bluuebunny/crossref_metadata_2025 huggingface dataset:
Criminal Competencies
Authors: Grover Matthew W.
Published: August 2014

Chapter 23 includes cases that are important for one of the staples of forensic psychiatric practice, competence to stand trial evaluations. Knowledge of the legal standards required for one to defend oneself, either with or without an attorney, is necessary for a practitioner to be able to capably assess whether a mental illness prevents a defendant from participating in the adjudication process. The cases in this chapter are Dusky v. U.S., Wilson v. U.S., Jackson v. Indiana, Drope v. Missouri, Godinez v. Moran, Cooper v. Oklahoma, and Indiana v. Edwards.
Diminished Capacity
Authors: Greenspan Michael
Published: August 2014

Chapter 24 describes cases that have played an important role in establishing reduced culpability by criminal defendants. People v. Patterson involves a mitigation defense called extreme emotional distress (EED); Ibn-Tamas v. U.S. involves evidence of battered woman syndrome to reduce culpability; and the final two cases, People v. Saille and Montana v. Egelhoff, involve voluntary intoxication.
Insanity
Authors: Frischer Katya
Published: August 2014

Chapter 25 relates to what is probably the most recognized, but perhaps the most rare, evaluation performed by a forensic professional. The pursuit of an insanity defense today is challenging and, in some states, not even permissible. These cases illustrate the evolution of the various state standards for establishing insanity (and therefore acquittal) for criminal defendants with mental illness. The following cases are included in this chapter: M’Naghten’s Case, Durham v. U.S., Washington v. U.S., Frendak v. U.S., Jones v. U.S., U.S. v. Torniero, Foucha v. Louisiana, and Clark v. Arizona.
Prisoners’ Rights
Authors: Khan Omar , Lewis Rebecca , Subedi Bipin
Published: August 2014

Chapter 26 includes a broad range of cases that relate to the rights of individuals detained in jails or prisons. Because the U.S. Constitution considers deprivation of liberty a significant harm, efforts are made to protect the rights, as much as possible, of those who are incarcerated. As related to mental health, those rights include medical and psychiatric care, right to refuse treatment, and due process rights related to psychiatric hospitalization. The cases in this chapter are Estelle v. Gamble, Vitek v. Jones, Washington v. Harper, Riggins v. Nevada, Farmer v. Brennan, Sell v. U.S., and Brown v. Plata.
Death Penalty
Authors: Straka Tara
Published: August 2014

Chapter 27 describes the cases that have defined the evolution of the United States’ relationship with the death penalty. Over time, the country has gradually narrowed the pool of those eligible to be executed, prohibiting the infliction of death on individuals with mental retardation or mental illness and, most recently, on adolescents. These cases are important for forensic professionals who may be involved in the evaluation or treatment of capital defendants. The cases in this chapter are Estelle v. Smith, Ake v. Oklahoma, Ford v. Wainwright, Payne v. Tennessee, State v. Perry, Atkins v. Virginia, Roper v. Simmons, and Panetti v. Quarterman.
Sex Offenders
Authors: Lee Li-wen G.
Published: August 2014

Chapter 28 includes cases related to the diagnosis and treatment of sexual offenders in the criminal justice system. Forensic practitioners may treat these individuals as part of their clinical work or may evaluate them to determine suitability for civil commitment upon release from prison or appropriateness for return to the community. The cases in this chapter are Specht v. Patterson, Allen v. Illinois, In re Young and Cunningham, Kansas v. Hendricks, McKune v. Lile, Kansas v. Crane, and U.S. v. Comstock.
Questions on Criminal Law and Incarceration
Authors: Ford Elizabeth , Rotter Merrill
Published: August 2014

This chapter contains 48 questions on criminal law and incarceration
Cardiovascular
Authors: Raine Tim , Dawson James , Sanders Stephan , Eccles Simon
Published: August 2014

Chest pain emergency

Chest pain

Tachyarrhythmia
emergency

Tachyarrhythmias

Bradyarrhythmia
emergency

Bradyarrhythmias

Hypertension emergency

Hypertension

Heart failure

Call for senior help early if
patient unwell or deteriorating.

•Sit patient up

•15l/min O2 if SOB or sats <94%

•Monitor pulse oximeter, BP, defibrillator ECG leads if unwell...
Gastroenterology
Authors: Raine Tim , Dawson James , Sanders Stephan , Eccles Simon
Published: August 2014

Abdominal pain
emergency

Abdominal pain

GI bleeding emergency

Acute upper GI bleeds

Acute lower GI bleeds

Nausea and vomiting

Diarrhoea

Constipation

Liver failure
emergency

Liver failure

Jaundice

Call for senior help early if
patient deteriorating.

•15l/min O2 if SOB or sats <94%

•...
A Global Perspective on Death
Authors: Breitbart William S.
Published: August 2014

Psycho-oncologists must be familiar with the information on why, when, where, and how patients die to best understand and manage psychiatric issues of terminally ill patients. This chapter provides an overview of the common causes of death, age and location of death, including a discussion on patient preferences for the location of death. World Health Organization guidelines for a “good death“ and Weisman’s criteria for an “appropriate death“ are reviewed to serve as general guidelines for psycho-oncologists in caring for terminally ill patients.
Role of the Psycho-oncologist in Palliative Care
Authors: Breitbart William S.
Published: August 2014

The psycho-oncologist’s role in the care of the dying patient is essential and diverse. The role of the psycho-oncologist, in the care of the dying, extends beyond the management of psychiatric symptoms and syndromes into areas that include existential issues, family and caregiver support, bereavement, doctor-patient communication, education, and training. This chapter provides an overview of the role of psycho-oncology health care professionals in palliative care settings.
Anxiety Disorders in Palliative Care
Authors: Breitbart William S.
Published: August 2014

Anxiety is common in palliative care patients and may significantly impact patients’ quality of life. Anxiety can have many etiologies resulting in different anxiety syndromes, ranging from adjustment disorder, anxiety resulting from general medical condition, to medication-induced anxiety disorders. Pre-existing anxiety disorders should also be taken into consideration in palliative care settings. Different screening and assessment tools have been used to improve recognition and assessment of anxiety in the terminally ill. Treatment of anxiety in this patient population includes use of a variety of pharmacological agents to relieve severe anxiety symptoms and use of psychotherapy interventions that have been shown to be safe and effective in the terminally ill. This chapter includes an overview of the prevalence, assessment, and management of anxiety disorders in palliative care settings.
Suicide, Assisted Suicide, and Desire for Hastened Death
Authors: Breitbart William S.
Published: August 2014

Suicide, suicidal ideation, and desire for hastened death are all important and serious consequences of unrecognized and inadequately treated clinical depression. Desire for hastened death is one the most controversial topics in palliative care. Despite legal prohibitions against assisted suicide, a substantial number of patients think about and discuss those alternatives with their physicians, family, and friends. This chapter provides a comprehensive overview of the prevalence, assessment, and management of suicide, suicidal ideation, and desire for hastened death in palliative care settings.
Psychotherapy and Behavioral Interventions in Palliative Care
Authors: Breitbart William S.
Published: August 2014

A range of psychotherapeutic and behavioural interventions have been demonstrated to be effective and useful for patients struggling with advanced life-threatening illness. Despite lack of evidence for prolonged survival, psychosocial interventions have been shown to be effective in decreasing depressive symptoms and suffering in advanced cancer patients. This chapter provides an overview of the commonly used, effective individual, group, and family psychotherapy modalities among advanced cancer patients and their families.
Psychiatric and Psychological Interventions for the Control of Pain and Selected Physical Symptoms
Authors: Breitbart William S.
Published: August 2014

In addition to the diagnosis and treatment of psychiatric disorders in palliative care settings, pain and other troublesome physical symptoms must also be aggressively treated in efforts aimed at the enhancement of the patient’s quality of life. These symptoms must be assessed by the psycho-oncologist concerned with the assessment and treatment of affective and other syndromes in the terminally ill population. This chapter provides a brief overview of the prevalence, assessment, and management of the commonly encountered, distressing physical symptoms such as pain, insomnia, and nausea among patients with advanced cancer.
Spiritual and Existential Issues in the Care of the Dying
Authors: Breitbart William S.
Published: August 2014

Spirituality is important in the lives of patients with serious illnesses. Terminally patients may experience a number of spiritual issues, including lack of meaning, guilt, shame, hopelessness, loss of dignity, loneliness, anger toward God, abandonment by God, feeling out of control, grief, and spiritual suffering. Assessment of a patient’s spiritual beliefs, assessing the importance of spirituality in his or her life, exploring whether he or she belongs to a spiritual community, and offering chaplaincy referral or connection with the patient’s religious or spiritual leaders comprise essential components of a spiritual assessment. Psycho-oncologists should seek both specialized training, as well as referrals to appropriate sources, in order to help patients deal more effectively with the often complicated and painful spiritual issues that arise as a consequence of serious illness. Existential concerns are intrinsic to the human experience of facing mortality in palliative care settings. Patients diagnosed with terminal cancer often confront universal existential issues such as death anxiety, isolation, and meaninglessness. Psycho-oncologists must therefore be familiar with these existential concerns, their manifestations, and approaches to deal with existential issues. Psycho-oncologists have the unique ability to use a variety of psychotherapeutic interventions to alleviate existential distress in palliative care settings including cognitive therapies to help patients and families modify their appraisal of their lives with terminal illness, known as cognitive restructuring, life review techniques to facilitate a constructive reappraisal of life events, dignity-conserving therapies, and meaning-centered therapies have been shown to effectively reduce existential distress in this patient population.
Cross-Cultural Issues
Authors: Breitbart William S.
Published: August 2014

Across cultures, the universal fear of cancer and other terminal illnesses are caused by the fear of death as well as images associated with debility and pain. Yet individual societies place different emphases on issues surrounding death and dying. This chapter provides an overview of the culturally specific issues surrounding death and dying, methods of evaluation of cultural issues, and guidance on delivering culturally sensitive palliative care around the globe.
Doctor-Patient Communication in Palliative Care
Authors: Breitbart William S.
Published: August 2014

Doctor-patient communication is an essential component in caring for a dying patient. Communication problems have been identified in 84% to 94% of clinical encounters. Good doctor-patient communication reduces the risk of iatrogenic suffering, mood, anxiety, and adjustment disorders among cancer patients and their families. This chapter provides an overview of the guidelines for communication and empathy in caring for terminally ill patients, including essential strategies for effective doctor-patient communication, core communication skills, and teaching methods utilized in communication training programs.
Grief and Bereavement
Authors: Breitbart William S.
Published: August 2014

Bereavement care is an integral dimension of palliative care. Identifying risk factors for complicated grief and routine assessment of the bereaved allow the psycho-oncologist to proactively intervene and reduce unnecessary morbidity. This chapter provides a comprehensive overview of definitions regarding grief and bereavement, the features of normal grief, anticipatory grief, inhibited or delayed grief, chronic grief, traumatic grief, and complicated grief, as well as a review of interventions used to support the bereaved.
Antineutrophil Cytoplasmic Antibody–Positive Vasculitis
Authors: Rosenwasser Lanny J. , Ledford Dennis K.
Published: August 2014

The antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis syndromes— eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome or allergic angiitis with granulomatosis), granulomatous polyangiitis (Wegener’s granulomatosis), and microscopic polyangiitis—are serious comorbidities of asthma or upper respiratory disease, or the symptoms of the vasculitis may resemble asthma or associated upper airway disease. ANCA-associated vasculitis is potentially fatal but is responsive to a variety of treatments, if the vasculitis is recognized before serious organ dysfunction. The role of ANCA in these conditions has not been defined because eosinophilic granulomatosis with polyangiitis, granulomatous polyangiitis, or microscopic polyangiitis may occur without ANCA, and the titer of ANCA does not predict clinical course. Clinical suspicion and consideration of tissue biopsy are important for recognition before irreversible complications occur. Corticosteroid therapy for asthma or suspected asthma may modify the presentations of ANCA-positive vasculitis.
Immunodeficiency: Innate, Primary, and Secondary
Authors: Brown Jean M. , Sleasman John W.
Published: August 2014

Clinical manifestations of immunodeficiency diseases are recurrent infections with sinopulmonary conditions as the predominant manifestation. Immune deficiencies also result in immune dysregulation, with asthma as a common feature. Many immune deficiencies can lead to chronic pulmonary infections that mimic asthma and remain unrecognized. Immunodeficiency disorders, based on their etiology, are classified as primary or secondary. Primary immunodeficiency diseases are usually due to heritable defects in innate or adaptive immunity resulting in distinct susceptibility to certain types of infections, immune dysregulation, or increased risk for malignancy. Secondary immunodeficiencies are acquired conditions, which occur in otherwise normal individuals and can lead to similar clinical manifestations, that is, chronic sinopulmonary infection. Immune deficiencies are often underdiagnosed and misdiagnosed, especially if pulmonary manifestations are involved.
Sleep Apnea in Children and the Upper Airway
Authors: Kaditis Athanasios
Published: August 2014

Obstructive sleep apnea (OSA) is the most severe form of “obstructive sleep-disordered breathing,” a spectrum of abnormal respiratory patterns during sleep characterized by snoring and increased respiratory effort due to increased upper airway resistance and pharyngeal collapsibility. Adenotonsillar hypertrophy and obesity are the most frequent causes of OSA in children. The clinical manifestations of OSA include apneas (cessation of oronasal airflow) and hypopneas (reduction of airflow), accompanied by arousals from sleep, restless sleep, daytime symptoms (sleepiness, inattention, hyperactivity), and academic difficulties. Cysteinyl leukotrienes contribute to the pathogenesis of both asthma and OSA in childhood. Cysteinyl leukotrienes have also been implicated in the pathogenesis of adenotonsillar hypertrophy. Preliminary evidence suggests that treatment of sleep apnea with adenotonsillectomy results in improved control of coexisting asthma.
Asthma and Obstructive Sleep Apnea
Authors: Ladi Larry M. , Schulman Edward S.
Published: August 2014

Obstructive sleep apnea syndrome (OSAS) results from obstruction of the upper airway with resultant brief periods of breathing cessation of at least 10 seconds (apnea) or marked reductions in flow (hypopnea) during sleep that are insufficient to meet the definition of apnea. This pattern is accompanied by oxyhemoglobin desaturation, persistent inspiratory efforts against the occluded airway, and arousal from sleep. Clinically, the condition is recognized by recurrent sleep interruptions, snoring, choking and gasping spells on awakening, and daytime drowsiness caused by loss of normal sleep. The diagnosis is confirmed and graded on overnight polysomnography criteria. If uncorrected, the disorder often can lead to hypertension, respiratory failure, and cardiac abnormalities. Data suggest that OSAS is an independent risk factor for asthma exacerbations and that OSAS symptoms are more common in asthmatic patients than in the general population, hence linking these two major diseases. Both conditions share mechanical, hormonal, and immunologic reasons for their effects. However, studies show that continuous positive airway pressure might modify airway smooth muscle function and asthma control in patients with both disorders.
Bronchiectasis
Authors: Naji Nizar , O’Byrne Paul M.
Published: August 2014

Bronchiectasis is one of the most debilitating chronic respiratory diseases, which affects all ages, with significant morbidity and mortality. It is recognized clinically by chronic persistent daily cough, productive of mucopurulent sputum. The defining characteristic is the permanent abnormal dilatation and destruction of bronchial walls, which involve both the major bronchi and bronchioles. It is a major contributor to progressive lung function decline and functional disability, especially in patients with respiratory comorbidities. Bronchial hygiene, to clear airway secretions, is the basis of management. Bronchodilators and fixed-dose combination therapy with an inhaled corticosteroid and a long-acting β‎-agonist provide clinical benefit, but do not reduce the risks for acute exacerbations. The airways of patients with bronchiectasis are often colonized with pathologic bacteria, and acute exacerbations require antibiotic therapy. Allergic bronchopulmonary aspergillosis often requires daily oral corticosteroids for management.
Bronchiolitis
Authors: Cowan Kelly J. , Guilbert Theresa W.
Published: August 2014

Bronchiolitis is a clinical syndrome in infants and children younger than 2 years that is characterized by airway obstruction and wheezing secondary to lower respiratory tract infection (LRTI) and resulting in inflammation of the small airways (bronchioles). The definition of bronchiolitis may be strictly narrowed to the first episode of wheezing in a child younger than 12 months with physical findings of LRTI and no other etiologies or risk factors associated with wheezing. Underlying disease, including asthma, may coexist with bronchiolitis. The age of the patient, time course of illness, response to treatment, symptom pattern, and presence of asthma risk factors may influence the diagnosis and management of bronchiolitis versus exacerbation of asthma.
Genetic Disorders and Asthma
Authors: Talreja Neetu , Dahl Ronald
Published: August 2014

Primary ciliary dyskinesia, cystic fibrosis, and α‎1-antitrypsin deficiency are autosomal recessive hereditary diseases. These diseases should always be considered in cases of asthma. The diagnosis and management of these diseases, particularly with asthma, is an important challenge for clinicians. However, the diagnosis of these chronic diseases is evolving with better definition of phenotypic features and expansion of diagnostic tests. Optimizing and expanding access to the nongenetic tests is critical for ensuring a timely and accurate diagnosis. Early diagnostic strategies, better understanding of the complex interactions underlying the pathophysiology of lung disease, and emerging treatments show great promise for the future. The discovery of genetic and biomarker studies that will predict individuals at risk to develop the clinical manifestations of these diseases can lead to more personalized treatment strategies and a better prognosis.
Other Pulmonary Abnormalities
Authors: Wise Robert A. , Brigham Emily P.
Published: August 2014

The purpose of this chapter is to describe various disorders not described elsewhere in this text that may present as asthma, coexist with asthma, or be confused with asthma. The cardinal symptoms of asthma—cough, wheezing, and dyspnea—are associated with nearly all respiratory illnesses. Because asthma is a common disorder, it is a widespread practice to initially treat the syndrome of cough, wheeze, and dyspnea with bronchodilators or inhaled corticosteroids to determine whether they respond to treatment. When such treatment is unsuccessful or only partially effective, then further evaluation may be necessary, including lung imaging, comprehensive lung function testing, inhalation challenge testing with methacholine or mannitol, and more extensive examination of the upper airway.
Pneumonia
Authors: Skevaki Chrysanthi L. , Tsakris Athanassios , Papadopoulos Nikolaos G.
Published: August 2014

Pneumonia is defined as an acute infection of the lung caused by bacteria, viruses, fungi, or other microorganisms and characterized by inflammation both within and around the alveolar tissues (consolidation). Community-acquired pneumonia, which is the most common presentation, represents a challenge for physicians because of the large number and diversity of causative agents, the difficulty in reaching the appropriate clinical diagnosis, and the fact that a single antimicrobial regimen able to combat all possible etiologies is currently missing. The clinical presentation of pneumonia is diverse with a range of symptoms, of which fever, cough, and tachypnea are most common. Diagnosis of pneumonia is supported by a chest radiograph displaying new shadowing, but most often, diagnosis is performed at the primary care level, in the absence of an imaging technique, and is based only on symptoms and physical examination. Pneumonia is caused by a broad spectrum of microorganisms, whose identification can be difficult and time consuming and often requires invasive techniques and procedures of uncertain diagnostic success.
Cough
Authors: Kelkar Pramod , Goldsobel Alan , Polosa Riccardo
Published: August 2014

Cough results from forced expulsion, usually against a closed glottis, creating a characteristic sound. It is a natural reflex and defense mechanism that helps the body clear excessive secretions and prevents foreign material from entering the respiratory tract. At times, cough can become excessive, nonproductive, disturbing to the patient, and potentially harmful. Cough is a complex symptom and often requires a multidisciplinary approach to ascertain its cause and effective treatment. Evaluation should be guided by a thorough history and physical examination, and testing should be individualized for cost effectiveness. Habit cough and unexplained cough are diagnoses of exclusion, and any tendency to underdiagnose or overdiagnose these conditions should be avoided. Most over-the-counter cough suppressants are not as effective as previously thought, and their use in routine practice should be minimized. Future research should be conducted to elucidate the mechanisms of cough production and to develop cough-suppressive pharmacotherapy. Allergists, as experts in the management of upper and lower airway disorders, should play a central role in the diagnosis and management of cough.
Occupational Asthma
Authors: Labrecque Manon , Castaño Roberto , Moullec Grégory , Ansottegui Ignacio , Gautrin Denyse
Published: August 2014

Work-related asthma can be divided in two major entities: work-exacerbated asthma and occupational asthma. Occupational asthma is further split into two subtypes: sensitizer-induced occupational asthma and irritant-induced asthma, which includes reactive airway dysfunction syndrome. The patient’s medical history (type of symptoms and timing) is not sufficient to diagnose occupational asthma. The diagnosis requires an objective confirmation of asthma and of work-related functional changes. Psychological distress, health-related quality-of-life impairment, and comorbid psychiatric disorder are frequent in patients with work-related asthma or work-related asthma symptoms and have to be considered in the evaluation and treatment. Many areas of research are still needed to understand the complexity of work-related asthma.
Adult Cardiac Conditions
Authors: Rogliani Paola , Segreti Andrea , Cazzola Mario
Published: August 2014

In this chapter, the relationship between asthma and its cardiovascular comorbidities is reviewed. Asthma seems not to be a risk factor for coronary heart disease in middle-aged adults; nevertheless, some reports suggest that subjects with severe asthma, especially females, are at significant risk for ischemic heart disease. Additionally, adult-onset asthma, particularly in females, may be a significant risk factor for coronary heart disease. The physician should know how to differentiate between asthma, chronic obstructive pulmonary disease, and cardiac asthma (congestive heart failure), often a difficult proposition. A systematic evaluation, not only of the presence of comorbid conditions, is necessary to ensure that such comorbidities are adequately treated and controlled so that the effect on asthma is minimized.
Pediatric Cardiac Conditions
Authors: Bezold Louis I.
Published: August 2014

Many cardiac conditions presenting in childhood belong on the differential diagnosis list of bronchial asthma, and vice versa. Asthma, through either direct disease action or undesired side effects of therapy, is associated with subclinical cardiac dysfunction and ischemia. Obesity, a tremendous public health issue, shares a common association with both cardiac disease and asthma. Considering these facts, close collaboration between pediatric subspecialists and primary care physicians is absolutely necessary to effectively manage children with the multiple comorbidities associated with asthma. More research is needed to optimize asthma therapies while reducing complications, with the goal of the best possible outcomes for all children struggling with these medical issues.
Pulmonary Hypertension
Authors: Waxman Aaron B. , Smith Kerri Akaya
Published: August 2014

Pulmonary hypertension (PH) is a spectrum of diseases involving the pulmonary vascular circuit and is defined as an elevation in pulmonary arterial pressures. PH is an uncommon disorder that presents with nonspecific complaints. There remains a significant delay in the diagnosis of PH and initiation of appropriate therapy because often patients are misdiagnosed with more common causes of dyspnea such as obstructive lung diseases like asthma. The diagnosis of PH should be considered in patients who do not fit the usual profile of patients presenting with dyspnea and asthma, especially if they do not respond to therapy. The finding of PH foreshadows a poor outcome if not discovered early and treated aggressively.
Allergic Rhinitis
Authors: Naclerio Robert M. , Pawankar Ruby
Published: August 2014

Allergic rhinitis is the most common atopic disease, with an increasing prevalence worldwide. It is an immunoglobulin E–mediated inflammatory disease of the nasal mucosa, characterized by symptoms of nasal itching, sneezing, runny nose, and stuffy nose. The stuffy nose is the most burdensome symptom to patients, but the itch and sneeze are the most characteristic. Although it is not a fatal disease, allergic rhinitis has a negative impact on the patient’s quality of life (QOL), which is detected not only on disease-specific QOL measures but also on general QOL measures such as the SF36. Sleep, presenteeism, mood and cognition, and participation in sports and leisure activities are all affected, causing a great physical and financial burden on the patient.
Nonallergic Rhinopathies and Lower Airway Syndromes
Authors: Baraniuk James N. , Blaiss Michael S. , Pattanaik Debendra
Published: August 2014

Nonallergic rhinitis is a heterogeneous disease consisting of wide variety of entities that present with persistent nasal symptoms. “United airways” has become a slogan verging on dogma. The concept gained momentum with the realization that the unifying atopic pathophysiology of the nose and tracheobronchial tree lead to coexistent allergic rhinitis and allergic asthma, respectively. Including nonallergic mechanisms and the differential diagnosis of comorbid rhinitides with reversible and irreversible lower airway obstructive entities is more problematic. Although the nose and foregut-derived tracheobronchial tree have distinct embryonic origins, they share exposure to air, pseudostratified epithelium with extensive submucosal glands, common elements of the innate and acquired mucosal immune systems, and extensive nociceptive and autonomic nervous system sensors and controls. Mechanisms affecting both anatomic sites are likely to develop comorbid disease. Anatomic differences contribute to discrete pathologic conditions, as allowed by the bony box of the nasal cavity versus the cartilaginous walls and elastic alveolar interstitial tethers for bronchi and bronchioles. The diverse pathologic states of the nasal mucosa and their relationships with bronchial hyperresponsiveness are the focus of the remainder of this discussion.
Nasal Polyps and Chronic Rhinosinusitis
Authors: Park Hae-Sim , Sánchez-Borges Mario , Shin Seung Youp , Kowalski Marek L.
Published: August 2014

Chronic rhinosinusitis (CRS) and nasal polyp (NP) are major comorbid conditions of bronchial asthma. CRS with NP (CRSwNP) occurs in the setting of CRS characterized by TH2 and eosinophilic inflammation. Therefore, CRSwNP is considered an entity separate from CRS without NP (CRSsNP). Previous studies demonstrated a strong association between asthma and CRS, and patients with asthma and CRS are more likely to have NP. The presence of CRSwNP can increase asthma severity, and effective medical management can improve asthma outcomes, including overall lung function and asthma control, and drug requirements. Surgery should be reserved for select patients with inadequate response to medical management or medication intolerance or side effects. Future research may further elucidate the pathophysiology of CRS and NP, which may in turn lead to development of more effective treatment modalities.
Vocal Cord Dysfunction and Paradoxical Vocal Fold Motion Disorder
Authors: Fox Roger W. , Glaum Mark C.
Published: August 2014

Diagnosis of vocal cord dysfunction (VCD) relies on clinical history, inspiratory flow–volume loops, and visualization of vocal cord motion by rhinolaryngoscopy. The treatment of VCD requires a multidisciplinary approach relying on elimination of triggers, treatment of comorbid conditions, and consultation with a speech pathologist. This chapter focuses on VCD as it relates to symptoms that suggest asthma and provides specific information to help with the evaluation of VCD.
Gastroesophageal Reflux
Authors: Banerjee Promila , Sontag Stephen J.
Published: August 2014

Most asthmatic patients have gastroesophageal reflux (GER), and the evidence is strong that GER plays an important role in some patients with asthma. Despite sophisticated study methods and technologically advanced diagnostic tests, the results of published studies on mechanisms fail to provide a diagnostic test with a degree of certainty great enough to identify which patients have GER-induced or GER-exacerbated asthma and which patients will respond to antireflux therapy. Indeed, even positive results on such direct tests as sputum inspection and scintigraphic monitoring, both of which establish reflux into the tracheobronchial tree, do not necessarily establish cause or effect and cannot be used to predict outcomes. The popular and frequently used ambulatory esophageal pH test (Bravo), believed by many to be the best GER test available, can only suggest, but not prove, the diagnosis of GER-induced asthma, and pH testing cannot be safely relied on to make our clinical decisions. Despite extensive research on mechanisms of GER-induced pulmonary symptoms, we are still forced to fall back on “the therapeutic trial”—a trial of a proton pump inhibitor (PPI) to assess whether asthma improves subjectively and objectively. A good PPI response may not necessarily predict a good surgery response, and a poor response to PPI does not necessarily predict a poor response to antireflux surgery.
Obesity and Asthma
Authors: Forno Erick , Boulet Louis-Philippe , Celedón Juan C.
Published: August 2014

The current epidemiologic and experimental evidence for a causal association between obesity and asthma is reviewed in this chapter. Putative mechanisms underlying the association between obesity and asthma, including genetics, changes in lung mechanics and airway smooth muscle physiology, hormonal differences, and detrimental effects of comorbidities and the systemic proinflammatory state of obesity are also discussed. These proposed causal pathways are largely speculative or insufficiently studied. Whereas obesity seems to be closely interrelated with the pathogenesis of asthma in some subjects who have the true “obese asthmatic phenotype,” obesity may simply coexist with asthma in others. Proper identification of subjects with true “obese asthma” may be key to dissecting any causal mechanism. Weight loss is beneficial and should be recommended for obese adults with asthma.
Endocrine Disorders
Authors: Sideri Kyriaki , Custovic Adnan
Published: August 2014

Several epidemiologic studies suggest an association of asthma with hormonal and metabolic disorders such as hypothyroidism and hyperthyroidism, Addison’s disease, and testosterone and vitamin D deficiencies. Several hypotheses have been proposed to explain these observed associations, but the precise pathophysiologic mechanisms underpinning these findings are not yet clarified.
Osteopenia and Osteoporosis
Authors: Steinberg Joshua A. , Apter Andrea J.
Published: August 2014

This chapter describes key factors specific to asthmatic patients that directly or indirectly affect bone health. The well-established association of corticosteroid therapy with osteoporosis is discussed, as are less commonly known and emerging osteoporosis risk factors pertinent to asthmatic patients. Additionally, osteoporosis management and therapy are reviewed, with a discussion of the role of the asthma specialist in preventing, screening, and treating osteoporosis and osteopenia.
Pregnancy
Authors: Namazy Jennifer A. , Schatz Michael , Gonzalez-Diaz Sandra
Published: August 2014

Asthma is the most common chronic medical condition to affect pregnancy. Asthma may adversely affect maternal quality of life and perinatal outcomes, as well as the course of asthma. Management of asthma during pregnancy should optimize the health of both the mother and her baby. Adherence to treatment, specifically inhaled corticosteroids, has been a problem for many pregnant asthmatic women and is usually due to concerns regarding the safety of these medications during pregnancy. Symptoms and pulmonary function need to be monitored on a monthly basis in pregnant asthmatic women so that any change in course can be matched with an appropriate change in therapy. Education is an important part of managing the pregnant asthmatic patient and includes explaining the relationship between asthma and pregnancy, identifying asthma triggers, providing training on correct use of inhalers, and establishing an asthma action plan. One of the most important needs for the future is the availability of further safety information for asthma medications used during pregnancy that can also account for asthma control.
Psychological Factors
Authors: Braido Fulvio , Slavyanskaya Tatiana , Sepiashvili Revaz , Baiardini Ilaria , Canonica Giorgio Walter
Published: August 2014

The patient plays a primary role in daily asthma management. The ideas that the patient has regarding asthma, the impact of the disease on daily life, the subjective interpretation of symptoms, and therapeutic adherence depend on psychological characteristics. Moreover, the disease itself may create psychological dysfunction. The aim of this review is to explore different patient-related factors that may influence the unsuccessful fulfillment of optimal levels of asthma control.
Asthma, Substance Abuse, and Tobacco Use
Authors: Polosa Riccardo , Caponnetto Pasquale
Published: August 2014

This chapter presents a review of current knowledge of relationships between asthma and substance abuse, including marijuana, cocaine, heroin, tobacco, and alcohol. Asthma and other medical conditions are found at higher rates among patients with substance-related disorders. There is a growing body of evidence that patients with substance-related disorders may receive lower quality care for some medical conditions. Patients with substance-related disorders and persistent asthma fill prescriptions for controller medications at lower rates than patients without substance-related disorders. Whether these differences are due to differential access to care, decreased compliance with treatment recommendations, or the receipt of substandard care, these findings still may partially explain the disparities in asthma outcomes observed for these patients. An integrated approach could lead to effective treatment for these conditions.
Environmental Protective and Risk Factors in Asthma
Authors: Haahtela Tari , Kalayci Ömer
Published: August 2014

Traditionally, environmental exposure has been considered a potential risk factor to develop asthma and allergy and, second, to exacerbate them and cause chronic disease. Exposure to common allergens, such as dust mites, pollens, molds, animal dusts, and foods, generates symptoms in sensitized individuals; this does not occur initially, and only occurs in sensitized individuals. The same applies to ambient air and indoor air pollutants. They irritate, aggravate inflammation, worsen symptoms, and increase the burden for asthmatic and allergic patients but are probably not significant as primary causes of these diseases. This chapter explores environmental determinants related to asthma and allergic comorbidities, especially immunoglobulin E–associated conditions, and emphasizes the development of tolerance. Finally, practical advice to improve asthma health is provided.
Asthma Over 65
Authors: Pope Chelle , deShazo Richard D. , King Monroe James
Published: August 2014

With the worldwide increase in the older population and the growing prevalence of asthma, it is no surprise that asthma in the elderly is also an increasing problem. Insufficient data exist to make firm conclusions on many important issues about this condition. Seniors with asthma often have coexisting and comorbid conditions, and the combination of age and illness has precluded, in general, their participation in clinical trials. Other important variables in this population include differences in perception, interpretation, and response to the symptoms of airway obstruction. Many patients mistakenly believe that wheeze and dyspnea are normal, and they commonly decrease their activity, a response that can induce further social isolation and a decreased quality of life. Coupled with the challenge of misdiagnosis or underdiagnosis are the potential problems associated with side effects from medications, drug–drug interactions, problems appropriately using medications, and compliance. This chapter identifies the prevalence of asthma, which affects decisions about therapy, and the important questions in this age group yet to be answered.
Atopic Dermatitis, Food Allergy, and Anaphylaxis
Authors: Wang Julie , Sampson Hugh A. , Fiocchi Alessandro , Sicherer Scott
Published: August 2014

Asthma, food allergy, and atopic dermatitis are common disorders affecting children that often coexist. Children can develop atopic dermatitis in infancy and later develop food allergies as new foods are introduced. In these highly atopic children, respiratory symptoms can also develop. This pattern of allergic disease progression has been termed the “atopic march.” Allergic (TH2-biased) inflammation and allergen sensitization are underlying mechanisms of these disorders, and control of one disease may affect the outcomes of the other disorders. Therefore, an understanding of the relationship between these allergic entities is important.
Parasitic Diseases
Authors: Meunier Yann A.
Published: August 2014

Presentation of the Geographic Distribution, Main Symptoms, Treatment and Preventive Measures of parasitic diseases (1) classified by adult parasite location: Blood and Lymphatic System Diseases, Digestive Tract Diseases, Lung Diseases, Nail and Hair Diseases, Sexual Organ Diseases, Skin and Integumentary System Diseases, Urinary Tract Diseases, and (2) Parasitic Dead-ends and Larval Diseases.
Bacterial, Chlamydial, and Prion Diseases
Authors: Meunier Yann A.
Published: August 2014

Presentation of the Geographic Distribution, Main Symptoms, Treatment and Preventive Measures of bacterial and chlamydial diseases: (1) Bacterial Diseases: Anthrax, Bartonellosis (or Carrion disease), Bejel (or endemic syphilis), Buruli ulcers (or Bairnsdale or Daintree or Mossman or Searls ulcer, or mycoburuli ulcers), Diphtheria, Granuloma inguinale (or Donovan disease), Leprosy (or Hansen disease) Leptospirosis (or Weil disease, or Nanukayami fever), Pertussis (or whooping cough), Pinta (or carate) Yaws (or pian, or parangi, or paru, or frambesia tropica), and (2) Chlamydial Diseases: Lymphogranuloma venereum (or Durand-Nicholas-Favre disease), Urethritis and Cervicitis
Advancing Novel Anesthetics
Authors: Campagna Jason A. , Pojasek Kevin , Grayzel David , Randle John , Raines Douglas E.
Published: August 2014

Background:

Cyclopropyl-methoxycarbonyl metomidate (CPMM, also known as ABP-700) is a second-generation “soft” (i.e., metabolically labile) etomidate analogue. The purpose of this study was to characterize CPMM’s pharmacology in beagle dogs in preparation for potential first in human phase 1 clinical trials.

Methods:

CPMM’s and etomidate’s hypnotic activity and duration of action were assessed using loss of righting reflex and anesthesia score assays in three or four dogs. Their pharmacokinetics were defined after single bolus administration and single bolus followed by 2-h infusion. Adrenocortical recovery times after single bolus followed by 2-h infusion of CPMM, propofol, etomidate, and vehicle were measured using an adrenocorticotropic hormone stimulation test.

Results:

Compared with etomidate, CPMM was half as potent as a hypnotic (ED50 approximately 0.8 mg/kg), was more rapidly metabolized, and had a shorter duration of sedative–hypnotic action. Recovery times after CPMM administration were also independent of infusion duration. After hypnotic infusion, adrenocorticotropic hormone–stimulated plasma cortisol concentrations were 4- to 27-fold higher in dogs that received CPMM versus etomidate. Adrenocortical recovery was faster in dogs after CPMM infusion versus etomidate infusion (half-time: 215 vs. 1,623 min, respectively). Adrenocortical responsiveness assessed 90 min after CPMM infusion was not significantly different from that after propofol infusion.

Conclusion:

The studies in dogs confirm that CPMM has hypnotic and adrenocortical recovery profiles that are superior than those of etomidate, supporting the continued development of CPMM as a clinical sedative–hypnotic to be used as a single bolus and by continuous infusion to induce and maintain general anesthesia or procedural sedation.
Volatile Organic Compounds during Inflammation and Sepsis in Rats
Authors: Fink Tobias , Wolf Alexander , Maurer Felix , Albrecht Frederic W. , Heim Nathalie , Wolf Beate , Hauschild Anne C. , Bödeker Bertram , Baumbach Jörg I. , Volk Thomas , Sessler Daniel I. , Kreuer Sascha
Published: August 2014

Background:

Multicapillary column ion-mobility spectrometry (MCC-IMS) may identify volatile components in exhaled gas. The authors therefore used MCC-IMS to evaluate exhaled gas in a rat model of sepsis, inflammation, and hemorrhagic shock.

Methods:

Male Sprague–Dawley rats were anesthetized and ventilated via tracheostomy for 10 h or until death. Sepsis was induced by cecal ligation and incision in 10 rats; a sham operation was performed in 10 others. In 10 other rats, endotoxemia was induced by intravenous administration of 10 mg/kg lipopolysaccharide. In a final 10 rats, hemorrhagic shock was induced to a mean arterial pressure of 35 ± 5 mmHg. Exhaled gas was analyzed with MCC-IMS, and volatile compounds were identified using the BS-MCC/IMS-analytes database (Version 1209; B&S Analytik, Dortmund, Germany).

Results:

All sham animals survived the observation period, whereas mean survival time was 7.9 h in the septic animals, 9.1 h in endotoxemic animals, and 2.5 h in hemorrhagic shock. Volatile compounds showed statistically significant differences in septic and endotoxemic rats compared with sham rats for 3-pentanone and acetone. Endotoxic rats differed significantly from sham for 1-propanol, butanal, acetophenone, 1,2-butandiol, and 2-hexanone. Statistically significant differences were observed between septic and endotoxemic rats for butanal, 3-pentanone, and 2-hexanone. 2-Hexanone differed from all other groups in the rats with shock.

Conclusions:

Breath analysis of expired organic compounds differed significantly in septic, inflammation, and sham rats. MCC-IMS of exhaled breath deserves additional study as a noninvasive approach for distinguishing sepsis from inflammation.
Stereotactic Body Radiation Therapy (SBRT) Combined With Chemotherapy for Unresected Pancreatic Adenocarcinoma
Authors: Gurka Marie K. , Kim Christine , He Aiwu Ruth , Charabaty Aline , Haddad Nadim , Turocy Jenna , Johnson Lynt , Jackson Patrick , Weiner Louis M. , Marshall John L. , Collins Sean P. , Pishvaian Michael J. , Unger Keith
Published: August 2014

Objectives:

The role of radiation therapy in the management of unresectable pancreatic cancer is controversial. One concern about concurrent chemoradiation relates to the timing of chemotherapy. In contrast to conventional radiation therapy, stereotactic body radiation therapy (SBRT) delivers high doses in a shorter duration resulting in minimal disruption in chemotherapy. Here, we report our results of patients treated with SBRT and chemotherapy for inoperable pancreatic cancer.

Materials and Methods:

Thirty-eight patients treated with SBRT and chemotherapy for locally advanced, borderline resectable, and medically inoperable pancreatic cancer at our institution from January 2008 to December 2012 were included in this retrospective analysis. Treatment was delivered in 5 fractions of 5 or 6 Gy per fraction over 5 days. Toxicities were scored using the Common Terminology Criteria for Adverse Events version 3. Survival was calculated using the Kaplan-Meier method.

Results:

The median age was 70 years (range, 45 to 90 y). Eastern Cooperative Oncology Group performance status ranged from 0 to 3. Thirty-four patients received concurrent chemotherapy. Four patients received sequential chemotherapy. Median overall survival was 14.3 months and median progression-free survival was 9.2 months from diagnosis. From radiation, overall survival and progression-free survival were 12.3 and 6.8 months, respectively. The overall local control rate was 79%. Acute toxicity was minimal. Severe late SBRT-related toxicities included 1 grade 3 gastric outlet obstruction, 1 grade 4 biliary stricture, and 1 grade 5 gastric hemorrhage.

Conclusions:

SBRT combined with chemotherapy for unresectable pancreatic cancer is convenient, feasible, and generally well tolerated. Outcomes of SBRT combined with chemotherapy compare favorably to results obtained with chemotherapy and conventional radiation therapy.