bluuebunny/crossref_metadata_2025 huggingface dataset:
Sudden Onset of Diplopia and a Skeletal Muscle Antibody
Authors: Mills John R.
Published: November 2021

A 62-year-old man with a history of migraine came to the emergency department with sudden onset of horizontal diplopia and, subsequently, bilateral ptosis. He noted feeling unsteady when walking. He reported that the diplopia worsened throughout the day. He had a history of hepatitis C infection. He had some vision loss in his left eye, which was thought to relate to a retinopathy. He disclosed that he had a history of cold feet and had notably high arches. He had a pacemaker because of syncope attributed to sick sinus syndrome. Computed tomography angiography of the head and neck were ruled negative for intracranial stenosis, occlusions, or aneurysms. Computed tomography of the head indicated a tiny lacunar infarct in the right caudate head. Magnetic resonance imaging of the brain identified a tiny, periaqueductal, enhancing abnormality in the right midbrain that was thought to be likely ischemic, but there was some concern for a demyelinating or inflammatory lesion. Cerebrospinal fluid evaluation indicated an increased protein concentration. Serologic evaluation for myasthenia gravis striational antibodies were positive at a titer of 1:240. Serum protein studies indicated the presence of polyclonal hypergammaglobulinemia. Myasthenia gravis was effectively ruled out. Given the hyperacute time course, the patient’s clinical disorder was most probably explained by an ischemic stroke that affected the oculomotor nuclei regions causing ptosis and ophthalmoparesis. On follow-up, the patient was discovered to have a patent foramen ovale. Whether the patent foramen ovale was a contributing factor to the stroke is uncertain. The recurrence rate in this setting is thought to be low relative to other causes of stroke. Ultimately it was decided to not close the patent foramen ovale and to maintain the patient on clopidogrel and adult low-dose aspirin. The onset of diplopia is typically sudden, but this occurs exclusively with vascular pathologic processes. Diplopia that appears intermittently with diurnal variation suggests the possibility of a neuromuscular junction disease such as myasthenia gravis.
A Woman With Fever, Confusion, and Seizures
Authors: Toledano Michel
Published: November 2021

A 62-year-old woman sought care in late summer for a 4-day history of upper respiratory tract symptoms, intermittent fevers, headache, and a 1-day history of disorientation, word-finding difficulties, and unsteady gait. Upon arrival to the emergency department, she had a witnessed seizure and was intubated because of increased lethargy. Her temperature was 39.4 °C, but she was otherwise hemodynamically stable. She had normal ophthalmoscopic examination findings and antigravity strength in all 4 extremities. Her deep tendon reflexes were brisk, but plantar responses were flexor. She had no rash. Cerebrospinal fluid analysis showed a normal glucose value, protein concentration of 82 mg/dL, and mixed pleocytosis. She had been hiking recently, but her family reported that there were no tick exposures or mosquito bites. Brain magnetic resonance imaging showed areas of T2 fluid-attenuated inversion recovery hyperintensity involving primarily the left thalamus and basal ganglia without definitive gadolinium enhancement. Both serum and cerebrospinal fluid were positive for immunoglobulin M antibodies to West Nile virus. The patient was diagnosed with West Nile virus encephalitis. After the seizure, the patient was treated with levetiracetam, and empiric antimicrobials were started for acute meningoencephalitis, along with adjunctive dexamethasone. Continuous electroencephalography was obtained because of the persistent encephalopathy and showed no evidence of subclinical seizures. The dexamethasone was stopped after 2 doses because of low suspicion for pneumococcal meningitis, and the antibiotics were discontinued after results of serum and cerebrospinal fluid cultures were negative for bacteria (48 hours). Acyclovir was stopped after the polymerase chain reaction results were negative for herpes simplex virus and varicella-zoster virus.
Rapid-Onset Hemibody Sensory Loss, Incoordination, and Muscle Jerking
Authors: McKeon Andrew , Zalewski Nicholas L.
Published: November 2021

A 61-year-old woman with no pertinent medical history had progressive decline in multiple neurologic domains over the course of 2 months. She had development of progressive sensory loss in her left foot that subsequently spread up the left lower extremity and into the left upper extremity; accompanied by a sense of unsteadiness. Later, jerky movements of the left leg occurred while she was lying supine and sometimes when walking. At times, her left hand would wander involuntarily. Later in the course of her symptoms, mild short-term memory loss was also noted. On examination, she was unable to recall her home address, but findings were otherwise normal. She had mild gaze-evoked nystagmus and significant saccadic intrusion of smooth pursuits. A mild upper motor pattern of weakness, action myoclonus, hyperreflexia, and moderate loss of vibration was present on the left. Gait was markedly ataxic. Repeated magnetic resonance imaging of the brain 2 months after illness onset showed right parietal cortical hyperintense signal on diffusion-weighted imaging consistent with cortical ribboning, a common diagnostic finding early in the course of prion disease. Although characteristic of prion disease, similar imaging findings have been reported in autoimmune encephalitis and in the postictal setting. However, the putamen and caudate nucleus also demonstrated subtle asymmetric diffusion-weighted imaging hyperintense signal, which in the clinicoradiologic context is highly specific for prion disease. Electroencephalography showed frequent sharp wave discharges over right posterior temporal and left occipital head regions, along with frontal intermittent rhythmic delta slowing, consistent with encephalopathy (not otherwise specified). Real-time quaking-induced conversion testing of cerebrospinal fluid was positive for misfolded prion proteins. The positive real-time quaking-induced conversion result confirmed a diagnosis of sporadic Creutzfeldt-Jakob disease. The patient’s treatment was palliative. Hospice services implemented a home palliation program. Clonazepam was prescribed to reduce myoclonus. The patient died 18 weeks after onset of her neurologic symptoms. The differential diagnosis of a rapidly progressive multifocal neurologic syndrome includes many considerations but can be focused in complex situations by first confirming lesion localization and characterization with neuroimaging or other objective studies (eg, electromyography).
Weakness and Punctate Enhancement
Authors: Tobin W. Oliver
Published: November 2021

A 40-year-old man sought care for a 3-year history of tingling in his cheeks and face, with progressive urinary urgency. He had a 1-year history of progressive binocular diplopia and ataxia. On examination, he had decreased vibration sensation in his toes and a mild broad-based gait. Magnetic resonance imaging of the brain indicated mild fluid-attenuated inversion recovery abnormality with punctate postgadolinium enhancement, primarily in the pons. Spinal fluid analysis showed 2 white blood cells/µL with 95% lymphocytes, protein value of 32 mg/dL, 0 unique oligoclonal bands, and normal immunoglobulin G index. Pontine biopsy showed a polyclonal lymphocytic infiltrate, with a small polyclonal B-cell infiltrate. The patient was treated with intravenous methylprednisolone. His symptoms markedly improved, and repeated brain magnetic resonance imaging showed resolution of the enhancing lesions. Six months later he had progressive ataxia and pseudobulbar affect. Repeated brain magnetic resonance imaging showed a recurrence of the punctate enhancing lesions in the pons. A diagnosis of chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids was made. The patient was treated with weekly intravenous methylprednisolone, oral methotrexate, and folic acid supplementation. After 6 weeks, the methylprednisolone infusion interval was lengthened. Serial magnetic resonance imaging for 16 years after the original disease presentation showed no recurrence of enhancing brain lesions. Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids is an inflammatory brainstem disorder of unknown cause. It presents with a progressive pontocerebellar dysfunction associated with punctate enhancing lesions centered on the pons and cerebellum.
Bilateral Paresthesias in Crohn Disease
Authors: Kunchok Amy C. , McKeon Andrew
Published: November 2021

A 43-year-old woman sought care for bilateral lower limb numbness and paresthesias accompanied by a tight, bandlike sensation around her torso at the mid chest level. She had an episode 4 months earlier of bilateral arm paresthesias. The right arm paresthesias lasted several hours, but the left arm paresthesias persisted for 1 week. Urinary frequency had recently developed, but no incontinence. She had no associated limb weakness, facial numbness or weakness, or vision loss. Magnetic resonance imaging of the cervical spine showed multiple, short-segment, T2-hyperintense lesions. C1 and C4-5 lesions demonstrated contrast enhancement. Magnetic resonance imaging of the brain showed multiple ovoid areas of T2 hyperintensity involving the periventricular regions. Postcontrast images indicated 2 contrast-enhancing lesions adjacent to the posterior aspect of the right lateral ventricle. Magnetic resonance imaging of the thoracic spine showed several T2-hyperintense lesions without contrast enhancement. Vitamin B12 level was low. Cerebrospinal fluid analysis revealed 1 nucleated cell/µL, protein concentration of 85 mg/dL, and 17 cerebrospinal fluid -exclusive oligoclonal bands. Testing for JC polyoma virus was negative in the cerebrospinal fluid by polymerase chain reaction, but serologic results were positive. The patient was diagnosed with central nervous system demyelination in association with Crohn disease and tumor necrosis factor-α‎ inhibitor use. The patient discontinued adalimumab and started vedolizumab (α‎4β‎7 integrin inhibitor) for her Crohn disease. Magnetic resonance imaging of the brain and cervical spine 3 months after the therapy changes showed 2 new periventricular lesions in the temporal lobes without contrast enhancement. Magnetic resonance imaging of the cervical spine was stable. Because of her seropositivity to JC polyoma virus and history of immunosuppression, natalizumab (α‎4β‎1 and α‎4β‎7 integrin inhibitor) was not recommended. After discussion regarding therapy choice, the patient elected to start fingolimod. Inflammatory bowel and connective tissue diseases are commonly treated with immunosuppressants including tumor necrosis factor-α‎ inhibitors. Tumor necrosis factor-α‎ is a cytokine with a wide range of functions, including immune cell regulation, induction of the inflammatory response, inhibition of tumor growth, and induction of apoptosis.
Progressive Bilateral Arm Pain, Gait Disturbance, Constipation, and Urinary Retention
Authors: Carabenciov Ivan D. , Ruff Michael W.
Published: November 2021

A 48-year-old woman sought care for progressive right arm and hand pain with radial nerve–distribution sensory loss. She had a past history of multiple prior athletics-associated, musculoskeletal, upper cervical spine injuries. Her symptoms were initially attributed to a right C6 radiculopathy. Over the next several months, the sensory loss spread to involve the entire right hand and subsequently the entire left hand. She had development of diffuse right hand weakness and a sense of imbalance that was particularly prominent while in the dark. Finally, she experienced progressive constipation and urinary retention. Magnetic resonance imaging of the cervical spine showed an expanded cervical spinal cord from C3 through C7-T1 with diffuse T2-hyperintense changes and heterogeneous gadolinium enhancement most prominent at C5-6. In combination with a congenitally small central canal, severe central canal narrowing was seen at C5-6 and moderate narrowing at C4-5. Magnetic resonance imaging of the brain and thoracic spine were normal, and magnetic resonance imaging of the lumbar spine indicated only mild lumbar spondylosis. On suspicion of a spinal cord neoplasm with a secondary compressive myelopathy, C3 through C7 laminectomy and posterior instrumented fusion from C2 through T1 was performed, with a biopsy obtained at the C5-6 level. Postoperatively, her gait and right upper extremity pain improved. The biopsy showed atypical glial cells. Neurofilament staining demonstrated an infiltrative pattern. Atypical cells were positive for glial fibrillary acidic protein, oligodendrocyte transcription factor 2, and a Lys27Met sequence variation of histone H3, with overexpression of p53 on immunohistochemical staining. There was loss of H3 K27-trimethylation on the infiltrating cells, corresponding to the presence of Lys27Met sequence variation of histone H3. These findings were diagnostic for diffuse midline glioma with Lys27Met sequence variation of histone H3 (World Health Organization grade IV). A total of 5,400 cGy of photon radiation was delivered in 30 fractions over 42 days. She was subsequently treated with an oral histone deacetylase inhibitor, panobinostat, for 12 months. During this time, she had clinical response to treatment and reported improvement in balance and numbness. Follow-up magnetic resonance imaging at 3 months showed a slight decrease in the size of the mass, and this response was sustained 1 year post radiotherapy. Diffuse midline gliomas that contain Lys27Met sequence variation of histone H3are incurable, often inoperable, midline brain tumors that are most commonly seen in the pediatric population. These tumors can also occur in adult patients and are considered high grade, even in the absence of features such as necrosis or microvascular proliferation.
A Woman With Subacute Numbness of the Trunk, Arms, and Legs
Authors: Flanagan Eoin P.
Published: November 2021

A 39-year-old woman had development of new-onset numbness in her left arm. This progressed over 2 to 3 weeks to involve the left axilla, trunk, lower extremities, and genital region. She had mild imbalance and left-sided weakness but remained ambulating without a gait aid. Repeated magnetic resonance imaging of the cervical spine showed the longitudinally extensive T2 lesion in a central location on axial sequences, with linear, dorsal, subpial gadolinium enhancement extending more than 2 vertebral segments. The magnetic resonance image findings were most suggestive of spinal cord neurosarcoidosis. Computed tomography of the chest showed bilateral hilar adenopathy. Serum levels of angiotensin-converting enzyme were normal. Transbronchial lung biopsy showed noncaseating granulomas. Noncaseating granulomas were confirmatory of pulmonary sarcoidosis, which led to a diagnosis of spinal cord neurosarcoidosis. Treatment with intravenous methylprednisolone for 5 days was repeated, followed by oral prednisone for 2 months. Her neurologic symptoms improved, and repeated magnetic resonance image showed a marked decrease in T2 hyperintensity and gadolinium enhancement consistent with interval response to treatment. A slow prednisone taper over 9 months was initiated. Spinal cord neurosarcoidosis often presents with an isolated myelopathy without symptoms of pulmonary sarcoidosis (eg, cough, dyspnea). The presentation can range from a subacute onset mimicking transverse myelitis (as in this case patient) to a more insidious progressive myelopathy over months to years.
Altered Mental Status During the COVID-19 Pandemic
Authors: Mariotto Sara , Bozzetti Silvia , Rui Maria Elena De , Mazzaferri Fulvia , McKeon Andrew , Ferrari Sergio
Published: November 2021

In March 2020, a 68-year-old man with a history of pulmonary thromboembolism sought care at the emergency department for fever, cough, headache, and confusion. Because of severe respiratory failure, orotracheal intubation was required, and the patient was admitted to the intensive care unit, where bilateral deep vein thrombosis and hematemesis occurred. After 2 weeks, owing to respiratory improvement, the patient was weaned from ventilator support and sedation. However, persistent fluctuations in confusion, anxiety, agitation, and cognitive-motor slowing were noted. One week later, he was referred to the infectious diseases unit, where altered mental status persisted in the absence of fever, seizures, or episodes of impaired consciousness.

Chest radiography showed small, bilateral, ground-glass opacities. Brain magnetic resonance imaging showed bilateral involvement of mesial temporal lobes and hippocampus on fluid-attenuated inversion recovery sequences, in the absence of contrast enhancement or restricted diffusion. Nasopharyngeal samples were positive for SARS-CoV-2 on reverse transcriptase–polymerase chain reaction testing. Cerebrospinal fluid examination showed a slight increase in protein concentration, 1 white blood cell/µL, and no evidence of central nervous system infection. In particular, SARS-CoV-2 RNA was not detected.

The patient was diagnosed with postinfectious inflammatory (limbic) encephalitis in the course of SARS-CoV-2 infection.

The patient was treated with lopinavir/ritonavir and hydroxychloroquine. His recent thromboembolism prevented the administration of intravenous immunoglobulins, and high-dose corticosteroids were not administered because of the recent episode of hematemesis. Improvement in cognitive symptoms was noted 6 weeks after onset.

At the time of this writing, May 2020, a few cases of encephalitis after COVID-19 had already been described. These have generally been characterized by fever, cognitive dysfunction, epileptic seizures, coma, and cerebrospinal fluid inflammatory findings. It appears that a common magnetic resonance imaging appearance in these patients is that of diffuse inflammatory encephalitis.
Nurses’ impact on care, role, training, and career pathway
Authors: Holloway Debra
Published: November 2021

This chapter outlines the key roles of nurses in primary care and the community in the context of women’s health. This includes practice nurses, sexual and reproductive health nurses, and school nurses, alongside healthcare assistants and associates. Hospital nurses (both clinic and ward) and specialist nurses have their roles defined, and aspects of relevant training and accreditation are covered. The chapter also discusses the evolution of specialist role in the context of prescribing. Finally, mentorship, supervision, and career development is covered.
Hormone and endocrine disorders
Authors: Kubba Ali , Gupta Sunanda , Noble Nikki
Published: November 2021

This chapter covers various hormonal and endocrine disorders that can occur in women. It starts with the definition, assessment, diagnosis, causes and treatment for both primary and secondary amenorrhoea. It then covers polycystic ovarian syndrome, including diagnosis, treatment, and long-term complications. Then it moves onto hirsutism, from a general overview, to investigations, treatment, and medication that may be prescribed in secondary care. Finally, premature ovarian syndrome (POF) is defined, and causes and treatments are suggested.
Menopause
Authors: Holloway Debra
Published: November 2021

Menopause is the permanent cessation of menstruation, caused by ovarian failure. It can only be diagnosed a year after the last menstrual period, and is therefore a retrospective event. This chapter covers the signs, investigations, and treatments available for menopause, including Hormone Replacement Therapy, alternatives, modes of delivery, and non-hormonal alternative options. Abnormal bleeding and sexual dysfunction at the menopause are also explained. It also covers premature ovarian insufficiency, and causes and treatments for this disorder.
Contraception
Authors: Raine Shelley
Published: November 2021

This chapter begins with the principles of contraception (choice, access, measures of effectiveness) and a risk/benefit analysis and eligibility of different types. It explains emergency contraception. The chapter goes on to discuss different formulations, preparations, methods of use (or administration and insertion). This includes the combined oral contraceptive pill (COCOP), the transdermal patch, intra vaginal rings, progestogen-only pills, the subdermal implant, injectables, intra-uterine devices and systems, barrier methods for both male and female use, and spermicides. Finally it covers fertility awareness, and the sterilization of women and men.
Reproductive endocrinology
Authors: Dhillo Waljit , Davies Melanie , Jayasena Channa , Seal Leighton
Published: November 2021

This chapter covers multiple aspects of reproductive endocrinology in both male and female patients. Gender dysphoria is also included. It begins with reproductive physiology, then goes on to regulation of gonadal function. Hirsuitism, PCOS, and CAH in adults are all discussed with reference to evaluation, investigation, and treatment. Menstrual function disorders are described, as is menopause and hormone replacement therapy regimens. Contraception and emergency contraception are discussed. Male hypogonadism, androgen replacement therapy, gynaecomastia, and testicular tumours are all evaluated, alongside erectile dysfunction. The investigation and management of male and female infertility are both described, alongside fertility preservation and the induction of ovulation.
Calcium and bone metabolism
Authors: Gittoes Neil , Eastell Richard
Published: November 2021

This chapter covers calcium and bone metabolism. It starts with the physiology of bone, investigation of the bones, imaging, mass measurements, and biopsy, then goes on to investigation of calcium, phosphate, and magnesium. Urine excretion and calcium-regulating hormones are explained. It goes on to hypercalcaemia, primary hyperparathyroidism and its treatment, vitamin D intoxication, sarcoidosis, and hypocalcaemia. Vitamin D deficiency, Paget’s disease, and inherited disorders of bone are all included. The pathology, epidemiology, presentation, investigation, and treatment of osteoporosis are covered in detail.
Paediatric endocrinology
Authors: Ong Ken , Hendriks Emile
Published: November 2021

This chapter covers paediatric endocrinology. It starts with normal growth, then goes on to short stature, and constitutional delay of growth and puberty. Primary and secondary growth hormone deficiency are then explained, and treatment is outlined alongside GH resistance. It goes on to hypothyroidism, coeliac disease, skeletal dysplasias, and Turner syndrome. Small gestational age, and tall stature and rapid growth are all covered, alongside normal puberty, precocious puberty, and delayed or absent puberty. Normal sexual differentiation and disorders of sexual development and the assessment of ambiguous genitalia are included.
Diabetes
Authors: Thanabalasingham Gaya , Lumb Alistair , Murphy Helen , Scanlon Peter , Buckingham Jodie , Tesfaye Solomon , Pokrajac Ana , Choudhary Pratik , Divilly Patrick , Dhatariya Ketan , Ajjan Ramzi , Besser Rachel , Owen Katharine
Published: November 2021

This chapter provides a comprehensive overview of diabetes care and management. It starts with a classification and diagnosis of diabetes, followed by sections on expert management of both Type 1 and Type 2 diabetes. Living with diabetes is then explored, from sports and exercise, travel, alcohol and recreational drug use, and special considerations such as Ramadan. Hospital inpatient management and diabetes-related emergencies are covered in detail. Diabetes and pregnancy, and paediatric and transition diabetes both have sections explaining common and rare presentations. Finally there are sections on discrete diabetic conditions, such as diabetic eye disease, nephropathy and chronic kidney disease, neuropathy, the diabetic foot, and macrovascular disease.
Lipids and hyperlipidaemia
Authors: Karpe Fredrik
Published: November 2021

This chapter begins with lipids and coronary heart disease, and the assessment of CVD risk in the patient. It describes primary hyperlipidaemias, polygenic and familial hypercholesterolaemia, familial hypertriglyceridaemia, and rare genetic hypertriglyceridaemias. Elevation of Lp(a), rare familial mixed dyslipidaemias, secondary hyperlipidaemias, and drug therapy are all covered.
Obesity
Authors: Wilding John
Published: November 2021

This chapter covers the definition of obesity and goes into the epidemiology and aetiology of obesity. The pathophysiology and consequences of living as an obese person are commented on, and the management of the obese patient is covered. Finally, bariatric surgery is explained.
Good practice and safety
Authors: Freedman Rachel , Herbert Lara , O’Donnell Aidan , Ross Nicola , Marroquin-Harris Mincho
Published: November 2021

This introductory chapter is intended to emphasise the importance of two fundamental duties: the anaesthetist looking after the patient, and the anaesthetist looking after themselves. Looking after the patient requires building a culture of good practice, and encompasses perioperative safety, the causes of complications, briefing and debriefing, documentation, drug safety, vigilance and crisis management, handling of serious events, and evidence-based medicine. Self-care encompasses resilience, recognition of fatigue and burnout, mental health issues among anaesthetists, working while pregnant, personal protective equipment, manual handling, and dealing with a complaint.
Cardiovascular disease
Authors: Payne Sonja , Ip James , Martinez Guillermo , Payne Sonja , Jackson Tom
Published: November 2021

This chapter describes the anaesthetic management of the patient with cardiovascular disease. The topics include ischaemic heart disease (including perioperative myocardial infarction and percutaneous coronary intervention), valvular heart disease (incuding prosthetic valves), congenital heart disease, cardiomyopathy, pericardial disease, the patient with a transplanted heart, narrow complex arrhythmias, broad complex arrhythmias and heart block. For each topic, pre-operative investigation and optimisation, treatment, and anaesthetic management are described including peri-operative management of pre-existing arrhythmias (such as atrial fibrillation), and the patient with an implanted pacemaker or defibrillator.
Respiratory disease
Authors: Jarvis Sarah
Published: November 2021

This chapter describes the anaesthetic management of the patient with respiratory disease. It describes the assessment of respiratory function and pre-operative respiratory investigations, and ventilatory strategies to reduce pulmonary complications. Common respiratory conditions covered include respiratory tract infection; smoking; asthma; chronic obstructive pulmonary disease; bronchiectasis; cystic fibrosis; obstructive sleep apnoea; sarcoidosis; restrictive pulmonary disease, and the patient with a transplanted lung. For each topic, pre-operative investigation and optimisation, treatment, and anaesthetic management are described. Recommendations for the patient who may require post-operative respiratory support (e.g. non-invasive ventilation) are provided.
Neurological and muscular disorders
Authors: Young Adam , Kabadayi Selin , Marsh Sarah
Published: November 2021

This chapter describes the anaesthetic management of the patient with those neurological or muscular disorders which are relevant to anaesthetic practice, including malignant hyperthermia (MH). Other topics covered include epilepsy, cerebrovascular disease; Parkinson’s disease; spinal cord lesions; myasthenia gravis; multiple sclerosis; Guillain-Barré syndrome; motor neuron disease; dystrophia myotonica and the muscular dystrophies. For each topic, pre-operative investigation and optimisation, treatment, and anaesthetic management are described.
Conduct of anaesthesia
Authors: Newland John , (Henry) Wu Heng-Yi , Cardinal Alexandra , Eaddy Nicholas
Published: November 2021

This chapter describes the safe conduct of general anaesthesia. Topics covered include induction of anaesthesia; maintenance of anaesthesia; total intravenous anaesthesia; and volatile anaesthetic agents. The important methods of monitoring the patient are discussed in detail, including monitoring of neuromuscular blockade, depth of anaesthesia and cardiac output. The measurement and control of patient temperature is described. The common surgical positions are described, together with their safety concerns. The chapter finishes with a discussion of the prevention and treatment of postoperative nausea and vomiting.
Specific circumstances
Authors: Evans Matthew , Kelligher Leigh , Ritchie-McLean Susanna , Mathiszig-Lee Jakob , Stocker Mary , Bainbridge Laura
Published: November 2021

This chapter brings together a series of small but important topics relevant to the practice of anaesthesia. First, the oncological impact of anaesthesia is explored. Next, the specific circumstances of anaesthesia for laser surgery are discussed. The third topic is robotic-assisted surgery. The fourth is anaesthesia for day-case surgery. The next two topics are the neurological determination of death, and organ donation surgery. The chapter closes with a discussion of how to handle a major anaesthetic mishap.
Thoracic surgery
Authors: Earnshaw Charlotte , Kamalanathan Kajan
Published: November 2021

This chapter discusses the anaesthetic management of thoracic surgery. It begins with general principles of thoracic surgery, including isolation of the lungs, one-lung ventilation, and providing analgesia for thoracic surgery. Surgical procedures covered include rigid bronchoscopy and bronchial stent insertion; mediastinoscopy; wedge resection; lobectomy; pneumonectomy; thoracoscopy and video-assisted thoracoscopic surgery (VATS); drainage of empyema and decortications; lung volume reduction surgery and bullectomy; repair of bronchopleural fistula; pleurectomy and pleurodesis; oesophagectomy and surgical management of chest injuries.
Endocrine surgery
Authors: Ford Pete , Valentine Peter
Published: November 2021

This chapter discusses the anaesthetic management of endocrine surgery. Surgical procedures covered include thyroidectomy, parathyroidectomy, phaeochromocytoma and carcinoid tumours.
Ear, nose and throat surgery
Authors: Turner Grant
Published: November 2021

This chapter discusses the anaesthetic management of ear, nose and throat (ENT) surgery (otolaryngological surgery). It begins with a discussion of relevant general principles (including the shared airway), and covers airway obstruction and jet ventilation. Surgical procedures covered include grommet insertion; tonsillectomy; adenoidectomy; myringoplasty; stapedectomy; tympanoplasty; nasal cavity surgery; microlaryngoscopy; tracheostomy; laryngectomy; radical neck dissection, and parotidectomy. It includes pertinent anaesthetic features for a series of additional miscellaneous ENT procedures.
Drug formulary
Authors: Bradley Andrew
Published: November 2021

This chapter provides a drug formulary which is pertinent to the anaesthetist. Adult and paediatric doses of over 100 drugs are provided, and a series of infusion regimes is presented.
The detection of radio emission from known X-ray flaring star EXO 040830−7134.7
Authors: Driessen L N , Williams D R A , McDonald I , Stappers B W , Buckley D A H , Fender R P , Woudt P A
Published: November 2021

We report the detection of radio emission from the known X-ray flaring star EXO 040830−7134.7 during Karoo Array Telescope (MeerKAT) observations of the nearby cataclysmic variable VW Hydri. We have three epochs of MeerKAT observations, where the star is not detected in the first epoch, is detected in the second epoch, and is marginally detected in the third epoch. We cannot distinguish whether the detection is quiescent emission or a transient radio burst. If we assume that the radio detection is quiescent emission, the source lies somewhat to the right of the Güdel–Benz relation; however, if we assume that the upper limit on the radio non-detection is indicative of the quiescent emission, then the source lies directly on the relation. Both cases are broadly consistent with the relation. We use archival spectral energy distribution data and new Southern African Large Telescope high-resolution spectroscopy to confirm that EXO 040830−7134.7 is a chromospherically active M-dwarf with a temperature of 4000 ± 200 K of spectral type M0V. We use All-Sky Automated Survey (ASAS), All-Sky Automated Survey for Supernovae (ASAS-SN), and Transiting Exoplanet Survey Satellite (TESS) optical photometry to derive an improved rotational period of 5.18 ± 0.04 d. This is the first radio detection of the source, and the first MeerKAT detection of an M-dwarf.
Morpho-kinematics of the wind of asymptotic giant branch star L2 Pup
Authors: Hoai D T , Nhung P T , Darriulat P , Diep P N , Ngoc N B , Thai T T , Tuan-Anh P
Published: November 2021

Single-dish observations of asymptotic giant branch star L2 Pup have revealed exceptionally low mass-loss rate and expansion velocity, challenging interpretations in terms of standard wind models. Recent VLT and ALMA observations have drawn a detailed picture of the circumstellar envelope within ∼20 au from the centre of the star: a nearly edge-on rotating disc of gas and dust, probably hosting a planetary companion near the star. However, these observations provide no direct information on the wind escaping the gravity of the star. This article uses ALMA observations of the 12, 13CO(3-2), 29SiO(8-7), 12CO(2-1), and 28SiO(5-4) line emissions to shed new light on this issue. It shows the apparent normality of L2 Pup in terms of the formation of the nascent wind, with important line broadening within 4 au from the centre of the star, but no evidence for a wind flowing along the disc axis. At larger distances, up to some 200 au from the centre of the star, the wind morpho-kinematics is dominated by a disc, or equatorial enhancement, expanding isotropically and radially with a velocity not exceeding some 5 km s−1, inclined in the north-west/south-east direction with respect to the plane of the sky. In addition, outflows of lower density are observed on both sides of the disc, covering large solid angles about the disc axis, contributing about half the flux of the disc. Such morphology is at strong variance with the expectation of a pair of back-to-back outflows collimated by the central gas-and-dust disc.
Rate coefficients of the aluminium monoxide formation by radiative association
Authors: Bai Tianrui , Qin Zhi , Liu Linhua
Published: November 2021

Radiative association may be a key pathway for the formation of aluminium monoxide (AlO) in diffuse interstellar clouds, especially for the oxygen-rich asymptotic giant branch (AGB) stars. In this work, we investigated the radiative association of AlO by the collision of the aluminium and oxygen atoms in their electronic ground states, which is thought to be the most probable radiative association process. First, the potential energy curves for 12 electronic states and the dipole moments between these states were calculated by the state-of-the-art ab initio methodology. Then, the cross-sections and rate coefficients for the radiative association of AlO were computed for the temperatures in the range of 10–10 000 K. The total rate coefficients are of the order of 2.73 × 10−19–1.14 × 10−16 cm3 s−1, and the A2Π → X2Σ+, 12Δ → A2Π, 12Π → X2Σ+, and 22Σ− → A2Π transitions play a key role. The calculated results can be used to investigate the chemical evolution of dust formation in the photospheres of the oxygen-rich AGB stars.
Tobacco Retailers’ Support for Point-of-Sale Tobacco Control Policies in England: Association Study of Retailers’ Perceived Importance of Tobacco Sales, Contact with the Tobacco Industry, and the Perceived Impact of the Policy
Authors: van Deelen Tessa R D , Arnott Deborah , Hitchman Sara , van den Putte Bas , Kunst Anton E , Kuipers Mirte A G
Published: November 2021

Introduction

Political acceptability and successful implementation of tobacco control policies at the point of sale may depend on, among other factors, tobacco retailers’ level of support for these policies. This study quantified the level of support among small tobacco retailers for four point-of-sale tobacco control policies and its association with three predictors.

Methods

We used cross-sectional telephone survey data (August 2019) of 508 small tobacco retailers in England. Weighted logistic regression analyses examined associations between support for the product display ban, price display ban, minimum pack size, and standardized packaging, and self-reported importance of tobacco sales for a business, contact with the tobacco industry, and the perceived impact of the policy on their overall business.

Results

A majority of retailers support minimum pack size (66%), product display ban (65%), price display ban (54%), and standardized packaging (55%). The importance of tobacco sales was not associated with support for the policies. More frequent contact with the tobacco industry was associated with higher odds of support for minimum pack size (OR: 2.01, 95%CI:1.25–3.21), but not with the other three policies. The negative perceived impact of the policies, compared with neutral, was associated with 1.5 to three times lower odds of support for all four policies.

Conclusion

In England, small retailers’ support for the four point-of-sale tobacco control policies varied between 54% and 66%. Support seems unrelated to the perceived importance of tobacco sales, and contact with the tobacco industry, but seems strongly related to the perceived impact of tobacco control policies on their business.

Implications

This study shows that small independent retailers’ support for point-of-sale (PoS) tobacco control policies is fairly high and that the lack of support voiced by retail trade organizations is not representative of the views of retailers in England. Support rates may be further improved by addressing retailers’ perceptions of the impact of policies on their business. Support was not related to retailers’ perceived importance of tobacco sales for their business and their contact with the tobacco industry. The industry rhetoric is not supported by our findings, as the majority of small independent retailers in England support tobacco control regulations.
Introduction
Authors: Schwartz Ellen C.
Published: November 2021

The introduction to this handbook explains the scope and purpose of Byzantine art, architecture and visual culture from 330 to 1453, across the Eastern Mediterranean world, including Italy and the Balkans, Russia, and the Middle East. It begins with an overview of the role of the arts in religious and secular life, and explains the periodicization of the field into Early, Middle and Late phases as a useful way to consider these artistic productions. It presents the development in scholarly approaches that flow from the beginning phase of Byzantine art history when modern scholars were first discovering the wealth of Byzantine materials, to the later analysis and interpretation of the arts in their historical roles, and finally to the contemporary use of newer (including scientific) techniques and interdisciplinary approaches often incorporating methods from other fields. Consideration of the arts after 1453 that continue to show Byzantine influence is included. Dissemination of information including publications, digital opportunities and display in collections and exhibitions is discussed. The section presents information about the authors, the use of the handbook, and offers thoughts for future exploration in the field of Byzantine art.
Magic and Byzantine Art
Authors: Tuerk-Stonberg Jacquelyn
Published: November 2021

The term magic has been long understood as problematic. Studies of Byzantine magic have rapidly developed over the past several decades, and have come to suggest various ways of understanding the term. Two Early Byzantine amulets, serving as case studies, display conventional linguistic structures, including persuasive analogy, speech-acts, and show-acts. These linguistic structures and ways of organizing information operate equally in religious, medical, and philosophical examples. Accordingly, art and texts of ritual power exemplify intersecting communities of thought and are useful for interpreting various types of social practices. Magic studies are interdisciplinary, and as such they open new directions for the history of Byzantine art, Byzantine religion, Byzantine mentalities, Byzantine women, Byzantine Jews, and even a history of the Byzantine “individual.”
Secular Art
Authors: Parani Maria G.
Published: November 2021

The definition of Byzantine secular art remains problematic because of the interpenetration of the sacred and secular in all imperial domains, including the city, the home, and the church. Monumental and portable works of art regarded as secular due to their non-religious content or function were produced throughout the Byzantine era and served multiple roles. These included entertainment and indulgence in intellectual or other pleasurable pursuits; self-representation and the expression of ideological messages; protection against evil; and following current fashions. Innovation, invention, subjectivity, erudition, subversiveness, and humor, often associated with nudity and sexual innuendo, are all qualities thought to distinguish Byzantine secular art. The modes of its engagement with Greco-Roman art and with contemporary non-Byzantine artistic traditions need further study.
The Byzantine Arts and Byzantine Literature
Authors: Maguire Henry
Published: November 2021

This chapter examines the relationships between literary and visual forms in Byzantium. Both in the Early and in the later Byzantine periods there were clear parallels between the ways that literary and visual compositions were structured, whether through the rhetorical techniques of repetition, variation, and acrostic in Early Byzantine art, or through comparison and antithesis along with the selective realism of ekphrasis and ethopoiia, after Iconoclasm. These parallels involved both fundamental principles of design and organization and more isolated instances of quotation, raising the complex question of whether one medium can be said to have exerted influence on the other, or whether the same forms occurred in literature and the visual arts as parallel expressions of common habits of thought.
Georgia
Authors: Skhirtladze Zaza
Published: November 2021

Georgia’s location at the crossroads of East and West determined the character of its culture, expressed in architecture and the visual arts, among other spheres. Along with centuries-old original and uninterrupted local traditions, Georgia maintained a close relationship with the surrounding world and cultural circles throughout the Middle Ages. Particularly significant were aspirations of closeness to Byzantium and an active involvement in the Christian Orthodox commonwealth, based on common interests and confessional unity. All this is evident in the architecture and various artistic expressions of medieval Georgia, which are marked by a combination of original forms inspired by the Byzantine themes and elements.
Islamic States and the Middle East
Authors: Dodd Erica Cruikshank
Published: November 2021

Byzantine art, born in the Middle East, is still alive in the area. The oldest Christians in the world—Armenians, Copts, Georgians, Syrian, and Eastern Orthodox—still have vital communities in the Middle East that express themselves through later forms of “Byzantine” artistic language. Byzantine art developed through four historical periods in this area: (1) early formation and growth in the Middle East; (2) art under the Muslim conquest; (3) the continuing Christian art under Islamic domination; and (4) the Crusader period. Despite these cataclysmic changes, an artistic language led by Constantinople developed in this area and survives in the modern world, somewhat erratically, but distinctive nonetheless.
“Byzance apre`s Byzance” and Post-Byzantine Art from the Late Fifteenth Century through the Eighteenth Century
Authors: Schilb Henry D.
Published: November 2021

The study of the post-Byzantine world is now regarded as a field in its own right, separate from Byzantine studies or Renaissance studies. However, the scope of the discipline and the meaning of the term post-Byzantine—its conceptual, geographical, and chronological limits—remain unsettled. For art historians, the term typically refers to certain tendencies (especially in iconography and style) observable in and around one of a few centers of activity or spheres of influence within the Orthodox Christian world, typically identified as Ottoman-held vs. Venetian-held lands, or as Venetian Crete, Mt. Athos, and the “periphery” (i.e., everywhere else). Scholarly attention has also focused primarily on portable icons. Broadening the field to consider more types of objects across the whole geography under scrutiny, we can consider how art and ideas were received and adapted over time and across regions.
The Byzantine Revival in Europe
Authors: Bullen J. B.
Published: November 2021

The nineteenth-century interest in Byzantium was essentially a romantic revival following the Gothic revival, triggered by the imagination of Ludwig I of Bavaria and his passion for the Byzantine architecture of Italy. His acquisitional taste was taken up by his brother-in-law, Friedrich Wilhelm IV, in socio-political terms, and by Ludwig II on aesthetic terms. French interest in Byzantium was archaeological, connected to what was called Byzantine or Romanesque building in southwest France. Britain’s contribution was highly individualistic, depending on a small number of strong-minded characters who were willing to challenge the prevailing Gothic orthodoxies. Strengthened first by John Ruskin and then by William Morris, it shifted attention away from the “primitive” simplicity of Byzantine work to its simple majesty.
Secular Architecture: Domestic
Authors: Snively Carolyn S.
Published: November 2021

Byzantine domestic housing of the fourth–fifteenth centuries is preserved predominantly in the Balkans and Asia Minor. Peristyle houses dominate in the Early Byzantine period and continue later: their construction and decoration, subdivision, and disappearance in the sixth century have been studied. The Middle Byzantine courtyard house was a typically urban form, centrally located in towns with Classical predecessors; it provided privacy for the residents who may have been merchants dealing in agricultural or industrial products. Most people in the Byzantine period, however, probably lived in variations of the “longhouse,” in agriculturally based small towns and villages, where they shared living quarters with livestock. Houses in Late Byzantine/Frankish centers such as Mystras were large and elaborate longhouses in an urban setting.
Secular Architecture: Military
Authors: Arvanitopoulos Stavros I.
Published: November 2021

The Byzantine state inherited a large number of defensive structures, on its borders and in the hinterland where ancient cities were refortified in response to barbarian raids, primarily during the third century. The fundamental characteristics of fortification architecture developed during the sixth century. Nevertheless, criteria for the selection of the location, dimensions, and certain construction and morphological features of the forts, towers, and city/barrier walls, were continually adapted to changes in society and state until the end of the empire. Systematic study of the defensive architectural remains including excavation, creation of synthetic works, and reliable maps will allow researchers to date, compare, and understand the evolution of fortification architecture as well as aspects of daily life in the empire.