bluuebunny/crossref_metadata_2025 huggingface dataset:
Central Sleep Apnea
Authors: Lim Diane C , Schwab Richard J
Published: January 2021

As part 3 of the three chapters on sleep-disordered breathing, this chapter reviews central sleep apnea (CSA). CSA is defined as recurrent apneic events during sleep in the absence of respiratory muscle effort and loss of neuronal output to respiratory muscles. The most common cause of CSA is compromised cardiac function. In patients with CSA whose ejection fraction is less than or equal to 45%, adaptive servo-ventilation (ASV) has been shown to increase mortality. With the abuse of opioids reaching epidemic proportions, it has been estimated that 30 to 75% of patients on chronic opioid therapy have a significant increased incidence of CSA. Opioid-induced sleep-disordered breathing can be treated with ASV.
This review contains 1 figure, and 37 references.
Key Words: adaptive servo-ventilation, central sleep apnea, Cheyne-Stokes respiration, congenital central hypoventilation syndrome, impaired central ventilatory drive, opioid abuse, PHOX2B gene, supplemental oxygen
Liver Transplant Immunology 1: Fundamentals of Liver Immunology and Allorecognition
Authors: Kriss Michael , Rosen Hugo
Published: January 2021

The liver is a multifunctional organ responsible for complex metabolic and immune functions. Although not a classic lymphoid organ, the liver is enriched with traditional immune cells as well as parenchymal and nonparenchymal cells that play a key role in immune homeostasis. Due to its location and unique anatomic structure, the liver must finely balance immunity and tolerance to avoid undue inflammation in the setting of constant antigenic exposure from portal blood flow while maintaining appropriate immunity against pathogens. Since the first successful liver transplantation in humans in 1967 at the University of Colorado, our knowledge of hepatic immunity and tolerance, in the context of both liver disease and liver transplantation, has evolved dramatically. With these advancements, therapeutic modalities have been developed that have revolutionized the care of liver transplant recipients. In Part 1: Fundamentals of Liver Immunology and Allorecognition, we review current knowledge of hepatic immunity, including anatomic features and cellular components that give the liver its unique properties. In addition, we describe critical concepts of innate and adaptive immune function to provide a context for understanding allograft injury and rejection.

This review contains 4 figures, 4 tables and 26 references.
Key Words: adaptive immunity; allorecognition; antigen presenting cells; innate immunity; liver transplantation; T lymphocytes
Medical Management Of Pulmonary Embolism
Authors: Waxman Aaron B , Schissler Andrew J
Published: January 2021

Acute pulmonary embolism (PE) can be fatal and requires prompt medical attention. This chapter reviews the treatment of acute PE, including a detailed report of the acute- and long-term management of high-risk (“massive”), medium-risk (“submassive”), and low-risk thrombi. It summarizes the reperfusion therapies available in hemodynamically unstable patients with massive PEs such as thrombolysis, embolectomy, and percutaneous catheter-directed treatment. There is further in-depth examination of the various anticoagulants available including parenteral therapies, vitamin K antagonists, and direct oral anticoagulants. Recommendations on the treatment duration are discussed. Other considerations are described, including how management changes in the pregnant patient with acute PE, when venous filters should be considered and whether to initiate treatment before confirming a diagnosis. Overall this chapter serves as an excellent evidenced-based guide to better manage the various presentations of acute PE.
 
This review contains 3 figures, 5 tables and 47 references
Key Words: anticoagulation, embolectomy, PE, pulmonary embolism, reperfusion therapy, thrombolysis, treatment
Alterations In Macronutrient ­Metabolism In Starvation And Disease
Authors: Hoffer L John
Published: January 2021

This review explains starvation as both a physiologic process and a disease. It includes a detailed explanation of the modifying effects of metabolic adaptation and systemic inflammation, as interpreted in a clinical context. It navigates the reader through the difficult shoals of vague and conflicting terminology that burden this topic and provides current definitions and nuanced explanations of the important but frequently misunderstood terms related to starvation and its modifiers and consequences. It provides a succinct explanation of the physiology of total fasting and its clinical correlates. Finally, it explains the interactions among starvation, sarcopenia, frailty, involuntary weight loss, systemic inflammation, cachexia, and disuse muscle atrophy. The multiple and interacting causes of generalized muscle atrophy are pointed out. Inadequate appreciation of these interactions can result in failure to diagnose and treat starvation-induced diseases. A clinical approach to involuntary weight loss is outlined.
 
This review contains 6 figures, 2 tables and 56 references
Key words: adaptation, cachexia, frailty, hypoalbuminemia, inflammation, ketosis, kwashiorkor, malnutrition, marasmus, muscle atrophy, protein-energy malnutrition, sarcopenia, starvation, systemic inflammation, weight loss
Nutrition in Kidney Failure
Authors: Deger Serpil Muge , Ikizler T. Alp
Published: January 2021

Among the many factors that affect outcome in patients with chronic kidney disease (CKD), a state of metabolic and nutritional derangements, more aptly called protein-energy wasting (PEW) CKD, plays a major role.1 Multiple studies now indicate that PEW is highly prevalent and is closely associated with important clinical outcomes, such as hospitalizations and risk of death in this patient population. The focus of this review is to provide an overview of nutrition and metabolism in all stages of CKD, including end-stage renal disease (ESRD).
This review contains 3 figures, 5 tables, and 105 references. 
Key words: chronic-kidney disease (CKD), dialysis, end stage renal disease (ESRD), inflammation, maintenance hemodialysis (MHD), protein-energy wasting (PEW),uremia
Herpesvirus Infections
Authors: Hirsch Martin S.
Published: January 2021

The herpes group of viruses is composed of at least eight human viruses and numerous animal viruses. The human herpesviruses include herpes simplex virus types 1 and 2 (HSV-1 and HSV-2), varicella-zoster virus (VZV), cytomegalovirus (CMV), Epstein-Barr virus (EBV), and human herpesvirus types 6 (HHV-6), 7 (HHV-7), and 8 (HHV-8, also known as Kaposi sarcoma–associated herpesvirus). Human herpesviruses share the properties of latency and reactivation. Members of the group can cause productive lytic infections, in which infectious virus is produced and cells are killed, or nonproductive lytic infections, in which viral DNA persists but complete replication does not occur and cells survive. After acute lytic infections, herpesviruses often persist in a latent form for years; periodic reactivations are followed by recurrent lytic infections. Sites of latency vary: HSV and VZV persist in neural ganglion cells, EBV persists in B cells, and CMV probably remains latent in many cell types. The sites of latency for HHV-6 and HHV-7 have not been identified, although both herpesviruses have been detected in salivary glands. All human herpesviruses have a worldwide distribution. Considerable efforts are being directed toward the development of vaccines and antiviral agents that will be active against herpesviruses. This chapter discusses the epidemiology, pathogenesis, diagnosis, prevention, and treatment of herpes simplex virus and varicella-zoster virus and their clinical syndromes. The descriptions of the clinical syndromes include complications and clinical features, as well as descriptions of symptoms. Tables provide information on chemotherapy for primary genital and mucocutaneous herpes infection, suppression of severe and recurring genital herpes infection, and varicella-zoster infection. Figures provide photographic illustrations of the various clinical syndromes. A sidebar about herpesvirus information on the Internet provides further detail.
This review contains 123 references, 4 tables, and 6 highly rendered figures.
Thyroid Disease I: Hyperthyroidism in Pregnancy
Authors: Martin Robert B. , Casey Brian
Published: January 2021

Thyroid physiologic adaptations in pregnancy may be confused with pathologic changes. Human chorionic gonadotropin rises early in pregnancy, stimulating thyrotropin secretion and suppressing thyroid stimulating hormone. These chemical changes are often seen in hyperemesis gravidarum and gestational transient thyrotoxicosis. Therefore, mild thyrotoxicosis may be difficult to differentiate from early pregnancy thyroxine stimulation.  However, overt hyperthyroidism usually includes classic symptoms seen outside of pregnancy in addition to suppressed TSH and T4 levels. Treatment includes thionamides propylthiouracil and methimazole.  Thyroid ablation is contraindicated in pregnancy. Often, in affected women, the fetus is euthyroid, but neonates can develop hyper or hypothyroidism with or without a goiter. Lastly, thyroid storm, though rare, is life threatening. Often presenting as a hypermetabolic state with cardiomyopathy and pulmonary hypertension, it generally results from decompensation from preeclampsia, anemia, sepsis, or surgery.  Treatment requires intensive care level management, with initiation of thionamides, iodine, and beta blockers.  
This review contains 2 figures, 4 tables and 38 references.
Keywords: Thyroid-releasing hormong, thyroid-stimulating hormone, thyromegaly, thyroid-stimulating immunoglobulins, thryotoxicosis, thionamides, thyroid storm
Thyroid Disease II: Hypothyroidism in Pregnancy
Authors: Martin Robert B. , Casey Brian
Published: January 2021

Hypothyroidism affects between 2 and 12 per 1000 pregnancies.  Symptoms in pregnancy are similar those encountered in the nonpregnant population, but may be attributed to the pregnancy itself. Thyroxine-binding globulin increases in pregnancy, leading to increased thyroxine levels in order to meet the metabolic needs of normal pregnancy.  Routine screening is not recommended, and testing should be done using a targeted approach in women with symptoms or history of thyroid disease. Diagnosis is based upon the finding of an elevated serum TSH using population and trimester-specific ranges. Overt hypothyroidism, identified by high serum TSH and low free thyroxine, is associated with increased risk of pregnancy-related complications, and is treated with maternal thyroxine supplementation.  Adequate iodine is necessary for fetal neurodevelopment, and women with iodine deficiency may present with a goiter, though it is important to distinguish it from other causes of thyroid enlargement, including malignancy.  Postpartum thyroiditis is diagnosed infrequently, as only a small subset of women will demonstrate the classic biphasic presentation,  Additionally, symptoms are often vague, nonspecific, and self-limited.  Importantly, many women are at risk of eventually developing permanent hypothyroidism.
This review contains 6 tables, and 48 references. 
Key words: euthyroid, goiter, overt hypothyroidism, postpartum thyroiditis, thyroixine binding globulin, thyroid peroxidase, thryroid nodules
Common Maternal Genetic Syndromes VI: 22q11.2 Deletion Syndrome
Authors: Boothe Megan , Robin Nathaniel
Published: January 2021

22q11.2 deletion syndrome (22q11.2DS) is the most common chromosomal microdeletion syndrome with an incidence of 1/3,000-1/4,000 live births. Common manifestations of 22q11.2DS include congenital heart defects, hypocalcemia, immune deficiency, cleft palate, cognitive deficits, and psychiatric disturbances. As childhood management of 22q11.2DS has improved, these individuals are living into adulthood and may have children of their own. Thus, it is imperative for the clinician to have an understanding of both the physical and psychiatric complications that may be seen in the adult with 22q11.2DS and how this may affect a pregnancy. Here we review the common features of 22q11.2DS in the adult and pregnancy management recommendations for the obstetrician. 
This review contains 4 figures, 1 tables, and 27 references.
Keywords: 22q11.2 Deletion Syndrome; DiGeorge Syndrome; Velocardiofacial Syndrome; 22q11.2 Deletion Syndrome Adult; 22q11.2 Deletion Syndrome pregnancy; DiGeorge Syndrome pregnancy; DiGeorge Syndrome adult.
Cough and Hemoptysis
Authors: Andaz Shahriyour , Danovich Svetlana
Published: January 2021

Cough is one of the most common complaints that brings patients to seek medical attention, resulting in 30 to 50 million visits annually. Cough can be divided into three categories based on chronicity: namely acute, subacute, and chronic. Treatment of cough depends on the chronicity and etiology of the cough. Similarly, hemoptysis is a common occurrence, albeit less frequent than cough. Like cough, the treatment is dependent on etiology.  Hemoptysis must always be taken seriously as death may occur from massive hemoptysis and result from asphyxiation. Whenever possible, attempts must be made to control massive hemorrhage by interventional techniques.
This review contains 6 figures, 3 tables, and 69 references.
Keywords: Cough, Hemoptysis, Smoking, Chest pain, GERD, Asthma, Hemorrhage, mucus, tracheoinnominate
Cleft Lip
Authors: Tse Raymond
Published: January 2021

Cleft lip is one of the most common congenital anomalies that present to plastic surgeons. Care involves a multidisciplinary approach to address both aesthetic and functional needs. This review covers embryology, epidemiology, classification, and anatomy. It also provides a more in-depth description of treatment for unilateral, bilateral, and minor form clefts. Given the spectrum of presentation and the multiple tissue types involved, the general principles of reconstructive surgery are used as the framework for this review.
This review contains 16 figures, 3 tables, and 119 references.
Keywords: cheiloplasty, cleft lip, Fisher repair, microform cleft lip, Millard repair, orbicularis muscle, primary rhinoplasty, septoplasty, Tennison-Randall repair
Management of Speech and Swallowing Disorders in Children with Oral Clefts
Authors: Garg Ravi K. , Mount Delora L
Published: January 2021

Cleft lip and palate are common congenital anomalies with significant implications for feeding, swallowing, and speech. If a cleft palate goes unrepaired, a child will have difficulty distinguishing nasal and oral sounds. Even following cleft palate repair, approximately 20 to 30% of nonsyndromic children have persistent hypernasal speech. This often occurs due to velopharyngeal dysfunction (VPD), a term describing failure of the soft palate and pharyngeal walls to seal the nasopharynx from the oropharynx during oral consonant production. The gold standard for diagnosis is perceptual examination by a trained speech pathologist, although additional diagnostic tools such as nasendoscopy are often used. Treatment options for VPD range from speech therapy to revision palatoplasty, sphincter pharyngoplasty, pharyngeal flap, and pharyngeal wall augmentation. Palatal prosthetics may also be considered for children who are not surgical candidates. Further research is needed to improve selection of diagnostic and treatment interventions and optimize speech outcomes for children with a history of oral cleft.
This review contains 1 figure, 3 videos, and 58 references. 
Key words: Cleft lip and palate, hypernasal resonance, levator veli palatine, nasal emission, nasendoscopy, palatoplasty, pharyngeal flap, posterior pharyngeal wall augmentation, sphincter pharyngoplasty, velopharyngeal dysfunction
Extensor Tendon Repair and Reconstruction
Authors: Ledbetter Kelly D. , Friedrich Jeffrey B.
Published: January 2021

The purpose of this chapter is to review the anatomy and function of extensor tendons, the physiology of tendon healing, and general principles regarding common acute and chronic extensor tendon injuries. Acute injuries are classified according to the modified Verdan system and the presenting symptoms, physical exam findings, and treatment strategies are discussed by zone of injury. Common chronic extensor tendon injuries are discussed as they relate to the dorsal wrist's division into six discrete fibro-osseous compartments. Lastly, this chapter reviews the role of  operative vs non-operative management as well as the use of immobilization vs early protective motion in the post-operative setting.
This review contains 7 figures, 1 table and 37 references.
Keywords: extensor, tendon, repair, reconstruction, rehabilitation, tendonopathy, surgery, splint
Minimally Invasive Approaches to Forehead Rejuvenation
Authors: Srinivasa Dhivya R , Cederna Paul S
Published: January 2021

Brow position is an established measure of both gender and youth. Patient goals can range from facial feminization to restoration of a more youthful form. Since its introduction in 1994, the endoscopic brow lift has become increasingly popular for elevation and stabilization of the brow, although numerous aesthetic surgeons still question its efficacy. The endoscopic brow lift demands a detailed understanding of specialized endoscopic instruments and regional anatomy. The dissection is tactile at times, but key portions require either direct or endoscopic visualization. Fixation options are numerous, each with their specific risks and benefits. Most importantly, well-planned surgical technique is key in avoiding the stigmata of brow surgery, such as a raised hairline, overcorrection with a surprised facade, and incisional alopecia. In this chapter, we review pertinent anatomy and an algorithm for brow ptosis evaluation. We discuss the specialized instruments necessary to perform this procedure and surgical techniques to maximize outcome while minimizing complications. In preparing patients for this procedure, we review the complication profile and key points of preoperative discussion. A well-done endoscopic brow lift can offer patients a sustainable, stable result with minimal surgical scars and should be included in the armamentarium of an aesthetic surgeon.
Free Flap-Based Breast Reconstruction
Authors: McArdle Adrian , Lipa Joan E.
Published: January 2021

Breast cancer is one of the most common cancers worldwide affecting one in eight women. Surgery continues to be the mainstay of treatment, and mastectomy is performed for treatment and prophylaxis of breast malignancies. Autologous microvascular tissue transfer is frequently an option for breast reconstruction. In appropriate patients, microsurgical breast reconstruction is a safe procedure with low donor site morbidities and excellent aesthetic results. The lower abdomen, thigh, and gluteal regions are the main source of free flaps frequently used in breast reconstruction. 
This review contains 10 figures, 2 tables, and 54 references
Keywords: breast cancer, breast reconstruction, breast surgery, microsurgery, autologous tissue transfer, free flap, deep inferior epigastric artery perforator flap (DIEP free flap), gracilis myocutaneous flap, gluteal artery perforator flap
Secondary Revision of Breast Augmentation (Capsular Contracture)
Authors: Smith J. Michael , Broyles Justin M.
Published: January 2021

Revisionary surgery to correct problems following primary breast augmentation is a potentially complex clinical issue. Scarring, compromised vascularity, and other anatomical changes resulting from prior surgery increase both the operative difficulty and risk of post-operative complications. In this review, the authors outline the etiology and management of common problems that motivate patients to seek secondary breast augmentation; including capsular contracture, malposition, ptosis, rippling, and asymmetry. It is the aim of this chapter to provide the reader with a foundational understanding of the tools and techniques available to treat affected patients in order to maximize the probability of future success.
This review contains 3 figures, 6 tables, 31 references
Keywords: breast augmentation, breast revision, capsular contracture, malposition, ptosis, rippling, acellular dermal matrix, revision augmentation
Treatment of Arterial Ulcers
Authors: Ornekian Vahram , Janhofer David E , Akbari Cameron , Evans Karen K
Published: January 2021

Ischemic ulceration of the lower extremity is a challenging problem that requires a careful, systematic approach to achieve healing and favourable outcomes. Ulceration may become limb and life threatening, and limb salvage requires a concerted, multispecialty approach that includes vascular surgeons, plastic surgeons, and podiatrists among others. In this chapter, we propose an algorithm for the evaluation and treatment of ischemic ulceration of the lower extremity. We provide a review of management guidelines, including a discussion of important considerations for appropriate history taking, physical examination evaluation, diagnostic testing modalities, and medical and surgical treatment strategies, taking into account patient functional and ambulatory goals of care.
This review contains 8 figures, 4 tables and 73 references
Key Words: amputation, diabetes, ischemic, limb salvage, lower extremity, peripheral arterial disease, reconstruction, revascularization, ulcer, wound
Primary and Metastatic Central Nervous System Malignancies
Authors: Iwamoto Fabio M. , Fine Howard A.
Published: January 2021

About 13,000 deaths each year in the United States are attributed to primary central nervous system (CNS) malignancies. An estimated 20% of patients with cancer eventually develop clinically apparent CNS metastases, and an estimated 170,000 cases of brain metastases are diagnosed in the United States yearly. Autopsy studies suggest that as many as 50% of patients dying from advanced cancer may have metastasis to the CNS. This chapter provides an overview of primary and metastatic CNS malignancies with in-depth discussion of gliomas, primary CNS lymphoma, meningioma, brain metastases, leptomeningeal metastases, and metastatic epidural spinal cord compression. Discussions cover epidemiology, etiology, diagnosis, and treatment of gliomas, including surgery, radiotherapy, and chemotherapy for both newly diagnosed gliomas and recurrent gliomas. The epidemiology, diagnosis, treatment and prognosis for primary CNS lymphomas are reviewed, as well as the epidemiology, etiology, diagnosis, treatment, and prognosis for meningiomas. Epidemiology, diagnosis, and prognosis for brain metastases are briefly discussed, and the section on treatment includes surgery, stereotactic radiosurgery, and whole-brain radiotherapy for patients with three or fewer brain metastases. The sections on leptomeningeal metastases and metastatic epidural spinal cord compression cover diagnosis, treatment, and prognosis. This chapter contains 126 references.
Neuroleptic Malignant Syndrome and Serotonin Syndrome
Authors: Sanders Richard , Krysiak Richard
Published: January 2021

Serotonin syndrome (SS) and neuroleptic malignant syndrome (NMS) are iatrogenic life-threatening conditions with similar clinical symptoms. Altered mental status, rigidity, and autonomic instability are common in both serotonin overload and toxic dopamine antagonism. It is paramount that providers understand the key differences between these two pathologies, as pharmacologic treatments can exacerbate the condition if SS is mistaken for NMS or vice versa. Hyperreflexia, clonus, diarrhea, and vomiting suggest the excessive activity of serotonin circuits in SS, whereas prominent rigidity and hyporeflexia suggest the underactivity of dopamine circuits in NMS. Supportive care and discontinuing the offending agent(s) are keys to treating both syndromes, but serotonin antagonists (eg, cyproheptadine) could be helpful in SS, whereas NMS may sometimes benefit from muscle relaxants (eg, dantrolene) and dopamine agonists (eg, bromocriptine). Following recovery, decisions about further use of an inciting agent (or similar agents) require reconsideration of risks, benefits, and alternatives, based on newly realized hazards. It is usually important to wait at least 2 weeks before rechallenge with any drugs resembling the inciting agents.
This review contains 1 figure, 8 tables, and 32 references.
Key Words: bromocriptine, cyproheptadine, dantrolene, Hunter criteria, neuroleptic malignant syndrome, parkinsonism, serotonin syndrome
Psychopharmacology for Substance Use Disorders
Authors: Simoyan Olapeju , Ulisse Krista
Published: January 2021

The illicit use of opioids is the fastest growing substance use problem in the United States. There are three FDA- approved medications for maintenance treatment for opioid use disorder: methadone, buprenorphine and naltrexone. Stimulants include cocaine and methamphetamines. 3,4-methylenedioxymethamphetamine (MDMA or “ecstasy”) is an amphetamine derivative that also has hallucinogenic properties. Treatment of stimulant withdrawal is primarily supportive. Psychosocial interventions for stimulant use disorder may improve adherence, but they have not been shown to improve abstinence at the end of treatment. Benzodiazepines have been shown to reduce the severity and duration of symptoms related to alcohol withdrawal, in addition to reducing the risk of seizures. The Food and Drug Administration has approved disulfiram, acamprosate and naltrexone for the treatment of alcohol use disorder.
This review contains 3 tables, and 31 references.
Keywords: Opioid use disorder, maintenance treatment for opioid use disorder, stimulant use disorder, stimulant withdrawal, benzodiazepine overdose, benzodiazepine withdrawal, alcohol use disorder, alcohol withdrawal
Psychiatry and Interpersonal Communication
Authors: Schnipke Brent D , Welton Randon S
Published: January 2021

Interpersonal and communication skills (ICS) are central to the practice of psychiatry. These skills are broad and can be defined in several ways, and several frameworks are presented, using the Accreditation Council for Graduate Medical Education competencies as well as other published guidelines. ICS are essential to good patient care and require special knowledge in psychiatry due to the particular diseases that are encountered. ICS are equally valuable to psychiatrists in communicating with family members, other physicians, and other members of the healthcare team, as well as in education and leadership. Recommendations for adapting ICS to these circumstances are outlined. For psychiatry trainees, regular evaluation of ICS is mandated but is also recommended for practicing psychiatrists. If deficiencies are noted, strategies for addressing them can be pursued, and suggested improvement practices are provided.
This review contains 2 figures, 4 tables, and 21 references.
Key Words: communication, communication skills, consultation-liaison psychiatry, doctor-patient communication, interpersonal, psychiatry, psychotherapy, therapeutic alliance, rapport
Approach to the Geriatric Patient
Authors: Kostas Tia , Simone Mark , Rudolph James L
Published: January 2021

As of 2012, over one in eight Americans is over the age of 65, and this number is rising, particularly in the 85+ age group. This segment of the population has a rate of hospitalization three times higher than that for persons of all ages. General internists and family medicine physicians provide a large portion of care for this age group and should therefore be comfortable using a comprehensive approach to geriatric assessment. This review describes general considerations regarding geriatric care, including the process of taking a functional history and clinical implications of geriatric care. The geriatric assessment process is discussed in terms of physical, cognitive, social, and medical domains. The benefits of geriatric assessment in primary care, specialty care, and hospitalized patients are described. Tables outline activities of daily living, sensory changes with aging, major causes of visual impairment in the geriatric population, major neurocognitive disorder diagnostic criteria, medications to avoid or use with caution based on Beers criteria and Screening Tool of Older individuals’ Potentially inappropriate Prescriptions criteria, U.S. Preventive Services Task Force–recommended services relevant to older adults, and vaccinations in older adults. Figures illustrate the key vulnerabilities of older adults; outcomes linked to functional dependence; common disorders associated with cognitive concerns; domains of cognition and examples of impairment in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition; the social and medical domains of geriatric assessment; barriers to medication adherence in older patients; and resources for medication appropriateness in older adults.
This review contains 8 highly rendered figures, 8 tables, 110 references, and 5 MCQs.
Dizziness
Authors: Kerber Kevin A. , Baloh Robert W.
Published: January 2021

Dizziness is the quintessential symptom presentation in all of clinical medicine. It is a common reason that patients present to a physician. This chapter provides background information about the vestibular system, then reviews key aspects of history-taking and examination of the patient, then discusses specific disorders and common presentation types. Throughout the chapter the focus is on neurologic and vestibular disorders. Normal vestibular anatomy and physiology are discussed, followed by recommendations for history-taking and the physical examination. Specific disorders that cause dizziness are explored, along with common causes of non-specific dizziness. Common presentations are discussed, including acute severe dizziness, recurrent attacks, and recurrent positional vertigo. Finally, the chapter looks at laboratory investigations in diagnosis and management. Figures include population prevalence of dizziness symptoms, the anatomy of inner structures, primary afferent vestibular nerve activity, the head thrust test, the Dix-Hallpike maneuver, the supine positional test, the canalith repositioning procedure, and the barbecue roll maneuver. Tables list physiologic properties and clinical features of the components of the peripheral vestibular system, information to be acquired from history of the present illness, common symptoms patients report as dizziness, examination components, distinguishing among common peripheral and central vertigo syndromes, common causes of nonspecific dizziness, types of dizziness presentations, relevant imaging abnormalities on neuroimaging studies, vestibular testing components, and medical therapy for symptomatic dizziness.
This review contains 8 highly rendered figures, 10 tables, and 68 references.
Primary and Preventive Care of Women
Authors: Henrich Janet B.
Published: January 2021

Women’s health can be defined as diseases or conditions that are unique to women or that involve gender differences that are particularly important to women. This definition acknowledges the increasing scientific evidence supporting a focus on sex and gender and expands the concept of women’s health beyond the traditional focus on reproductive organs and their function. Over time, the definition has come to include an appreciation of wellness and prevention, the interdisciplinary and holistic nature of women’s health, the diversity of women and their health needs over the life span, and the central role of women as patients and as active participants in their health care. This broader interdisciplinary perspective has important implications for clinicians providing care to women. In addition to understanding basic female physiology and reproductive biology, clinicians need to appreciate the complex interaction between the environment and the biology and psychosocial development of women. When dealing with conditions that are not specific to women, clinicians need to be aware of those aspects of disease that are different in women or have important gender implications. The ability to apply this information requires that clinicians adopt attitudes and behavior that are culturally and gender sensitive. Figures visualize female life expectancy, age-adjusted death rates, female breast cancer incidence and death rates, trends in female cigarette smoking, and the U.S. Preventive Services Task Force guidelines for preventive primary care in women. 
This chapter contains 5 highly rendered figures, 52 references, 5 MCQs, and 1 teaching slide set.
Pathophysiology and Treatment of Infection Stones
Authors: Gomella Patrick T , Mufarrij Patrick W
Published: January 2021

Infection stones are a well-known clinical entity that can cause significant long-term morbidity and even mortality if not treated appropriately. Infection stones are primarily composed of magnesium ammonium phosphate and calcium carbonate apatite. These stones form in alkaline urine containing ammonium. This environment is generated by infection with urease-producing organisms. Definitive treatment is aimed at removal of all stone. Percutaneous nephrolithotomy is typically the procedure of choice. Medical therapy can be used as an adjunct to surgery or as primary treatment in patients who are not surgical candidates.
This review contains 8 highly rendered figures, 4 tables, and 72 references
Key words: Infection stone; struvite; percutaneous nephrolithotomy; urease; dissolution therapy; magnesium ammonium phosphate; calcium carbonate apatite
Imaging for Nephrolithiasis
Authors: Wollin Daniel A , Dale Joanne , Jiang Ruiyang , Sexton Stephanie , Preminger Glenn M
Published: January 2021

Nephrolithiasis is a common condition that affects a large number of Americans. An imaging diagnosis is required for adequate treatment and follow-up, and a large variety of imaging modalities exist for this purpose. In this review, we discuss the advantages, disadvantages, and specific uses for a wide array of imaging methods, including plain radiography, ultrasonography, CT, and others. In addition, special attention is paid to specific clinical situations for individual tests, such as when dealing with children, pregnant women, and patients in an intraoperative setting. Approximate costs and radiation doses of each modality are discussed as well. At the conclusion of this review, the reader should understand the utility of each imaging technique, along with the optimal situation for use and reasoning for these decisions.

This review contains 5 highly rendered figures, 2 tables, and 85 references
Key words: CT, diagnosis, digital tomosynthesis, fluoroscopy, follow-up, imaging, intravenous pyelography, MRI, nephrolithiasis, radiation dose, radiography, ultrasonography
Pediatric Renal Trauma
Authors: Husmann Douglas A
Published: January 2021

This review addresses the new staging criteria applied to classify renal trauma accurately. We discuss the unique differences in the etiology and management of renal trauma between adults and children. The commentary defines the differences in managing low-, medium-, and high-velocity traumatic injuries compared with blunt renal trauma, and the criteria and methods used to screen for these injuries in children are provided. Absolute and relative indications for surgical exploration of traumatic renal injuries are examined. Management of the complications of acute and delayed renal hemorrhage, asymptomatic and symptomatic urinomas, chronic pain, and hypertension is discussed. Recommendations for physical activity following the traumatic loss of a kidney are reviewed.

This review contains 10 figures, 7 tables and 49 references
 Key words: false aneurysm, hematuria, kidney, nonpenetrating wounds, penetrating wounds, renal hypertension, renal trauma, therapeutic embolization, traumatic shock, urinoma
Respiratory Viral Infections
Authors: Ison Michael G.
Published: January 2021

The respiratory tract can be infected by a diverse group of viruses that produce syndromes ranging in severity from mild colds to fulminant pneumonias. Respiratory viral infections are a leading cause of morbidity, hospitalization, and mortality throughout the world; influenza and pneumonia were the most prevalent infectious causes of death during the 20th century in the United States.

This review contains 8 figures, 26 tables and 87 references.
Keywords: Virus, infection, respiratory tract, antiviral, pneumonia, croup, pharyngitis, epidemic, pandemic, outbreak
Tumor Immunology
Authors: Maus Rachel L , Dong Haidong , Markovic Svetomir N
Published: January 2021

The immune system has effectively evolved to protect the host against foreign invaders, including bacterial, viral, and parasitic infiltrates. Less clear has been the interaction and the protective effects the immune system mounts against its own infiltrates: cancer cells. Here we consider the dynamic interactions between cancer and the associated host immune response by highlighting the key players involved in engaging an effective antitumor immune response and the mechanisms responsible for enabling the evolution of cancer cells to escape immunosurveillance. By developing an appreciation for the dual function of the immune system in the setting of cancer biology, we also consider the clever strategies that have been employed to uncover tumor targets, including tumor-associated antigens and the mechanisms for enhancing or reengaging the immune system to mount an effective antitumor immune response. Finally, we incorporate these key findings into the context of immunotherapy, a rapidly evolving field aimed at combating tumor escape by enabling the host immune system to regain its tumor-eradicating functions.
This review contains 5 figures, 9 tables and 60 references
Key words: adoptive T cell therapy, checkpoint inhibitors, cytokine therapy, immunotherapy, neutralizing antibodies, tumor immunity, tumor microenvironment, vaccines
Approach to the Patient with Acute Respiratory Failure
Authors: Fan Eddy , Vendramin Alice
Published: January 2021

Acute respiratory failure (ARF) is a common reason for admission to the intensive care unit (ICU), and is associated with significant morbidity and mortality. Failure of one or more components of the respiratory system can lead to hypoxemia, hypercabia, or both. Initial evaluation of patients with ARF should include physical examination, chest imaging, and arterial blood gases (ABG) sampling. As ARF is often a life-threatening emergency, a patient’s oxygenation and ventilation will need to be supported at the same time that diagnostic and therapeutic interventions are planned. The priorities for early treatment are essentially those of basic life support: airway and breathing. The first step is to assess a patient’s airway and ascertain that it is patent. This is followed by efforts to support both oxygenation and ventilation. This can include non-invasive or invasive mechanical ventilatory support. As with all interventions, there are risks inherent in the use of mechanical ventilation, which may be minimized by the use of lung protective ventilation (i.e., with low tidal volumes and airway pressures). Finally, due to the potential complications associated with mechanical ventilation, it is important to regularly assess whether a patient continues to require the assistance of the ventilator, and to liberate patients from mechanical ventilation at the earliest opportunity when clinically safe and feasible to do so. Figures depict pressure-time curve. Tables list the clinical causes of hypoxemic respiratory failure, oxygen delivery devices, indications for noninvasive positive pressure support, common causes of abnormal respiratory mechanics, and common causes of acute respiratory distress syndrome (ARDS).
This review contains 2 highly rendered figures, 5 tables, and 86 references.
Adrenal Hypertension
Authors: Fisher Naomi D.L. , Adler Gail K
Published: January 2021

The secondary causes of hypertension are associated with the excess of the principal hormones produced by the adrenal glands: cortisol, epinephrine, and aldosterone. Excess aldosterone production is recognized as primary hyperaldosteronism, or primary aldosteronism (PA). Individuals with PA are at increased risk for a variety of disorders, including atrial fibrillation, coronary artery disease, myocardial infarction, and stroke. Pheochromocytoma is a very rare tumor (accounting for fewer than one in 10,000 hypertension cases) and is marked by high secretions of catecholamines, mostly epinephrine as well as norepinephrine. Cushing disease and Cushing syndrome are addressed in a separate review.
This review contains 5 highly rendered figures, 4 tables, and 39 references.
Nausea and Vomiting of Pregnancy
Authors: Roberts Elizabeth , Young Brett C
Published: January 2021

In pregnancy, the majority of women experience at least some nausea and vomiting. For many women, these symptoms are mild and self-limiting and resolve by the second trimester. A minority of women experience severe symptoms of hyperemesis gravidarum with persistent vomiting, weight loss, and electrolyte derangements. The diagnosis of hyperemesis gravidarum is based on clinical history and exclusion of other etiologies of nausea and vomiting. First-line pharmacologic treatment is with pyridoxine and doxylamine. Other medical treatments include metoclopramide, phenothiazines, antacids, and ondansetron. In refractory cases, corticosteroids and enteral or parenteral nutrition may be considered.

This review contains 3 figures, 2 tables and 83 references
Key words: enteral feeding, hyperemesis gravidarum, maternal outcomes, nausea and vomiting of pregnancy, neonatal outcomes, nonpharmacologic antiemetics, pharmacologic antiemetics
Normal Menstrual Cycle
Authors: Pierson Rebecca , Pagidas Kelly
Published: January 2021

A normal menstrual cycle is the end result of a sequence of purposeful and coordinated events that occur from intact hypothalamic-pituitary-ovarian and uterine axes. The menstrual cycle is under hormonal control in the reproductively active female and is functionally divided into two phases: the proliferative or follicular phase and the secretory or luteal phase. This tight hormonal control is orchestrated by a series of negative and positive endocrine feedback loops that alter the frequency of the pulsatile secretion of gonadotropin-releasing hormone (GnRH), the pituitary response to GnRH, and the relative secretion of luteinizing hormone and follicle-stimulating hormone from the pituitary gonadotrope with subsequent direct effects on the ovary to produce a series of sex steroids and peptides that aid in the generation of a single mature oocyte and the preparation of a receptive endometrium for implantation to ensue. Any derailment along this programmed pathway can lead to an abnormal menstrual cycle with subsequent impact on the ability to conceive and maintain a pregnancy.

This review contains 7 figures and 26 references
Key words: follicle-stimulating hormone, follicular phase, gonadotropin-releasing hormone, luteal phase, luteinizing hormone, menstrual cycle, ovulation, progesterone, proliferative phase, secretory phase
Upper Airway Disorders
Authors: Proano Lawrence , Gemme Seth , Partridge Robert
Published: January 2021

Upper airway disorders are frequently encountered in the primary care setting and present in both adults and children.  This review covers earache, sinusitis, sore throat, peritonsillar abscess, sialolithiasis and sialadenitis, parotitis, epiglottitis, epistaxis, foreign body in the ear, nose, or throat, and Ludwig angina. Figures show right-sided peritonsillar abscess demonstrating swelling and distortion of the anterior and posterior tonsillar pillars and uvular deviation, peritonsillar abscess demonstrated by an ultrasound image of a hypoechoic fluid collection, ultrasound imaging of sagittal view of the tonsillar pillars, lateral radiograph of the neck demonstrating a swollen epiglottis and widened vallecula, photographs of brawny swelling of the submandibular region of the neck in Ludwig angina, and a patient with peritonsillar abscess with extension to the base of the tongue. Tables list criteria for diagnosing acute sinusitis, and clinical presentations that best identify patients with acute bacterial versus viral rhinosinusitis.
 
This review contains 7 figures, 17 tables, and 66 references
Keywords: Epiglottitis, epistaxis, parotitis, peritonsillar abscess, pharyngitis, sialolithiasis, sinusitis
Genitourinary Trauma
Authors: Lakoff Daniel , Hill Adam D.
Published: January 2021

Injury to the urogenital tract from blunt or penetrating trauma comprises 10% of injuries sustained from trauma with renal injuries comprising the majority of those cases at 1-5 % of all trauma, followed by bladder injuries. Worldwide variations in trauma mechanisms exist, with blunt trauma causing the majority of renal trauma in the United States. Careful attention to the mechanism, anatomic location, and specific physical and radiologic findings can aid in the diagnosis and appropriate management to optimize patient outcomes. Unless trauma is overtly obvious on a physical examination, imaging is required for diagnosis and staging purposes. Owing to the complexity of the urogenital tract, there is a great deal of variation in management, ranging from a conservative approach in most renal injuries to the need for operative intervention with intraperitoneal bladder rupture. This review discusses common practice and provides more recent up-to-date guidelines pertaining to the clinical history, examination findings, and imaging modalities, along with the diagnosis and management of injuries to the genitourinary system.
Keywords: Genitourinary Trauma, Renal Trauma, Ureter Trauma, Bladder Trauma, Urethral Trauma, External Genitalia Trauma
Dizziness
Authors: Kerber Kevin A. , Baloh Robert W.
Published: January 2021

Dizziness is the quintessential symptom presentation in all of clinical medicine. It is a common reason that patients present to a physician. This chapter provides background information about the vestibular system, then reviews key aspects of history-taking and examination of the patient, then discusses specific disorders and common presentation types. Throughout the chapter the focus is on neurologic and vestibular disorders. Normal vestibular anatomy and physiology are discussed, followed by recommendations for history-taking and the physical examination. Specific disorders that cause dizziness are explored, along with common causes of non-specific dizziness. Common presentations are discussed, including acute severe dizziness, recurrent attacks, and recurrent positional vertigo. Finally, the chapter looks at laboratory investigations in diagnosis and management. Figures include population prevalence of dizziness symptoms, the anatomy of inner structures, primary afferent vestibular nerve activity, the head thrust test, the Dix-Hallpike maneuver, the supine positional test, the canalith repositioning procedure, and the barbecue roll maneuver. Tables list physiologic properties and clinical features of the components of the peripheral vestibular system, information to be acquired from history of the present illness, common symptoms patients report as dizziness, examination components, distinguishing among common peripheral and central vertigo syndromes, common causes of nonspecific dizziness, types of dizziness presentations, relevant imaging abnormalities on neuroimaging studies, vestibular testing components, and medical therapy for symptomatic dizziness.
This review contains 8 highly rendered figures, 11 tables, and 69 references.