Oxford Textbook of Medicine最新文献_第7页

Oxford Textbook of Medicine Pub Date : 2020-01-01 DOI: 10.1093/med/9780199204854.003.2119

Á. Burns, C. Ashley

{"title":"Drugs and the kidney","authors":"Á. Burns, C. Ashley","doi":"10.1093/med/9780199204854.003.2119","DOIUrl":"https://doi.org/10.1093/med/9780199204854.003.2119","url":null,"abstract":"The kidney plays a critical role in the elimination of many drugs from the body, hence consideration should be given to a patient’s renal function whenever any drug is prescribed. Much kidney disease is unrecognized, but the widespread reporting of estimated glomerular filtration rates (eGFR) has brought greater awareness of the prevalence of chronic kidney disease (CKD), thereby encouraging medical practitioners to take account of reduced renal function when prescribing. CKD is very often one of many coexisting comorbid conditions, especially in elderly patients, when particularly careful thought must be given to appropriate drug dosing and the possibility of drug interactions. A reduced GFR is the primary reason for reduced excretion of drugs in renal failure, but drug absorption, distribution, protein binding, metabolism, and pharmacodynamics may all be affected. Key general points—both filtration and secretion of drugs appear to fall in parallel and in proportion to the GFR. The clinical significance of a reduction in GFR and increased drug half-life depends on the relative importance of renal excretion and metabolism as a mode of elimination, and the therapeutic ratio of the drug. If nonrenal clearance accounts for elimination of more than 50% of a drug, then no adjustment needs be made to dose/frequency of administration. Dosages of drugs which are mainly excreted in active form by the kidney may need to be modified to avoid accumulation. Potentially toxic drugs should only be used in patients with renal failure if there is a specific indication for their use and if therapy can be monitored appropriately. If dose adjustment is required, then dose, dose interval, or both can be adjusted to achieve the desired therapeutic profile.","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":"121634927","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}

引用次数: 0

Pneumoconioses 尘肺

Oxford Textbook of Medicine Pub Date : 2020-01-01 DOI: 10.1093/med/9780199204854.003.1813_update_001

P. Reid

引用次数: 7

Filoviruses

Oxford Textbook of Medicine Pub Date : 2020-01-01 DOI: 10.1093/med/9780198746690.003.0093

J. T. ter Meulen

引用次数: 0

Tumours of the pancreas 胰腺肿瘤

Oxford Textbook of Medicine Pub Date : 2020-01-01 DOI: 10.1093/med/9780198746690.003.0337

J. Skipworth, S. Pereira

{"title":"Tumours of the pancreas","authors":"J. Skipworth, S. Pereira","doi":"10.1093/med/9780198746690.003.0337","DOIUrl":"https://doi.org/10.1093/med/9780198746690.003.0337","url":null,"abstract":"Pancreatic cancer, most commonly in the form of a solid ductal adenocarcinoma, accounts for 3% of all cancers but ranks in the top five leading causes of cancer deaths in most developed countries, reflecting the fact that it has a very poor prognosis (median survival 6–9 months). It is a disease of older age (85% of patients >65 years), and commoner in smokers.\u0000 Most patients present with locally advanced or metastatic disease, often with obstructive jaundice. Pain is unusual in early disease, but when present is characteristically described as ‘gnawing’, ever present, and frequently radiating into the back. Weight loss is commonly due to anorexia as a result of jaundice or pain, but can occasionally be the only presenting symptom.\u0000 Serum biochemistry will typically show elevated bilirubin and a cholestatic picture of liver enzymes, with particular elevation of alkaline phosphatase and γ‎-glutamyl transferase. Transabdominal ultrasonography is usually the primary investigation in a patient with jaundice and can detect pancreatic tumours greater than 2 cm in size or hepatic metastases with a diagnostic accuracy of 75%, but identifies smaller tumours much less reliably. The essential investigations for the diagnosis and staging of pancreatic cancer are contrast-phased CT scan and occasionally MRI.\u0000 The only curative treatment for pancreatic cancer is surgical excision. This is technically feasible in up to 20% patients at presentation, but even after careful selection almost 40% of these will have positive microscopic resection margins, and overall postoperative survival is only around 10% at 5 years, the remainder experiencing metastatic disease in the peritoneum, liver, or lungs. Adjuvant chemotherapy with gemcitabine can double the 5-year survival rate. Palliative management may require biliary stenting for jaundice, duodenal stenting (or surgical bypass) for gastric outlet obstruction, pain control, and palliative chemotherapy.","PeriodicalId":347739,"journal":{"name":"Oxford Textbook of Medicine","volume":"144 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":"122818349","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}

引用次数: 0

Immunodeficiency 免疫缺陷

Oxford Textbook of Medicine Pub Date : 2020-01-01 DOI: 10.1093/med/9780198746690.003.0041

Sophie Hambleton, S. Marshall, D. Kumararatne

引用次数: 0

Alcoholic liver disease 酒精性肝病

Oxford Textbook of Medicine Pub Date : 2020-01-01 DOI: 10.1093/med/9780198746690.003.0327

E. Forrest

{"title":"Alcoholic liver disease","authors":"E. Forrest","doi":"10.1093/med/9780198746690.003.0327","DOIUrl":"https://doi.org/10.1093/med/9780198746690.003.0327","url":null,"abstract":"The incidence of alcoholic liver disease (ALD) follows the trend of per capita alcohol consumption, with hepatic injury which extends from fatty liver to alcoholic hepatitis and cirrhosis. It is unclear how alcohol causes liver disease, but postulated mechanisms include (1) oxidative stress and acetaldehyde generated by the metabolism of ethanol, and (2) innate and adaptive immune responses. Factors determining the susceptibility to liver disease in heavy drinkers are believed to include a variety of host and environmental factors, with genetic factors increasingly recognized. Clinical manifestations are extremely variable, and some patients remain relatively well while others suffer the effects of severe hepatic failure. Although patients can come to light with a life-threatening complication, most often they develop symptoms which are not immediately related to the liver, such as nonspecific digestive symptoms or psychiatric complaints. The key to the early recognition of alcohol-related disease is having a high index of suspicion, with confirmation by (1) direct questioning for alcohol history and alcohol-related symptoms; (2) clinical examination for signs of chronic liver disease; (3) supportive investigations, including aspartate aminotransferase, which is less than 500 IU/litre and greater than the alanine aminotransferase level; and (4) liver biopsy, which may be required in some cases of diagnostic uncertainty and to confirm the stage of the disease, revealing alcoholic fatty liver, alcoholic hepatitis, or cirrhosis. Management is governed by the stage and severity of the liver disease, but always includes abstinence and adequate nutritional support. In selected patients with severe acute alcoholic hepatitis, corticosteroids can reduce short-term mortality. Transplantation remains the only effective treatment for advanced alcoholic cirrhosis, although this remains controversial, mainly because of concerns about post-transplant recidivism.","PeriodicalId":347739,"journal":{"name":"Oxford Textbook of Medicine","volume":"44 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":"133576492","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}

引用次数: 0

Bone cancer 骨癌

Oxford Textbook of Medicine Pub Date : 2020-01-01 DOI: 10.1093/med/9780198746690.003.0471

H. Hatcher

引用次数: 0

Human disasters 人类的灾难

Oxford Textbook of Medicine Pub Date : 2020-01-01 DOI: 10.1093/med/9780198746690.003.0026

Amartya Sen

引用次数: 2

Haemopoietic stem cell transplantation 造血干细胞移植

Oxford Textbook of Medicine Pub Date : 2020-01-01 DOI: 10.1093/med/9780198746690.003.0549

E. Gordon-Smith, E. Morris

{"title":"Haemopoietic stem cell transplantation","authors":"E. Gordon-Smith, E. Morris","doi":"10.1093/med/9780198746690.003.0549","DOIUrl":"https://doi.org/10.1093/med/9780198746690.003.0549","url":null,"abstract":"Haemopoietic stem cells (HSCs) give rise to the blood cell lineages and the cells of the immune system, and their transplantation may be an appropriate part of the management of conditions including (1) malignant haematological disorders (e.g. leukaemia, lymphoma, myeloma); (2) bone marrow failure syndromes (e.g. aplastic anaemia); and (3) congenital disorders—(a) haematological (e.g. Fanconi’s anaemia); (b) immunological—inherited immunodeficiency syndromes; and (c) metabolic (e.g. lysosomal storage diseases). Transplantation of HSCs uses either autologous HSCs (patient’s own stem cells) or allogeneic HSCs (harvested from an appropriately matched sibling or unrelated healthy donor). Successful engraftment of allogeneic HSCs depends upon (1) overcoming immune rejection by the recipient; (2) preventing or suppressing graft-versus-host disease (GVHD), in which donor cells mount an immune attack against recipient tissues; and (3) supporting the patient through periods of profound cytopenias and immune deficiency with susceptibility to infection. Identification and sources of HSCs—HSCs are principally identified by expression of the surface antigen CD34. Sources include (1) bone marrow; (2) peripheral blood—following stimulation by cytokines (e.g. granulocyte colony-stimulating factor); and (3) umbilical cord blood.","PeriodicalId":347739,"journal":{"name":"Oxford Textbook of Medicine","volume":"61 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":"134003193","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}

引用次数: 0

Coronary heart disease: Epidemiology and prevention 冠心病:流行病学和预防

Oxford Textbook of Medicine Pub Date : 2020-01-01 DOI: 10.1093/med/9780199204854.003.161302_update_002

G. Danaei, Timothy M. Cox David A. Warrell, J. Firth

引用次数: 0