bluuebunny/crossref_metadata_2025 huggingface dataset:
Talking to adolescents
Authors: Wrate R M
Published: November 2023

Adolescents, because of their particular developmental concerns and vulnerabilities, present doctors with special problems in communication. Because of the proximity of their own adolescence, medical students can tune in to what an adolescent is saying much more readily than an older doctor. But this close identification with adolescents’ attitudes and concerns can make it much more difficult for the student to form an objective, detached assessment of the extent and nature of problems within families. By and large, they are a healthy group; medical contact is more likely to arise as a result of psycho-social problems than from physical illness. Apart from the regular medical consultations associated with the treatment of chronic disorders, such as juvenile diabetes, rheumatoid arthritis, sensory impairment, and so on, the physical conditions in adolescents for which medical advice is most frequently sought are glandular fever, traumatic injury, and pregnancy. However, the last two are often associated with psycho-social problems, and these also complicate, or contribute significantly to, the functional impairment of adolescents with chronic disability.
Constructing a curriculum
Authors: Havelock Peter , Hasler John , Flew Richard , Mcintyre Donald , Schofield Theo , Toby John
Published: November 2023

Two aims of vocational training were identified at the beginning of Chapter 3; first, that at the end of training the trainee will have acquired the ability to perform the work of general practitioner competently, and, secondly, that the trainee will be able to continue, develop, and maintain that competence, and to adapt to change over a professional lifetime. In this chapter we shall review briefly some previous work that attempts to define a curriculum for general practice education, and suggest a three-stage model for the trainee year. Then we shall examine the content and context of general practice and the attributes needed of the doctor.
Assessment for learning
Authors: Havelock Peter , Hasler John , Flew Richard , Mcintyre Donald , Schofield Theo , Toby John
Published: November 2023

Chapter 4 discussed what trainees need to learn, and a three-stage model for the trainee year was suggested. In this chapter ways of establishing the trainee’s strengths and weaknesses, and how to measure his or her progress will be discussed. This process of ‘assessment’ must be distinguished from ‘evaluation’, which refers to a review of the teaching process. In other words, assessment looks at the trainee: evaluation looks at the trainer and training package—this is examined in detail in Chapter 11.
Crescentic nephritis in systemic lupus erythematosus
Authors: III Howard A Austin , Boumpas Dimitrios T , Balow James E
Published: November 2023

Glomerulonephritis is a major determinant of the course and prognosis of systemic lupus erythematosus (SLE). Although nearly the entire spectrum of glomerular, interstitial, and vascular lesions is seen in lupus nephritis, severe crescentic glomerulonephritis, and its usual clinical counterpart, rapidly progressive glomerulonephritis, characterize a relatively small subset of patients (<10%) early in the course of SLE.
Novel treatment strategics in rapidly progressive glomerulonephritis
Authors: Mathieson Peter W , Lockwood C Martin
Published: November 2023

There is no other area in nephrology in which such radical transformation in prognosis has occurred during the last 20 years as it has for patients with rapidly progressive glomerulonephritis (RPGN). In 1973, the outlook for kidney survival was dismal (Cameron 1978). Now nephrologists expect most patients with RPGN to achieve sustained recovery of renal function, even if they present dependent on dialysis. What has led to these increased expectations? Undoubtedly, a major factor has been the recognition that autoimmune mechanisms play an important role in the development of almost all forms of RPGN, leading to the realization that treatment with immunosuppressive drugs can be swiftly effective.
The King’s Medical Firm in the Community
Authors: Collcrton Joanna , Booton Paul
Published: November 2023

The King’s Medical Firm in the Community (KMFC) was the first initiative aiming to teach a major hospital specialty, in this case general medicine, from a primary care base. This chapter describes the background to the firm’s inception and its evolution to the present day. The concept behind KMFC arose from local plans to develop a more communityorientated teaching hospital (the King’s 2000 Plan). Medical advances and changes in health service provision were resulting in a fall in in-patient numbers which, together with the increasing specialization of consultants, meant that students attached to traditional hospital medical firms were having less adequate clinical experience. The community offered a more representative case mix, the opportunity to see patients in their psychosocial context, and an experienced group of community-based teachers in the GP tutors who were currently teaching on the general practice firm.
Quality assurance
Authors: Elliott AT
Published: November 2023

Quality assurance (QA) is the archetypal topic ‘more honoured in the breach than the observance’. Nevertheless, it is of vital importance if the best possible patient service is to be provided and should form part of the routine of every department. The aims are to ensure that the equipment meets (and preferably surpasses) specification and to keep it operating at peak performance. The two most important facets of a QA program are to produce objective (usually, quantitative) data and to keep adequate records, both of those results and of equipment faults. Guidance on QA is offered in the publications of the Hospital Physicists’ Association [1], Institute of Physical Sciences in Medicine [2], American Association of Physicists in Medicine [3], World Health Organisation [4] and the US Department of Health and Human Services [5-7).
The central nervous system
Authors: Smith Francis W
Published: November 2023

the principles and technique of radionuclide brain imaging is important. The central nervous system can be studied in a number of ways using different radiopharmaceuticals and techniques. The brain study is used not only to detect intracranial pathology but also to assess carotid and intracranial bloodflow. The development of radiopharmaceuticals which are trapped by cerebral grey matter enables the estimation of regional cerebral bloodflow by a non-invasive method. The study of the ventricular system and the kinetics of cerebrospinal fluid is also possible.
Thyroid, parathyroid, and adrenal gland imaging
Authors: Martin W H , Sandler M P , Shapiro, B , Gross M D
Published: November 2023

Thyroid, parathyroid, and adrenal gland disorders affect a wide spectrum of our population from the fetus and neonate through the adolescent and young adult to the middle-aged adult and the elderly. Numerous imaging modalities, including nuclear medicine, ultrasound, computerized tomography (CT), and magnetic resonance imaging (MRI), have been used in an attempt to provide a pathophysiologically related diagnosis in patients with diseases of the thyroid, adrenal, and parathyroid glands.
Tumour imaging
Authors: Perkins AC
Published: November 2023

Figures released from the Cancer Research Campaign show that in 1993 there were 161 770 deaths from cancer in the United Kingdom and that 1 in 3 people suffer from cancer during their lifetime. Nearly half of all cancer deaths are due to just four types of cancer those of lung, breast, prostate, and colon. In males and females respectively cancers of the lung and breast are by far the most common accounting for 30% and 19% of cancers occurring within each sex.
99m-technetium pertechnetate
Authors: Smith Francis W
Published: November 2023

Technetium is the forty-third element in the periodic table. It was not conclusively isolated until 1936, when Perrier and Segre showed that radioactivity obtained by the irradiation of molybdenum with deuterons in the Berkeley cyclotron belonged to isotopes of the ‘missing’ element ekamanganese. Only in 1947 was it named technetium from the Greek word meaning artificial. Today 21 isotopes and numerous isomers of this element, with mass numbers ranging from 90 to 110, are known. The half-lives of these isotopes range from less than one second to 4.2 X 106 years; 99mTc is the most significant of the metastable isotopes, emitting gamma-rays to decay with a half-life of 6 h to 99Tc which has a half-life of Technetium-99m has gained importance as a radionuclide for nuclear medicine imaging because of its favourable biodistribution, excretion characteristics, and relatively short physical half-life, coupled with its 140 keV gamma emission.
Introduction
Authors: Heather Nick , Robertson Ian
Published: November 2023

This book is written for the wide range of people with a professional interest in alcohol problems. It aims to describe and summarize the important changes which have taken place over the last 25 years or so in the scientific understanding of problem drinking. But although written mainly for the student reader, the book is not simply another general introduction to the subject of alcoholism. It has a more specific purpose than that. The main intention is to present a sustained argument, one which derives from recent scientific advances but which, as far as we are aware, has not been made widely available before in Britain.
The evidence
Authors: Heather Nick , Robertson Ian
Published: November 2023

We have seen that the twentieth-century disease theory of alcoholism began to look suspect when it emerged from the relative obscurity of its origins in the Alcoholism Movement and was subjected to the light of scientific scrutiny. Here we will examine the various lines of evidence which are relevant to an evaluation of the disease concept of alcoholism described in the last chapter. We make no bones, however, about our ultimate intention in this chapter, which is to show that the disease theory simply cannot handle the facts.
Pros and cons of the disease perspective
Authors: Heather Nick , Robertson Ian
Published: November 2023

In his classic discussion of the disease theory of alcoholism’, E. M. Jellinek made the following statement: ‘It comes to this, that a disease is what the medical profession recognizes as such.’ With the benefit of hindsight, we may now conclude that Jellinek was both right and wrong when he made this much-quoted remark.
Cognition
Authors: Heather Nick , Robertson Ian
Published: November 2023

Having covered the two earliest forms in the last chapter, we now ascend the phylogenetic scale and tum to higher forms of learning. The relationship between the various forms of learning is complex and inadequately understood. What we can be certain of is that there is no contradiction in using both conditioning and higher forms of learning to explain alcohol problems; indeed, we need both to come anywhere near a proper understanding.
Patient assessment
Authors: Wardrope Jim. , English Bryan
Published: November 2023

90 per cent of patients with soft-tissue problems present after an episode of trauma. Management is often straight-forward.10 per cent of patients present with musculo-skeletal pain with no history of trauma. These patients require careful assessment.If there is no history of trauma exclude sepsis, ischaemic syndromes, referred pain, and epiphyseal problems.
Quality assurance in radiotherapy physics
Authors: McKenzie A L , Kehoe T M , Thwaites D I
Published: November 2023

Traditionally in radiotherapy, the term ‘quality assurance’ has been applied to programmes for checking the performance of radiotherapy equipment and for measuring, against agreed criteria, the characteristics and parameters of the output from the equipment, such as radiation beams, images or treatment plans. These programmes are intended to give assurance that, ultimately, radiation dose will be delivered to target volumes with specified accuracy. It is possible to produce such programmes for all of the equipment and techniques described in this book, but, taking a wider view, it becomes clear that, while these programmes are requirements for quality, they are not sufficient m themselves to give the desired assurance.
Epidemiology of end-stage renal failure: a global perspective
Authors: Wing A J , Jones E
Published: November 2023

The ultimate problem resulting from progressive renal disease is end-stage renal failure (ESRF). Many diseases and the interplay of a spectrum of mechanisms result in damaged kidneys which are doomed to be incapable of maintaining the integrity of the internal environment on which life depends. Description of the numbers of patients suffering from these conditions is the business of epidemiology. The tool of its trade is the classification and nomenclature of renal diseases.
Experimental insights into the mechanisms of tubulo-interstitial scarring
Authors: Jernigan Stephanie M , Eddy Allison A
Published: November 2023

The relationship of chronic tubulo-interstitial disease to the decline in renal function and long-term prognosis was first highlighted in the landmark structure-function studies by Risdon et al. [I] and Schainuck et al. [2]. Investigators today continue to reaffirm the importance of chronic damage to tubules and the surrounding interstitial space to renal failure progression [3,4] and to search for the mechanisms involved in the development of glomerular and tubulo-interstitial fibrosis. It is likely that the pathogenesis is similar in each compartment of the kidney but not identical. In addition, pathways involved in interstitial fibrosis overlap with the normal repair process in tissues and may be reversible at some level. In this chapter current concepts of the pathogenesis of renal interstitial fibrosis will be reviewed. A schematic overview of these pathways is summarized in Fig. 4.1. Several theories have been proposed as initiating events in the pathogenesis of interstitial scarring (Table 4.1).
Hypertension in renal parenchymal disease: role in progression
Authors: Dworkin Lance D , Weir Nlatlzew R
Published: November 2023

Hypertension is both a cause and consequence of chronic renal disease. After diabetic nephropathy, systemic hypertension is the second most common factor identified as causing end-stage renal disease (ERSD) and accounts for approximately one-fourth of all patients currently receiving dialysis in the United States. Even in those individuals in whom hypertension is not the primary cause of renal disease, elevations in systemic blood pressure may accelerate the rate at which kidney function is lost. This is particularly true for patients with glomerular disease and clinically evident proteinuria. Numerous studies in experimental animals and in humans suggest that antihypertensive drugs can slow the rate at which glomerular filtration rate (GFR) declines in chronic renal disease. Drugs that inhibit the renin-angiotensin system may be particularly effective in retarding renal disease progression.
The natural history and management of renovascular disease
Authors: Scoble John E
Published: November 2023

In the recent past the natural history of major renal diseases would not have included a chapter on renovascular disease. The presentations of renovascular disease are diverse and complex (Table 9.1), and this chapter represents a recognition of renovascular disease as a major cause of acute [l] and chronic renal failure [2]. Renovascular disease is important in the pediatric population as a cause of hypertension [3] but the importance of the atherosclerotic renal artery stenosis (ARAS) as a cause of end-stage renal failure in the older population becomes clearer with each year [4-6]. It possibly now represents the single most common cause of end-stage renal failure in patients over the age of 60years [5,6].
Prevalence and predictors of nephropathy in patients with type 2 diabetes
Authors: Estacio Raymond O , Mehler Philip , Schrier Robert W
Published: November 2023

In 1997, the Center for Disease Control and Prevention (CDC) announced their statistics about the prevalence of type 2 diabetes mellitus. The results were alarming. There are about 16 million cases in the United States and that number is growing. The increased prevalence of diabetes in minority populations is equally alarming. Both in the United States and in developing countries, as compared with White Americans with type 2 diabetes, African-Americans, Native-Americans, and Asian-Americans have a two to six times greater prevalence. Estimates are that the rising global burden will increase the worldwide total of diabetics from 123 million to 220 million by the year 2010.
Diabetic nephropathy: animal models of human type 2 diabetes
Authors: Perico Norberto , Remuzzi Giuseppe
Published: November 2023

Diabetic nephropathy is one of the most common disabling complications of diabetes mellitus (Ruggenenti and Remuzzi 1997). It is characterized clinically by the development of persistent proteinuria, hypertension, and progressive loss of renal function. This complication can occur in patients with either insulin dependent (type 1 diabetes) and non-insulin dependent diabetes mellitus (type 2 diabetes) (Gellman et al. 1959; Andersen et al. 1983), and, if left untreated, it frequently leads to progressive renal structural damage, terminating in end-stage renal disease (ESRD).
Lipid management in type 2 diabetes with nephropathy
Authors: Zimmermann Josef , Wanner Christoph , Quaschning Thomas
Published: November 2023

Diabetic nephropathy is one major complication of diabetes mellitus.In about 40% of all dialysis patients today, diabetic nephropathy is the cause for terminal renal failure. In addition to hypertension, glycaemic control, and genetic influence, diabetic dyslipidaemia plays an important role in the pathophysiology and progression of vascular disease and probably also diabetic nephropathy.; About 30% of all patients with diabetes mellitus develop overt nephropathy which additionally impairs lipid metabolism.
Management of the patient with type 2 diabetes and renal failure
Authors: Ritz Eberhard , Rychlik Ivan
Published: November 2023

The high incidence of proteinuria and renal failure in patients with diabetes mellitus has been known for more than a century. At that time little could be done about it. With the relatively recent introduction of effective renal replacement therapies the management of diabetic patients with renal failure has become a major challenge, however. Maintenance haemodialysis in the diabetic was used as early as 1966, but results were poor.
Innovation in primary care for older people - what went wrong?
Authors: Iliffe Steve , Drennan Vari
Published: November 2023

In 1948 the National Health Service (NHS) inherited a massive amount of unmet medical need, especially amongst the older generation that had not been the focus for pre-war efforts to improve child and maternal health, or to eradicate infectious disease. This included a backlog of endlessly-postponed gynaecological surgery, and a cohort of old men sitting at home with catheterized bladders for want of prostate operations. The NHS made dentures for edentulous pensioners previously denied access to dental care through lack of money and a shortage of dentists, and corrected short-sightedness and cataract in the three-quarters of the population who had never had access to free ophthalmic services. It is no surprise that the first recipient generation described their NHS as ‘the envy of the world’, for it rewarded them for their efforts, suffering and sacrifice in wars and economic depression.
Promoting continence with older adults: Mandy Wells, Continence Nurse Specialist
Authors: Iliffe Steve , Drennan Vari
Published: November 2023

The health visitor had arranged a home visit to Mrs N. for an annual over-75 assessment. Mrs N. had some problems with arthritis but had not been seen by anyone at the surgery for some time. Mrs N. opened the front door to her flat, greeted the health visitor, then slowly led the way to the front room. As she did so the health visitor noticed a wet patch on the seat of her skirt. Mrs N. sat down in her armchair and the pungent scent of urine wafted across to the health visitor, seated nearby. After settling themselves down, the health visitor started working her way through her list of areas to be explored, offering health promotion advice and suggestions as problems were identified. She then asked, ‘Any problems with your bladder or bowels?’. ‘No; said Mrs N. looking the health visitor squarely in the eye. ‘So, no difficulties with your waterworks?’ asked the health visitor, checking the language was understood. .
Depression, anxiety, and dementia
Authors: Iliffe Steve , Drennan Vari
Published: November 2023

Old age brings plenty of problems. As we age we may face ill health, disability, dependency in ourselves or our spouse, problems with our housing, growing fear of our own vulnerability to crime, the desolation of social isolation and loneliness, and lower incomes. Our families give us other problems to worry about - separation, illness, failure, tragedy - and may not be willing or able to help us when we need them. Later life’s a problem list, and then you die! Looked at that way, depression and anxiety in old age become understandable, even ‘normal’ responses to declining faculties and dwindling resources. Dementia then becomes the cruellest way of outliving yourself, from which those of sound mind (even if not body) recoil in horror. Professionals and public alike can turn away from such problems, fatalistically attributing them to ageing because they believe that so little can be done.
Pregnancy in women on renal replacement therapy
Authors: Jacobs Claude
Published: November 2023

The hormonal abnormalities that are commonly encountered in women with advanced/ end-stage renal disease (ESRD) strongly interfere ,With conception and successful outcome of pregnancy. They are very incompletely—if at all—corrected with well-conducted dialysis treatment. Pregnancy is, thus, a rare event among women of childbearing age who undergo long-term hemodialysis (IID) or peritoneal dialysis (PD). In contrast, pregnancies are much more common among women whose renal function is restored thanks to a successful transplant, with, in most cases, an excellent outcome and a very low rate of short- or long-term complications in mothers and children.
Renal replacement therapy for diabetic patients with end-stage renal disease (ESRD)
Authors: Jacobs Claude
Published: November 2023

The course of events that have developed over the past 20 years in the domain of ESRD in diabetic patients, well illustrates the current popular saying, according to which ‘one should never make predictions, especially for the future’. Indeed, the paper authored by W.J. Kolff et al. in 1972, based on the outcome of nine insulin-receiving diabetic patients treated ,With maintenance hemodialysis (HD) for a maximum duration of 20 months, stated that ‘Dialysis for such patients should be considered as a palliative measure with little likelihood of long-term survival or improvement in quality of life’ (1). A quarter-century later, diabetic patients account for 15-40% of all the new patients taken yearly on renal replacement therapy (RRT) in most of the economically developed countries, and their survival rates on dialysis or transplantation come steadily closer to that of non-diabetic patients of comparable age-range.
Ethical conflicts in renal replacement therapies
Authors: Kjellstrand J Cecilia , Kjellstrand Carl M
Published: November 2023

The speed of technology in the field of nephrology continues to accelerate, causing unexpected ethical conflicts for physicians. The physician still must balance the four generally recognized ethical principals of beneficence, non-maleficence, autonomy, and justice against each other, but is further called upon to strike this balance in increasingly complex ways. Physicians also have to fulfill an often overlooked ethical obligation, that of advocacy. This is a duty to patient groups, as well as to individuals. For nephrologists it is patients with end-stage renal failure for whom we advocate. Advocacy is necessary to secure enough funds to apply the treatments to all in need and to avoid rationing. It makes physicians compete with the conflicting financial demands of other societal needs, such as defense and education. They also face colleagues who are also advocating for other patient groups for limited funding. The physician-advocate has to harass politicians and bureaucrats and vie with other physicians to secure funds for their patients in need.
Treatment strategies for end-stage renal failure in developing countries
Authors: Davison Alex M , Barsoum Rashad , Lai Kar Neng , Mani M K , Morad Zaki , Rutkowski Boleslaw
Published: November 2023

Hemodialysis was first introduced for the treatment of acute renal failure but it soon became obvious that a number of patients did not have a satisfactory return of renal function and so the clinician was faced with the decision of stopping further dialysis or finding a satisfactory method of providing long-term therapy. In addition, it also became obvious that treatment suitable for acute renal failure could be applied to patients ,With end-stage irreversible renal failure. The major obstacle to overcome was the development of a means of achieving repeated vascular access and, had it not been for the Teflon-silastic® shunt, and subsequently the subcutaneous arteriovenous fistula, it is doubtful whether long-term hemodialysis would ever have become a viable long-term treatment. The remarkable success of dialysis is now obvious, with more than one million people world-wide depending on dialysis for survival. This success, however, is not enjoyed with equity around the world because of the cost-implications of providing such treatment and the differing healthcare priorities that exist in the various communities of the world.
The epidemiology of cancer
Authors: Kee Frank
Published: November 2023

The World Health Organization established a subcommittee on the registration of cancer which provided the initial spur for the establishment of the International Union Against Cancer (UICC) in 1950 and ultimately the International Agency for Research on Cancer (IARC).

Since that time, data collection and quality assurance systems have been established that ensure that national and international comparisons of cancer rates can be made.
The Molecular Biology of Cancer
Authors: Harkin D Paul
Published: November 2023

Cellular growth and division is a carefully regulated process that depends on the precise interaction of multiple regulatory factors. Cancer represents a deregulation of this process, in which some of the normal constraints on cell growth and division have been lost. How this deregulation occurs has been the focus of intense interest over the last three decades. However, it is now generally accepted that tumoursarise through the accumulation of several genetic changes affecting the control of cellular growth. Recent advances in molecular biology have made it possible to define some of the molecular changes that regulate the mechanisms by which certain tumours arise.
The psychology of cancer
Authors: Davidson Robin
Published: November 2023

Behavioural, lifestyle factors contribute to almost half of cancer mortality, whilst smoking behaviour alone accounts for almost 30% of all cancer deaths. Models, which include the Health Belief Model and the Theory of Planned Behaviour, enable us to understand how people reduce carcinogenic behaviours like smoking, alcohol use, or exposure to ultraviolet light, and how they permanently acquire positive behaviours like breast and testicular self-examination, physical exercise, or healthy eating habits.
The principles of cancer surgery
Authors: Spence Roy A J
Published: November 2023

With the current emphasis on a multidisciplinary approach to cancer management, the surgeon is one member of a closely knit team who can all be involved at various stages of the treatment of the patient’s disease. All should be involved in the discussion of the patient’s management in the initial stages. The team may include an oncologist, cancer surgeon, radiologist, pathologist, nurse counsellor, geneticist, plastic surgeon, nursing staff, dietetics, pain team, social worker, and psychologist.
Gynaecological Malignancy
Authors: Price John H
Published: November 2023

Gynaecological cancers account for one in seven cancers in women. Approximately one in 20 women will develop a gynaecological malignancy and one in 40 will die of the disease. In the UK, ovarian cancer is now the commonest gynaecological cancer, although worldwide, cervical cancer remains the most important.
Thoracic tumours
Authors: McManus Kieran
Published: November 2023

Mediastinal tumours fall into three general categories, the commonest being secondary bronchogenic carcinoma. Often the primary tumour is small and asymptomatic, even being undetectable in the case of small cell carcinoma. The second group entails systemic malignancy manifesting itself in the mediastinum. Lymphomas are characteristic of this group, though metastases from breast, renal, and gastrointestinal tract cancers are also common. Primary tumours of the organs or tissues of the mediastinum make up the third group and include thymomas, neurogenic tumours, germ cell tumours, ectopic thyroid and parathyroid tumours, and the rare lipomatous, vascular, and primitive ectodermal (Askin) tumours.
Haematological and lymphoid tumours
Authors: M. (Curly) Morris T C
Published: November 2023

The malignant haematological conditions considered individually (see Box 19.1) are relatively uncommon conditions. However, acute lymphatic leukaemia is the commonest cancer of childhood, and taken together, the haematological malignancies, because of a relatively high incidence in younger patients, are the most common cause of cancer in the working population. Modern therapeutic techniques, including improved supportive measures, dose intensification, and bone marrow transplant procedures, have produced a significant cure rate in many of these conditions over the past four decades.
Oncological emergencies
Authors: McKenna Sarah
Published: November 2023

An oncological emergency is defined as a situation arising in the cancer patient, related either to the cancer itself or its treatment, for which early diagnosis and treatment is necessary to prevent major morbidity or mortality.
Lumps in the scrotum and hernias
Authors: Stonebridge Peter , Smith David , Duncan Lesley , Thompson Alastair
Published: November 2023

Chapter contents

Lumps in the scrotum can be caused by a swelling in the testes, fluid around the testes, or from a swelling descending from the groin (an inguinoscrotal hernia).

If you can feel above the lump, this implies that it is arising from within the scrotum rather than descending as with a hernia and is caused by a swelling either within the testis itself or around the testes (the tunica vaginalis).

This means that the cause of the swelling is a hydrocoele, caused by a build up of lymph between the covering of the testis (the tunical vaginalis) and the testis itself. If the swelling was separate from the testis, then it would probably be an epididymal cyst.
Perioperative care
Authors: Stonebridge Peter , Smith David , Duncan Lesley , Thompson Alastair
Published: November 2023

The patient is visited preoperatively by the anaesthetist, to ensure that the patient is in an optimal condition for anaesthesia.

It allows the anaesthetist to reassure the patient and to discuss with her the choices for anaesthesia and postoperative analgesia. Any preoperative investigations should be based on history and examination and should only be performed if they can provide information that will influence the patient’s perioperative care.

In this case the preoperative visit is likely to be largely for reassurance and to discuss options for anaesthesia and analgesia. ‘Routine’ investigations, e.g. U&Es, ECG, and CXR will be extremely unlikely to provide information that will alter the perioperative management. However, women of child-bearing age may be anaemic and, therefore, the haemoglobin (Hb) concentration may be measured.
Summarizing data
Authors: Bland Martin , Peacock Janet
Published: November 2023

This chapter covers frequency, histograms, means and standard deviations. A variable has different values for different menders of the population, e.g. Whether people smoke, how many children they have, their height. Qualitative variables have no numerical value, e.g. whether people smoke. Quantitative variables have numerical value and may be discrete, with only a few possible values, e.g. how many children, or continuous, being able to take any value within a range, e.g. height. A set of observations of a variable form a distribution. A frequency is the number of times a particular value occurs. A frequency distribution is the set of frequencies for all possible values. For continuous variables we divide the scale into class intervals and find the frequency for each interval. A frequency distribution may be graphed as a histogram, a frequency5
General questions
Authors: Bland Martin , Peacock Janet
Published: November 2023

In this chapter there is no particular theme or body of material to be covered. Instead, we look at several research papers from start to finish. We have not attempted to reproduce the papers in full but have precise the key points. Many issues of study design, analysis and interpretation are revised. We are grateful to the authors of the five papers in this chapter for agreeing that we could make extensive quotations from their work.
Antenatal emergencies
Authors: Neuberg Roger
Published: November 2023

Severe intractable vomiting of all ingested fluids and solids is now a relatively uncommon problem in early pregnancy. Dehydration, ketosis, and weight loss are early consequences of the condition. If left untreated there is the risk of rapid deterioration. Exceedingly rarely, liver failure, jaundice, and polyneuritis can develop, until finally the continued starvation leads to encephalopathy and death in coma.
Induction of labour
Authors: Neuberg Roger
Published: November 2023

Improvements in monitoring fetal well-being have reduced the incidence of intervention in modern obstetric practice. However, induction of labour must be considered if it is felt that delivery is in the best interests of either the mother or the baby, or both.
Objectives of stroke care
Authors: Ebrahim Shah , Harwood Rowan
Published: November 2023

Are epidemiological ideas and methods of any use to the clinician? Epidemiology is a major tool for public health tasks of monitoring the population’s health, assessing needs, prevention, and commissioning services. Such work may seem remote from the day-to-day work of looking after stroke patients, but should provide a broader context within which the effects of clinical activity can be understood. Increasingly, clinicians are expected to be involved in the commissioning and evaluation of services, and to be aware of the wider health and social consequences of their decisions.
Prevention
Authors: Ebrahim Shah , Harwood Rowan
Published: November 2023

It is better to be healthy than to be ill or dead. That is the beginning and the end of the only real argument for preventive medicine. It is sufficient.(Rose 1992) The idea of prevention is attractive, but preventative interventions must still be judged by the same criteria as any others. They must be effective, affordable, acceptable, humane, accessible, and equitable. Indeed, the target population will be more or less healthy, so evaluation should be even more stringent than usual. The costs of prevention in terms of resources, time, inconvenience, and changes to life style must be carefully weighed against likely benefits. Failure to do this may lead to poor prioritization, and lack of understanding of important motivational factors will lead to poor compliance and reduced effectiveness.
Preventing recurrence
Authors: Ebrahim Shah , Harwood Rowan
Published: November 2023

One in five strokes is a recurrent stroke (Jorgensen et al. 1997), and someone who has had a first stroke is at tenfold increased risk of another. Secondary prevention attempts to reduce the risk of recurrence, and it makes sense to target people who have already had a stroke or TIA as these individuals, with high baseline risk, stand to gain most. The distinction between primary and secondary prevention is not clear-cut (see Chapter 8). Many patients with apparent TIAs can be shown to have infarcts on neuroimaging, and prognostically TIAs and minorischaemic cortical strokes behave similarly (Dennis et al. 1989a). All the risk factors for stroke described in Chapter 3 are likely to remain determinants of increased risk after a TIA or stroke. However, most evaluations of secondary prevention have not been concerned with reducing modifiable risk factors (e.g. alcohol use, smoking, physical inactivity) but have studied pharmacological interventions-anticoagulation, antiplatelet drugs, antihypertensives-and carotid surgery. A change in this emphasis might be of benefit, although trials of life-style modification are more challenging to conduct than drug trials.
Mortality
Authors: Ebrahim Shah , Harwood Rowan
Published: November 2023

Why should doctors bother to understand the pattern and predictors of death after a stroke? Knowing when death is most likely and what causes it should help decide where to concentrate effort and lead to innovations in treatment. Perhaps the devastating nature of some strokes leads doctors to feel that death is not a bad outcome, and indeed preferable to a lengthy period of rehabilitation leading to a nursing home bed. This gloomy outlook is far from the truth for the majority of patients (see Chapter 15). Information about prognosis is useful for the following reasons: patients and relatives need information to plan their lives; to permit triage of patients with different prognoses, thus allowing rationing of resources and balanced comparisons in treatment trials; to permit triage of patients with different prognoses, thus allowing rationing of resources and balanced comparisons in treatment trials; to identify patients with a poor prognosis who may benefit from special efforts, including palliative care; to find predictors of poor prognosis that may be amenable to change, and thus possibly improve prognosis.
Recovery
Authors: Ebrahim Shah , Harwood Rowan
Published: November 2023

Giving a prognosis for recovery is of obvious importance to patients and relatives. Prognostic information is also needed for deciding who should continue to have rehabilitation and should help in planning services and policy. Highlighting the problems of patients who make a poor recovery should make us look for new solutions and treatments. Indicators of recovery may also be used as a yardstick to audit the work done during rehabilitation.
Molecular Biology and Pathology of Paediatric Cancer
Authors: Cullinane Catherine J , Burchill Susan A , Squire Jeremy A , O’leary John J , Lewis Ian J
Published: November 2023

There has been an explosion of knowledge and enormous progress in the fundamental understanding of the biology of cancer in recent years. This has included the realisation that cancer occurs when normal cellular functions are disturbed leading to a malignant phenotype. Much research has focussed on understanding the types of disturbances that can occur, the contribution that these abnormalities can make to the development and behaviour of particular cancers and more recently, the recognition that these cellular and genetic abnormalities can provide rational targets for new therapeutic approaches. Information about the biology of cancers that occur in children has increased in parallel with these more general advances and this book is intended to provide a focus for readers who wish to have an understanding of our current state of knowledge. A international group of editors and contributors provide guidelines on the molecular biology and pathology of paediatric oncology, aimed at clinicians and scientists working in the specialty who wish to understand current developments in molecular pathology as applied to their field. The book is a broad ranging review focusing on the impact of molecular and cytogenetic techniques on our understanding of the aetiology, clinical behaviour, diagnosis and management of paediatric cancer. The first section outlines the laboratory handling of tissue samples, theory and methodology of cytogenetic and molecular techniques and discusses predisposition syndromes. The second section highlights the application of cytogenetic and molecular methods in diagnosis and treatment of the major paediatric cancers.
Cells, tissues, and the diagnostic laboratory
Authors: Cullinane Catherine J , Burchill Susan A , O’Leary John J
Published: November 2023

Advances in the histogenesis and molecular cell biology of paediatric cancer have refined and improved the diagnostic process. Good communication with clinical colleagues, knowledge of the types of tumours encountered at particular sites in different age groups, and recognition of the characteristic light microscopic appearances of these neoplasms is essential for correct diagnosis and management. Childhood malignancies however, may appear similar by routine light microscopy often as a non-descript population of small round cells known as round cell tumours (RCT) of childhood (Table 1.1). The application of ancillary investigations such as immunohistochemistry (IHC), electron micro scopy (EM), and molecular techniques is used not only to improve the accuracy of diagnosis but also to predict prognosis; this multidiscipline approach increases the amount of material required at diagnosis (1-3).
Methods of genetic analysis applied to pediatric cancer
Authors: Zielenska Jane Bayani Maria , Squire Jeremy A
Published: November 2023

Genetic technologies have made major advances in recent years, and both the power and sensitivity of methods in molecular biology have been greatly aided by the increasing number of genes discovered as part of the Human Genome Project (1, 2). The fields of genetics and pediatric cancer overlap in many areas, and much of the success in our understanding of genetic defects in childhood tumors has depended on the application of molecular genetic and advanced cytogenetic methodologies. Some of the newest genomics methods used to identify and investigate genes associated with pediatric cancer are presented below. The reader is directed to more comprehensive texts for a full explanation of the methodologies and experimental details (3-6).
The Rett syndrome: a proposed mechanism of genetic origin and inheritance
Authors: Hulten M A
Published: November 2023

There can be no doubt that the Rett syndrome (RTT, McKusick Catalogue No. 312750) affects females primarily, occurring with an incidence of around 1 per 10 to 15 000 new-born girls (Akesson et al. 1996). In the British Survey, conducted by Kerr, of 640 recorded Rett cases, 531 (83 ) were classic and 109 (17 ) atypical (in 1999) (see Chapter 1). In congruence with observations elsewhere, the majority of these RTT cases are sporadic, and there are only a few families having more than one affected RTT child. Nevertheless, not only RTT concordance between identical twin sisters and the occurrence of RTT in sisters, half sisters and cousins, but in particular the report of a mother and daughter, both having Rett syndrome (Witt Engerström and Forslund 1992), points to this severe neurological disorder being a single gene condition, which is either X-linked or sex limited in its expression— although more complex models have also been postulated (Johnson 1980; Buhler et al. 1990).
Musical responsiveness in the Rett disorder
Authors: Merker Bjorn , Wallin Nils L
Published: November 2023

Despite numerous informal indications that music plays a significant role in the lives of Rett patients (Chapter 1), there are few reports of research on music in relation to Rett syndrome (Wesecky 1986; Kerr 1987; Hadsell and Coleman 1988; Wigram, 1991; Cass et al. 1993; Wigram and Cass 1995; Wylie 1996; Sigafoos et al. 1996; Burford and Trevarthen 1997; Wigram 1997; Takehisa and Takehisa Silvestri, n.d.).
The developmental perspective in the Rett disorder: where next?
Authors: Kerr Alison M , Engerström lngegerd Witt
Published: November 2023

Discovery of the gene and growing insight into the pathophysiology of the Rett disorder has answered many important questions. It is now beyond doubt that we are dealing with a prenatal disturbance of growth which profoundly affects cognitive, motor and autonomic functions of the brain and to a lesser extent of the rest of the body, leading to the sequence of events and signs we recognize in the ‘Rett syndrome’. Here we consider some implications of these discoveries, what remains to be done, how the new objectives might be achieved and how the knowledge acquired may be directed to produce more effective intervention for people with the disorder and their families.
Locomotion analysis
Authors: Brand Richard
Published: November 2023

Doctors have used observation of human movement to interpret disease states for at least as long as recorded history. The skilled clinician often finds qualitative observational analysis critical to establish the presence of disorders, to distinguish between certain classes of conditions, or to ascertain the severity of disease. The notion of using technology to measure quantitatively and record critical clinical information arose in the nineteenth century. However, despite thousands of studies over more than 100 years and despite many technical advances, recorded locomotion analysis beyond the observational has never gained widespread clinical use.
Classification of Soft Tissue Disorders
Authors: Speed Cathy
Published: November 2023

Controversy relating to the relevance of taxonomy has complimented literature for centuries and there is clearly varied opinion on the subject in general. Nevertheless, nomenclature in medicine is of paramount importance, as it is by words that we convey our meaning to others, and they to us. Nomenclature is also important in the development of clear case definitions to permit interventional and epidemiological studies of specific complaints.
The Epidemiology of Soft Tissue Rheumatic Disorders
Authors: Walker-Bone Karen , Cooper Cyrus
Published: November 2023

Soft tissue rheumatic disorders are common—the lifetime prevalence of neck and back pain approach 70 and 80 per cent, respectively. However, the model of traditional rheumatological practice is associated with the management of articular, principally inflammatory, diseases. It is unsurprising, therefore, that a popular misconception has arisen—that the majority of disability from musculoskeletal disorders is caused by inflammatory disease. This chapter will challenge this misconception, describing our current knowledge of the burden of pain and disability in the population arising from soft tissue rheumatic complaints. However, the epidemiology of soft tissue rheumatic disorders is currently poorly characterized for several reasons. Therefore, this review will scrutinize the available epidemiological research, highlight its strengths and weaknesses, and identify those areas in which further research is urgently required.
The Diagnosis of Soft Tissue Disorders: Radiology
Authors: Bearcroft Philip
Published: November 2023

A variety of radiological techniques is available for the assessment of soft tissue pathology. Each has certain strengths and advantages that must be seen in the context of the corresponding weaknesses and disadvantages. In the current chapter, each radiological technique will be considered in turn. The technical aspects will be outlined, together with the associated strengths and weaknesses and the specific clinical uses for which the technique is best suited. In the final section, two fundamental principles of imaging will be described. The first is an understanding of the potential harm that a patient might suffer when undergoing a radiological examination and the sources of that harm. The second is an understanding that the result of a radiological test once obtained must be put into a wider context, and a mathematical model will be described to help with this analysis.