bluuebunny/crossref_metadata_2025_split huggingface dataset:
Psoriatic arthropathy
Authors: Silman Alan J , Hochberg Marc C 
Published: October 2023

Abstract
Epidemiologically, the concept of psoriatic arthritis is a complex one. Initially described several years ago as the association of arthritis in a patient with psoriasis (Alibert 1922), the concept has been considerably refined as understanding of different clinical and pathological entities of arthritis has increased. The dilemma seems superficially simple: if all the cases observed can be explained by the chance co-occurrence of two relatively common disorders, psoriasis and a specific type of arthritis such as rheumatoid arthritis, then the syndrome is not appropriate for consideration in an epidemiological sense. Alternatively, if either there is a distinct clinical or pathological type of arthritis restricted to psoriasis, or the presence of psoriasis increases the susceptibility to certain specific types of arthritis, then it is relevant to consider this disorder as a separate entity and investigate its epidemiology. There is also a middle ground and that is the possibility that the presence of psoriasis modifies the clinical and other features of any concurrent arthritis although the latter’s occurrence is no different from that observed in the nonpsoriatic population.
Pharmaco-epidemiology
Authors: Silman Alan J , Hochberg Marc C 
Published: October 2023

Abstract
Pharmaco-Epidemiology and the Rheumatic Diseases
Pharmaco-epidemiology is the application of epidemiological methods to the effects of drugs in human populations. Thus the descriptive epidemiology of patterns of drugs use both within and between populations, including trends over time, fall within this remit and as such are comparable to descriptive data on any environmental exposure within a population. The investigation of the role of drugs in improving prognosis is the remit of the intervention study, more conventionally known as the clinical trial. The conduct of clinical trials should adhere to sound epidemiological principles but their results are more relevant to publications of therapeutics and will not be considered further here. The most widely accepted application of pharmaco-epidemiology is in the ascertainment of toxicity of drugs, where they are investigated as risk factors in a similar fashion to other environmental agents. Thus the frequency of specific toxic reactions together with their possible predictors are appropriate targets for investigation.
Maxillofacial Surgery
Authors: McNeil M 
Published: October 2023

Abstract
Maxillofacial surgery is surgery to the bones and the skull. The indications for the surgery can vary from trauma, to congenital malformations to cosmetic surgery. The trauma patients can often present problems because of the effects of the tissue damage on their airway. Furthermore, there is some¬ times an underlying head injury which, of course, must be treated as the number one priority. Many of these injuries are associated with alcohol abuse, road traffic accidents and assault. The anaesthetist must carefully assess the airway with particular attention to any limitation in mouth opening, which can commonly result from fractures to the facial bones. Awake fibreoptic intubation may be the safest technique of intubating these patients.
Biological aspects of psychiatry
Authors: Lader Malcolm , Herrington Reginald 
Published: October 2023

Abstract
Each of the main biological hypotheses of the mechanisms of psychiatric disorders—affective illness, schizophrenia, and anxiety—relies to a substantial extent on data accruing from therapeutic trials. However, it must be borne in mind constantly that the modes of action of most psychotropic drugs are still poorly understood. Consequently, elaborating hypotheses on the pathophysiology of disorder based on mechanisms of drug action is little more than attempting to explain one unknown in terms of another. Nevertheless, establishing such hypotheses has proved heuristic, at least in stimulating studies incorporating careful clinical observations. Developments in the symptomatology of chronic schizophrenia and in the nosology of the anxiety disorders owe much to observations made in the course of therapeutic studies. This chapter’s emphasis on biological processes in psychiatric disorders should not lead to the impression that other influences, for example social or psychological, are unimportant. Rather it is the interaction between these various factors that would best repay careful analysis (Kidman 1985).
Drugs of abuse
Authors: Lader Malcolm , Herrington Reginald 
Published: October 2023

Abstract
The general topic of substance misuse and abuse is in itself a large specialty with many aspects impinging on day-to-day medical practice. Also, psychological, sociological, economic and political considerations are important in this area. Indeed, illicit drug distribution and sales constitutes one of the biggest ‘industries’ in the USA and is fast assuming similar proportions in many other countries in Europe and elsewhere.
Cardiac arrest associated with special circumstances
Authors: Skinner David V , Vincent Richard 
Published: October 2023

Abstract
A number of conditions other than major cardiac arrhythmias present with life-threatening disorders of circulatory or respiratory function. They can often be suspected from the patient‘s immediate history or surroundings, but occasionally the underlying pathology is obscure. Airway protection, ventilation, and circulatory support, as previously described, remain central to their treatment; but particular aspects of diagnosis and management are worth noting.
Management of common arrhythmias associated with cardiac arrest
Authors: Skinner David V , Vincent Richard 
Published: October 2023

Abstract
This chapter will encompass the recognition and treatment of arrhythmias that cause either circulatory arrest or a profound fall in cardiac output. The correct interpretation of an arrhythmia requires a ‘noisefree‘ ECG, a lead configuration that gives a clear P wave as well as a distinct QRS (leads II and V1 are best), and a familiarity with the patterns and mechanisms of common rhythm disorders. These ideals may be difficult to achieve during cardiopulmonary arrest.
Biochemistry and pharmacology of cardiac arrest
Authors: Skinner David V , Vincent Richard 
Published: October 2023

Abstract
The biochemical derangements associated with cardiac arrest are determined partly by the clinical setting in which the arrest occurred, and partly by the effects of circulatory standstill whatever the cause. For example, cardiac arrest following a period of profound hypoxia may be accompanied by a metabolic acidosis, whereas when ventilation has been suppressed (stroke, drugs) or obstructed (choking, trauma, drowning), the picture will be complicated by a prior respiratory acidosis with a raised Pco2
Children in the Accident and Emergency department
Authors: Morton Rosemary J , Phillips Barbara M 
Published: October 2023

Abstract
Between 20 and 30 per cent of attenders at District General Hospital Accident and Emergency (A & E) departments are children under 16 years old. In England and Wales there are more than two million child attenders at A & E departments annually. There is a disproportionately high number of attenders under five years of age.
It is sometimes considered that because children are small they require a smaller provision of space in hospital buildings than do adults. In fact the opposite is true. Children attending A & E departments are usually accompanied by at least one adult, and often siblings, prams, or pushchairs.
Respiratory and ENT problems
Authors: Morton Rosemary J , Phillips Barbara M 
Published: October 2023

Abstract
1 The severity of acute respiratory disease is best assessed by observation of the child’s work of breathing and his state of alertness.
2 The child with respiratory disease who is drowsy or agitated is probably hypoxic. Pulse oximetry is a useful tool to assess hypoxia.
3 Respiratory disease is more likely to be severe in infants under the age of one year
4 Inspiratory stridor is always a serious symptom.
The origins and physiology of menstruation
Authors: Campbell Steven , Cameron lain T 
Published: October 2023

Abstract
Menstruation is the physiological process during which healthy adult tissue lining the uterus disintegrates and is expelled from the body. A new surface is formed by rapid healing or regeneration although, intriguingly, scarring does not occur. Menstruation is therefore an unusual event, possibly without parallel in adult mammalian physiology.
Menstrual dysfunction secondary to medical disease
Authors: Higham Jenny 
Published: October 2023

Abstract
Menstruation, being the end result of a complex endocrine pathway, is susceptible to a wide variety of influences. Disruption of menstruation can be provoked by both systemic and local disease. This chapter concerns the precipitation of the common problem of excessive menstrual bleeding by ill-health. It should be remembered that only a very small proportion of menorrhagia cases can be attributed correctly to systemic disease. For these few, however, the correct diagnosis may result in successful curative therapy, rather than disappointing palliative medication or unnecessary surgery.
Hysteroscopic endometrial ablation
Authors: Goldrath Milton 
Published: October 2023

Abstract
Menorrhagia represents a widespread clinical problem, and is the leading cause of elective hysterectomy in women with a normal uterus (D’Esopo 1962; Cole and Berlin 1977; Dyck et al. 1977). Various methods are used to treat this condition, including dilatation and curettage (D&C), hormone therapy, ergot derivatives, anti-fibrinolytic agents, and non-steroidal anti-inflammatory drugs (Nilsson and Rybo 1971). While oral contraceptives appear to be the most effective approach to medical treatment, their usefulness is limited by side-effects and contraindications to therapy. Until recently, women who did not respond to pharmacologic intervention were limited to one of two options: hysterectomy or continued cycles of heavy menstrual bleeding.
lntermenstrual and post-coital bleeding
Authors: Landgren Britt-Marie , Schoultz Bo von 
Published: October 2023

Abstract
Disruption of the cyclical pattern of menstrual bleeding may occur at any age and for a variety of reasons. An understanding of the physiological life cycle variations is essential to determine whether a pattern of bleeding episodes should be regarded as normal or abnormal. Normal men-struation occurs in response to the decline in progesterone following the regression of the corpus luteum. Any alteration in the cyclical exposure of the endometrium first, to unopposed oestrogen during the follicular phase and, after ovulation, to oestrogen and progesterone, is likely to result in disturbances in the menstrual pattern. Intermenstrual bleeding may last only a few hours or persist for several days. Bleeding perceived as abnormal or unusual evokes fear and anxiety and is a common reason for gynaecological consultation.
Care in labour
Authors: Mander Rosemary 
Published: October 2023

Abstract
The term ‘normal’ is difficult to define (Downe 1996). For clarity, therefore, this chapter covers care of the woman with an uncomplicated labour and birth where medical/high-tech intervention is not required. The environment for labour and birth is discussed first, followed by support in labour and the control of pain. These three factors are fundamental and closely interrelated in the care of women in labour. Routines in care are then examined, the evidence base and its quality are described, and the extent to which that evidence informs present practice.
Differentiation of the common dementias
Authors: Feldman Howard H , O’Brien John T 
Published: October 2023

Abstract
With the greying of society, diseases causing dementia are now recognized as being one of the most important challenges facing western medicine in the 21st century. The term ‘dementia’ describes a syndrome of acquired loss of cognitive function, behavioural changes, and loss of social function. There is no implied aetiology for dementia and most broadly it represents a neuro-behavioural syndrome that occurs in a large number of diseases. Most dementias occur on the basis of primary degenerative disorders of the central nervous system, though some occur with multisystem inflammatory diseases, infectious diseases, or metabolic/endocrine disorders. Surgically treatable dementias account for a very small percentage of all cases. The potential reversibility of dementia has been emphasized, though longitudinal studies from dementia clinics have demonstrated that in practice this is seen in only 3 to 8 per cent of cases (Clarfield 1988). In patients with dementia associated features such as depression, toxicity related to medications and metabolic disorders are the most frequently modifiable/ reversible problems (Clarfield 1988). The course of dementia is quite variable, though most typically a progressive declining disorder is seen. However, with careful workup and management of treatable components of dementia patients may live with an optimal level of function through their illnesses. The broadest goal for each dementia clinic, community based team, and individual practitioner should be to diagnose and manage each individual to their best level of cognition, behaviour, and function.
Carer support
Authors: Gilliard J , Rabins P V 
Published: October 2023

Abstract
Introduction It is estimated that dementia affects approximately one in ten of the population over the age of 65, one in five of those over the age of 80, and a smaller proportion of younger people (Alzheimer’s Disease Society, 1995). This means that there are about 640000 people with dementia in the United Kingdom and approximately 3900000 in the United States. Most of these are cared for by a family member, so that when we consider the numbers of people who are affected by dementia we should probably at least double the above figures.
Non-pharmacological approaches to treatment
Authors: Woods Bob , Bird Mike 
Published: October 2023

Abstract
In the context of the dementias, a group of diseases with no known cure and none at present foreseeable, it is crucial to define the concept of ‘treatment’. The conceptual basis adopted for this chapter is an assertion made by Woods and Britton in 1985: We need to break away from our pre-occupation with treatment in the sense of cure and recovery, and be aware of the different types of goals that are feasible, and the value of some of the more limited goals in improving the patient’s quality oflife (Woods and Britton, 1985, p. 217).
Frostbite
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K 
Published: October 2023

Abstract
Prevent stiffness by allowing mobility within the dressings from day 1. Very early debridement is not warranted as a surprising amount of healing can take place at the fingertips. Lesions of the fingertips similar to burn wounds, with a similar classification by depth (see p. 66).
Long-term complications of dialysis: an introductory chapter
Authors: Harris Susan , Brown Edwina A 
Published: October 2023

Abstract
Charing Cross hospital (CXH) was one of the first centers in the UK to begin a maintenance hemodialysis program. Encouraged by the work of Scribner and his colleagues in the USA, Professor de Wardener sent a team of doctors and nurses to Seattle in 1964 to learn the technique. It was decided to start with just one patient. This patient was carefully selected to have the best chance of a successful outcome, such that the result of the treatment would be most likely to encourage other centers to take an interest in chronic dialysis. In 1964, watched by all 15 members of the renal team, this patient began his first treatment on a schedule of long-term hemodialysis (this patient survived for 27 years). Teething problems were expected, difficulties with fluid and electrolyte balance were anticipated and tackled as they arose. But the expectation was that this would be a complete renal replacement therapy, and that once patients were established on hemodialysis they would return to work and live a full and happy life. For, apart from the problems of vascular access which were fully recognized and described as ‘the Achilles heel’ of long-term dialysis (de Wardener, 1966) the other long-term complications such as amyloidosis and cardiovascular disease could not have been foreseen.
Clones, Clones, Clones
Authors: Greaves Mel 
Published: October 2023

Abstract
If there is one respect in which cancer is special as an illness, it is that all the cancer cells in one patient are, in almost every case, derived from a single cell. They are a clone. Not necessarily all identical because the capacity of the progeny of the founder or mother cell to diversify genetically is another critical feature of cancer cells, as we shall see - but a clone nonetheless. A clone of up to or more than 1012 (a million, million) cells that may have dispersed throughout the body. A clone that if removed from the confines of the body could, given suitable conditions, expand to fill any large and well-known building. But clones - multiple copies of the same thing, abound in nature.
How Cancer Cells Play the Winning Game
Authors: Greaves Mel 
Published: October 2023

Abstract
To generate a fully-fledged or dominant cancer clone, a cell has to subvert multiple rules of engagement and negotiate major evolutionary bottlenecks. For most types of cancer, this is only possible by the accumulation of a set of mutations in genes exercising different, but complementary or interlocking, functions. Because of the statistical rarity of DNA damage creating one of these mutations and because accrual of a set of mutations is only possible by sequential addition, the process can only operate in single cells, or clonally and over an extended period of time. This makes the whole process probabilistic and pervaded by chance (Fig. 8.1).
Other Ways of Getting Bugged
Authors: Greaves Mel 
Published: October 2023

Abstract
You might suppose that cancers caused by common viruses must be very unusual. Not so. Around 15 per cent of the total cancer burden world wide can be linked to persistent infection with common viruses or other microbial invaders that are transmitted person to person. These cancers are all more common in less developed countries and it is likely that they have been around for a very long time. The links include liver cancer (or hepatocarcinoma) with hepatitis B and C (HBV and HCV); both nasopharyngeal cancer (which is very common in South East Asia) and African Burkitt’s lymphoma with Epstein Barr virus (EBV); Kaposi’s sarcoma with a new human herpes virus (HHV8); and finally, a form of adult leukaemia (common in southern Japan and the Caribbean basin) that is associated with an RNA virus or retrovirus called HTLV-1. These cancers are all of special interest because of the opportunity they provide for prophylactic vaccination.
Epilogue: Cancer In The Twenty-First Century
Authors: Greaves Mel 
Published: October 2023

Abstract
The evolutionary and historical picture I have tried to paint might encourage a fatalistic trait of resigned inevitability. I hope not, because that’s not how I and, I believe, most cancer researchers (admittedly inveterate optimists) now see the problem. Cancer is in one sense an inevitability, at a certain level. The height of that level for different cancers is however a social variable. Understanding how cancer clones operate tactically is one half of the battle won. We can tackle the clone more cleverly or we can confront the social ratchet that escalates risk; or we can try to do both. It surely has to be both, but there are choices and priorities to be made. There still will not be a ‘magic bullet’, however sophisticated, for cancer in general. Political leaders and advisers should now recognize that the problem isn’t equivalent to the task of building the first atomic bomb and getting a man on the moon.
Preoperative investigations
Authors: Hwang Dr Nian Chih , Sinclair Dr Michael 
Published: October 2023

Abstract
The baseline ECG may show areas of new or old myocardial infarctions, abnormal rhythms, conduction defects, or evidence of ventricular hypertrophy, atrial dilatation, and electrolyte abnormalities. The exercise ECG was developed to identify the patient with coronary artery disease who presented with atypical chest pain or with a normal resting ECG and symptoms suggestive of coronary artery disease. It helps the cardiologist to identify patients at risk for myocardial infarction and to decide who should have coronary angiography. Exercise testing includes using the treadmill or bicycle in the cardiac catheterization or radionuclear laboratories. All exercise stress test protocols progressively increase myocardial work. The most familiar protocol, the Bruce protocol, consists of 3-min stages where the grade of inclination and the speed of the treadmill increase gradually. The heart rate and blood pressure are continuously measured, and the exercise is terminated when symptoms and signs of myocardial ischaemia, dysrhythmias, and left ventricular dysfunction occur. Development of hypotension during the stress test indicates a significant stenotic lesion of the left main stem (left main coronary artery). However, exercise-induced ischaemic changes in the awake patient, even though they may occur at a reproducible rate-pressure product, may not be applicable to the stress of coronary artery bypass graft surgery and anaesthesia. Stress during surgery could provoke similar dysrhythmias, and a history of them occurring during exercise testing can provide valuable information for the anaesthetist.
Preoperative visit and preparation
Authors: Hwang Dr Nian Chih , Sinclair Dr Michael 
Published: October 2023

Abstract
Review the medication that the patient has been prescribed; as the types of drugs used will give an indication of the patient’s symptoms. For example, nitrates, -blockers, calcium-channel blockers, potassium-channel activators, aspirin, and/ or cholesterol lowering agents are taken to relieve angina, intravenous infusions of heparin and/ or nitroglycerin are taken to relieve unstable angina, digoxin, diuretics, and vasodilators (such as ACE inhibitors) are to relieve congestive cardiac failure (from poor ventricular function or incompetent valve), and digoxin and warfarin are taken when atrial fibrillation is present. Any complications with previous general anaesthetics should be ascertained. The usual examination of the airway and of potential venous and arterial access should be carried out. Ascending thoracic aortic aneurysm is associated with Marfan’s syndrome, and the possibility of difficult laryngoscopy should be anticipated in the presence of a high arched palate. A clinical impression of the cardiac status of the patient can be obtained by taking note of the conditions discussed below.
Guidelines for implantation of an automatic internal cardioverter–defibrillator
Authors: Hwang Dr Nian Chih , Sinclair Dr Michael 
Published: October 2023

Abstract
Recurrent sustained ventricular tachycardia (episodes of at least 10 con secutive ventricular ectopic beats) is a known sequela of ischaemic heart disease and acute myocardial infarction. An automatic internal cardioverter-defibrillator can be implanted subcutaneously in the chest to treat recurrent ventricular dysrhythmias when the side-effects of chronic drug therapy are undesirable (amiodarone) or when medical therapy fails.
Congenital abnormalities of the heart and great vessels
Authors: Hwang Dr Nian Chih , Sinclair Dr Michael 
Published: October 2023

Abstract
The complex development of the heart and major arteries accounts for a multitude of congenital abnormalities. The majority of cardiac abnormalities involve intracardiac and extracardiac shunts resulting in the mixing of deoxygenated and oxygenated blood. Atrial septal defect, ventricular septal defect, and persistent ductus arteriosus are common congenital cardiac lesions (Figs. 17.1 and 17.2). These shunts may exist with or without associated cardiac obstructive lesions (complex shunts or simple shunts respectively).