bluuebunny/crossref_metadata_2025_split huggingface dataset:
Measurement of Myocardial Blood Flow by SPECT
Authors: de Oliveira Brito Juliana Brenande , Small Gary R. , Ascah Kathryn J. , Wells R. Glenn , Ruddy Terrence D. 
Published: February 2024

Abstract
Stress MPI with SPECT and PET is widely used for diagnosis and determining prognosis in patients with suspected or known CAD. However, a major limitation of MPI is the use of relative perfusion for diagnosis of obstructive CAD and leads to underestimation of the extent of obstructive CAD. However, MBF and MFR can be measured with PET and provide additional diagnostic and prognostic value over relative PET MPI. Similarly, SPECT measurement of MBF may improve the clinical value of SPECT and greatly increase the availability and use of MBF with MPI. The accuracy of CZT SPECT measurement of MBF has been validated in clinical evaluations in patients undergoing coronary angiography and PET imaging. Reduced global stress MBF and MFR can identify the presence of severe MVD. Regional reductions in stress MBF and MFR have high diagnostic accuracy for specific vessel CAD. Reduced global and regional SPECT MFR can predict reduced global and regional PET MFR. SPECT measurement of MBF has good day-to-day repeatability and interobserver variability. We describe the use of SPECT MBF at the University of Ottawa Heart Institute, including image acquisition and processing and clinical interpretation of test results with case examples. The clinical use of SPECT MBF is in the early stages of implementation. Protocols including radiotracers, camera systems and software need to be standardized. Multicenter studies are necessary to better define the diagnostic value of CZT SPECT MBF for obstructive CAD and the incremental prognostic value of SPECT MBF measurement compared to relative MPI.
Pharmacologic Stress Testing
Authors: Andrikopoulou Efstathia , Iskandrian Ami E. , Hage Fadi G. 
Published: February 2024

Abstract
Stress MPI using SPECT is widely used for CAD detection and risk stratification. While exercise is the preferred mode of stress in the majority of patients, pharmacologic stress is recommended for patients who have exercise limitations and patients with ventricular pre-excitation, LBBB, or artificially paced rhythms. Pharmacologic stress agents produce coronary hyperemia by completely different sets of mechanisms than exercise, but the hyperemia achieved with these agents is at least as intense as that achieved by maximal exercise. This chapter will discuss the pharmacology, mechanisms of action, hemodynamic effects, safety, and side effect profiles of the pharmacologic stress agents used for MPI and the protocols used with these agents either alone or when combined with exercise. The chapter also includes a description of the utility of pharmacologic stress MPI data on clinical management.
SPECT MPI and Risk Assessment Before Non-Cardiac Surgery
Authors: Fisher Daniel C. , Phillips Lawrence M. 
Published: February 2024

Abstract
SPECT MPI is routinely used to evaluate patients with chest pain, both for diagnostic and prognostic purposes. The evaluation of patients prior to non-cardiac surgery can also provide an opportunity to evaluate both symptomatic and asymptomatic patients for the presence of obstructive coronary artery disease. This chapter reviews the most recent ACC/AHA guidelines for preoperative risk evaluation, particularly as they pertain to the role of stress testing with nuclear imaging. It also includes tools that are recommended for risk stratification in patients who are preparing for non-cardiac surgery as well as test selection in such patients. Finally, it will discuss the application of these results with respect to pharmacologic therapy and invasive evaluation with coronary angiography.
Role of PET in Diagnosis and Risk Assessment in Patients with Known or Suspected CAD
Authors: Wiefels Christiane , Mc Ardle Brian A. , Renaud Jennifer M. , deKemp Robert A. , Beanlands Rob S. B. , Promislow Steven 
Published: February 2024

Abstract
The use of cardiac PET MPI for evaluating CAD continues to increase due to more widespread availability of PET systems and a shifting focus toward minimizing patient radiation exposure from diagnostic testing. Ongoing advances in camera technology and radiotracer development coupled with consistent attenuation correction contribute to a higher diagnostic accuracy compared to other noninvasive means of evaluating for CAD, such as SPECT imaging. In particular, the ability to quantify myocardial blood flow further increases sensitivity for the detection of CAD and provides incremental prognostic value. This chapter provides a review of PET MPI and myocardial blood flow for diagnosis and risk assessment in patients with known or suspected CAD, focusing on imaging protocols and interpretation, prognosis, recent expanded use and applications of myocardial blood flow quantification, and utilization of PET imaging to guide clinical decision-making. Potential future directions for PET imaging are also highlighted.
Radionuclide Imaging in Heart Failure
Authors: Shpilsky Daniel , Soman Prem 
Published: February 2024

Abstract
Radionuclide imaging techniques are widely available and are applicable irrespective of body habitus, cardiac rhythm, renal function, the presence of implanted cardiac devices, or allergy to iodinated contrast. Nuclear cardiac imaging can be applied with advantage at several stages in the evaluation and management of the heart failure patient, including the assessment of etiology, selection of patients for coronary revascularization, and the measurement and serial evaluation of left ventricular function. Imaging with SPECT or PET can identify specific pathophysiologic states of CAD-related LV systolic dysfunction and thus differentiate ischemic cardiomyopathy from nonischemic cardiomyopathy coexisting with CAD. In addition, radionuclide approaches have a unique role in the evaluation of specific heart failure etiologies such as amyloidosis, where Tc-99m pyrophosphate imaging has been transformative, and sarcoidosis and post-transplant allograft vasculopathy. Evolving applications are likely to expand the utility of radionuclide imaging in heart failure.
Esophageal Motility
Authors: Codipilly Chamil C. , Ravi Karthik 
Published: February 2024

Abstract
The esophagus is the conduit for oral contents to pass from the oropharynx into the stomach. An intricate network of neuromuscular processes allows for the propulsion of food into the stomach while avoiding the passage of boluses into the respiratory system and inhibiting the reflux of gastric contents into the esophagus. Esophageal dysmotility manifests mainly as dysphagia or gastroesophageal reflux disease, although in rare instances it may also result in chest pain and discomfort. This chapter reviews the normal physiology of swallowing and discusses the pathophysiology, diagnostic evaluation, and management of esophageal motility disorders.
Peptic Ulcer Disease
Authors: Hansel Stephanie L. 
Published: February 2024

Abstract
A peptic ulcer is a persistent break in the gastrointestinal mucosa of the stomach or duodenum that is at least 5 mm and penetrates through the muscularis mucosa. At endoscopy, an ulcer with perceivable depth should be readily apparent. Smaller, shallower mucosal breaks are erosions. Most peptic ulcers are due to Helicobacter pylori infection or the administration of nonsteroidal anti-inflammatory drugs. The term peptic ulcer disease refers to ulceration that depends in part on the acid and peptic (ie, with pepsins) activity of gastric juice. Most peptic ulcers occur in the stomach or duodenal bulb.
Gastric Neoplasms and Gastroenteric and Pancreatic Neuroendocrine Tumors
Authors: Sweetser Seth R. 
Published: February 2024

Abstract
Gastric neoplasms are an important contributor to cancer-related mortality. Of the various neoplasms that can affect the stomach, adenocarcinoma is the most common and accounts for up to 85% of gastric neoplasms, with 15% due to lymphomas, gastrointestinal stromal tumors, neuroendocrine tumors, and metastatic disease involving the stomach. This chapter considers the epidemiology, pathogenesis, clinical manifestation, diagnostic evaluation, treatment, and prognosis of these neoplastic diseases.
Endoscopy for the Gastroenterology Board Examination
Authors: Sawas Tarek , Bruining David H. , Storm Andrew C. 
Published: February 2024

Abstract
Colonoscopy is a widely used diagnostic and therapeutic tool. The goal of a screening colonoscopy is to detect and remove early neoplastic lesions to prevent the development of colorectal cancer in asymptomatic patients. Performing a high-quality colonoscopy with comprehensive mucosal visualization is essential. The following metrics have been proposed as indicators for high-quality examinations: colon preparation, cecal intubation rate, withdrawal time, and adenoma detection rate.
Inflammatory Bowel Disease: Therapy
Authors: Pardi Darrell S. , Chedid Victor G. 
Published: February 2024

Abstract
There are many therapies available for patients with inflammatory bowel disease (IBD). Medical therapies include aminosalicylate drugs such as sulfasalazine, olsalazine, balsalazide, and various formulations of mesalamine; antibiotics; corticosteroids; immunosuppressive medications such as azathioprine, 6-mercaptopurine, methotrexate, and cyclosporine; and biotechnology medications such as anti–tumor necrosis factor agents, anti-interleukins, anti-integrins, and other newer agents with different targets and mechanisms of action. This chapter reviews these various treatments and where they fit in the treatment algorithms for Crohn disease and ulcerative colitis. Many surgical therapies also are used in patients with IBD, although a detailed review of these options is beyond the scope of this chapter.
Inflammatory Bowel Disease: Extraintestinal Manifestations and Colorectal Cancer
Authors: Quinn Kevin P. , Raffals Laura E. 
Published: February 2024

Abstract
Ulcerative colitis and Crohn disease are inflammatory disorders that affect the gastrointestinal tract. However, these diseases are systemic disorders that may involve other organ systems. Extraintestinal manifestations can affect any organ system, and while in many cases these symptoms are believed to be a result of the underlying intestinal inflammation, some extraintestinal manifestations are independent of the luminal disease course. Extraintestinal manifestations may precede the diagnosis of inflammatory bowel disease. Many patients who have extraintestinal manifestations have colonic disease, and in persons with 1 extraintestinal manifestation, another extraintestinal symptom is more likely to develop.
Intestinal Infections
Authors: Khanna Sahil 
Published: February 2024

Abstract
Intestinal infections are common. An estimated 180 million illnesses occur annually in the US and over 1 billion cases of infectious diarrhea occur annually worldwide. Despite advances in diagnosis, supportive care, and antibiotic guidance, the mortality from these infections remains extremely high, especially in the pediatric age group. Some estimates indicate that enteric infectious diarrhea in children younger than 5 years leads to 1 death every 10 seconds. Infectious diarrhea from enteric pathogens is more common in children and in resource-limited countries than in adults in industrialized countries. The clinical features of infectious diarrhea vary, depending on whether the organism is invasive and whether the infection occurs in the small bowel or colon.
Colorectal Neoplasms
Authors: Ebner Derek W. , Kisiel John B. 
Published: February 2024

Abstract
Colorectal cancer (CRC) is primarily a disease of urban, industrialized societies. In the US, the lifetime risk of CRC is similar for men (4.4%) and women (4.1%). Recent data have suggested that the incidence rates of CRC may be decreasing gradually in some subgroups of the population but increasing in adults younger than 50 years. However, the mechanisms underlying these trends have not been defined completely. Several national organizations have endorsed screening and surveillance guidelines, which undoubtedly have contributed to more effective prevention of CRC.
Gastrointestinal Disease and Pregnancy
Authors: Kane Sunanda V. 
Published: February 2024

Abstract
Pharmacotherapy for the management of common gastrointestinal illnesses continues to evolve. Women with chronic illnesses who would have been unwilling or unable to conceive in the past are now healthy enough to consider pregnancy. In addition, many women are deferring childbearing until later in life, when polypharmacy and illness may be more common. This chapter discusses the use of medications during pregnancy according to the best available evidence. Because the amount of high-quality controlled data in pregnancy is limited, absolute safety is not guaranteed with any medication. This chapter covers the treatment of common gastrointestinal and liver diseases, the management of common gastrointestinal symptoms, and the use of medications during endoscopy.
Portal Hypertension–Related Bleeding
Authors: Hilscher Moira , Simonetto Douglas A. 
Published: February 2024

Abstract
Portal hypertensive bleeding encompasses a spectrum of conditions that include esophageal, gastric, and ectopic varices and portal hypertensive gastroenteropathy. Esophageal variceal hemorrhage occurs through a combination of increased portal pressure and local factors within the varix itself. Management of esophageal varices includes primary prophylaxis of variceal hemorrhage, treatment of actively bleeding varices, and prevention of variceal rebleeding (secondary prophylaxis). The choice of therapy for primary prophylaxis depends on patient preferences and includes pharmacologic therapy with nonselective β-blockers (NSBBs) or variceal band ligation, especially if NSBB therapy fails or is not tolerated by the patient. Active bleeding is best treated endoscopically.
Metabolic Liver Diseases
Authors: Cheung Angela C. , Sanchez William 
Published: February 2024

Abstract
Metabolic liver disease refers to inherited disorders of metabolism that manifest prominently with liver disease. The 3 major inherited disorders that cause liver disease in adults are α1-antitrypsin deficiency, Wilson disease, and hereditary hemochromatosis. All are multisystem disorders that cause liver injury by various mechanisms but which can ultimately lead to cirrhosis and complications of liver failure. Also, various inborn errors of metabolism that cause liver disease manifest during childhood. These inborn errors of metabolism are, in aggregate, a major indication for pediatric liver transplant. As more patients who have childhood syndromes with liver involvement survive into adulthood, gastroenterologists who treat adults will need to become familiar with their care; however, the childhood syndromes rarely manifest initially in adulthood.
Cholestatic Liver Disease
Authors: Eaton John E. 
Published: February 2024

Abstract
Cholestatic liver disease in adults may or may not show evidence of large bile duct obstruction. Drug-induced cholestasis may be the most common explanation for cholestasis, which is often self-limiting. Primary biliary cholangitis is the most common chronic cholestatic liver disease in adults, and primary sclerosing cholangitis is about half as common as primary biliary cholangitis. In contrast to primary sclerosing cholangitis, the cause of secondary sclerosing cholangitis can often be identified.
Drug-Induced Liver Injury
Authors: Mousa Omar Y. , Leise Michael D. 
Published: February 2024

Abstract
Despite increased awareness through the efforts of public and regulatory agencies, the syndrome known as drug-induced liver injury (DILI) is still a major public health problem in the US and the world. Moreover, it is the single most common reason for US Food and Drug Administration regulatory actions, including the removal of drugs from the marketplace. Although the frequency of this clinical syndrome is low within populations, DILI causes a significant clinical and economic burden. This chapter highlights new developments in the field of idiosyncratic DILI and provides information about DILI from acetaminophen.
Liver Disease in Pregnancy
Authors: Udompap Prowpanga , Allen Alina M. 
Published: February 2024

Abstract
Because most pregnant women are young and healthy, liver disease is uncommon in this population. Also, the presence of liver disease must not be confused with some of the physiologic changes of pregnancy that mimic features commonly associated with liver dysfunction (Table 35.1). Examples of physiologic changes include spider angioma and palmar erythema, which may occur in half the pregnant women because of the hyperestrogenic state, increased serum alkaline phosphatase level from placental production, and decreased albumin and hemoglobin levels with volume expansion. Increased bilirubin and transaminase levels, hepatomegaly, splenomegaly, liver tenderness, and bruits do not occur in normal pregnancy, and the clinical finding of jaundice is always abnormal.
Liver Transplantation
Authors: Mousa Omar Y. , Ilyas Sumera I. 
Published: February 2024

Abstract
Liver (LT) is highly effective for patients with liver failure to restore normal health and a normal lifestyle. Patient survival after LT is excellent, reaching 90% at 1 year and 77% at 5 years in the US according to the Scientific Registry of Transplant Recipients. The 5-year survival rate for living-donor LT (LDLT) recipients for 2008-2011 was 81.2%. Timely evaluation for transplant and optimization of pretransplant care is essential for the potential liver recipient. However, the demand for donor organs greatly exceeds supply. In 2019 in the US, 8,345 liver transplants were performed for patients 18 years or older, 442 (5.3%) of whom underwent LDLT.
A 45-Year-Old Man With Chronic Cough and Dyspnea on Exertion
Authors: Olson Emily M. , Kelm Diana J. 
Published: February 2024

Abstract
The differential diagnosis for uncontrolled asthma is broad and includes vasculitis, eosinophilic pneumonia, structural abnormalities such as vocal cord dysfunction, and infectious causes such as allergic bronchopulmonary aspergillosis among many others. Eosinophilic granulomatosis with polyangiitis should be considered when patients have uncontrolled asthma, eosinophilia and rhinosinusitis, and systemic symptoms such as neuropathy, skin lesions, or glomerulonephritis. Glucocorticoids are the mainstay of management, and often patients require long-term therapy with prednisone for asthma control.
A 59-Year-Old Woman With Episodic Dyspnea
Authors: Marty Paige K. , Niven Alexander S. 
Published: February 2024

Abstract
Dyspnea is a symptom with many possible causes, including upper airway pathology. Inducible laryngeal obstruction should be considered when patients have acute-onset episodic dyspnea, stridor, and difficulty with inspiration. The mainstays of treatment include optimization of other upper airway pathologic findings, speech-behavioral therapy, and management of behavioral health conditions if identified.
A 52-Year-Old Man With Suicidal Ideation and Bipolar Disorder
Authors: Gopalratnam Kavitha , Hocker Sara E. 
Published: February 2024

Abstract
Patients with serotonin syndrome present with the triad of mental status changes, neuromuscular abnormalities, and autonomic dysfunction after exposure to a serotonergic drug. A high degree of awareness is required for an accurate diagnosis. Prompt discontinuation of the drug and symptom management are the mainstays of therapy.
A 61-Year-Old Man With Dyspnea on Minimal Exertion
Authors: Krishna Rachana , Ryu Jay H. 
Published: February 2024

Abstract
Pulmonary Langerhans cell histiocytosis (PLCH) is a diffuse cystic lung disease related to smoking in adults. The disease may coexist with other smoking-related conditions, including respiratory bronchiolitis, DIP, and emphysema. Decreased Dlco is the most common finding on pulmonary function testing. Extrapulmonary involvement, mainly with bone and pituitary involvement, occurs in 10% to 15% of adults with smoking-related PLCH. Treatment of PLCH is mainly smoking cessation; rarely, corticosteroids and cladribine are used if the disease continues to progress despite smoking cessation. Complications of PLCH include spontaneous pneumothorax, pulmonary hypertension, and increased risk of malignancies.
A 67-Year-Old Woman With Progressive Dyspnea and Atypical Infiltrates
Authors: Kubbara Aahd F. , Moua Teng 
Published: February 2024

Abstract
Diagnosis of pulmonary amyloidosis tends to be delayed because the condition is rare and few symptoms develop, although incidental radiologic findings may be extensive. The 3 types of pulmonary amyloidosis have distinctive radiologic and clinical presentations, underlying causes, and prognoses. Nodular amyloidosis tends to be associated with a local lymphoproliferative disorder and usually carries a favorable prognosis. Diffuse alveolar septal amyloidosis is typically associated with underlying systemic disease and, with its histologic pattern of alveolar damage, tends to impair gas exchange and lead more commonly to dyspnea and hypoxemia. Tracheobronchial amyloidosis may result in airway compromise and hemoptysis. Of these, diffuse alveolar septal forms carry the worst prognosis.
A 36-Year-Old Man With Recurrent Fevers, Dry Cough, and Weight Loss
Authors: Kanj Amjad N. , Pennington Kelly M. 
Published: February 2024

Abstract
Tuberculosis (TB) is most common in resource-limited populations and has major public health implications. Usually, the disease arises from reactivation of a latent focus in the lungs. Prompt diagnosis and effective treatment are essential. Adjunctive corticosteroids are important in the management of tuberculous meningitis and should be considered during the first 4 weeks after antiretroviral therapy initiation in HIV-infected patients who have active TB disease and are at risk for TB-associated immune reconstitution inflammatory syndrome.
A 51-Year-Old Woman With Fever and Cough
Authors: Mudrakola Harsha V. , Skalski Joseph H. 
Published: February 2024

Abstract
When patients have isolated ground-glass opacities on radiography, the differential diagnosis is broad. Pneumocystis jirovecii pneumonia must be considered if a patient is immunosuppressed. In patients without HIV infection, hematologic malignancies and their therapy-related immunosuppression portend the greatest risk for Pneumocystis jirovecii pneumonia. The treatment algorithm is similar for patients with HIV infection and for patients without HIV infection.
A 56-Year-Old Man With Persistent Pneumonia
Authors: Long Cameron M. , Hoskote Sumedh S. 
Published: February 2024

Abstract
Unresolving pneumonia, characterized by a lack of radiographic clearance in normal lungs by 6 weeks, has a broad differential diagnosis. Malignancy occurs in 1% to 2% of patients and requires vigilance to ensure timely diagnosis. Early-stage non–small cell lung cancer is curable, and surgical resection is recommended. Advanced-stage adenocarcinoma is treatable, and life expectancy is improving, but survival is still poor (40% survival at 5 years) for patients with stage III or IV disease (6).
A 65-Year-Old Man With Shoulder Pain, Cough, and Dyspnea
Authors: Vu Ann N. , Li Heyi , Kern Ryan M. 
Published: February 2024

Abstract
Malignant pleural mesothelioma is a rare but aggressive primary pleural malignancy. Diagnosis often requires invasive biopsy for acquisition of sufficient tissue. Despite decades of research and multimodality therapy, the optimal treatment regimen for MPM is unclear, and the prognosis is poor. In the future, though, the use of immunotherapy and biologic agents may revolutionize treatment guidelines and improve patient survival.