bluuebunny/crossref_metadata_2025 huggingface dataset:
Anesthetic Implications of Natural Orifice Translumenal Endoscopic Surgery (NOTES) and Single-Incision Laparoscopic Surgery (SILS)
Authors: Gromski Mark A. , Matthes Kai
Published: October 2018

This chapter introduces the concepts of natural orifice transluminal endoscopic surgery (NOTES) and single-incision laparoscopic surgery (SILS). The field of NOTES has evolved over the past decade, and this developmental framework is also outlined to help better understand the current state of the field. NOTES describes a minimally invasive approach to surgical diseases in which instruments are passed transluminally to achieve access to the desired body. SILS is a minimally invasive approach carried out as an extension of traditional laparoscopic surgery. The anesthetic implications of NOTES and SILS are explained, including potential complications that are unique to each. Finally, future directions in developmental endoscopy are discussed to give a sense of what types of procedures may become available or commonplace in the coming decade.
Electroconvulsive Therapy
Authors: Ross Lisa
Published: October 2018

The anesthetic management of patients who receive electroconvulsive therapy (ECT) for various psychiatric conditions in both the inpatient and the outpatient settings must take into account a number factors, such as its associated physiologic responses, existing comorbidities, medication management, monitoring, complications, and contraindications in order for it to remain a safe procedure. This chapter reviews the indications for ECT, the preprocedure anesthetic evaluation; theories regarding the therapeutic mechanism of action leading to the efficacy of ECT; cerebrovascular, cardiovascular, and neuroendocrine responses and monitoring standards. Furthermore, it discusses the selection of medications for induction, inhalational agents, and muscle relaxants as well as common drug interactions and premedication practices. The chapter culminates with an assessment of the morbidity and mortality associated with ECT both anesthetic and nonanesthetic related.
Anesthetic Considerations in Homeland Disasters
Authors: Perelmut Robert , Pretto Ernesto A.
Published: October 2018

This chapter will primarily focus on anesthetic considerations in homeland disasters likely to require the presence of the anesthesiologist in the out-of-hospital or prehospital environment. In order to understand the context within which anesthesiologists might be asked to function in the out-of-operating room setting during disaster response, we will provide a brief review of the disaster management functions of prehospital emergency medical services (EMS)/trauma systems. We will also describe the reorganization of hospital and intensive care services necessary to handle a surge of incoming critically injured or ill casualties. Our focus will be the role of the anesthesiologist, working in partnership with community or local EMS/trauma system and its network of hospitals, since the local EMS/ambulance system constitutes the basic functional unit of disaster medical response in the United States. We will end with a brief description of the major challenges we face in the delivery of intensive care services in mass and catastrophic casualty disasters.
Anesthesia Considerations in Dental Practice
Authors: Townsend Janice A. , Hernandez Gabriel , Harhad Lynda
Published: October 2018

Demand for anesthesia personnel outside of the operating room is increasing in dentistry. Anesthesia for dentistry is unique due to the shared airway and the limitations of the dental office environment. Knowledge of local anesthesia in dentistry is necessary as profound anesthesia is essential for sedation and may be indicated as an adjunct for general anesthesia. Nitrous oxide is also utilized alone or in conjunction with oral or parenteral sedation, and the anesthesia staff must be familiar with its use in dentistry. Stringent protocols for patient selection and monitoring are essential for safe administration of anesthesia in the dental setting.
Ultrarapid Opiate Detoxification
Authors: Gevirtz Clifford M. , Frost Elizabeth , Kaye Alan D.
Published: October 2018

Extended opioid use results in physical dependence and neural adaptation. Opioid dependence treatment can be carried out with opioid receptor agonists, partial agonists, and antagonists. Conventional treatments have low success rates. Methadone and buprenorphine treatments involve substituting long-duration agonists for the opiate of abuse, essentially substituting one opiate for another. Rapid opiate detoxification is a 3-day process involving large amounts of an opiate antagonist. Both treatments have associated problems. Ultrarapid opiate detoxification (UROD) anesthetizes a patient and precipitates withdrawal while unconscious. It shortens withdrawal, avoiding much of the subjective withdrawal discomfort. Clonidine is critical to reduce catecholamine levels and mitigate central nervous system hyperarousal in acute withdrawal. A UROD advantage is that the withdrawal period is markedly shortened to 8 hours or less versus up to several months for conventional treatments. The patient is anesthetized during the acute withdrawal period and does not experience the unpleasant consequences of acute detoxification.
Nonelective Care On Board an Aircraft
Authors: Connor Christopher , O’Brien Ben
Published: October 2018

The International Air Transport Association recognizes that “the airline is responsible for carrying its passengers safely and efficiently to the destination,” yet “the airline has no real means of ensuring that all passengers are fit to begin their journey.”1 There exists an extensive body of work, including textbooks and guidelines,2–4 to support prehospital in-flight care. These references deal with the challenges of emergent and elective aeromedical transport and repatriation, as would be confronted by a flight physician or flight nurse. This chapter, on the other hand, aims to support the anesthesia practitioner with a clinic or hospital-based practice, highlighting important factors to consider should he or she be called on to provide medical care and advice incidentally while on an aircraft as a passenger.
The Future of NORA
Authors: Matthews Donald M.
Published: October 2018

NORA is a very young field of anesthesia practice. The idea of a text concerning NORA would have seemed unlikely as recently as five years ago, so prognosticating about the future of NORA has potential pitfalls. Most particularly, the pace of change in medical practice can be very rapid, especially if a disruptive or innovative technology is introduced. None-the-less, certain predications can be made based on the rapid evolution of NORA. It will be interesting to look back in thirty years and to see what percentage of these predications prove to be accurate. This chapter discusses and predicts the future of NORA, its expected growth, and how facilities and practices will need to evolve to accommodate it.
Routine Clinical Electromyography
Authors: Katirji Bashar
Published: October 2018

Nerve conduction studies and needle EMG represent the two essential parts of the clinical EMG study. In almost all patients, both studies need to be completed before a final conclusion is made. This chapter outlines the basic concepts of nerve conduction studies including stimulations, recordings, variables and sources of errors. This is followed by detailed discussions of basic pathophysiological changes that accompany peripheral nerve disorders. The chapter then covers the normal needle EMG findings including normal insertional activity, motor unit action potential morphology and recruitment. This is followed by details on abnormal spontaneous activity findings and changes in motor unit action potential morphology and recruitment seen on needle EMG with peripheral nerve and muscle disorders.
Case 8
Authors: Katirji Bashar
Published: October 2018

Peroneal (fibular) neuropathy is the most common entrapment/compressive mononeuropathy in the lower extremity, often presenting with foot drop and numbness. The majority of the lesions are across the fibular neck, but more proximal and distal lesions exist. This case presents the clinical and electrodiagnostic findings in peroneal neuropathy and discusses in detail the differential diagnoses of foot drop. It highlights the importance of distinguishing peroneal nerve lesions from L5 radiculopathy, lumbar plexopathy, and sciatic neuropathy. Causes of acute and subacute peroneal mononeuropathies are emphasized.
Case 14
Authors: Katirji Bashar
Published: October 2018

Carpal tunnel syndrome is the most common entrapment neuropathy encountered in clinical practice. It is also the most common reason for referral to the electromyography laboratory. The anatomy of the median nerve and the carpal tunnel are outlined in details in this case presentation. The recommended nerve conduction studies needed to make a diagnosis are outlined. This includes internal comparison nerve conduction studies in which the median nerve is compared to a neighboring nerve such as ulnar or radial nerves, as well as the inching studies across the carpal tunnel. Finally, special situations are emphasized including severe carpal tunnel syndrome, carpal tunnel syndrome associated with peripheral polyneuropathy, carpal tunnel syndrome in the presence of Martin–Gruber anastomosis, and carpal tunnel syndrome during pregnancy.
Case 17
Authors: Katirji Bashar
Published: October 2018

Myasthenia gravis is a relatively common neuromuscular junction disorder. The diagnosis of myasthenia gravis may be challenging particularly in seronegative patients. This case starts by discussing the diagnostic modalities available to confirm the diagnosis of myasthenia gravis including serum antibodies, the Tensilon test, and the ice pack test. After a detailed discussion of the physiology of neuromuscular transmission, the case emphasizes the role of electrodiagnostic studies in the diagnosis of myasthenic gravis. This includes detailed findings on repetitive nerve stimulation recording distal and proximal muscles as well as single-fiber electromyography jitter studies. Finally, the diagnostic sensitivity of the available tests in myasthenia gravis is compared and a suggested electrodiagnostic strategy for patients with suspected myasthenic gravis is outlined.
Case 25
Authors: Katirji Bashar
Published: October 2018

Multifocal motor neuropathy (MMN) is a relatively rare chronic immune-mediated neuropathy. Distinguishing MMN from motor neuron disease is essential since the disorder is amenable to treatment. This case presents a patient with MMN and multiple conduction blocks of motor nerves. It highlights the total sparing of sensory nerve conduction studies. Criteria for the diagnosis of MMN are emphasized. The importance and relevance of serum anti-glycolipid antibodies and conduction blocks in the diagnosis of MMN remains a controversial issue. The differential diagnosis often includes chronic inflammatory demyelinating polyradiculoneuropathy and Lewis-Sumner syndrome (multifocal acquired demyelinating sensory and motor neuropathy).
A Case of Myelitis with a Positive Anticardiolipin Antibody
Authors: Miller Aaron E. , DeAngelis Tracy M. , Fabian Michelle , Sand Ilana Katz
Published: October 2018

Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by thromboembolic events and/or pregnancy morbidity in the setting of persistent antiphospholipid antibodies (aPL). APS may occur as a primary disorder or in the setting of underlying lupus. Common systemic manifestations include deep vein thrombosis and/or pulmonary embolism, livedo reticularis, thrombocytopenia, and fetal loss. The most common neurological consequence is stroke/transient ischemic attack (TIA) due either to in situ thrombosis or embolic disease. APS should be a primary consideration in a young patient with unexplained stroke/TIA. CNS abnormalities may occur in the absence of stroke, thought to be related to direct neuronal injury by aPL. Cognitive dysfunction is relatively common and has been shown to be associated with the presence of white matter lesions on MRI and livedo reticularis. T2 hyperintensities on MRI may be difficult to distinguish from those seen in multiple sclerosis. Less commonly reported neurological symptoms associated with aPL include chorea, transverse myelopathy, migraine, seizures, sensorineural hearing loss, and neuropsychiatric symptoms. Patients with stroke and persistent aPL should be treated with long-term anticoagulation. Select patients with other aPL-associated neurological syndromes may be treated with anticoagulation and/or immunomodulatory therapy on a case-by-case basis.
A Case of Stiffness in the Legs and Gradual Difficulty Walking
Authors: Miller Aaron E. , DeAngelis Tracy M. , Fabian Michelle , Sand Ilana Katz
Published: October 2018

Atlanto-axial subluxation, which causes a spastic paraparesis, is a relatively rare, but very important to recognize, complication of rheumatoid arthritis (RA). The presence of myelopathy usually warrants surgical intervention. Other central nervous system manifestations of RA are very unusual, but occasionally involvement of the leptomeninges occurs. A variety of peripheral neuropathies may occur, but most common are compressive neuropathies caused by tenosynovitis or joint deformities. In addition to the neurological complications of RA itself, a variety of neurological complications, both in the central and in the peripheral nervous systems, may be associated with the medications used to treat the disease.
Family Matters
Authors: Miller Aaron E. , DeAngelis Tracy M. , Fabian Michelle , Sand Ilana Katz
Published: October 2018

Many women with multiple sclerosis are diagnosed in their childbearing years. It is important to understand the impact of MS on pregnancy and the impact of pregnancy on MS. Children born to mothers with MS have an increased risk for getting MS themselves. Babies born to mothers with MS are equally healthy compared to control groups. The risk for MS relapse decreases during pregnancy, but there is an increased risk for relapse in the three-month postpartum period. Most MS medications need to be discontinued prior to conception. Breastfeeding may have a protective effect on the risk for postpartum relapse.
A SREATable Encephalopathy
Authors: Miller Aaron E. , DeAngelis Tracy M. , Fabian Michelle , Sand Ilana Katz
Published: October 2018

Steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT), more commonly known as Hashimoto’s encephalopathy, is a rare, poorly understood, and probably under-diagnosed disorder. SREAT is characterized by a progressive cognitive decline, with neuropsychiatric features and possible seizures, myoclonus, and tremors in association with the presence of anti-thyroid, anti-thyroid peroxidase (TPO) and/or anti-thyroglobulin (TG) antibodies. Importantly, alternative explanations for encephalopathy must be excluded. There are no specific clinical, radiographic, or EEG abnormalities. MRI brain and CSF analysis can be normal. Antithyroid antibodies, either in serum or CSF, provide the key diagnostic clue but are not clearly pathogenic. The hallmark of SREAT is an excellent therapeutic response to steroids.
The One-Sided Encephalitis
Authors: Miller Aaron E. , DeAngelis Tracy M. , Fabian Michelle , Sand Ilana Katz
Published: October 2018

Rasmussen’s encephalitis is a rare, progressive inflammatory disorder of unknown etiology, which results in focal seizures, hemiplegia, cognitive decline, and unihemispheric atrophy. It affects primarily children and young adults. In dominant hemisphere cases, aphasia occurs. The acute phase involves motor seizures, with 50% of patients presenting with epilepsia partialis continua. A chronic, “residual” phase ensues with decrease in seizure activity, atrophic changes on MRI and permanent neurological deficits. Pathophysiology is suspected to involve immune-mediated mechanisms promoting CNS neurodegeneration, but while glutamate receptor antibodies were of initial interest, identification of an exact pathogenic factor has been elusive. Trials of immunotherapies have, at best, slowed progression of disease, but none have been curative. Hemispherectomy remains the definitive treatment, resulting in seizure freedom in 70–80% of cases, but timing of surgery remains controversial, particularly in the acute phase, when diagnostic uncertainty still remains and immunotherapy and anti-epileptics offer temporizing options.
Teratoma: “It’s Driving Me Crazy”
Authors: Miller Aaron E. , DeAngelis Tracy M. , Fabian Michelle , Sand Ilana Katz
Published: October 2018

Anti-N-methyl-D-aspartate-receptor (NMDAR) encephalitis is a severe, but often reversible, form of encephalitis associated with autoantibodies to the NR1–NR2 heteromers of the NMDA receptor. It is a paraneoplastic, immune-mediated condition predominantly affecting young women with ovarian teratomas. Encephalitis in the setting of an ovarian tumor should immediately raise suspicion for anti-N-methyl-D-aspartate-receptor (NMDAR) encephalitis, a paraneoplastic syndrome, which is typically underdiagnosed and can be fatal. Clinical presentation involves a prodromal viral-like illness, followed by neuropsychiatric disturbances, dysautonomia, seizures, dyskinetic movements, and potential progression to coma and possibly death. Early diagnosis and treatment with immunotherapy and tumor removal are instrumental in optimizing patient outcomes, as this is a potentially reversible condition.
Gad-Awful Spasms
Authors: Miller Aaron E. , DeAngelis Tracy M. , Fabian Michelle , Sand Ilana Katz
Published: October 2018

Stiff person syndrome (SPS) is a rare autoimmune neurological disease that causes progressive, fluctuating, painful muscle rigidity and spasms, generally beginning in the axial muscles, truncal region, and progressing to proximal musculature. A hyperlordotic posture is considered an early clinical hallmark of the condition. The most common pathological correlate is with anti-glutamic acid decarboxylase (GAD) 65 antibodies, but several other associated antibodies have been identified There is a clinical spectrum of disease with variants including stiff leg syndrome, progressive encephalomyelitis with rigidity and myoclonus (PERM), and a paraneoplastic variant, often associated with anti-amphiphysin antibodies. Electromyographic findings reveal continuous motor activity. Treatment modalities for SPS focus primarily on symptomatic relief to improve quality of life. Gamma amino butyric acid (GABA)ergic agonists, including benzodiazepines, such as diazepam and baclofen, are first-line therapies for muscle rigidity and spasms. Immunotherapies such as corticosteroids, intravenous immunoglobulin (IVIg), plasmapheresis, and rituximab have demonstrated benefit, As symptoms can be provoked by anxiety and emotional stressors, psychological support with cognitive behavioral therapy should be considered.
To CIDP or Not to CIDP
Authors: Miller Aaron E. , DeAngelis Tracy M. , Fabian Michelle , Sand Ilana Katz
Published: October 2018

POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal plasma cell disorder, and skin changes) is a rare paraneoplastic syndrome. It is generally associated with an underlying plasma cell neoplasm, most commonly osteosclerotic myeloma. The most common paraprotein identified is either IgG or IgA lambda. The dominant symptom of POEMS is neuropathy, present in essentially all cases. The neuropathy of POEMS is a chronic progressive polyneuropathy with predominant motor disability. The fundamental treatment for POEMS is directed at the underlying systemic condition. Among the most commonly used therapies are steroids, alkylating chemotherapies, and autologous peripheral blood stem cell transplantation, as well as bortezomib, a protease inhibitor approved for the treatment of myeloma.
A Case of Relapsing Visual Loss
Authors: Miller Aaron E. , DeAngelis Tracy M. , Fabian Michelle , Sand Ilana Katz
Published: October 2018

Chronic relapsing optic neuritis (CRION) is a rare inflammatory condition that is characterized by repeated episodes of optic neuritis. Diagnostic testing for all other causes of optic neuropathy is negative in CRION, and the diagnosis is made on clinical grounds. At some point in the condition, both optic nerves are commonly affected. Eye pain often precedes the visual symptoms. Visual loss can be more severe than in optic neuritis from multiple sclerosis. Steroid dependence is usual, with a rebound in symptoms upon steroid discontinuation. Treatment involves high-dose steroids followed by a long taper. Most patients require long-term immunosuppression to maintain clinical stability.
Life Events Shape Us
Authors: Gorman Jack M.
Published: October 2018

Psychiatry downplayed the importance of life events in causing mental illness from the 1960s on, favoring a view that all disorders except one are the result of abnormal genes affecting chemical processes in the brain. Studying the exception, posttraumatic stress disorder (PTSD), when it was defined in 1980 helped lead to renewed recognition that early life adversity is central to all psychiatric conditions. At the same time, neuroscientists showed that early life experiences are capable of changing life-long behavior and brain function in laboratory animals. One mechanism by which this occurs is through the epigenetic regulation of gene expression. Epigenetics is the way that the expression levels of genes are controlled without changing the underlying genetic code. Epigenetics is an attractive way of understanding how individual life experiences are translated in the brain into each person’s unique set of emotions, behaviors, abilities, and risks for psychiatric abnormalities.
Bone and joint injuries of the hand
Authors: Mason Will , Warwick David
Published: October 2018

The small bones and joints of the hand are vulnerable to fracture and dislocation. These same structures need to be pain-free, stable, and mobile for proper function. Careful diagnosis and meticulous management is required. This may entail early mobilization (e.g. a metacarpal neck fracture) or temporary splinting (e.g. mallet fracture), early repair (e.g. unstable thumb ulnar collateral avulsion), complex sequential and dynamic splinting (e.g. central slip rupture); percutaneous wires (e.g. Bennett’s fracture) or plate fixation (e.g. displaced index metacarpal shaft). There is often a trade-off between the mobilization required to avoid stiffness and the immobilization required to allow anatomical healing. Rigid surgical fixation with meticulous hand therapy may both contribute in certain patients.
Tendons
Authors: Lamyman Michael , Dunn Roderick
Published: October 2018

The tendon chapter is written by surgeons together with hand therapists to describe tendon pathology and its treatment (including hand therapy). The anatomy of flexor and extensor tendons is detailed, along with zones of injury, surgical principles of tendon repair, and their rehabilitation. Late tendon reconstruction is also described including the principles of tenolysis and also tendon grafting. There is also a section on annular pulley injury and reconstruction. Inflammatory tendon pathology including trigger digits and tenosynovitis and tendonitis is described, along with a section on work-related upper limb disorder.
Children
Authors: Grant Ian , Dunn Roderick
Published: October 2018

Congenital hand anomalies are common and various, and the terminology may be confusing to the uninitiated. This chapter provides an overview of congenital hand anomalies, including general considerations about dealing with parents and children. Embryology, ossification of upper limb bones, and common classification systems are described. Aetiology, incidence, associated disorders, clinical features, and principles of surgical and conservative management are described where possible for each condition. At the end of the chapter there is a short section on specific considerations for the treatment of hand trauma in children.
Vascular
Authors: Sierakowski Adam , Warwick David , Dunn Roderick
Published: October 2018

Vascular pathology in the hand may present to many different specialties, and delayed referral to hand specialists is not unusual. We provide an overview of vascular hand anatomy and pathophysiology to enable early diagnosis and treatment. We discuss general assessment of vascular hand pathology, including vascular anomalies, vascular injury, and Raynaud’s disease. It is important to understand the diagnosis and emergency surgical treatment of compartment syndrome of the upper limb which if unrecognized can lead to permanent loss of function from post-ischaemic fibrosis (and may be less anticipated than lower limb compartment syndrome).
Necrotizing enterocolitis
Authors: Puntis John
Published: October 2018

Necrotizing enterocolitis is a common and serous disease predominantly affecting premature newborns, with an incidence, morbidity, and mortality that has remained unchanged for several decades. Around 7% of infants between 500g and 1500g birth weight are affected, with the disease often manifesting with vomiting, bilious aspirates, distended abdomen, and blood in stools around 8–10 days of age. Medical management includes decompression of the gastrointestinal tract via a nasogastric tube, broad-spectrum antibiotics, and bowel ‘rest’ (total parenteral nutrition). Surgical intervention is required for intestinal perforation or ongoing deterioration despite medical management. The pathogenesis is multifactorial and includes genetic predisposition, gastrointestinal immaturity, imbalance in microvascular tone, abnormal intestinal microbiological colonization, and a highly immunoreactive intestinal mucosa. Breast milk feeds appear to confer some degree of protection.
Intestinal failure
Authors: Batra Akshay , Puntis John
Published: October 2018

This chapter discusses the aetiology, prevalence, and management of intestinal failure in children. The commonest cause of intestinal failure is short bowel syndrome followed by disorders of intestinal motility and congenital enteropathies.
Food allergy
Authors: Puntis John
Published: October 2018

Food allergy is an immune response to food that can be classified as immunoglobulin (Ig)-E and non-IgE mediated. Milk, egg, peanut, tree nuts, and fish are among the most prevalent causes of food allergy. Mild reactions can include itchy rash, watering eyes, and nasal congestion while a severe reaction results in anaphylaxis. A detailed clinical history is essential when making a diagnosis, and skin prick testing and quantitative measurement of food-specific IgE antibodies can be helpful. Cow milk protein allergy causes a plethora of symptoms and frequently resolves spontaneously over the first 2 years of life; diagnosis is based mainly on clinical history. Food challenges have a pivotal role in the diagnosis of food allergy. Introduction of ‘allergic’ foods at 3–6 months alongside continuing breastfeeding may prevent allergy.
Acute gastroenteritis
Authors: Wiskin Anthony
Published: October 2018

This chapter covers acute gastroenteritis. It includes sections on aetiology, clinical features, differential diagnosis, assessment, management, and complications. It is practically focused for the practising clinician.
Helicobacter pylori infection and peptic ulceration
Authors: Beattie Mark
Published: October 2018

This chapter covers Helicobacter pylori infection and other causes of peptic ulceration. The section on Helicobacter pylori infection includes section on pathophysiology, investigation, and management.
Cyclical vomiting syndrome
Authors: Beattie Mark
Published: October 2018

This chapter covers cyclical vomiting syndrome (includes discussion of cyclical vomiting syndrome plus). There are sections on the clinical features, triggers, investigation, and management including prophylaxis.
Gastrointestinal bleeding
Authors: Howarth Lucy , Beattie Mark
Published: October 2018

This chapter covers the assessment and management of gastrointestinal bleeding in infancy and childhood. There are separate sections on upper and lower gastrointestinal bleeding. The chapter includes detail on the investigation, differential diagnosis, and practical management.
Nutritional management of Coeliac disease
Authors: Heather Nicky
Published: October 2018

This chapter discusses the nutritional management of coeliac disease. This includes the practicalities of the diet, nutritional assessment, and long term monitoring.
Bacterial overgrowth
Authors: Beattie Mark
Published: October 2018

This chapter discusses the aetiology, clinical features, assessment, and management of bacterial overgrowth.
Nutritional management of Crohn’s disease
Authors: Heather Nicky
Published: October 2018

This chapter discusses the nutritional management of Crohn’s disease. This includes assessment and practical management and a section on the use of exclusive enteral nutrition as primary treatment for Crohn’s disease.
Drug-induced liver injury
Authors: Hegarty Rob , Kiparissi Fevronia
Published: October 2018

The chapter on drug-induced liver injury discusses the definition, clinical manifestations, and then management of this frequently challenging to diagnose situation. It also covers in more detail the management of paracetamol overdose.
Wilson disease
Authors: Tanner Stuart
Published: October 2018

The chapter on Wilson disease covers the genetics, clinical signs, and symptoms and the criteria for diagnosis of this condition. It presents an evaluation of the various laboratory results as well as treatment with penicillamine or other drugs and of course the role of liver transplantation.
Bacterial, fungal, and parasitic infections of the liver
Authors: Verma Anita
Published: October 2018

The chapter on infections of the liver focuses on bacterial, fungal, and parasitic infections that may affect the organ. It includes liver abscess, cholangitis, spirochaetal, rickettsial, and fungal infections.
Liver tumours
Authors: Samyn Marianne
Published: October 2018

The chapter on liver tumours covers the features and management of infantile haemangiomas, mesenchymal hamartoma, focal nodular hyperplasia, nodular regenerative hyperplasia, hepatoblastoma, and hepatocellular carcinoma.
A framework of understanding
Authors: Harding Duncan
Published: October 2018

This chapter starts the work towards developing a framework of psychological understanding. The chapter begins with a consideration of mindfulness, the development of that skill on a daily basis, and how mindfulness might be useful in our approach to the interview. It considers motivations and expectations, both of us as candidates and of the examiner, not just during the interview, but if we are successful in getting the appointment. This chapter sets out an exercise in which we can learn how to ground ourselves in the moment and read our surroundings. Practising this technique on a daily basis will then allow us to read the interview room as second nature.
We all fail in interviews
Authors: Harding Duncan
Published: October 2018

This chapter considers failure in an interview, how it impacts on us as candidates, and how it can be utilized to improve our future performance. Learning from past mistakes is essential in the process of preparing and performing in an interview, and the best lessons are when things don’t go well. Loss and failure are an opportunity for growth if harnessed correctly. This chapter looks at techniques to employ during an interview, to help bounce back after mistakes have been made. The chapter also includes a practical exercise that can help us as candidates constructively analyse a failed interview after the event.
Confidence and self-belief
Authors: Harding Duncan
Published: October 2018

This chapter considers our confidence and self-belief with regards to the interview, and starts by discussing the concept of building a psychological scaffolding that underpins an interview performance. It goes on to consider being robust and resilient, and within that, the importance of understanding that we may fail and having the ability to reflect truthfully on what went wrong. The chapter then discusses interview clothing from a psychological perspective and provides an anecdote to reinforce the suggestion of wearing suitable attire. The chapter sees ourselves from the perspective of the examiner and ideas are suggested as to how we may question ourselves in order to strengthen our position as the best candidate. Finally, it thinks about optimization and belief in our own abilities.
Rehearsal strategies
Authors: Harding Duncan
Published: October 2018

Like most challenging tasks in life rehearsal helps us to improve our performance, and with the interview, rehearsal is essential. This chapter discusses rehearsal strategies for the interview, considering groups, courses, modelling, and feedback (both from the group and on video). The advantages and disadvantages of interview courses are discussed. The chapter explores the benefit of rehearsal groups, the importance of the correct composition of such groups to be a positive influence, and how to give constructive feedback without undermining confidence. The chapter continues with an explanation of the modelling process as a group rehearsal strategy and thinks about how to apply empathy in the rehearsal group in order to enhance communication during the interview. This chapter includes a useful exercise for an interview rehearsal group to work towards having a panoramic perspective of performance.
Skills toolkit 1: Building your toolkit
Authors: Harding Duncan
Published: October 2018

This chapter introduces the idea of a generic interview skills toolkit, what such a toolkit is, and describes the value of this toolkit in the interview. The chapter looks at contextually acquired skills and how these might be transformed into a more modular form. It then, by way of an exercise, looks at a method for extracting modular threads from our content skills for us to adapt these modules in any given interview situation. The chapter then discusses our modular skillset and considers how this might be usefully applied in the interview. The chapter explores the idea of being armed with an appropriate skillset which means we enter the interview unburdened by too much information, allowing us space to connect with the interview experience.
Skills toolkit 2: An authentic narrative
Authors: Harding Duncan
Published: October 2018

This chapter is concerned with narrative, and suggests a method for infusing your own interview answers with a narrative thread that will make them more accessible and interesting for the interviewer. It considers the value of narrative, then discusses being authentic: the importance of appearing authentic to our listeners, what it actually means to be authentic, and how to aim for congruence in what we say and how we come across. The chapter discusses a narrative framework, how to reframe an abstract fact, then considers a method by way of a structured exercise to find narrative within an answer to an interview question. Finally, the chapter considers the importance of believing the story and how to inject emotion into our narrative.
The MR scanner in a nutshell
Authors: Kozerke Sebastian , Boubertakh Redha , Miquel Marc
Published: October 2018

In the magnetic resonance (MR) scanner, a well-controlled interplay of a static main magnetic field, time-varying gradient magnetic fields, and radiofrequency fields is used to generate images. Here these three different types of magnetic or electromagnetic fields are summarized in relation to hardware components of the MR system. The sequential activation of gradient magnetic and radiofrequency fields, along with the data collection process, is accomplished using MR pulse sequences, of which the overall concept is outlined.
Spatial encoding and image reconstruction
Authors: Kozerke Sebastian , Boubertakh Redha , Miquel Marc
Published: October 2018

In order to form images with the required resolution and anatomical coverage, gradient magnetic fields are used to excite magnetization in a predefined slice or slab, with subsequent spatial encoding to obtain spatial resolution in the slice or slab. It is demonstrated how the spatial encoding principle is implemented and how it can be conceptualized using the so-called k-space representation. The relations between the field of view, spatial resolution, and k-space sampling are illustrated, along with the implementation using a simple pulse sequence. Once magnetic resonance data have been collected in k-space, the process of image reconstruction will yield the final images.
Scan acceleration
Authors: Kozerke Sebastian , Boubertakh Redha , Miquel Marc
Published: October 2018

In cardiovascular magnetic resonance imaging, scan time is of critical importance, as many applications require breath-holding to suppress respiratory-related image artefacts. In this chapter, approaches to reduce scan time, while maintaining resolution, are described. Besides partial sampling of k-space, non-Cartesian k-space trajectories are introduced, followed by an overview of data under-sampling techniques as they are implemented on clinical magnetic resonance systems. Advantages and limitations of each of these methods are briefly described.
MRI interactions with medical devices
Authors: Censi Federica , Mattei Eugenio , Calcagnini Giovanni
Published: October 2018

Given the particular environment created by a magnetic resonance imaging (MRI) scanner, various kinds of interaction can occur with other medical devices, depending on the nature of the device, active or passive, on the materials. Generally speaking, manufacturers of medical devices must analyse and indicate any potential risk related to reasonably foreseeable environmental conditions such as magnetic fields and to other medical treatments such as MRI. Thus, information about the compatibility of a medical device with MRI should be available on the device user manual. According to the latest international standard (ASTM 2503), a medical device can be magnetic resonance (MR) Safe, MR Conditional, and MR Unsafe. MR Safe poses no known hazards in all MRI environments; MR Conditional has been demonstrated to pose no known hazards in a specified MRI environment with specified conditions of use; MR Unsafe is known to pose hazards in all MRI environments. Implanted medical devices are those raising major concerns in MR environments. Each implanted device must be clearly identified, and it is important to screen each patient before MRI examination. The prevalence of patients with various kinds of implants is increasing. For these devices, it could be important to refer not only to the user manual, but also to the scientific literature. Indeed, it could happen that it is necessary to perform an MRI examination which does not completely respect the MRI conditions indicated by the device manufacturer. In these cases, the clinical or in vitro experiences reported in the scientific literature could help in yielding elements to support the medical decision.
Blood flow and phase contrast CMR
Authors: Witschey Walter RT , Markl Michael
Published: October 2018

Flow-sensitive cardiovascular magnetic resonance (CMR) is a widespread non-invasive imaging method for the clinical evaluation of blood flow in cardiovascular disease. The basic principle of phase contrast magnetic resonance imaging (MRI) is the use of bipolar gradients to encode blood velocity in the magnetic resonance (MR) signal phase. The most common type of flow-encoded scan two-dimensional (2D) cine phase contrast CMR with single-direction velocity encoding is clinically used to quantify cardiovascular flow and velocities. Trade-offs between resolution (temporal and spatial) and acquisition time are illustrated in the context of patient examination, considering high-velocity jet flow, patient breath-hold duration, respiratory motion artefacts, and patient comfort. In addition, the chapter describes how the velocity-to-noise ratio and aliasing behaviour of flow measurements are affected by the velocity-encoding sensitivity (VENC). An advantage of phase contrast MR is that flow encoding may be performed in all three spatial dimensions, improving peak velocity measurement accuracy. Several clinical applications (aortic stenosis, coarctation, and ventricular shunting) and best practices are explained in detail with illustrations. Analysis and post-processing of phase contrast data are summarized. The progressive development of advanced phase contrast techniques is discussed by adding incremental complexity, starting with 2D phase contrast (2D spatial and one-dimensional velocity) and ending with four-dimensional flow encoding (three-dimensional spatial and velocity). Methods to accelerate phase contrast, such as parallel imaging, are briefly discussed. Finally, the chapter concludes with a summary of emerging topics for accelerated scanning and special applications such as compressed sensing, real-time phase contrast, and ultra-short echo time imaging.
Chronic ischaemic heart disease
Authors: Gerber Bernhard L , Al-Mallah Mouaz H , Lima Joao AC , Ostovaneh Mohammad R
Published: October 2018

Chronic ischaemic heart disease (IHD) is one of the most common cardiac conditions worldwide and is generally caused by the consequences of coronary atherosclerosis, including myocardial infarction. Clinical challenges in chronic IHD include detection of myocardial ischaemia in symptomatic patients with suspected coronary artery disease (CAD), evaluation of myocardial viability in patients with established IHD and poor left ventricular ejection fraction (LVEF) when revascularization is considered, as well as risk stratification and identification of patients with chronic IHD at high risk of complications. Cardiovascular magnetic resonance (CMR) can provide vital answers to all three of these challenges. Stress CMR is now increasingly used to detect ischaemia by means of vasodilator stress perfusion or dobutamine stress contractile reserve stress imaging. For viability assessment, late gadolinium enhancement is currently the method of choice to detect myocardial infarction, and low-dose dobutamine stress magnetic resonance can provide additional information to determine viability and guide therapy. Cardiovascular risk in patients with chronic IHD is mainly determined by left ventricular function, most commonly utilizing LVEF, as well as infarct size, infarct characteristics, and ischaemic burden, which can all be measured reliably with CMR. This chapter will review the role of CMR for the detection of myocardial ischaemia, viability, and risk.
Hypertrophic cardiomyopathy
Authors: Chan Carmen , Maron Martin S
Published: October 2018

Hypertrophic cardiomyopathy (HCM) is a genetic cardiomyopathy and the most common cause of sudden death in young people, as well as a cause of limiting heart failure symptoms at any age. Mutations in the cardiac sarcomere, the structural apparatus of the heart muscle, cause HCM and a diagnosis is made when maximal left ventricular (LV) wall thickness is ≥15 mm in the absence of another cause. Cardiovascular magnetic resonance (CMR) can reliably identify areas of increased LV wall thickness, as well as detailed characterization of myocardial structures such as the papillary muscles and mitral valve, with implications on management strategies. In addition, contrast-enhanced CMR with late gadolinium enhancement sequences (LGE) can identify areas of myocardial fibrosis/scarring in patients with HCM. Extensive LGE is an important marker for development of future systolic dysfunction and may identify patients at increased risk for ventricular tachyarrhythmias and cardiac mortality. As a result, CMR currently serves an important and evolving role in the evaluation of HCM patients by providing information with regard to diagnosis, morphology, and clinical course in HCM patients.
Arrhythmogenic cardiomyopathy
Authors: Marcus Frank I , Tandri Harikrishna , Marra Martina Perazzolo , Abidov Aiden
Published: October 2018

Arrhythmogenic cardiomyopathy is a genetic disease that is manifested clinically with ventricular arrhythmias between the ages of 20 and 50. There is no single ‘standard’ for the diagnosis that needs to be based on a combination of electrical structural and genetic abnormalities. Two-dimensional echocardiography is the usual imaging modality that is preferred in patients suspected of the disease, but cardiovascular magnetic resonance has the advantage of quantitative assessment of right and left ventricular function, as well as being more precise in evaluating cardiac wall motion abnormalities. Other imaging modalities, such as three-dimensional echocardiography and cardiac computed tomography scanning, are promising diagnostic techniques in identifying those individuals who present with dominant left ventricular involvement.
Chagas’ cardiomyopathy
Authors: Rochitte Carlos Eduardo , Coelho-Filho Otávio Rizzi
Published: October 2018

Chagas’ cardiomyopathy is a major complication emerging from Trypanosoma cruzi infection, appearing in up to 30% of individuals with positive serology and being the principal cause of death from heart failure in some areas of South America. The natural history of Chagas’ cardiomyopathy classically includes two phases: an acute phase, typically with absence of symptoms to mild, non-specific symptoms, and a chronic phase which comprises two forms of disease—an indeterminate (latent, pre-clinical) form and a determinate or clinical form. Patients with the indeterminate form may be asymptomatic for decades, until unidentified triggers initiate disease progression to chronic chagasic cardiomyopathy, manifesting in a broad range of clinical presentations, including cardiac arrhythmias, thromboembolism, heart failure, and sudden death. Non-invasive imaging modalities capable of characterizing not only cardiac morphology and function, but also myocardial tissue remodelling and disease progression, may play an important role in Chagas’ disease. Myocardial late gadolinium enhancement by cardiovascular magnetic resonance (CMR) has been considered the most accurate method to detect myocardial fibrosis in ischaemic and non-ischaemic cardiomyopathy, including Chagas’ cardiomyopathy. Myocardial tissue characterization, uniquely provided by CMR, holds enormous potential within a complex and not completely understood cardiomyopathy, with poor prognosis and limited therapeutic options. This chapter aims to discuss several relevant aspects of Chagas’ cardiomyopathy, focusing on the usefulness of CMR in the diagnosis and risk stratification of affected patients.
Transplant cardiomyopathy
Authors: Miller Christopher A , Jordan Jennifer H , Angelini Annalisa , Hundley W Gregory , Schmitt Matthias
Published: October 2018

Heart transplant recipients present with a unique set of anatomical and pathophysiological considerations. Cardiac allograft disease often presents non-specifically, requiring a low index for further investigation. Accurate assessment with standard imaging modalities can be difficult, and cardiovascular magnetic resonance (CMR) is increasingly requested for further clarification. The anatomy of the transplanted heart, common transplant pathologies, and the role of CMR are described.
Cardiac involvement in oncologic patients
Authors: Jordan Jennifer H , Schmitt Matthias , Miller Christopher A , Angelini Annalisa , Hundley W Gregory
Published: October 2018

As cancer survival rates improve, the development of chemotherapy-induced cardiotoxicity is becoming increasingly relevant and more widely recognized. Childhood survivors of cancer are seven times more likely to die from cardiac causes and 15 times more likely to develop heart failure than their contemporaries. It is not only well-established chemotherapeutic agents that promote cardiac morbidity, but also many newer ‘targeted’ agents share cancer and cardiac receptor targets that also promote cardiovascular injury. This chapter addresses how the imaging specialist may interact with patients receiving potentially cardiotoxic cancer treatment in three clinical scenarios: baseline assessment of cardiac anatomy and function, assessment of acute and subacute treatment-related complications, and long-term surveillance of cardiotoxicity.