bluuebunny/crossref_metadata_2025 huggingface dataset:
Occipital Neuralgia
Authors: Deroee Armin , Cheng Jianguo
Published: January 2019

Occipital neuralgia is a primary headache disorder characterized by intermittent, sharp stabbing occipital pain. Diagnosis is made by history, clinical examination, and positive response to anesthetic block of the greater occipital nerve. Occipital neuralgia should be differentiated from cervicogenic headache, migraines, and other causes of headaches as some of them may manifest with similar symptoms, including occipital pain and allodynia, and may also respond to occipital nerve block. Conservative treatment with physical therapy and low-dose antiepileptics or tricyclic antidepressants can be effective. Refractory cases may respond to occipital nerve block, Botox injection, pulse radiofrequency, or occipital nerve stimulation.
Basic Pathology of the Central Nervous System
Authors: Ciarlini Pedro de Sá Cavalcante , Seilhean Danielle , De Girolami Umberto , Gray Françoise
Published: January 2019

This chapter considers the three consecutive steps involved in the pathological diagnosis of lesions of the nervous system: a morphological/laboratory analysis of the basic cellular reactions to injury seen in the neurons, glia, connective tissue, and vascular structures as general tissue reactions of the central nervous system to injury; the importance of ascertaining a topographical distribution of the lesions; and the need for a critical integration of these findings and their correlation with the clinical data and the general autopsy findings, thus permitting an etiological diagnosis to be made in most instances. Macroscopic and microscopic descriptions and an illustration of these changes are provided.
Infections of the Central Nervous System
Authors: Chrétien Fabrice , Jouvion Gregory , Wong Kum Thong , Sharer Leroy R.
Published: January 2019

This chapter describes and illustrates the different lesions observed in central nervous system (CNS) infections. A wide variety of pathogenic infectious organisms may affect the CNS. They can be classified as pathogenic (causing diseases in every individual) or opportunistic (only affecting patients with impaired immune defenses). Bacteria may cause pyogenic infections or so-called specific infections in which the morphology of the lesions suggest a specific agent. Mycoses and parasitic infections were relatively uncommon and restricted to certain countries; however, due many factors in the modern world, including, for example, immunodeficiency of various causes and intercontinental travel, they are now more frequently encountered. Viral infections of the CNS cause lesions due to immunoallergic reactions or specific encephalitides. In AIDS, infection by HIV causes a unique encephalitis and immunodeficiency with a wide range of secondary opportunistic infections.
Human Prion Diseases
Authors: Ironside James W.
Published: January 2019

Human prion diseases include idiopathic, genetic, and acquired disorders. Heterogeneous clinicopathologic features make diagnosis challenging. Accurate diagnosis requires a combined clinical, neuropathologic, genetic, and biochemical approach. Neuropathologic assessment is performed following autopsy in most cases. The brain is sampled and studied by tinctorial stains and immunohistochemistry for disease-associated form of the prion protein. Unfixed frozen brain tissue is retained for Western blot analysis of protease-resistant prion protein isoform and for DNA extraction to sequence the prion protein gene. Assessment of spongiform change, gliosis neuronal loss, and accumulation of disease-associated prion protein in the brain can help to determine major categories of human prion disease. Additional clinical, genetic, and biochemical data allow diagnosis and subclassification into disease subtypes, particularly in sporadic Creutzfeldt–Jakob disease. Neuropathology continues to play a role in the recognition and understanding of the expanding spectrum of human prion disease and identification of disease variants that may emerge in the future.
Diseases of the Pituitary Gland
Authors: Nosé Vânia , Santagata Sandro , Laws Edward R.
Published: January 2019

Diseases of the pituitary gland are common, and the most frequently encountered lesions within the sella turcica and pituitary are described and illustrated in details in this chapter. The lesions present within this chapter include cysts and malformations, vascular lesions, inflammatory disorders, infectious diseases, systemic diseases, and both benign and malignant neoplasms. The most common neoplasms of the pituitary are the pituitary adenomas, and these are described in detail including the numerous subtypes depending on the cell differentiation and hormone production. The chapter contains numerous tables and figures illustrating the pathological findings.
Signs and Symptoms
Authors: Holtz Danielle
Published: January 2019

Patients present to the emergency department (ED) every day with a constellation of signs and symptoms. It is the emergency medicine physician’s job to recognize these signs and symptoms and make the correct diagnosis. Pattern recognition is essential in emergency medicine. This chapter presents questions that cover a wide variety of classic disease states and conditions that may be seen in the ED. Photographs, radiologic images, and electrocardiograms are provided for some of the questions to aid in diagnosis. Risk factors and associations, including the patient’s age and gender, are included and can offer clues to certain disease processes for which a patient may be at more risk.
Obstetrics and Gynecologic Emergencies
Authors: Bengiamin Deena , Lewis Miranda
Published: January 2019

Obstetrics and gynecologic emergencies cover a broad range of female conditions that may present to an emergency department (ED). Vaginal bleeding associated with abdominal pain in women is one of the top chief complaints that present to an ED. Emergency care providers need to be adept at recognizing obstetric emergencies like ectopic pregnancy, placenta previa, and placenta abruption. They also need to be prepared to care for the pregnant women who present with infections, trauma, and other disease processes. Sexually transmitted infections are prevalent, and diagnostic and treatment options from the ED are needed.
Toxicologic Emergencies
Authors: Darracq Michael A. , Holtz Danielle
Published: January 2019

Toxicologic emergencies are common presentations to the emergency department (ED), and knowledge of the appropriate management of these situations, including available antidotes, is critical to the practice of emergency medicine. Most toxicologic emergencies are due to intentional overdoses or use of recreational drugs, but they can also be due to work or environmental exposures or, more frightening, to acts of terrorism or war. These potential terrorism agents are usually asked about on standardized exams. This chapter presents questions related to the diagnosis, clinical effects, and most appropriate treatment of a wide range of these toxicologic emergencies.
Emergency Medical Services, Disaster Medicine, and Legal Issues
Authors: DeShields Scott , Woodmansee Susan
Published: January 2019

There are miscellaneous topics in emergency medicine (EM) that are important to clinical practice and to performance on standardized EM tests, including emergency medical services (EMS), disaster medicine, and legal issues. Most EM physicians work closely with EMS and need to understand the basics of medical control and care in the prehospital setting. Although disasters are, fortunately, rare events, EM physicians need to know the basics of how to respond in such situations because they will often be at the forefront of care. Legal aspects of the practice of medicine are rarely taught in medical school or residency. Unfortunately, many physicians are forced to take a hands-on crash course the first time that they are confronted with a lawsuit, administrative investigation, or other legal inquiry. The legally oriented questions in the chapter will help the learner to become acquainted with some of the basics within the legal realm of medical practice, including the Health Insurance Portability and Accountability Act (HIPAA), informed consent, the Emergency Medical Treatment and Labor Act (EMTALA), malpractice liability, and mandatory reporting.
Therapeutics
Authors: Mackowiak Philip A.
Published: January 2019

Chapter 3 (“Therapeutics”) contains a series of works that reflect the long history of medical treatments, beginning with therapeutic rituals and progressing to modern intensive care. Whereas there is a current tendency to think of drug therapy as a recent innovation, written records of the use of salicylates, cannabis, mandrake, and opioids in ancient Egypt, Greece, and China attest to the fact that some of the earliest physicians gave patients drugs that were both effective and surprisingly modern. For over 1500 years, however, these were less important than interventions directed at correcting humoral disproportions. Some of this chapter’s most engaging works depict the bleeding, purging, cupping, and burning that were performed in an effort to achieve a proper balance between the various corporal humors. Also depicted in stunning works are the roles played by nurses, hospitals, and quacks in the evolution of medical practice.
Surgery
Authors: Mackowiak Philip A.
Published: January 2019

Although surgery’s history is nearly as old as the human species, the practice as we know it today did not exist before the 19th century C.E. Chapter 4 (“Surgery”) transports the reader through art across 40,000 years of surgical history, stretching from trephination performed during the Cro-Magnon era to the miraculous transplant surgeries of today. Concepts covered by the artworks include barber-surgeons, “laudable pus,” carbolic acid-decontamination of operative fields, the ancient origin of general anesthesia, antiseptic surgical practice, the control of puerperal fever, Caesarian section, and surgical subspecialists in the ancient world. These are accompanied by portraits of some of the greatest figures in the pre-modern history of surgery, including Joseph Lister, William T. Morton, Samuel T. Gross, and Ignaz Semmelweis.
Mental Health
Authors: Mackowiak Philip A.
Published: January 2019

Chapter 6 (“Mental Health”) contains works that speak to psychiatry’s long struggle to attain the professional status of the other branches of the healing arts. These works tell the story of a discipline that has struggled to understand and manage diseases of the mind, based on concepts ranging from the work of malicious spirits to humoral dyscrasias, demonic possession, lunar influences and “rocks in the head.” Past treatments, no less than those of the present, have, of necessity, focused on alleviating symptoms rather than preventing or curing the underlying disorders. As the works featured in this chapter demonstrate, much progress has been made in the area of mental health over the course of many centuries, although substantially less than that achieved by the other branches of the healing arts.
Military Medicine
Authors: Mackowiak Philip A.
Published: January 2019

Chapter 7 (“Military Medicine”) illustrates war’s long history of functioning as a pragmatic training ground for physicians, especially surgeons, was well as a giant field trial for developing, testing, and refining medical advances. The images included in this chapter transport the reader from the first aid stations of imperial Rome to the ligatures of Ambrose Paré, the “flying ambulances” Dominique Jean Larrey introduced during the Napoleonic Wars, Florence Nightingale’s implementation of the principles of proper sanitation in her hospital at Scutari during the Crimean War, the advent of reconstructive surgery in Germany just prior to the outbreak of World War I, the evolving concept of the post-traumatic stress disorder, and the war crimes committed by German and Japanese physicians during World War II.
Acute Coronary Syndrome
Authors: Kenaan Mohamad , Eagle Kim
Published: January 2019

This chapter guides the reader on the diagnosis and management of acute coronary syndrome in hospitalized patients.
Approach to the Chest Radiograph
Authors: Mendez Michael P.
Published: January 2019

This chapter guides the reader on the approach to interpreting chest radiographs for inpatient care.
Interstitial Lung Disease
Authors: Mendez Michael P.
Published: January 2019

This chapter guides the reader on the diagnosis and management of interstitial lung disease in hospitalized patients.
Pulmonary Embolism
Authors: Mendez Michael P.
Published: January 2019

This chapter guides the reader on the diagnosis and management of pulmonary embolism in hospitalized patients.
Mechanical Ventilation
Authors: Mendez Michael P.
Published: January 2019

This chapter guides the reader on the approaches to using mechanical ventilation for inpatient care.
Abdominal Pain
Authors: Saini Sameer D. , Waljee Akbar K.
Published: January 2019

This chapter guides the reader on the general principles, clinical manifestations, and management of abdominal pain in hospitalized patients.
Liver Tests
Authors: Saini Sameer D. , Waljee Akbar K.
Published: January 2019

This chapter guides the reader on the approaches to using and interpreting liver tests for inpatient care.
Acute Gastrointestinal Bleeding
Authors: Saini Sameer D. , Waljee Akbar K.
Published: January 2019

This chapter guides the reader on the general principles, clinical manifestations, and management of acute gastrointestinal bleeding in hospitalized patients.
Acute Pancreatitis
Authors: Saini Sameer D. , Waljee Akbar K.
Published: January 2019

This chapter guides the reader on the diagnosis and management of acute pancreatitis in hospitalized patients.
Alcoholic Liver Disease
Authors: Saini Sameer D. , Waljee Akbar K.
Published: January 2019

This chapter guides the reader on the diagnosis and management of alcoholic liver disease in hospitalized patients.
Renal Tubular Defects
Authors: McGuire Matthew , Pennathur Subramaniam
Published: January 2019

This chapter guides the reader on the diagnosis and management of renal tubular defects in hospitalized patients.
Skin and Soft Tissue Infections
Authors: Shuman Emily
Published: January 2019

This chapter guides the reader on the general principles, clinical manifestations, and management of skin and soft tissue infections in hospitalized patients.
Gastrointestinal Manifestations of HIV Disease
Authors: Shuman Emily
Published: January 2019

This chapter guides the reader on the general principles and management of gastrointestinal manifestations in HIV disease.
Thrombocytosis
Authors: Devata Sumana
Published: January 2019

This chapter guides the reader on the diagnosis and management of thrombocytosis in hospitalized patients.
Polycythemia
Authors: Devata Sumana
Published: January 2019

This chapter guides the reader on the diagnosis and management of polycythemia in hospitalized patients.
Leukocytosis
Authors: Devata Sumana
Published: January 2019

This chapter guides the reader on the diagnosis and management of leukocytosis in hospitalized patients.
Myeloproliferative Neoplasms and Myelodysplastic Syndrome
Authors: Bixby Dale
Published: January 2019

This chapter guides the reader on the diagnosis and management of myeloproliferative neoplasms and myelodysplastic syndromes in hospitalized patients.
Metastatic Neoplasms
Authors: Bixby Dale
Published: January 2019

This chapter guides the reader on the general principles, clinical manifestations, and management of metastatic neoplasms in hospitalized patients.
Arthritis
Authors: Marks Rory M.
Published: January 2019

This chapter guides the reader on the general principles, clinical manifestations, and evaluation of arthritis in hospitalized patients.
Hypocalcemia
Authors: Choksi Palak , Lash Robert W.
Published: January 2019

This chapter guides the reader on the diagnosis and management of hypocalcemia in hospitalized patients.
Thyroid Disease
Authors: Choksi Palak , Lash Robert W.
Published: January 2019

This chapter guides the reader on the general principles, clinical manifestations, and management of thyroid disease in hospitalized patients.
Vertigo
Authors: Burke James
Published: January 2019

This chapter guides the reader on the general principles, clinical manifestations, and management of vertigo in hospitalized patients.
Alcohol Intoxication and Withdrawal
Authors: Shewakramani Sanjay
Published: January 2019

This chapter guides the reader on the approaches and considerations in managing alcohol intoxication and withdrawal in hospitalized patients.
Preoperative Cardiovascular Risk Assessment for Noncardiac Surgery
Authors: Grant Paul J.
Published: January 2019

This chapter guides the reader on the approaches and considerations in managing preoperative cardiovascular risk assessment for noncardiac surgery in hospitalized patients.
Immune Mechanisms Affecting the Functioning of the Central Nervous System (CNS)
Authors: Bauer Moises E. , Rocha Natália P. , Savino Wilson , Teixeira Antonio L.
Published: January 2019

This chapter presents an overview of the immune mechanisms affecting the functioning of the central nervous system (CNS). The cross-talk between the immune system and the CNS is established by three independent pathways: the humoral, neural, and cellular (leukocyte) routes. Of note, increased circulating pro-inflammatory cytokines and concomitant activation of brain-resident microglia can lead to impaired cognition and depressive behavioral symptoms. The activated microglia phenotype has been associated with neuroinflammation reported in neurodegenerative and psychiatric disorders. This chapter also reviews novel physiological roles for adaptive immunity (especially T cells) during health and disease. T cells support hippocampal neurogenesis, cognition, mood, resilience to stress, and are protective against the development of psychiatric disorders.
The Immune System as a Sensor Able to Affect Other Homeostatic Systems
Authors: del Rey Adriana , Besedovsky Hugo
Published: January 2019

This chapter deals with the capacity of the immune system to sense the intrusion of external challenges and modifications of self-components, and to provide information to the brain about these disturbances. These properties allow us to classify the immune system as a classical sensory organ. Besides its intrinsic function directed at the elimination of dangerous stimuli, the activation of the immune system also affects the functioning of other homeostatic systems, such as the endocrine and the nervous systems. We also discuss our view of how immune-derived information could be processed by the brain and integrated with other inputs that it permanently receives, leading to a resetting of regulatory adaptive systems. Due to the high energetic cost of immunity, we discuss how brain-borne cytokines, in particular IL-1, could affect glucose homeostasis. Deregulation of these immune-neuroendocrine interactions can affect brain mechanisms that include behavior, cognition, mood, and personality.
Microbiota-Gut-Brain Axis and Neuropsychiatric Disorders
Authors: Lach Gilliard , Dinan Timothy G. , Cryan John F.
Published: January 2019

It is well known that the influence of the gut microbiota extends beyond their intestinal limits. A growing body of preclinical and clinical evidence suggests that the changes in the composition of the gut microbiota may regulate brain function and behavior through different gut-to-brain pathways, including immune modulation. Interestingly, studies have suggested that few commensal intestinal bacteria play a significant role in in the physiology of neuropsychiatric disorders. Here, we summarize recent discoveries on the potential role of the microbiota-gut-brain communication in the origins and development of anxiety, depression, neurodegenerative disorders, and autism-spectrum diseases. The investigation of the microbiota from the point of host–microbiota interaction can lead to the design of therapeutic interventions targeting gut microbial composition with clinical relevance for neuropsychiatric conditions.
Investigating Immune Changes in the Psychiatric Patients
Authors: Teixeira Antonio L. , Bauer Isabelle , Camkurt Akif , Selvaraj Sudhakar
Published: January 2019

Among potential biomarkers in psychiatry, immune markers have been regarded as very promising due to the role played by the immune system in the physiopathology of psychiatric disorders and the relatively easy access to them. The most studied immune markers are C-reactive protein (CRP), the cytokines TNF-α‎, interleukin 1 beta (IL-1β‎), IL-6, IL-8, IL-10, and the neutrophil:lymphocyte ratio. These markers lack specificity; therefore, they are not useful as diagnostic markers. Overlapping inflammatory markers across psychiatric disorders point to a likely common and/or shared immune dysfunction. Regarding diagnosis, anti-NMDA antibodies seem to be promising, being able to identify a group of patients experiencing an acute neuropsychiatric syndrome marked by psychosis and motor signs. Beyond psychiatric diagnoses, immune markers have been evaluated as risk, subgroup, and treatment-response markers.
Depression as a Neuroinflammatory Condition
Authors: Borsini Alessandra , Zunszain Patricia A.
Published: January 2019

Depressive disorder is a multifactorial and complex disease, the etiology of which is not well understood. However, the role of dysregulation of the immune system in the pathogenesis of the disease has been established. Emerging research suggests the regulation of neurogenesis as a biological mechanism involved in the relationship between immune activation and depression. Neurogenesis is a complex process through which new neurons are generated from neural stem cells in distinct areas in the brain, including the hippocampus, a region well known for its role in synaptic plasticity and memory formation. Inflammatory molecules, known as cytokines, are recognized to modulate distinct neurogenic pathways, which might be one of the mechanisms activated by the immune system and potentially involved in the development of psychiatric disorders such as depression.
Immunology of Late-Life Psychiatric Disorders and Dementias
Authors: Rocha Natalia P. , Vieira Erica Leandro , Diniz Breno Satler , Teixeira Antonio L.
Published: January 2019

Aging is a complex process associated with significant physiological functions across all body systems, especially the immune system. The age-related changes in the immune system are collectively known as immunosenescence. As a consequence of immunosenescence, advanced age is characterized by a decrease in the ability to cope with stressors. The multifaceted immunosenescence profile includes a constitutive low-grade inflammation, a phenomenon known as inflammaging. This low-grade chronic inflammation observed in aging may contribute to the development and/or progression of age-related chronic diseases, including neuropsychiatric disorders. Herein, we discuss the age-related immune/inflammatory changes observed in late-life psychiatric disorders.
CABG conduits and graft configuration
Authors: Glineur David
Published: January 2019

Coronary artery bypass surgery remains the gold standard in the treatment of multivessel coronary artery disease. Success of coronary artery bypass graft (CABG) is dependent on the patency of the conduits used. Many conduits have been used in the practice of surgical revascularization with inherent advantages and limitation. Since the late 1960s, CABG using saphenous vein conduits has been championed as the solution to coronary artery disease. However, it was soon evident that CABG provides only palliation to an ongoing process that is further complicated by the rapid development of vein graft atherosclerosis. The various conduits used are discussed in detail in the following account including the anatomy, pathophysiology, and long-term outcomes, in addition to technical aspects of graft configuration.
Surgical therapy for heart failure
Authors: Westaby Stephen
Published: January 2019

Congestive heart failure affects 23 million people worldwide, and is the final pathway for many diseases that affect the myocardium. Successful intervention in acute coronary syndromes together with improved management of idiopathic dilated cardiomyopathy and dysrhythmia provide an ever-increasing number of advanced heart failure patients spread over a wide age range. In Western countries, coronary artery disease is responsible for about 70% of patients with idiopathic dilated cardiomyopathy and valvular heart disease accounting for 15%. Since 10% of patients older than 65 years suffer systolic left ventricular dysfunction, the numbers with heart failure will double within the next 25 years. For end-stage patients, cardiac transplantation provides the benchmark for increased longevity and symptomatic relief. However, the vast majority of patients are over 65 years of age or are referred with established comorbidity, which precludes transplantation.
Surgery for atrial fibrillation
Authors: Robertson Jason O. , Saint Lindsey L. , Damiano Ralph J.
Published: January 2019

Atrial fibrillation (AF) is the most common of all cardiac arrhythmias and accounts for nearly one-third of all hospital admissions due to heart rhythm irregularities. AF affects nearly 4.5 million people in the European Union and 2.2 million people in the United States. Its prevalence increases with age, afflicting 4% of the population over 60 years old and nearly 9% of persons 80 years and older. The most serious complication of AF is thromboembolism and resultant stroke; however, significant morbidity and mortality also result from hemodynamic compromise due to loss of atrial contraction, exacerbations of congestive heart failure from atrioventricular asynchrony, and tachycardia-induced cardiomyopathy. As a result, atrial fibrillation has an enormous socioeconomic impact. Available medical treatments for atrial fibrillation have many shortcomings, and the rationale, methods, and results of surgical techniques for the treatment of atrial fibrillation are addressed in this chapter.
Intracranial Pressure
Authors: Stefanits Harald , Reinprecht Andrea , Klein Klaus Ulrich
Published: January 2019

Intracranial pressure (ICP) is determined by the volume of the contents of the intracranial vault and the stiff hull of the bony calvarium. The three compartments, including brain parenchyma, cerebrospinal fluid, and blood, may compensate for volume demands of the other compartments until a certain threshold is reached. Increasing ICP is reflected by headache, nausea, and vomiting as well as impairment of consciousness, and may lead to brain herniation. ICP can be measured by means of intraparenchymal and intraventricular probes, the latter of which also allow external drainage of cerebrospinal fluid. Conservative measures to decrease ICP include elevation of the head, optimization of venous drainage, hyperventilation, osmodiuretics, and deep sedation. Surgical interventions, including decompressive craniectomy, are an ultima ratio to prevent cerebral injury and brainstem damage.
Neurophysiologic Monitoring for Neurosurgery
Authors: Koht Antoun , Hemmer Laura B. , Toleikis J. Richard , Sloan Tod B.
Published: January 2019

Intra-operative neurophysiological monitoring (IOM) has evolved substantially since its beginnings in the 1970s with somatosensory evoked potentials (SSEP) and facial nerve electromyography (EMG). The introduction of new techniques (especially motor evoked potentials [MEP]) and refinements of older techniques have become important tools that the surgeon can use to enhance intra-operative decision making and improve patient outcome of surgical (e.g., intracranial, neurovascular, skull base and brainstem, spine and spinal cord, peripheral nerve) procedures. These monitoring modalities are used to map the anatomic location of neural structures and monitor the functional status of the neural tracts. The anaesthetist plays a key supportive role in monitoring and management when IOM indicates potential neural compromise.
Brain Trauma
Authors: Sebastiani Anne , Engelhard Kristin
Published: January 2019

This chapter focuses on brain trauma, which leads to a disruption of normal neurologic function. Before arrival in the hospital, a guideline-based treatment of traumatic brain injury (TBI) patients has to be initiated on-site. The patient then has to be transported to a specialized hospital equipped with a head computed tomography (CT), a neurosurgical department, and a neurointensive care unit. The chapter describes this process as well as the primary goals of maintaining an adequate perfusion and oxygenation of brain tissue. To achieve these goals, the intracranial pressure (ICP) and physiological variables should be kept within the normal range (homeostasis). This chapter also discusses complications like sepsis, pneumonia, and severe disturbances of coagulation, which should be prevented because they are independent predictors of adverse outcome.
Pituitary and Neuroendocrine Surgery
Authors: Colquhoun Douglas A. , Nemergut Edward C.
Published: January 2019

Surgeries on the pituitary and neuroendocrine system are commonly encountered in neuroanaesthesia practice. Pituitary tumours are the third most common brain tumour, comprising about 10–15% of all primary brain tumours. Patients with pituitary tumours pose unique challenges to the anaesthestist caring for them in the peri-operative period, and they require the care of a multi-disciplinary team to accurately diagnose and manage their disease process as they undergo surgical resection. This chapter on pituitary and neuroendocrine surgery includes sections on anatomy and physiology, systemic changes associated with pituitary tumours, pre-operative evaluation (including intra-operative management), and common complications (for example, diabetes insipidus).
Hydrocephalus and Associated Surgery
Authors: Hurtado Paola , Fàbregas Neus
Published: January 2019

Hydrocephalus is a pathology that usually requires surgical treatment independently of aetiology, associated diseases, or age. Effects of hydrocephalus range from almost imperceptible to life-threatening. It can develop at any point in the lifespan and, in some cases, can be difficult to diagnose and treat. Technical innovations have improved hydrocephalus diagnosis, with magnetic resonance imaging surpassing the static picture to show flow patterns and even molecular events. Powerful software algorithms can show the evolution of patient intracranial pressure. Therapeutically, minimally invasive neurosurgery and neuroendoscopic devices have allowed endoscopic third ventriculostomy to become a curative procedure in many patients. New shunt valves and surgical approaches to the peritoneum are improving ventriculoperitoneal shunt surgery efficacy and reducing frequent postoperative complications. This chapters focuses on hydrocephalus and associated surgery, which requires a multidisciplinary team approach with members from physics, mathematics, biology, physiology, radiology, neurology, neurosurgery, and anaesthesia.
Spine Trauma
Authors: Urakov Timur M. , Wang Michael Y.
Published: January 2019

The estimated global incidence of spinal cord injury (SCI) is 250,000 to 500,000 people a year. North America tends to have higher rates of incidence of SCI than Europe. Statistically, young adults and the elderly are more likely to be injured. Motor vehicle accidents are the leading cause of SCI in the world, followed by falls, violence, sports, recreational activities, and iatrogenic sources. This chapter on spine trauma includes elements of anatomy and anaesthesia care for acute cervical spine cord injury (including airway management, blood pressure management, fluid management, hypothermia, monitoring, and steroids). It also covers anaesthesia care for chronic spinal cord injury (including autonomic dysreflexia, physiological changes in chronic SCI patients, and obstetrics).
Paediatric Neuroanaesthesia
Authors: Soriano Sulpicio G. , McClain Craig D.
Published: January 2019

The anaesthetic management of infants and children undergoing neurosurgical procedures should be based on the developmental stage of the patient. For the safe conduct of anaesthesia, the evolving maturational changes of the various organ systems must be considered when choosing drugs and techniques in the peri-operative period. This chapter on paediatric neuroanaesthesia discusses the developmental aspects of the central nervous system (CNS), pre-operative assessment and planning, intra-operative management (including induction of anaesthesia, vascular access and positioning, maintenance of anaesthesia, and management of fluids and blood loss), anaesthetic management of specific neurosurgical procedures (e.g., congenital disorders, neoplasms, epilepsy, cerebrovascular disease, neuroendoscopy), and postoperative course.
Peri-Operative Considerations of Dementia, Delirium, and Cognitive Decline
Authors: Vlisides Phillip E. , Xie Zhongcong
Published: January 2019

As the elderly population increases, so will the number of surgical patients with dementia and other cognitive disorders. Laboratory evidence suggests that some commonly used anaesthetic agents may accelerate the Alzheimer’s disease (AD) process, but robust clinical research is still needed. This chapter discusses the need for peri-operative guidelines for patients with dementia, and the many opportunities for further research to inform such guidelines. It also covers postoperative delirium and its association with longer hospital and intensive care unit stays, cognitive decline after surgery, and higher mortality. Finally, it covers postoperative cognitive dysfunction (POCD), how standardized definitions and study methodology are lacking, and that studying cognitive trajectory after anaesthesia and surgery is often confounded by various clinical elements that cannot be accounted for methodologically.
Treatment of Psychiatric Diseases with General Anaesthetics
Authors: Vutskits Laszlo
Published: January 2019

Psychiatric disorders are defined as mental or behavioural patterns causing either suffering or a poor ability to function in ordinary life. These conditions are generally characterized by a combination of abnormal thoughts, perceptions, emotions, behaviour, and relationships with others. The burden of mental disorders continues to grow and the estimated global lifetime prevalence of these pathological states is estimated to reach over one-third of the population worldwide. Depression, one of the most common psychiatric diseases, is difficult to treat. This chapter on the treatment of psychiatric diseases with general anaesthetics includes discussion of major depressive disorder and its epidemiology and treatments, clinical trials suggesting a therapeutic role for anaesthesia in patients with depressive disorders, rapid antidepressant effects of ketamine, and mechanisms of actions underlying the antidepressant effects of anaesthetics.
Signs and symptoms of psychiatric disorders
Authors: Harrison Paul , Cowen Philip , Burns Tom , Fazel Mina
Published: January 2019

‘Symptoms and signs of psychiatric disorders’ introduces psychiatry from the perspective of the clinical features that characterize and define its disorders, providing an essential first step in an understanding of the subject. The chapter starts with an introduction to psychopathology and an outline of the conceptual and practical issues involved. It then describes the cardinal symptoms of mental disorders, grouped according to the main headings used in a mental state examination. The chapter includes definitions of important and sometimes misunderstood terms, such as paranoia and delusions. The chapter is written from a practical perspective and assumes no prior knowledge of the subject.
Reactions to stressful experiences
Authors: Harrison Paul , Cowen Philip , Burns Tom , Fazel Mina
Published: January 2019

‘Reactions to stressful experiences’ covers emotional and physiological elements of the response to stress and the way in which maladaptive coping patterns and inappropriate defence mechanisms can lead to clinical disorders. Stress reactions are often short-lived and respond to support from friends and family. However, particularly severe stresses can lead to the condition of post-traumatic stress disorder (PTSD), an important source of morbidity and disability, whose clinical features, psychology, neurobiology, and treatment are described in detail. The chapter also covers adjustment to threatening and traumatic life events, such as childhood abuse, sexual assault in women, the refugee experience, serious physical illness, and bereavement. These events can produce various kinds of adverse psychological consequences over the lifespan, and the chapter shows how these psychiatric sequelae can be recognized, theoretically understood, and best managed according to current evidence-based practice.
Anxiety and obsessive–compulsive disorders
Authors: Harrison Paul , Cowen Philip , Burns Tom , Fazel Mina
Published: January 2019

‘Anxiety and obsessive–compulsive disorders’ covers the range of anxiety disorders encountered in adult general psychiatry, including generalized anxiety disorder, the phobic disorders, panic disorder, and agoraphobia. The chapter contains descriptions of the relevant clinical phenomenology, epidemiology, diagnosis, and classification, as well as aetiological formulations based on experimental psychological and neurobiological concepts. The chapter also provides an account of available treatment modalities, ranging from psychological treatments such as cognitive behaviour therapy to psychopharmacological approaches. Management strategies for the various disorders, based on current evidence-based guidelines, are outlined. A similar approach is followed for the description of obsessive–compulsive disorder as well as the related conditions of hoarding disorder and trichotillomania.
Bipolar disorder
Authors: Harrison Paul , Cowen Philip , Burns Tom , Fazel Mina
Published: January 2019

‘Bipolar disorder’ provides an account of the clinical and scientific aspects of bipolar disorder (‘manic depressive illness’). Identification of varying degrees of mood elevation is critical to the diagnosis of bipolar disorder to allow its distinction from unipolar depression, and the phenomenology and classification of manic states is described in detail. The range of aetiological factors involved in the development of bipolar illness is covered, from genetics and brain structure to psychology and life events. The efficacy of treatments both psychological and pharmacological in bipolar disorder is assessed, including new approaches with psychoeducation, atypical antipsychotic drugs, and anticonvulsant mood stabilizers. An additional section covers the clinically challenging treatment of bipolar depression. The evidence from clinical trials is then placed in the context of good clinical management of both the acute phases of bipolar illness as well as longer-term maintenance treatment.
Paranoid symptoms and syndromes
Authors: Harrison Paul , Cowen Philip , Burns Tom , Fazel Mina
Published: January 2019

‘Paranoid symptoms and syndromes’ focuses on the recognition and significance of paranoid symptoms, and on paranoid syndromes (delusional disorders). The latter are related to, but usually considered to be distinct from, schizophrenia. The area has a complicated conceptual and terminological history, and this is outlined before explaining how paranoid symptoms and syndromes are currently defined and classified. Specific paranoid syndromes, such as morbid jealousy, erotomania (de Clérambaut’s syndrome), and several other eponymous syndromes, are then described. Finally, the principles of assessment and treatment of delusional disorders are outlined
Personality and personality disorder
Authors: Harrison Paul , Cowen Philip , Burns Tom , Fazel Mina
Published: January 2019

‘Personality and personality disorders’ covers how personality influences and is influenced by psychiatric disorders, and also the disorders of personality. Personality refers to the wide range of ensuring qualities and behaviours that characterize an individual and that we generally use to recognize them. This chapter covers the varied theories of personality, both of personality types and personality development. It covers the classification of abnormal personalities and the range of personality disorders, along with their diagnostic criteria and how this classification is currently being subject to potentially radical reorganization. While the diagnosis of personality disorders remains controversial it is an essential tool in clinical psychiatry. Its course, impact, and treatment and management strategies are outlined, with particular attention paid to the impact of personality disorders on the outcome of other psychiatric and medical conditions and the ethical problems such disorders present.
Intellectual disability (mental retardation)
Authors: Harrison Paul , Cowen Philip , Burns Tom , Fazel Mina
Published: January 2019

‘Intellectual disabilities’ covers the life course, with a focus on the assessment and treatment of the intellectual disabilities at younger ages. This chapter outlines current understanding of the aetiology of the more common intellectual disabilities. The clinical features are discussed for severe/profound, moderate, and mild intellectual disability, and the more common psychiatric presentations for those with intellectual disabilities. Mood disorders, anxiety disorders, and dementia are discussed in greater detail, as are the more common presentations of intellectual disability, with sections on Down’s syndrome and fragile X. The importance of prevention of mental health problems and better understanding and management of more challenging behaviours are discussed alongside other treatments for psychiatric disorders.
Introduction
Authors: Khan Umraz , Perks Graeme , Morgan-Jones Rhidian , James Peter , Esler Colin , Smyth Vince , Gant Vanya
Published: January 2019

This chapter introduces the book and discusses the definition of periprosthetic joint infection, classification of surgical site infections, incidence of prosthetic joint infection (PJI) in total knee replacement, quantifying PJI, and the burden of PJI. The aims are to unify our understsanding of this condition, to bring into sharp focus the need for vigilance, and to raise the profile of this condition amongst allied specialties. Whilst remaining reatively low, the incidence of PJI is not zero. Prevention is far better for the patient, surgeon, and the National Health Service and must remain the goal of the operating surgeon.
Preoperative assessment
Authors: Khan Umraz , Perks Graeme , Morgan-Jones Rhidian , James Peter , Esler Colin , Smyth Vince , Gant Vanya
Published: January 2019

This chapter discusses preoperative assessment and includes discussion on assessing risk factors for prosthetic joint replacement, vascular issues for major joint replacement, what risk assessment for vascular complications should include, acute limb ischaemia, vascular injury, general cardiovascular considerations, pressure area ulceration, and amputation and rehabilitation. The importance of this aspect of patient care cannot be overstated. Pre-incision improvement in patient physiology to improve the chances of primary wound healing will reduce the chances of prosthetic joint infection.
Introduction to humanitarian medicine
Authors: Kravitz Amy S. , Fink Sheri
Published: January 2019

This chapter introduces the concept of humanitarian medicine and the specifics which differentiate this from other disciplines. It highlights the impetus for the development of the Oxford Handbook of Humanitarian Medicine including recognition of the complexity of the sector, the changing contexts of humanitarian emergencies, and the challenges of promoting best practices. It also covers the historical origins and foundations of humanitarian principles, and outlines the key developments in humanitarian responses, including coordination, standardization, evidence-based approaches, and security.
Responses and responders
Authors: Robitalle Patrick , Tiller Sandrine
Published: January 2019

This chapter examines the organizations and coordination structures involved in international responses to natural disasters and complex emergencies. It outlines the typology of humanitarian action, and how the origin of the crisis, the type of emergency, and the phase of the operating context all inform the types and speed of the response and the roles assumed. It also covers aid architecture and coordination, including the many types of organization within the humanitarian aid system, and the United Nations-led humanitarian coordination mechanism implemented at a local, regional, and national level.
International law for healthcare workers
Authors: Bouchet-Saulnier Françoise
Published: January 2019

This chapter provides the reader with the essential elements which form international humanitarian law and an understanding of the rights, obligations, and protections bestowed to humanitarians under these frameworks. It covers the historical evolution from war law to humanitarian law, including the Geneva Conventions and the main provisions in customary international humanitarian law which are universally recognized in all types of armed conflicts and provide the legal grounds for humanitarian action and protections of vulnerable people. This chapter outlines how these laws apply to humanitarian settings, and provides legal guidance and clarification for many of the most urgent legal and ethical issues which humanitarians face, such as protection of medical facilities and war crimes, and includes practical medicolegal advice for situations including torture and survivors of violence.
Security
Authors: Sheehan Norman , Houston Chris
Published: January 2019

This chapter provides general precautions and guidance based on sound practices, including procedures and protection measures, which serve to keep humanitarian workers and operations safe. With serious incidents on the rise in humanitarian operations and with humanitarian workers increasingly viewed as political targets, this chapter providers an overview of security theory and applications, including essential operative elements such as field communications, operational guidelines, and evacuation procedures. It also includes practical guidance on scenarios such as road safety, kidnaping and hostage taking, sexual harassment and assault, landmines, unexploded ordnances, political instability, and evacuation procedures.
Medical logistics in humanitarian settings
Authors: Chomilier Bernard , Chomilier Christine
Published: January 2019

This chapter discusses the importance of the supply chain for a well-functioning humanitarian operation and outlines the essential elements necessary to ensure that supply meets the demand for a programme, including the logistical principles and the role that field providers have in collaborative planning. The nature of the humanitarian work makes the supply chain often more complex than a commercial supply chain, and this chapter provides the necessary information for field providers regarding the classification of supplies, procurement, transport, importation, storage, distribution, and inventory of drugs and supplies, including those requiring the cold chain, to ensure collaboration with logisticians and continual availability of essential supplies.
Working for international organizations
Authors: Volway Rod
Published: January 2019

This chapter provides the reader with guidance on how to prepare for a mission and to help align expectations prior to heading out to the field, including information on important cultural and professional aspects to consider, guidance for working in teams, and coping with stress. It offers information on practical considerations, such as finances and preparations for departure, as well as professional aspects, including expectations for working and living as a team, and working through a translator. It also provides guidance on administrative roles which one might assume, including human resources, media and public relations, and budget management, as well as practical recommendations for personal well-being.