Oxford Textbook of Medicine最新文献

{"title":"Health promotion","authors":"E. de Leeuw","doi":"10.1093/med/9780198746690.003.0019","DOIUrl":"https://doi.org/10.1093/med/9780198746690.003.0019","url":null,"abstract":"The ‘Ottawa Charter for Health Promotion’ (1986) remains a benchmark for the global health promotion community, but the context for health promotion has changed with increasing recognition of the significance of inequalities in health. Health promotion is a key strategy to deal with the social determinants of health that create these inequities. Attention has shifted from the mere recognition that all public policies may impact on health to active strategies and actions to move health concerns into all policies. Clinicians are key actors in shaping social and cultural priorities and beliefs: they should be committed to the reduction of health inequity, with health promotion as a core commitment and responsibility.","PeriodicalId":347739,"journal":{"name":"Oxford Textbook of Medicine","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131216081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hodgkin lymphoma","authors":"V. Bhatt, J. Armitage","doi":"10.1093/med/9780198746690.003.0524","DOIUrl":"https://doi.org/10.1093/med/9780198746690.003.0524","url":null,"abstract":"Hodgkin’s lymphoma is derived from a profoundly defective B cell, with the pathobiology, histology, and clinical features being both characteristic and distinct from non-Hodgkin’s lymphomas. Its cause is unknown. Incidence is about 3 per 100 000 per year in Western countries with a bimodal age distribution meaning that it is one of the commoner lymphomas of young people. Most cases are highly responsive to combination chemotherapy, with many patients being cured of their disease. Patients with Hodgkin’s lymphoma may present with lymphadenopathy, a mediastinal (or other) mass, and systemic symptoms including weight loss, fever, and night sweats (B-symptoms). Workup requires staging with positron emission tomography (PET)-CT imaging, and biopsy. Classical Hodgkin’s lymphoma is defined by the presence of the binucleate Reed–Sternberg cell in an appropriate inflammatory histological context. These cells have a characteristic immunohistochemical phenotype, showing CD15 and CD30 positivity, but being immunonegative for classical B-cell markers such as CD20. Additional histological subtypes have been defined, with the most clinically significant being lymphocyte-predominant Hodgkin’s lymphoma. Patients with localized disease may be treated with chemotherapy with or without radiotherapy. Those with more advanced-stage disease require combination chemotherapy, with radiotherapy to sites of initial bulk disease. While relapse is uncommon in patients with early-stage disease, some 20% of patients with advanced-stage disease may need ‘salvage’ chemotherapy regimens for relapsed disease, when the aim is to attain PET negativity before embarking on high-dose therapy with stem cell rescue. Since many patients have a good outcome, it is essential to minimize the long-term sequelae of treatment. Risk stratification is a major focus of clinical trials in this area to determine optimal treatment strategies.","PeriodicalId":347739,"journal":{"name":"Oxford Textbook of Medicine","volume":"24 10","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132693972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ataxic disorders","authors":"N. Wood","doi":"10.1093/med/9780198746690.003.0587","DOIUrl":"https://doi.org/10.1093/med/9780198746690.003.0587","url":null,"abstract":"Ataxia is a feature of disorders of the cerebellum and its connections. It may be found in a large range of neurological conditions, in some of which it is the principal or main feature, but clinical assessment is complicated by the fact that few ataxic patients have disease restricted to the cerebellum alone. The term ataxia derived from the Greek means ‘irregularity’ or ‘disorderliness’. Unsteadiness can result from several causes, including poor vision, impairment of postural reflexes, or due to a deficiency of sensory input (i.e. sensory ataxia). This chapter focuses on the symptoms, signs, and the pathological and clinical features of the disorders of the cerebellum (and its connections).","PeriodicalId":347739,"journal":{"name":"Oxford Textbook of Medicine","volume":"307 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132702473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Traumatic brain injury","authors":"Tim P. Lawrence, L. Watkins","doi":"10.1093/med/9780198746690.003.0592","DOIUrl":"https://doi.org/10.1093/med/9780198746690.003.0592","url":null,"abstract":"Traumatic brain injury is one of the leading causes of death and disability worldwide. It is an extremely heterogenous condition with respect to mechanism, pathophysiology, injury pattern, and investigation findings, with highly variable outcomes, posing a significant challenge to clinicians treating it.\u0000 Essential to the management of traumatic brain injury is an integrated, multidisciplinary approach from rapid resuscitation and early intervention through to rehabilitation. The pathophysiology can be divided into primary and secondary injury, where primary represents the injury at the point of trauma and secondary the progression of injury due to a cascade of downstream events occurring as a consequence of the primary injury and subsequent physiological insults.","PeriodicalId":347739,"journal":{"name":"Oxford Textbook of Medicine","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132786473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Autoimmune hepatitis","authors":"G. Webb, G. Hirschfield","doi":"10.1093/med/9780198746690.003.0324","DOIUrl":"https://doi.org/10.1093/med/9780198746690.003.0324","url":null,"abstract":"Autoimmune hepatitis is an idiopathic inflammation of the liver attributed to immune responses against self-antigens presumed to be of hepatocyte origin. It is typically a relapsing and remitting corticosteroid-responsive condition associated with hepatitic serum liver tests, elevated gammaglobulins, and positive immune serology. Histological features are not specific but often include expanded portal tracts with a lymphoplasmacytic infiltrate. Epidemiology: predominantly affects women, may occur throughout life, has some heritable component, and 60% of patients have other autoimmune diseases. Clinical features: many patients are asymptomatic and identified through investigation of abnormal serum liver tests. Presentation may be with anorexia, nausea, hepatic discomfort, and jaundice, but others may have nonspecific malaise or extrahepatic manifestations such as arthralgia, arthritis, or fever. Clinical signs vary greatly, ranging from none to jaundice and tender hepatomegaly to fulminant hepatic failure. One-third of patients present as cirrhotic. Diagnosis: characteristic laboratory findings include elevated serum transaminase activities, hypergammaglobulinaemia (as IgG), and circulating autoantibodies (e.g. antismooth muscle antibodies, anti-liver–kidney microsomal antibodies, and antinuclear antibodies). Diagnosis depends on the combination of clinical features and biochemical, immunological, and liver biopsy abnormalities, with exclusion of viral and other aetiologies. There may be overlap features with other autoimmune liver diseases (primary sclerosing cholangitis or primary biliary cholangitis). Treatment and prognosis: the condition tends to progress to hepatic fibrosis and cirrhosis. Most cases should be treated with an immunosuppressive regimen, typically prednisolone with azathioprine in the first instance, and most require long-term immunosuppression. Crude 10-year survival rate is 65% for those presenting with cirrhosis and greater than 95% for those presenting without. End-stage decompensated cirrhosis and acute nonresponsive autoimmune hepatitis with liver failure can be indications for liver transplantation.","PeriodicalId":347739,"journal":{"name":"Oxford Textbook of Medicine","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128086752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mitochondrial disease","authors":"P. Chinnery, D. Turnbull","doi":"10.1093/med/9780198746690.003.0612","DOIUrl":"https://doi.org/10.1093/med/9780198746690.003.0612","url":null,"abstract":"Mitochondrial encephalomyopathies are caused by primary defects of the respiratory chain that lead to disturbed generation of adenosine triphosphate by aerobic metabolism. This characteristically impairs the function of high-demand tissues such as the brain, eye, cardiac, and skeletal muscle, as well as endocrine organs. The numerous proteins involved are encoded by genes in mitochondrial or nuclear DNA. Mutations in these genes can lead to clinical disorders. Disorders of intermediary metabolism (such as fatty acid β‎-oxidation or tricarboxylic acid cycle defects) involve mitochondrial enzymes, but the term ‘mitochondrial disease’ usually means a disease which is due to an abnormality of the final common pathway of energy metabolism—the mitochondrial respiratory chain, which is linked to the production of adenosine triphosphate by oxidative phosphorylation. The respiratory chain is essential for aerobic metabolism, and respiratory chain defects characteristically affect tissues and organs that are heavily dependent upon oxidative metabolism.","PeriodicalId":347739,"journal":{"name":"Oxford Textbook of Medicine","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128147041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Smoking cessation","authors":"P. Aveyard","doi":"10.1093/med/9780198746690.003.0642","DOIUrl":"https://doi.org/10.1093/med/9780198746690.003.0642","url":null,"abstract":"Smoking is harmful to health. The main harms are cardiovascular disease, lung cancer, and chronic obstructive pulmonary disease. Most people who smoke start in their teens, and some become addicted. Stopping smoking may be prompted by public policy or price rises, and while physicians have a role in lobbying for these, the main opportunity a physician has to help their patients stop smoking is during the medical consultation. Advising the patient to stop has some effect, but is more likely to be effective when combined with practical help, the best form of which is regular face-to-face meetings to support the patient combined with drugs that reduce craving. Helping a patient to stop smoking greatly reduces their risk of illness and early death.","PeriodicalId":347739,"journal":{"name":"Oxford Textbook of Medicine","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128152664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heat","authors":"M. A. Stroud","doi":"10.14321/j.ctvh9vz6m.23","DOIUrl":"https://doi.org/10.14321/j.ctvh9vz6m.23","url":null,"abstract":"Rising body temperature triggers behavioural and physiological responses including reduction in physical activity, alterations of clothing, skin vasodilatation, and sweating. Heat-related illness is relatively common, especially with high humidity or prolonged physical activity. Risk can be reduced by acclimatization with repeated heat exposure, but some individuals seem to be particularly susceptible. Clinical presentations of heat-related illness include (1) ‘heat exhaustion’—the commonest manifestation, with symptoms including nausea, weakness, headache, and thirst. Patients appear dehydrated, complain of being hot, and are flushed and sweaty. Treatment requires rest and fluids, given orally or (in severe cases) intravenously. (2) ‘Heat stroke’ victims often complain of headache, may be drowsy or irritable, and may claim to feel cold. Core temperature is usually 38–41°C, but the patient is shivering with dry, vasoconstricted skin. Treatment requires (a) aggressive rapid cooling; (b) close biochemical monitoring; (c) supportive care for organ failure. There is significant mortality.","PeriodicalId":347739,"journal":{"name":"Oxford Textbook of Medicine","volume":"12 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131858917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sexual dysfunction","authors":"I. Eardley","doi":"10.1093/med/9780198746690.003.0254","DOIUrl":"https://doi.org/10.1093/med/9780198746690.003.0254","url":null,"abstract":"Male sexual dysfunction is common, with the most common types being erectile dysfunction, premature ejaculation, penile deformity, and priapism. Erectile dysfunction is common, becomes commoner with increasing age, and is often associated with cardiovascular disease and its risk factors. Patient assessment should seek to identify causative risk factors and treatment in the first instance is usually the management of risk factors and oral pharmacotherapy with a phosphodiesterase type 5 inhibitor. In women, sexual desire disorders are commoner in older postmenopausal women and a new treatment, flibanserin, has recently been licensed for this indication. Sexual arousal disorders in women also become more common postmenopausally and have a multifactorial aetiology. Treatment should be directed at the aetiological factor in the first instance while trials of oral pharmacotherapy for this condition have been disappointing.","PeriodicalId":347739,"journal":{"name":"Oxford Textbook of Medicine","volume":"52 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134279475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute kidney injury","authors":"J. Firth","doi":"10.1093/med/9780198746690.003.0477","DOIUrl":"https://doi.org/10.1093/med/9780198746690.003.0477","url":null,"abstract":"Definition—for practical clinical purposes, acute kidney injury (AKI) is defined as a significant decline in renal excretory function occurring over hours or days, detected by either a fall in urinary output or a rise in the serum concentration of creatinine. Oliguria—defined (arbitrarily) as a urinary volume of less than 400 ml/day—is usually present, but not always. Clinical approach: diagnosis—all patients admitted to hospital with acute illness, but particularly older people and those with pre-existing chronic kidney disease, should be considered at risk of developing AKI. The most common precipitant is volume depletion. Serum creatinine and electrolytes should be measured on admission in all acutely ill patients, and repeated daily or on alternate days in those who remain so. Assessment—after treatment of life-threatening complications, the initial assessment of a patient who appears to have AKI must answer three questions: (1) is the kidney injury really acute? (2) Is urinary obstruction a possibility? And (3) is there a renal inflammatory cause? General aspects of management—the immediate management of a patient with renal impairment is directed towards three goals: (1) recognition and treatment of any life-threatening complications of AKI, (2) prompt diagnosis and treatment of hypovolaemia, and (3) specific treatment of the underlying condition—if this persists untreated then renal function will not improve. Specific causes of acute kidney injury—there are many possible causes of AKI, but in any given clinical context few of these are likely to require consideration. By far the most frequent are prerenal failure and acute tubular necrosis, which together account for 80 to 90% of cases of AKI seen by physicians.","PeriodicalId":347739,"journal":{"name":"Oxford Textbook of Medicine","volume":"111 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133246311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}