M B
Published: October 2023

Amyloidosis is a generic term for a heterogeneous group of disorders caused by the extracellular deposition of protein in a characteristic abnormal fibrillar form. There are acquired and hereditary types and amyloid deposits may be focal, localized, or systemic in distribution. When focal or small in amount, amyloid may be only an incidental finding at autopsy and, indeed, such deposition in the brain, heart, seminal vesicles, and joints is an almost universal accompaniment of ageing. In contrast, systemic amyloidosis or significant local deposition disrupt the normal structure and function of the affected tissues and are usually progressive. The systemic forms are frequently fatal. Although there is no specific treatment, intervention that reduces the supply of the protein precursors of amyloid fibrils can be associated with marked regression of amyloid deposits in some cases (Hawkins et al. 1993a, b; Holmgren et al. 1993).
Arthropathy and carpal tunnel syndrome of 2-microglobulin amyloidosis
Authors: Bardin T
Published: October 2023

Rheumatic disorders develop with increasing frequency with length of survival in patients under maintenance haemodialysis (Chou et al. 1985; Benhamou et al. 1987; Hardouin et al. 1987; Bardin and Laredo 1991). They are at present one of the main factors limiting the quality of life of long-term survivors (Goldstein et al. 1985; Brown et al. 1986; Bardin et al. 1988; Fardellone et al. 1988; Hurst et al. 1989; Kessler et al. 1992). The deposition of (32-microglobulin amyloid in osteoarticular tissues plays a major role in the genesis of these complications, but other aetiological factors including aluminium and iron overload, microcrystalline inflammation, and secondary hyperparathyroidism are also important (Bardin et al. 1986; Bardin 1987; Gaucher et al. 1982). This review will describe the clinical features of dialysis amyloid arthropathy and differentiate it from articular symptoms of other aetiologies in dialysis patients.
Determinants of fibril precipitation and aggregation in amyloid deposits
Authors: Campistol Josep M
Published: October 2023

Amyloidoses are complex diseases of pathological conformational change and polymerization, in which insoluble fibrils are derived from normally soluble precursors (Cohen 1967; Glenner et al. 1970). Using nonpolarizing optics, amyloid deposits in tissue sections appear homogenous, eosinophilic, and amorphous when analysed by light microscopy. With polarizing light, unstained amyloid deposits exhibit birefringence, indicating the presence of highly ordered structures. On staining with Congo red dye, the birefringence of amyloid deposits is intensely increased in a manner that is not seen with other fibrillar structures such as collagen, elastin, and fibrin (Cooper 1974). This indicates that the linear dye molecules are arranged in parallel along the amyloid fibril axis. All types of amyloid deposit contain characteristic and specific 10-15 mm fibrils by electron microscopy, as well as common elements in extracted material, such as amyloid P component, glycosaminoglycans, and proteoglycans (Cohen and Calkins 1959; Glenner 1980). X-ray diffraction studies of isolated amyloid fibrils demonstrated that the proteins are arranged in a crossed [3-pleated sheet conformation, with the polypeptide backbones oriented perpendicular to the long axis of the fibril; infrared spectroscopic analysis revealed that the orientation of the polymerized polypeptides is antiparallel (Eanes and Glenner 1968).
Chronic respiratory failure
Authors: Frcp Anita Simonds Md
Published: October 2023

A 54-year-old delivery man was admitted to a medical ward with a 3-day history of breathlessness, wheeze, and cough with purulent sputum. He had smoked 25 cigarettes a day for 40 years, but had never previously been hospitalized for a respiratory problem. His only regular medication was inhaled salbutamol. Exercise tolerance was reported by his family to be around 400 m on the flat until this current episode.
Asthma
Authors: Frca Brian F Keogh
Published: October 2023

An 18-year-old male suffered a severe asthma attack at home in associa tion with a recent upper respiratory tract infection. On arrival in the A&E department, the ambulance officers reported that the patient was initially conscious but unable to speak and had rapidly become unresponsive during transfer. On initial assessment, despite mask oxygen, SpO2 was 65% and the patient essentially apnoeic in gross hyperinflation. The patient was immediately intubated by A&E staff and manually ventilated with FiO.
Ventilator management
Authors: Frca George G Collee
Published: October 2023

A 45-year-old, 75 kg man was admitted to hospital with severe acute pancreatitis. Two days after admission he developed respiratory failure requiring mechanical ventilation on the intensive care unit. Over the course of the next .’.3 days his pulmonary function continued to deteriorate.
Multiple trauma
Authors: Frca D R Goldhill
Published: October 2023

A 25-year-old female was found alone in her car, having collided with a tree. lttook 1 hour to extricate her from the wreckage. During that time she was reportedly ‘semi;.conscious’ but deteriorated in the ambulance. On arrival in the emergency room her BP was unrecordable, respiratory rate was .25/min, and she had a Glasgow coma score (GCS) of 5. Initial emergency room resuscitation was according to advanced trauma life support (ATLS) protocols.
Oxygen delivery in trauma
Authors: Frca D Watson , Frca M Hayes Md
Published: October 2023

A 30-year-old male fell from a third-floor window. On admission to hospital he was shocked but conscious. BP was 80/60 mmHg; pulse 120/min. X-ray of the pelvis revealed an acetabular fracture. Peritoneal lavage was positive for blood and laparotomy revealed a massive retroperitoneal haematoma. Prior to transfer to the angiography suite he had been transfused 27 units of packed red cells.
Hypothermia
Authors: Frcs M P Hayward
Published: October 2023

A 28-year-old woman was found,. apparently dead; at 0700 hours on a park bench. The air temperature overnight 2.°C with continuous overnight rain. No discernible pulse could be felt but a passing policeman detected faint infrequent respiratory efforts; ..External cardiac massage was commenced and she was brought to the local A&E department. On admission she had no detectable. cardiac output,. was ranking no respiratory effort, and had fixed, dilated pupils. A low-reading rectal thermometer gave a core temperature below 28°C; ECG showed slow ventricular. fibrillation. She was intubated and ventilated, and external cardiac massage was continued. There was no cardiac response to DC cardioversion or any standard resuscitation drugs.
Hypovolaemia
Authors: Mrcp A Webb Md
Published: October 2023

A 32-year-old female patient was admitted to the ICU from the A&E department. She had presented after collapsing with left loin pain. She had a past history of recurrent urinary tract infections. Pyrexia 38.0°C; pulse 130/min; sinus rhythm respiratory rate 24/min; BP 70/40 mmHg. Jugular venous pulse not visible. Heart sounds normal with no added sounds. Chest normal. Abdomen tender to palpitation in the left loin. Central nervous system normal other than mild drowsiness.
Aortic dissection
Authors: Frcs M P Hayward
Published: October 2023

A 59-year-old man was admitted to ITU. from the A&E department. At the time of admission to A&E, his history was of collapse at home with sudden, severe chest pain radiating to his back, neck, and jaw. He was overweight and had smoked 20 Cigarettes daily for 40 years. He gave a history of hypertension for 10 years. He was cool, sweaty, and in pain. >Pulse 110/min; BP 150/90 mmHg (both arms); soft non-tender abdomen. No neurological abnormalities except for weakness and tingling in the left arm. An initial ECG (during pain) showed non-specific ST - T changes in the lateral leads only.
Heart block
Authors: Frca D Rosser Mrcp
Published: October 2023

You are asked to see a 58-year-old lady on the cardiac surgical ICU who has recurrent ventricular fibrillation. You are told that she has had an aortic valve replacement that day which was uneventful, although she has marked left ventricular hypertrophy. She was otherwise well preoperatively except for controlled hypertension. Postoperatively she was noted to have become bradycardic, rate 40/min, shortly before going into ventricular tachycardia which rapidly regenerated to ventricular fibrillation. She responded to a 220 J DC shock, emerging into a broad complex bradycardia of 40/min with a BP of 95/40 mmHg (MAP 55 mmHg) for some minutes before again degenerating to ventricular tachycardia/fibrillation (VTNF). This sequence of events was repeated twice more despite the administration of 100 mg of lignocaine intravenously. Prior to her first arrest she was ventilated with good blood gases, normal acid-base status, and blood biochemistry.
Human immunodeficiency virus (HIV)
Authors: Mrcp A Severn Phd , Frcp R F Miller
Published: October 2023

Staff Grade Physician, In-Patient HIV/AIDS Unit and, Senior Lecturer, Division of Pathology and Infectious Diseases, UCL Medical School; Consultant Physician, Camden and Islington Community Health Services (NHS) Trust Middlesex Hospital London [AF] A 32-year-,old taucasian, homosexual, male teacher was a:c:lmitted to a general medical ward with a 4 week hist9ry of increasing exertional dyspnoea and unproductive cough. He had been HIV-I aii’tibody positive for 6 years and his most recent CD4 lymphocyte count was 0.22 X 109/1 (normal range = 0.35 -2.2 X 109/1). He had no previous AIDS defining diagnoses and was taking no prophylaxis against Pnevmocystis carinii pneumonia (PCP).
Leptospirosis
Authors: Mrcp D G Sinclair Md
Published: October 2023

A previously-well, 22-year-old male was brought to casualty as an emergency. On admission he gave a history of a pyrexial illness of 3 days duration. There was no history of foreign travel or drug ingestion. Positive findings on examination were marked jaundice; temperature 38°C; a small right-sided inferior subconjunctival haemorrhage; the liver was just palpable; the musculature of both legs was swollen and exquisitely tender; cerebration was sluggish; and he was mildly confused. BP was 120/60 mmHg; pulse 110/min; respiratory rate 20/min. Catheterization of the bladder revealed a small quantity of urine.
The post-operative neurosurgical case
Authors: Frca M Smith
Published: October 2023

A 25-year-old male was admitted with a head injury following a road traffic accident. At the accident site his GCS was 3 and he was intubated and ventilated for transfer. CT scan revealed an acute left-sided extradural haematoma and small frontal lobe contusions. There were no other injuries. The extradural haematoma was evacuated and postoperatively the patient was sedated and ventilated on the intensive care unit. ICP was 12 mmHg. Twelve hours postoperatively his ICP rose to over 30 mmHg and, despite treatment, his left pupil suddenly dilated.
Hyponatraemia
Authors: Frcp(Edin) D Bell Md
Published: October 2023

A 23 year-old, HIV-positive, caucasian, female was admitted to hospital with cough, fever, and dyspnoea. Initial chest X-ray showed bilateral pulmonary infiltrates, and arterial blood gases breathing air showed PaO2 9.5 kPa; PaCO 4.0 kPa; pH 7.36. Other routine bloods, including electrolytes, were normal. The diagnosis of a first episode of PCP was confirmed by bronchoscopy and bronchoalveolar lavage, and treatment started with intravenous co-trimoxazole 120 mg/kg/day in divided doses. Twenty-four hours following admission, the patient developed persistent nausea and vomiting. Metoclopramide was prElscribed.
Rhabdomyolysis
Authors: Mrcp H Cairns Md
Published: October 2023

A 25-year-old man was admitted, having been found unconscious in a local public toilet. On examination he was apyrexial (36.8°C) and drowsy (GCS 10), with bilaterally small pupils and multiple needle tracks in both arms and groins. His left arm and leg were both swollen and clearly tehder to palpitation. Peripheral pulses were all easily felt.
Prevention of acute renal failure (ARF)
Authors: Fanzca N Soni Md , Frca R Juste
Published: October 2023

A 55-year-old man presented to outpatients with abdominal pain radiating to his back. He was overweight arid had a long history of hypertension, treated with atenolol. He was known to have chronic renal failure secondary to a degree of renal artery stenosis in his singleton kidney. The other kidney was congenitally absent. On presentation his creatinine and urea Were 280 µ.mol/1 and 18. mmol/1 respectively; 8P 180/100 mmHg.
Hepatic failure
Authors: Mrcp A J Ellis , Mrcp J A Wendon
Published: October 2023

A 35-year-old lady was found collapsed and disorientated on the floor of her flat. She had previously complained to her partner of abdominal pain, nausea, and vomiting for 24 hours. In casualty a medical history revealed mild asthma, alcohol consumption of 20-30 units per week, and no recreational drug use. On examination her GCS was 12, muscle tone was normal, and there was no neck stiffness. The respiratory rate was 30/min; pulse 120/minute; and BP 90/40 mmHg. The abdomen was soft, there was no organomegaly, and no evidence of jaundice.
Pre-eclampsia
Authors: Mrcp D J Williams
Published: October 2023

A 19-year-old primigravida booked in for antenatalcare at 14 weeks gestation. BP was 100/65 mmHg and there was no significant past medical history. Her pregnancy progressed uneventfully until 28 weeks when .she was admitted from a routine antenatal clinic with a BP of 155/100 mmHg, +++ proteinuria, but no peripheral oedema
Withdrawal of treatment
Authors: Frcp S L Cohen
Published: October 2023

A 22-year-old female patient, married with a young child, was diagnosed as having acute leukaemia. She developed respiratory and renal failure following bone marrow transplantation. She was leucopenic and thrombocytopenic. The haematologists considered both conditions were reversible and she was transferred to the ICU for ventilation and haemofiltration.
Principles of treatment
Authors: Lader Malcolm , Herrington Reginald
Published: October 2023

The management of any problem logically depends on the analysis of its nature and causes and on its likely development if left to itself. In clinical practice, diagnosis and prognosis precede treatment and ‘of these diagnosis is by far the most important, for upon it the success of the other two depends’ (Ryle 1948). Diagnosis contains two processes: firstly, the development of a system of classification of disease or disorders; and secondly, the assignment of an individual patient to the appropriate category. Diagnosis or classification has a number of functions, notably to aid the communication amongst clinicians and scientists and to provide a key to existing knowledge about a particular disorder mcluding knowledge of its course and response to treatment (that 1s, prognosis). To be useful a diagnostic system should provide the basis for describing important similarities and differences between patients. Diagnostic entities should be fairly homogeneous (although patients with the same diagnoses need have only some of a range of symptoms and signs) and it ought to be possible to allocate a diagnosis to most patients (clearly a diagnostic scheme accommodating only half the patients would be of limited use). In short, a diagnostic system aids the recognition of a disorder in an mdividual patient and allows knowledge gained from the management of previous patients with a similar disorder to be applied to him.
The evaluation of treatment
Authors: Lader Malcolm , Herrington Reginald
Published: October 2023

The evaluation of treatment accounts for much of the decision making of everyday clinical practice. It combines naturalistic observation of the individual patient with past personal experience, general clinical consensus and that frac tion of accumulated scientific information known to the clinician. In psychiatry it is not as straightforward or efficient as in many other branches of medicine partly because of the mtncacics of the treatment process described in Chapter 2. The biological and social forces acting on the patient quite mdcpendenrly of his attendance at the clinic, his expectations and reaction to contact with the clinic, the intimacies of the interaction between patient and doctor and the expertise of the latter are all potent forces at work before pharmacological agents are introduced into the transaction.
Psychoses and antipsychotic medication
Authors: Lader Malcolm , Herrington Reginald
Published: October 2023

This topic encompasses a large part of psychiatric phenomenology and classification and a detailed account is inappropriate here. The basic division is into the organic psychoses and the functional psychoses but antipsychotic medication is used to combat disturbed behaviour and psychotic symptoms in whatever context they arise. Thus, the acutely psychotic patient is given large doses of chlorpromazine, haloperidol, or a similar drug whether the underlying psychopathology is mania, brain tumour, epilepsy, agitated depression, or schizophrenia.
Electroconvulsive therapy and brain surgery
Authors: Lader Malcolm , Herrington Reginald
Published: October 2023

In the 1930s several physical treatments were introduced including insulin shock, sleep narcosis, leucotomy and camphor, metrazol and shock-induced electroconvulsive therapy. Chemically induced convulsions were initially used, based on the mistaken premise that epilepsy and schizophrenia were mutually incompatible in the same person, and, ergo, fits would ameliorate schizophrenic illnesses (Meduna 1938). Electrically produced convulsions were found to be more easily controlled and more acceptable to the patient (Cerletti and Bini 1938), and soon it was recognized that it was usually depressed patients who showed the most gratifying responses to electroconvulsive therapy (ECT).
Minor trauma
Authors: Morton Rosemary J , Phillips Barbara M
Published: October 2023

One of the most common reasons for a child attending an A & E department is a wound. The treatment given will vary with the type of wound. The main points to be considered are the following.

• Is the wound suitable for primary suture?

• Is there any damage to deep structures?

• Are there foreign bodies in the wound?

• Is the wound dirty?

• Is the wound suitable for management in the A & E department?

If possible the parents should be allowed to accompany the child throughout all procedures.
Children brought in dead
Authors: Morton Rosemary J , Phillips Barbara M
Published: October 2023

1 All children brought to hospital who may be dead should be admitted to the resuscitation room and unless contra-indications are very clear, for example rigor mortis or injuries incompatible with life, resuscitation should be initiated.

2 Sensitive and caring management of the bereaved family in the A & E department will aid the long-term grieving process.

3 Ensure that all relevant community health workers are informed of the child’s death.

4 Ensure that the arrangements are made for later counselling of the family.
The practical assessment of endometrial morphology and function
Authors: Russell Peter , Fraser Ian S
Published: October 2023

The central role of the endometrium in reproduction has been increasingly recognized in the past decade as its complexity as an organ has begun to be defined. The endometrium is highly sensitive to changes in hormonal exposure, as are the interactions of its different tissue components. These interactions are regulated by a series of complex molecular changes with a range of effects on morphology and function.
Menstrual problems in adolescence
Authors: Edmonds D Keith
Published: October 2023

During adolescence, girls become preoccupied with the physical and emotional changes which occur over a number of years, and which translate the girl into a fully sexually and reproductively competent adult female. These changes are also associated with changes in emotional and intellectual status, which identify the adult female as different from the adult male. The outward changes of breast growth, pubic hair and axillary hair growth, and the attainment of full adult height usually precede the outward manifestation of maturity, i.e. the menarche. For many girls their first menstrual period is truly the sign of adulthood and psychologically extremely important to achieve. However, it is also associated with times of stress and the absolute wish to be normal. Thus, changes that occur which are abnormal may have a very serious impact on psychological well-being. Being normal as an adolescent and accepted as a normal member of that peer group is extremely important. In differentiating the range of normality from true abnormality, an understanding of the onset and control of puberty is essential, as in many cases, misinformation leads these adolescent teenagers to states of anxiety which can be well avoided, and a deep knowledge and understanding of the adolescent will make management effective and help her to achieve normal adulthood. In fact, in some cases, poor management of menstrual problems at the time of adolescence may leave her with a life-long menstrual phobia which may be used in later life as a prop against adversity.
The role of synthetic progestogens in the medical management of menorrhagia
Authors: Andersson Kerstin , Rybo Gōran
Published: October 2023

Synthetic progestogens have been widely used in the treatment of heavy menstrual bleeding. The physiological background for this is the change of the endometrium which occurs after administration of progestogens indicative of endometrial suppression: small depleted glands lined with a thin epithelium and a more or less pronounced decidual transformation of the stroma.
Amenorrhoea
Authors: Zreik Tony G , Olive David L
Published: October 2023

Amenorrhoea, defined as the absence or cessation of menstrual flow, is the end result of a number of different pathological states, some congenital, others benign, and occasionally one of several that are life-threatening. For this reason, correct diagnosis is of critical importance. Amenorrhoea is a relatively common disorder, with an estimated prevalence of 1.8-3 per cent in the general female population during the reproductive years (Petterson et al. 1973), and as high as 8.5 per cent in an unselected adolescent population (Johnson and Whitaker 1992). Although a number of classification schemes for amenorrhoea are available, it is conventional to subdivide the patients initially into those with primary versus those with secondary amenorrhoea.
Menstrual disturbance and contraceptive steroids: mechanisms and management
Authors: Hickey Martha , Fraser Ian S
Published: October 2023

Contraceptive steroids are used by an estimated 100 million women worldwide (Olive and Schlaff 1992), and provide safe, reliable, and affordable protection against unwanted pregnancy. All contraceptive steroids have the capacity to alter normal menstrual bleeding patterns, and the majority of women using these methods will notice some change in their regular menstrual cycle. For those contraceptive methods containing oestrogen and a progestogen, the change may be minor and quite acceptable to the user. For those using progestogen-only methods, the disruption of menstrual bleeding pattern may be profound, and dissuade the woman from utilizing these methods or from continuing with them (Odlind and Fraser 1990). As progestogen-only contraceptives have a number of distinct advantages over oestrogen and progestogen combinations - including safety, high efficacy, simplicity, flexibility of delivery systems, and cost-breakthrough bleeding constitutes a major problem for contraceptive providers.
Introduction
Authors: Marsh Geoffrey N , Renfrew Mary J
Published: October 2023

This book makes the case quite unashamedly for placing the majority of maternity care in the setting of the community. It reviews the components of that care, it discusses today’s major issues and challenges, and it indicates the way forward.
Multidisciplinary teamwork in maternity care
Authors: Dowell Anthony , Price Helene
Published: October 2023

The current provision and outcomes of community-based maternity care demonstrate how effectively multidisciplinary teams of health professionals can work together. Collaboration and team working between midwives, GPs, obstetricians, health visitors, paediatricians, and public health professionals has provided a framework of care which has witnessed significant reductions in obstetric and perinatal morbidity and mortality over the last 30 years.
The economics of maternity care
Authors: Twaddle Sara , Young Denise
Published: October 2023

This chapter introduces the basic concepts of economic evaluation before discussing their particular relevance to maternity services. It begins by defining the terminology used by economists, the techniques used in economic appraisals, and briefly discussing issues in costing and the measurement and evaluation of outcomes of maternity care. The cost effectiveness of different forms of maternity care is then reviewed. The chapter concludes by identifying areas where further work is required.
Auditing care
Authors: Maresh Michael
Published: October 2023

Before discussing precisely how maternity care can be audited it is necessary to clarify what is and is not audit. It is often claimed that audit in the maternity services has existed for many years. It has been commonplace to have local reports on clinical activity and outcome from maternity units and from those general practitioners supervising significant numbers of pregnant women. These have been supplemented by both regional and national reports such as the Confidential Enquiries into Maternal Deaths, The National Birthday Trust Surveys, and more recently the Confidential Enquiry into Stillbirths and Deaths in Infancy (CESDI).
Narrowing the gap: social class, age, and ethnic differences in maternity outcomes
Authors: Hirst Janet , Eisner Maggie
Published: October 2023

Readers will be aware that it is not easy to define the terms used in this area, and that there are problems in collecting statistics. Although mortality seems to be an unambiguous term, it is difficult to differentiate between those maternal deaths directly caused by pregnancy and childbirth and those due to related or coexistent medical problems. Estimates of the annual number of maternal deaths worldwide vary between 585 000 (WHO 1995) and 1.3 million (reported by Population Action International, quoted in Dillner 1995).
The use of technology in maternity care
Authors: Neilson James P
Published: October 2023

This chapter will concentrate on the use of machines to complement or replace the clinical care of women during pregnancy or childbirth by doctors and midwives. The use of equipment is not necessarily bad if it clearly produces tangible benefits compared with standard clinical care alone, but it is the responsibility of proponents of new techniques and/or equipment to demonstrate such benefits before these are accepted into practice. It has been realized belatedly that the rigorous processes of evaluation that are necessary before a new drug can be given to patients have not been applied to new machines or techniques. In consequence, many uses of technology are of questionable value and others may be downright harmful.
Born too soon or too small or both
Authors: MacPhail Sheila , Walkinshaw, Stephen , Walton Stuart
Published: October 2023

One in every 200 births occurs at less than 28 weeks’ gestation, and three in 200 at less than 32 weeks’ gestation. Over 11000 babies are therefore born before 32 weeks in the UK, with 3750 of these before 28 weeks. Almost a half of all deaths occurring in live born infants in the first month of life in England, Wales, and Northern Ireland are the consequence of premature birth and, in 1994, over 1500 babies died because they were born too soon.
New thoughts on the physiology of pregnancy
Authors: Walker James J , Simpson Nigel A B
Published: October 2023

Pregnancy produces considerable physiological changes in the mother to accommodate the developing baby, to allow growth and development to occur in a favourable environment, and to deliver the baby at the optimal time. These changes have traditionally been regarded in terms of the maternal response to the developing needs of her baby. However, the majority of physiological processes are determined and implemented well in advance of their needs and are driven separately by the mother’s body and the placenta.
Psychological health before, during, and after childbirth
Authors: Clement Sarah , Elliott Sandra
Published: October 2023

Pregnancy and childbirth are major life events which bring with them emotional challenges and the potential for psychological distress. Since women’s contact with the health services is greater during maternity than at any other time in their lives, this period presents an ideal opportunity for promoting psychological health and preventing psychological problems (Royal College of Midwives 1987; Prince and Adams 1990; Royal College of General Practitioners 1995). The importance of pyschological care was also emphasized in Changing Childbirth (Department of Health 1993).
Breastfeeding
Authors: Inch Sally , Fisher Chloe
Published: October 2023

Since 1975 the Office of Population Censuses and Surveys (now the Office of National Statistics) has carried out national infant feeding surveys at five yearly intervals. The 1995 survey found that 67% of all women who gave birth started breastfeeding. By the end of the first week only 57% of women were breastfeeding, by the end of the second week 53%, and by the end of the sixth week only 43%. By four months only 28% of babies were receiving any breast milk (White et al. 1992; Foster et al. 1997).
Medical assessment
Authors: Wilcock G K , Skoog I
Published: October 2023

Although more than 70 diseases can cause dementia, three are probably responsible for 70 to 80 per cent of all cases: Alzheimer’s disease; vascular dementia; and dementia associated with Lewy bodies. Most other causes are by themselves uncommon, but together they may constitute 10 to 25 per cent of patients referred for a dementia evaluation, and they are important to recognize as several of them are potentially treatable or involve a process which may be retarded by appropriate treatment. Furthermore, several potentially treatable physical and mental disorders may be superimposed on a primary dementia and thus aggravate this condition. In patients with a primary dementia, these conditions are often neglected. In people under 65, up to 20 per cent may have a treatable or remediable aggravating factor, although the proportion decreases with age to less than 5 per cent in those aged 65 and over (Smith and Kiloh 1981). All comorbid conditions, which may aggravate the dementia, become more common with age.
Investigations—laboratory, radiological, and neurophysiological
Authors: Jobst Kim A , Suarez Rodolfo , Miller Bruce L
Published: October 2023

Dementia is a clinically-defined syndrome. It may be caused by a plethora of conditions (see Chapters 4, 14, and 15). Making the diagnosis of dementia is important because some causes are treatable, and because accurate diagnostic information can help patients and their families to plan for the future and come to terms with their condition (Jobst 1996; Smith et al. 1988). Since it is obviously impractical to exclude all possible causes of dementia in each case, the specific and differential diagnosis of dementia is a challenge to the astute clinician. If the memory disorders team is to be clinically effective and financially viable, good clinical judgement is the cornerstone upon which to determine which laboratory tests and special investigations should be requested (Larson et al. 1986; Terry et al. 1994).
Neuropsychological assessment
Authors: Bucks Romola S , Loewenstein David A
Published: October 2023

Neuropsychological assessment offers the clinician the means to measure an individual’s cognitive performance in a standardized way using normative data gathered for persons of that age, education, gender, and cultural/ language background. It therefore forms an important means of quantifying the NINCDS-AD RDA (McKhann et al., 1984) criteria for a diagnosis of probable Alzheimer’s disease, which require that there is impairment in memory functioning plus at least one other cognitive domain such as language, praxis, perceptual skills, problem-solving abilities, attention, or orientation, supported by the Folstein Mini-Mental State Evaluation (MMSE) (Folstein et al., 1975), Blessed Dementia Rating Scale (BDRS) (Blessed et al., 1968), or a similar evaluation. These difficulties must interfere with everyday functional capacity. A diagnosis of possible Alzheimer’s disease is rendered when a patient presents with only a single progressive cognitive deficit, an atypical presentation, or when there is a medical or neuropsychiatric condition that might account for observed deficits but is not considered to be the cause of the dementia.
Functional assessment
Authors: Carswell A , Spiegel R
Published: October 2023

The measurement of function is integral to the assessment and diagnosis of individuals with suspected dementia (Blessed et al. , 1968). With the gradual decline in cognitive abilities, there is an accompanying decline in role, social, and physical abilities. Nevertheless, traditional mental status screening tools such as the Mini-mental State Examination (MMSE) (Folstein et al., 1975) which focus on cognitive functions are not suited for monitoring the progression of the everyday manifestations related to cognitive impairment.
The assessment of dementia in the community setting
Authors: Mallery Laurie Herzig , Page Sean , Burns Alistair
Published: October 2023

Dementia is a medical syndrome with important psychosocial implications for the patient, family, and community at large. Assessment of dementia is commonly conducted in a clinic, where, in most cases, an accurate diagnosis can be made efficiently. However, the needs of the patient and/or caregiver cannot always be fully appreciated in a clinic setting. Behavioural disturbances, such as delusions and agitation, may worsen when patients leave the familiar home environment. As well, patients may not be willing to come to a clinic. In such cases, properly conducted community assessment can clarify unresolved issues and uncover specific needs. This chapter reviews the relative advantages and disadvantages of evaluating dementia in the home.
Assessment
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K
Published: October 2023

When a patient presents with an injury to the hand it is essential to take an adequate history and carry out a thorough examination if injuries and complications are not to be overlooked. It is possible to carry out a fairly comprehensive examination of the hand in a very short time if a well-practised systematic approach is employed. The principles of look, feel, move, X-ray apply. When the hand is injured, have a low threshold for ordering an X-ray.
Simple lacerations
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K
Published: October 2023

It is best to leave sutures in the hand longer than elsewhere in the body-thus it allows the patient to mobilize without concern about the wound opening.
Major lacerations and crush injuries
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K
Published: October 2023

These injuries can look dreadful, but primary management is straight forward. Ascertain exact nature of injury—what sort of blade, how long limb trapped, any heat involved etc.
High-pressure injection injuries
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K
Published: October 2023

Uncommon but important industrial injury frequently affecting the index fingertip of the non-dominant hand. High pressure injection of foreign material (e.g. wax, grease, paint, solvent, oil). The patient has frequently been cleaning the nozzle of a high-pressure gun when material is inadvertently injected.
Thermal burns
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K
Published: October 2023

In children always consider non-accidental injury. Small burn + NAI-refer to the paediatricians. Do not use Flamazine if the depth of the burn needs to be assessed at 48 hours to consider early surgery. If in doubt, use a paratulle dressing or a plastic bag.
Fingertip injuries
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K
Published: October 2023

This is the term used for injuries to the pulp. Nail bed injuries are different (see p. 49). Shortening the digit of a small child is bad practice.
Flexor tendons
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K
Published: October 2023

In some individuals the little finger has no functioning FDS tendon The FDP tendon of the index finger is independent of the other FDP tendons. When testing FDS to the index, confirm that the DIPJ is floppy (see Assessment, Chapter 4).
Extensors tendons 3 y —division of extensors over MPJs
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K
Published: October 2023

Danger of septic arthritis if a tooth wound is missed. Patients often deny this part of the history. Ask them specifically and tell them that its important.
26
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K
Published: October 2023

Extensor tendons are flat and therefore it is difficult to use a Kessler-type core stitch. Two 3/0 or 4/0 vicryl horizontal mattress sutures are adequate.
Phalangeal fractures
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K
Published: October 2023

Painful swollen digit with decreased movements. Check for rotation or angulation caused by the fracture (Fig. 34.l(a)). Look at the fingertips end on with the MPJs at 90° and the IPJs at 0°-this will show any rotation. Then ask the patient to flex the fingers-angulation will cause scissoring (Fig. 32.l(a) ).
Interphalangeal joint dislocation
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K
Published: October 2023

Dorsal dislocation of the PIPJ is most common. May have been reduced by the time the patient attends A&E.In describing fractures and dislocations, the direction of the angulation or displacement refers to the movement of the distal fragment.
Cellulitis
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K
Published: October 2023

Consider admission for IV antibiotics Streptococcal infection of the skin and subcutaneous tissues. Patient presents with a spreading area of redness and tenderness on the hand or forearm. There may or may not be a history of injury, a puncture wound, or a scratch. Possible malaise.
Septic arthritis
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K
Published: October 2023

An infected joint is usually stiff, and passive movement is not allowed by the patient. Delayed referral may lead to destruction of the articular cartilage.
Web space abscess
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K
Published: October 2023

Look for an abscess on both the dorsal and volar surfaces of the web (collar stud). Drain both via a dorsal approach as a volar scar may be tender. Don’t incise transversely across the web space as this will form a tight scar between fingers.
Preparation for patient transfer
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K
Published: October 2023

Many straightforward hand conditions are adequately dealt with in A&E. More serious problems require assessment by an experienced hand surgeon who may be an orthopaedic or plastic surgeon based in your hospital or in a specialized unit elsewhere.
The context
Authors: Rogers Wendy Stainton
Published: October 2023

Something strange happened in the USA in 1875. A little girl called Mary Ellen was presented to a court as an ‘animal’ in need of protection from the cruel treatment she was suffering from her guardians. You may wonder why she had to be identified as an ‘animal’ rather than a child. The answer is that, in the USA at that time, while there was legislation to protect animals (such as horses and dogs) from cruelty, there was none to protect children. The reason for that is that there was then—in Britain as well as in the USA—a strong belief that the family was a private sphere in which nobody had any right to intervene.
The presentation and diagnosis of child abuse
Authors: Wynne Jane
Published: October 2023

The primary care team has the opportunity to work with families towards prevention of all types of child abuse. However, as the causes of abuse, especially child sexual abuse (CSA), are not well understood, often the most professionals may do is to constantly be vigilant and have good networks of communication, both between team members and also with local organizations such as nurseries.
The aftermath
Authors: Mayer Vera
Published: October 2023

Having concluded a child protection investigation pursuant to Section 37 of the Children Act, or after obtaining an emergency protection order (see Chapter 6b), the local authority will have to decide whether they need to intervene in the life of a family by way of applying for a (further) statutory order. This is a drastic step, in as much as it takes any proceedings concerning children out of the realm of private law (which deals, in the main, with disputes between a child’s relations about residence and contact, and protection of a parent and a child from violence of another parent) and into the realm of public law-i.e. the state intervening in family life.
The meaning of domestic violence
Authors: Heath Iona
Published: October 2023

In 1990 a Home Office Circular to police forces, advising on their role in responding to violence in the home, declared: Violent assaults, or brutal or threatening behaviour over a period of time by a person to whom the victim is married or with whom the victim lives, are no less serious than a violent assault by a stranger. In September 1991, speaking 1 year after the issuing of the circular, John Patten, the then Home Office Minister, said: We wish to dispel for good any lingering notion that a man who attacks a woman in the home is somehow automatically less deserving of society’s censure than one who assaults a woman he doesn’t know in the street. I hope that approach has been consigned to the dustbin of social attitudes.
Onward referral
Authors: Heath Iona
Published: October 2023

While, as detailed in the preceding chapter, there is much that the general practitioner can and should do for a woman presenting with a history of having been subjected to domestic violence, there is little scope for direct intervention (Fig. 13.1). Perhaps this is appropriate, because the medical profession is notorious for taking action on behalf of patients, whereas the key to escaping from domestic violence is through promoting the autonomy and self-determination of women themselves. None the less, however limited the practitioner’s scope for providing direct help, members of the primary health care team are very well placed to provide information and to refer on to other agencies.
The context
Authors: Kingston Paul , Phillipson Chris
Published: October 2023

The extent and nature of abuse against older people has become a major topic of concern over the past decade. This development reflects issues relating to the care and treatment of vulnerable adults; and, as well, anxieties about the pressures facing formal as well as informal carers. To provide a context to the debate, this chapter has four main objectives: first, to present an overview of the background to research in the field of elder abuse and neglect; second, to examine some problems with definitions; third, to summarize findings on the nature of its incidence and prevalence, and fourth to explore areas for future research.
Complications of long-term dialysis: cardiovascular complications and cardiac risk-factor interventions
Authors: Foley Robert N , Parfirey Patrick S
Published: October 2023

Pericarditis frequently heralded the demise of patients with end-stage renal disease (ESRD), before the advent of renal replacement therapy (Schreiner and Maher, 1961). Cardiomyopathy, which was remarked on less frequently, was felt to reflect hypertension and underlying vascular disease; some authors speculated on the existence of a specific uremic cardiomyopathy, a concept that has since gained widespread acceptance (Schreiner and Maher, 1961). In the early days of chronic dialysis it became evident that perhaps 30—40% of all deaths were due to cardiac disease (Drukker et al., 1966; Brunner et al., 1972), a noteworthy burden of disease, considering that in this era patients selected for maintenance dialysis therapy were young and largely free of comorbid illness. In 1974 the Seattle group reported that 60% of deaths in their dialysis program were due to cardiovascular disease, and proposed that uremia led to accelerated atherosclerosis (Lindner et al., 1974). This latter contention remains to be proved or refuted with any degree of finality.
ß2-Microglobulin amyloidosis
Authors: fadoul Michel , van Charles , Strihou Ypersele de
Published: October 2023

ß2-Microglobulin amyloidosis (ß2mA) is a now well-characterized complication of long-term dialysis. Assenat et al. (1980) first reported the presence of amyloid deposits in carpal tunnel biopsies from hemodialysis (HD) patients.This ‘dialysis-related amyloidosis’ (DRA) was renamed ß2-microglobulin amyloidosis after Gejyo eta!. (1985) demonstrated that ß2m is the major component of DRA deposits. It subsequently became apparent that the prevalence of B2mA increased both with age at the onset of dialysis and with the duration of the treatment (van Yperseleetal., 1991)Our understanding of this crippling complication has improved markedly over the last 10 years. In this chapter, we review the clinical characteristics of ß2mA, the available diagnostic tools, the risk factors for the development of the disease, and briefly summarize current pathophysiological concepts.