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1
Reneland, Richard. Angiotensin-converting enzyme and its relation to blood pressure, metabolic factors, and indicators of organ damage in man. Uppsala: [Uppsala Universitet], 1997.
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2
Vasil'ev, Oleg, Evgeniy Achkasov, and Sergey Levushkin. Damage to the musculoskeletal system from overload in ballet and sports medicine. ru: INFRA-M Academic Publishing LLC., 2023. http://dx.doi.org/10.12737/1938064.
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The monograph, based on a long-term interdisciplinary study, outlines the features of the diagnosis and rehabilitation of injuries from overload of the lower limb on movement patterns unnatural for normal life, but typical for types of motor activity associated with the art of movement (choreography, classical dance, rhythmic gymnastics, etc.). It is shown that not so much professional requirements, as a lack of constitutional conditioned abilities are the cause of overload damage, the main predictor of which is muscle hypertonicity.
The main X-ray morphological types of the structure of hip joints in this contingent of persons are given. The clinical significance of evaluating the performance of basic choreographic elements and the availability of professional abilities for diagnostic purposes is shown. A professionally oriented algorithm for diagnosing overload damage has been proposed, unique clinical-functional and clinical-biomechanical diagnostic methods have been developed. Reference indicators of dosing and assessment of the adequacy of local physical activity on the restored link of the musculoskeletal system are proposed, a mathematical model of their application is developed.
Professionally oriented methods and features of using physical activity with a training effect for rehabilitation purposes using sports training tools and natural and geographical factors, as well as features of the use of Chinese Taijiquan gymnastics are described. The algorithm of multilevel rehabilitation based on N.A. Bernstein's theory of motion construction is described.
For students, postgraduates and teachers of medical universities. It will be of interest to sports medicine doctors, orthopedic traumatologists, rehabilitologists and other specialists in the field of medical and biological support of choreography and sports.
3
Gadzhiev, Nazirhan, Sergey Konovalenko, and Mihail Trofimov. Theoretical aspects of the formation and development of the ecological economy in Russia. ru: INFRA-M Academic Publishing LLC., 2022. http://dx.doi.org/10.12737/1836240.
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The monograph is devoted to the place and role of ecology and environmental safety in ensuring sustainable socio-economic development of society. In the conditions of the forced transition of the economies of the leading countries of the world from an industrial type to a new formation of a green economy aimed at ensuring the preservation of ecological systems and the maximum reduction of damage to the biodiversity of ecological systems, the Russian Federation faces the task of forming a new course of socio-economic development of society focused on the preservation of natural potential and ecology at a level normal for the maintenance of the vital activity of society, flora and fauna in the foreseeable future and in the long term.
The role and importance of environmental safety in the system of ensuring the economic security of the state are outlined, the concept of the ideology of "Global Commons" in ensuring sustainable socio-economic development of society is considered, the problems and prospects of the implementation of the program "Green Course of Russia" are analyzed, special aspects of environmental audit, accounting and control, damage assessment in the field of ecology are investigated. Special attention is paid to the forecast of the dynamics of key environmental indicators for the medium term. The main directions of increasing the effectiveness of the mechanism for ensuring environmental safety in a market economy are proposed.
For a wide range of readers interested in environmental economics. It will be useful for students, postgraduates and teachers of economic universities.
4
The effect of exercise on exercise-induced muscle soreness and other indicators of muscle damage. 1987.
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5
The effect of exercise on exercise-induced muscle soreness and other indicators of muscle damage. 1988.
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6
The effect of exercise on excercise-induced muscle soreness and other indicators of muscle damage. 1988.
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7
Ö. Sevim*, U. Ahsan, O. Tatlı, E. Kuter, E. Karimiyan Khamseh, A. Reman Temiz, Ö. Sayın Özdemir, et al. Effect of dietary nano-selenium on stress indicators, immune response, and DNA damage in broiler subjected to different stocking density. Verlag Eugen Ulmer, 2021. http://dx.doi.org/10.1399/eps.2021.345.
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Teta, Keoni (John), Ralph Esposito, and Jade Teta. Sexual Dysfunction and Exercise (DRAFT). Edited by Madeleine M. Castellanos. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190225889.003.0011.
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Sexual dysfunction often is multifactorial, with contributing etiologies ranging from cardiometabolic, neuronal, hormonal to psychological in origin. Whatever the origin, there is one very productive, often overlooked intervention for sexual dysfunction: exercise. Both female and male sexual dysfunction can be indicators of poor general health and may be linked to multiple conditions that respond exceptionally well to precise and tailored therapeutic exercises. Major contributing risk factors to sexual dysfunction include obesity, diabetes, hormonal imbalances, nerve damage, pharmaceutical side effects, cardiometabolic dysregulation, psychoemotional imbalance, menopause, pregnancy, and childbirth. A “go hard and rest hard” approach creates an intricate balance between high-intensity training and restorative exercise designed to address the underlying causes and risk factors of sexual dysfunction. This chapter discusses therapeutic exercise for sexual dysfunction and provides tailored exercises, detailed routines, and key practitioner-patient tools to provide a framework for a successful response to treat, reverse, and prevent sexual dysfunction.
9
McAuley, Danny F., and Thelma Rose Craig. Measurement of extravascular lung water in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0140.
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The accumulation of fluid in the interstitium and alveolar space is known as extravascular lung water (EVLW). EVLW is associated with increased morbidity and mortality in critically ill patients and is elevated in patients with cardiogenic pulmonary oedema, acute lung injury (ALI), and the acute respiratory distress syndrome (ARDS). Pulmonary oedema is a consequence of increased pulmonary capillary hydrostatic pressure and/or an increased capillary permeability. The quantity of pulmonary oedema fluid is dependent on the balance of fluid formation and clearance, and this contributes to the overall dynamic net lung fluid balance. Measurement of EVLW is therefore an indirect surrogate measurement of the alveolar epithelial and endothelial damage in ALI/ARDS. The single indicator transpulmonary thermodilution technique is an available bedside technique to measure EVLW.
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Speed, Cathy. Pharmacological pain management in sports injuries. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199533909.003.0015.
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The perception of pain is a biological mechanism which warns that damage has occurred and protects against further damage, allowing healing to occur. Acute pain often acts as an indicator of injury severity and progression or healing. The same may apply in some with chronic injuries, but in others pain may not correlate with tissue damage and/or may not be a sign that the tissue needs to be protected from mechanical stress. The management of most sports injuries involves early mobilization where possible, and pain management in the treatment of these injuries is important to allow rehabilitation to proceed and to ease distress. Modalities play an important role in this respect, and are discussed elsewhere (Chapter 2.4). Injection therapies are also discussed elsewhere (Chapter 2.6). Thorough counselling of the athlete is a priority to ensure that he/she understands what the pain represents, as this will be likely to affect compliance. For example, a degree of pain during eccentric exercise protocols in the rehabilitation of chronic tendinopathies would be anticipated, and would not contraindicate continuation of a set programme. In contrast, when an athlete is returning to sporting activities after injury, pain that is experienced during the activity would not be acceptable, and the athlete is also advised during this period that conclusions as to the tissue’s reaction to activity should not be drawn until the day after the training session. Athletes should also be taught appropriate self-help strategies to manage their pain and when this involves medication, how and when to take it. Principles for the use of medications in pain management are given in ...
11
Sabri, Omar, and Martin Bircher. Management of limb and pelvic injuries. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0336.
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Pelvic ring injuries can be life and limb threatening. The mechanism of injury can often be a good indicator of the type of injury; the Young & Burgess classification deploys that concept to full effect. Early identification based on mechanism of injury and improved prehospital care can play a major role in the outcome following such injuries. Pelvic ring injuries can lead to significant haemorrhage. Mechanical measures to stabilize the pelvis, in addition to modern concepts of damage control resuscitation (DCR), have been shown to be effective in early management of potentially life-threatening haemorrhage. Emphasis is now entirely on protecting the primary clot following a pelvic ring injury. Mechanical disturbance by log rolling the patient or springing of the pelvis are strongly discouraged. Early radiological clearance of the pelvis is encouraged. The lethal triad of coagulopathy, acidosis, and hypothermia should be corrected simultaneously to improve outcome. A traffic light system for monitoring venous lactate as an indicator of the patients’ physiological state can help the intensive care practitioner and the surgeon identify optimum timing for surgery. Pelvic ring injuries are associated with significant concomitant injuries. Limb trauma can also be life or limb threatening. Early identification, splinting, and resuscitation follow the same guidelines as pelvic ring injuries. Open long bone fractures should be managed by senior orthopaedic and plastic surgeons.
12
Thomas, David F. M. Prenatal diagnosis and perinatal urology. Edited by David F. M. Thomas. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199659579.003.0113.
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The kidney is formed by the interaction of the ureteric bud and metanephros during the fifth week of gestation and urine is excreted into the amniotic cavity from the ninth week onwards. The introduction of routine antenatal ultrasonography into obstetric practice has had a profound impact on the specialty of paediatric urology and the majority of urological abnormalities which pose a serious threat of morbidity are now detected prenatally. The results of foetal intervention to treat severe lower tract obstruction have been disappointing because renal damage (notably dysplasia) is largely irreversible by the time the anomaly is first identified. Indications for urgent postnatal evaluation include bilateral upper tract dilatation, thick-walled bladder, and impaired bladder emptying. A selective approach to the postnatal investigation of unilateral pelvic dilatation is required to avoid submitting healthy infants to unnecessary investigations.
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Herrington, William G., Aron Chakera, and Christopher A. O’Callaghan. Diabetic renal disease. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0164.
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Diabetic nephropathy is kidney damage occurring as a result of diabetes mellitus. Overt diabetic nephropathy is defined as proteinuria greater than 0.5 g/day. Diabetic nephropathy has a complicated pathogenesis including glomerular hypertension with hyperfiltration and advanced glycation end products. Poor glycaemic control is associated with progression to microalbuminuria and overt diabetic nephropathy. The lifetime risk is fairly equivalent for type 1 and type 2 diabetes mellitus. Early disease is usually asymptomatic. Hyperglycaemia causes an osmotic diuresis and, thus, diabetes can present with polyuria. Hypertension develops with microalbuminuria; oedema indicates abnormal sodium and water retention and, occasionally, the development of nephrotic syndrome. Patients with diabetes, perhaps due to accompanying cardiac disease, are particularly susceptible to fluid overload and uraemic symptoms. End-stage renal disease can occur as early as when the estimated glomerular filtration rate is 15 ml/min 1.73 m−2.
14
Seyfried, Thomas N., and Laura M. Shelton. Metabolism-Based Treatments to Counter Cancer. Edited by Jong M. Rho. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780190497996.003.0012.
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Accumulating evidence indicates that cancer is a type of mitochondrial metabolic disease. Chronic damage to mitochondria causes a gradual shift in cellular energy metabolism from respiration to fermentation. Consequently, fermentable metabolites become the drivers of cancer. Mitochondrial injury can explain the long-standing “oncogenic paradox,” and all major hallmarks of cancer including genomic instability. Restriction of fermentable fuels therefore becomes a viable therapeutic strategy for cancer management. The ketogenic diet (KD) is a metabolic therapy that lowers blood glucose and elevates blood ketone bodies. Ketone bodies are a “super fuel” for functional mitochondria, but cannot be metabolized efficiently by tumor mitochondria. The efficacy of KDs for cancer management can be enhanced when used together with drugs and procedures (such as hyperbaric oxygen therapy) (that further target fermentation. Therapeutic ketosis can represent an alternative, nontoxic strategy for managing and preventing a broad range of cancers while reducing healthcare costs.
15
Hooper, Timothy, and David Lockey. Assessment and management of ballistic trauma. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0340.
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The severity of ballistic trauma is dependent upon multiple factors including bullet type, velocity, tissue type penetrated, and energy transfer. Patient management needs a considered approach with careful assessment, appropriate imaging and directed treatment of the wounds found. Triage, treatment and transport form the framework of effective prehospital care. In the emergency department a rapid primary survey is essential to reveal any injuries that need immediate intervention. The decision to operate and nature of surgery is determined by the patient’s suspected injuries, physiological condition and expertise available with some patients benefiting from damage control resuscitation and surgery. Indications for intensive care admission include the need for ongoing organ support, cardiovascular instability, and injuries that require close observation. Attention should be paid to cardiovascular status, coagulation, nutrition, thromboprophylaxis, infective issues, and management of specific injuries. Patients may require protracted hospital stays and extensive reconstructive surgery. The psychological and social impact of these injuries should not be underestimated.
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Feneck, R., and F. Guarracino. Perioperative echocardiography. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199599639.003.0025.
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Perioperative echocardiography is one of the fastest growing areas of echocardiography. Although transthoracic imaging has a role, intraoperative imaging is mostly undertaken using transoesophageal echocardiography (TOE).The indications for perioperative echo have recently been re-evaluated, resulting in recognition of the ubiquitous benefit in patients undergoing cardiac surgery, and recognition of the value in non-cardiac surgery and critical care also.Although TOE is safe, it should be remembered that there may be a greater risk of traumatic damage to the soft tissues in anaesthetized patients who cannot complain of pain during probe insertion.Perioperative imaging should be used to confirm and refine the preoperative diagnosis, detect new or unsuspected pathology, adjust the anaesthetic and surgical plan, and assess the results of surgical intervention. Using imaging to optimize myocardial function is a constantly developing technique, and one which may ensure that patients leave the operating room in the best possible condition. The use of perioperative echo in some procedures, for example, in mitral repair, is now regarded as so valuable that it is arguable that perioperative TOE should be mandatory in these cases.
17
Brimioulle, Serge. Pathophysiology, causes, and management of metabolic alkalosis in the critically ill. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0257.
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Metabolic alkalosis occurs in up 51% of abnormal acid-base samples in the hospital. It is characterized by a primary increase in bicarbonate concentration and is always associated with chloride depletion. In critically-ill patients, it is most often generated by diuretic administration, digestive losses, alkali administration, or rapid correction of hypercapnia. Even after all causal factor are removed, it can be maintained by blood volume depletion and potassium depletion. Metabolic alkalosis results in hypercapnia, hypoxaemia, cardiac arrhythmias, altered consciousness, and neuromuscular hyperexcitability. It is first treated by removing the causal factors, whenever possible. Maintaining factors must be reversed by sodium chloride and/or potassium chloride administration. Acetazolamide and renal replacement therapy, when given for specific indications, can also correct the alkalosis. Lysine and arginine chloride are no longer used. If metabolic alkalosis is severe or when other treatments are contraindicated or ineffective, hydrochloric acid infusion is useful. Dilute hydrochloric acid can be infused safely, provided adequate precautions are taken to prevent extravascular leakage, vessel damage, and tissue necrosis.
18
Wouters, Patrick F., Fabio Guarracino, and Manfred Seeberger. Perioperative echocardiography. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198726012.003.0066.
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Perioperative echocardiography is one of the fastest growing areas of echocardiography. Transthoracic imaging is increasingly being used in postoperative patients, in critical care settings, and in emergency medicine. Intraoperative imaging remains the exclusive domain of transoesophageal echocardiography (TOE) where cardiac surgery is the primary field of application. However, the use of intraoperative TOE is gradually expanding towards non-cardiac surgery. The indications for perioperative echo have recently been re-evaluated, resulting in recognition of the ubiquitous benefit in patients undergoing surgery. Although TOE is safe, there may be a greater risk of traumatic damage to the soft tissues in anaesthetized patients who cannot complain of pain nor resist during probe insertion. Perioperative imaging in cardiac surgery should be used to confirm and refine the preoperative diagnosis, detect new or unsuspected pathology, adjust the anaesthetic and surgical plan, and assess the results of surgical intervention. Using imaging to optimize myocardial function is a constantly developing technique to ensure that patients leave the operating room in the best possible condition.
19
Schwitter, Juerg, and Jens Bremerich. Cardiac magnetic resonance in the intensive and cardiac care unit. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0023.
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Current applications of cardiac magnetic resonance offer a wide spectrum of indications in the setting of acute cardiac care. In particular, cardiac magnetic resonance is helpful for the differential diagnosis of chest pain by the detection of ischaemia, myocardial stunning, myocarditis, and pericarditis. Also, Takotsubo cardiomyopathy and acute aortic diseases can be evaluated by cardiac magnetic resonance and are important differential diagnoses in patients with acute chest pain. In patients with restricted windows for echocardiography, according to guidelines, cardiac magnetic resonance is the method of choice to evaluate complications of an acute myocardial infarction. In an acute myocardial infarction, cardiac magnetic resonance allows for a unique characterization of myocardial damage by quantifying necrosis, microvascular obstruction, oedema (i.e. area at risk), and haemorrhage. These features will help us to understand better the pathophysiological events during infarction and will also allow us to assess new treatment strategies in acute myocardial infarction. To which extent the information on tissue damage will guide patient management is not yet clear, and further research, e.g. in the setting of the European Cardiovascular MR registry, is ongoing to address this issue. Recent studies also demonstrated the possiblity to reduce costs in the management of acute coronary syndromes when cardiac magnetic resonance is integrated into the routine work-up. In the near future, applications of cardiac magnetic resonance will continue to expand in the acute cardiac care units, as manufacturers are now strongly focusing on this aspect of user-friendliness. Finally, in the next decade or so, magnetic resonance imaging of other nuclei, such as fluorine and carbon, might become a reality in clinics, which would allow for metabolic and targeted molecular imaging with excellent sensitivity and specificity.
20
Schwitter, Juerg, and Jens Bremerich. Cardiac magnetic resonance in the intensive and cardiac care unit. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199687039.003.0023_update_001.
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Current applications of cardiac magnetic resonance offer a wide spectrum of indications in the setting of acute cardiac care. In particular, cardiac magnetic resonance is helpful for the differential diagnosis of chest pain by the detection of ischaemia, myocardial stunning, myocarditis, and pericarditis. Also, Takotsubo cardiomyopathy and acute aortic diseases can be evaluated by cardiac magnetic resonance and are important differential diagnoses in patients with acute chest pain. In patients with restricted windows for echocardiography, according to guidelines, cardiac magnetic resonance is the method of choice to evaluate complications of an acute myocardial infarction. In an acute myocardial infarction, cardiac magnetic resonance allows for a unique characterization of myocardial damage by quantifying necrosis, microvascular obstruction, oedema (i.e. area at risk), and haemorrhage. These features will help us to understand better the pathophysiological events during infarction and will also allow us to assess new treatment strategies in acute myocardial infarction. To which extent the information on tissue damage will guide patient management is not yet clear, and further research, e.g. in the setting of the European Cardiovascular MR registry, is ongoing to address this issue. Recent studies also demonstrated the possiblity to reduce costs in the management of acute coronary syndromes when cardiac magnetic resonance is integrated into the routine work-up. In the near future, applications of cardiac magnetic resonance will continue to expand in the acute cardiac care units, as manufacturers are now strongly focusing on this aspect of user-friendliness. Finally, in the next decade or so, magnetic resonance imaging of other nuclei, such as fluorine and carbon, might become a reality in clinics, which would allow for metabolic and targeted molecular imaging with excellent sensitivity and specificity.
21
Schwitter, Juerg, and Jens Bremerich. Cardiac magnetic resonance in the intensive and cardiac care unit. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199687039.003.0023_update_002.
Full textAbstract:
Current applications of cardiac magnetic resonance offer a wide spectrum of indications in the setting of acute cardiac care. In particular, cardiac magnetic resonance is helpful for the differential diagnosis of chest pain by the detection of ischaemia, myocardial stunning, myocarditis, and pericarditis. Also, Takotsubo cardiomyopathy and acute aortic diseases can be evaluated by cardiac magnetic resonance and are important differential diagnoses in patients with acute chest pain. In patients with restricted windows for echocardiography, according to guidelines, cardiac magnetic resonance is the method of choice to evaluate complications of an acute myocardial infarction. In an acute myocardial infarction, cardiac magnetic resonance allows for a unique characterization of myocardial damage by quantifying necrosis, microvascular obstruction, oedema (i.e. area at risk), and haemorrhage. These features will help us to understand better the pathophysiological events during infarction and will also allow us to assess new treatment strategies in acute myocardial infarction. To which extent the information on tissue damage will guide patient management is not yet clear, and further research, e.g. in the setting of the European Cardiovascular MR registry, is ongoing to address this issue. Recent studies also demonstrated the possiblity to reduce costs in the management of acute coronary syndromes when cardiac magnetic resonance is integrated into the routine work-up. In the near future, applications of cardiac magnetic resonance will continue to expand in the acute cardiac care units, as manufacturers are now strongly focusing on this aspect of user-friendliness. Finally, in the next decade or so, magnetic resonance imaging of other nuclei, such as fluorine and carbon, might become a reality in clinics, which would allow for metabolic and targeted molecular imaging with excellent sensitivity and specificity.
22
Stocchetti, Nino, and Andrew I. R. Maas. Causes and management of intracranial hypertension. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0233.
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Intracranial hypertension may damage the brain in two ways—it causes tissue distortion and herniation, and reduces cerebral perfusion. The many different pathologies that can result in intracranial hypertension include subarachnoid haemorrhage, spontaneous intra-parenchymal haemorrhage, malignant cerebral hemispheric infarction, and acute hydrocephalus. The pathophysiology and specific treatment of intracranial hypertension may be different and depend on aetiology. In patients with subarachnoid haemorrhage a specific focus is on treating secondary hydrocephalus and maintaining adequate cerebral perfusion pressure (CPP). Indications for surgery in patients with intracranial hypertension due to intracerebral haemorrhage (ICH) are not only related to the mass effect, but also to remove the toxic effect of extravasated blood on brain tissue. Decompressive surgery should be considered for patients with a malignant hemispheric infarction, but in order to benefit the patient this surgery should be performed within 48 hours of the onset of the stroke. Hydrocephalus may result from obstruction of cerebrospinal fluid (CSF) flow, from impaired CSF re-absorption and occasionally from overproduction of CSF. Emergency management of acute hydrocephalus can be accomplished by external ventricular drainage of CSF. More definitive treatment may be either by third ventriculostomy or implantation of a CSF shunt diverting CSF to the abdominal cavity (a ventriculoperitoneal shunt) or to the right atrium of the heart (ventriculo-atrial shunt).
23
Alfredo, Ollero Ojeda, Conesa García Carmelo, and Vidal-Abarca Gutiérrez María Rosario, eds. A GUIDE TO GOOD PRACTICES FOR THE MANAGEMENT AND RESTORATION OF MEDITERRANEAN EPHEMERAL STREAMS:RESILIENCE AND ADAPTATION TO CLIMATE CHANGE. Editum. Ediciones de la Universidad de Murcia, 2022. http://dx.doi.org/10.6018/editum.2912.
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Ephemeral channels (ramblas or dry channels - except in sudden occasional flash foods) are prevalent in the Mediterranean, where they make up most of the fluvial network. They are fundamental natural systems in the hydrological cycle for transporting water, sediment and nutrients, and, therefore, are excellent indicators of climate and global change. Their promotion, the recognition of their role, their hydromorphological values and ecosystemic services are all absolutely essential for understanding their level of resilience and contribution to adapting to climate change. And it is urgent for us to work on their management, recovery and conservation, because overall they are subjected to strong pressures and are being greatly damaged. This guide warns the reader about the multiple impacts these channels are subjected to, it informs us about their important Mediterranean heritage, which is so underestimated and ignored; and it proposes 33 good practices for their management and recovery. It is a book that can offer ideas to the people responsible for managing them, but is aimed at the whole of society, because the challenge is very complex: we have to recover ephemeral channels by improving understanding and raising awareness. And we must act quickly, because it is already late and until now practically nothing has been done to respect, protect and recover these vital fluvial systems on our land. This is our challenge.
24
Raggi, Paolo, and Luis D’Marco. Imaging for detection of vascular disease in chronic kidney disease patients. Edited by David J. Goldsmith. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0116.
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The well-known severity of cardiovascular disease in patients suffering from chronic kidney disease (CKD) requires an accurate risk stratification of these patients in several clinical situations. Imaging has been used successfully for such purpose in the general population and it has demonstrated excellent potential among CKD patients as well. Two main forms of arterial pathology develop in patients with CKD: atherosclerosis, with accumulation of inflammatory cells, lipids, fibrous tissue and calcium in the subintimal space, and arteriosclerosis. The latter is characterized by accumulation of deposits of hydroxyapatite and amorphous calcium crystals in the muscular media of the vessel wall, and is believed to be more closely associated with alterations of mineral metabolism than with traditional atherosclerosis risk factors. The result is the development of what appears to be premature arterial ageing, with loss of elastic properties, increased stiffness, and increased overall fragility of the arterial system. Despite intensifying research and increasing awareness of these issues, the underlying pathophysiology of the aggressive vasculopathy of CKD remains largely unknown. As a consequence, there are currently very limited pathways to prevent progression of vascular damage in CKD. The indications, strengths and weaknesses of several imaging modalities employed to evaluate vascular disease in CKD are described, focusing on coronary arterial circulation and the peripheral arteries, with the exclusion of the intracranial arteries.
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Donaghy, Michael. The clinical approach. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780198569381.003.0030.
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This chapter describes the appropriate clinical approach to take when presented with a patient reporting a neurological symptom. Just under 10 per cent of the population consult their general practitioner about a neurological symptom each year in the United Kingdom. About 10 per cent of these are referred for a specialist opinion, usually to a neurologist. Nine conditions account for roughly 75 per cent of general neurological referrals and are diagnosed initially on purely clinical grounds, with the other 25 per cent representing the full range of other, potentially very rare, neurological disorders.This chapter underlines the importance of a thorough and informative history to achieve successful diagnosis. Crucial facets for a good history include information on the time course of symptom development, whether symptoms are negative or positive, previous neurological history (both personal and familial), as well as other potentially contributory general medical disorders. The general neurological examination is also described, as are specific examination manoeuvres that may be added to the general neurological examination in specific clinical circumstances.Reflexes play an important role in diagnostic neurology because they reflect the integrity of, or alterations in, the neural structures responsible for their arc. Loss of a reflex may be due to interruption of the afferent path by a lesion involving the first sensory neurone in the peripheral nerves, plexuses, spinal nerves, or dorsal roots, by damage to the central paths of the arc in the brainstem or spinal cord, by lesions of the lower motor neurone at any point between the anterior horn cells and the muscles, of the muscles themselves, or by the neural depression produced by neural shock. In clinical practice, the most useful and oft-elicited reflexes are the tendon reflexes of the limbs, the jaw jerk, the plantar response, the superficial abdominal reflexes, the pupil-light response, and in infants, the Moro reflex. The place of these particular reflexes in the routine neurological examination is outlined, and the elicitation and significance of these reflexes and of a wide variety of others which are used occasionally are described.Examinations that allow localization lesions that are responsible for muscle weaknesses and the assessment of somatosensory abnormalities are described, as are neurological disorders that result in identifiable gait disorders. The clinical signs and examinations relevant to autonomic disorders are also discussed.Intensive care may be required for patients critically ill either as a result of primary neurological disease, or in those in whom a neurological disorder is a component of, or secondary to, a general medical disorder. Indications for admission to neurological intensive care have been defined (Howard et al. 2003): impaired consciousness, bulbar muscle failure, severe ventilatory respiratory failure, uncontrolled seizures, severely raised intracranial pressure, some monitoring and interventional treatments, and unforeseen general medical complications. Naturally specific treatments indicated for the particular diagnosis should be instituted along with general intensive care measures.Finally, the discussion of diagnoses of chronic or terminal conditions with patients is discussed, with particular focus on the best way to present the diagnosis to the patient.
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Shaibani, Aziz. Pseudoneurologic Syndromes. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190661304.003.0022.
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The term functional has almost replaced psychogenic in the neuromuscular literature for two reasons. It implies a disturbance of function, not structural damage; therefore, it defies laboratory testing such as MRIS, electromyography (EMG), and nerve conduction study (NCS). It is convenient to draw a parallel to the patients between migraine and brain tumors, as both cause headache, but brain MRI is negative in the former without minimizing the suffering of the patient. It is a “software” and not a “hardware” problem. It avoids irritating the patient by misunderstanding the word psychogenic which to many means “madness.”The cause of this functional impairment may fall into one of the following categories:• Conversion reaction: conversion of psychological stress to physical symptoms. This may include paralysis, hemisensory or distal sensory loss, or conversion spasms. It affects younger age groups.• Somatization: chronic multiple physical and cognitive symptoms due to chronic stress. It affects older age groups.• Factions disorder: induced real physical symptoms due to the need to be cared for, such as injecting oneself with insulin to produce hypoglycemia.• Hypochondriasis: overconcern about body functions such as suspicion of ALS due to the presence of rare fasciclutations that are normal during stress and after ingestion of a large amount of coffee. Medical students in particular are targets for this disorder.The following points are to be made on this topic. FNMD should be diagnosed by neuromuscular specialists who are trained to recognize actual syndrome whether typical or atypical. Presentations that fall out of the recognition pattern of a neuromuscular specialist, after the investigations are negative, they should be considered as FNMDs. Sometimes serial examinations are useful to confirm this suspicion. Psychatrists or psychologists are to be consulted to formulate a plan to discover the underlying stress and to treat any associated psychiatric disorder or psychological aberration. Most patients think that they are stressed due to the illness and they fail to connect the neuromuscular manifestations and the underlying stress. They offer shop around due to lack of satisfaction, especially those with somatization disorders. Some patients learn how to imitate certain conditions well, and they can deceive health care professionals. EMG and NCS are invaluable in revealing FNMD. A normal needle EMG of a weak muscles mostly indicates a central etiology (organic or functional). Normal sensory responses of a severely numb limb mean that a lesion is preganglionic (like roots avulsion, CISP, etc.) or the cause is central (a doral column lesion or functional). Management of FNMD is difficult, and many patients end up being chronic cases that wander into clinics and hospitals seeking solutions and exhausting the health care system with unnecessary expenses.It is time for these disorders to be studied in detail and be classified and have criteria set for their diagnosis so that they will not remain diagnosed only by exclusion. This chapter will describe some examples of these disorders. A video clip can tell the story better than many pages of writing. Improvement of digital cameras and electronic media has improved the diagnosis of these conditions, and it is advisable that patients record some of their symptoms when they happen. It is not uncommon for some Neuromuscular disorders (NMDs), such as myasthenia gravis (MG), small fiber neuropathy, and CISP, to be diagnosed as functional due to the lack of solid physical findings during the time of the examination. Therefore, a neuromuscular evaluation is important before these disorders are labeled as such. Some patients have genuine NMDs, but the majority of their symptoms are related to what Joseph Marsden called “sickness behavior.” A patient with carpal tunnel syndrome (CTS) may unconsciously develop numbness of the entire side of the body because he thinks that he may have a stroke.