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1
McCormack, Brendan Anthony Oliver. On damage accumulation in cemented hip replacements. Dublin: University College Dublin, 1997.
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2
Adorno and modern theatre: The drama of the damaged self in Bond, Rudkin, Barker and Kane. New York: Palgrave Macmillan, 2015.
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3
Guevara, David L. The bona fide prospective purchaser defense: A guide for lawyers. Chicago: American Bar Association, 2013.
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4
New Jersey. State Beach Erosion Commission. Commission meeting of State Beach Erosion Commission: "Blue Acres" (a proposed bond program to purchase from willing sellers storm-damaged or environmentally sensitive lands in the coastal area). Trenton, N.J: The Commission, 1994.
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5
New Jersey. Legislature. Senate. Environment Committee. Committee meeting before Senate Environment Committee and Assembly Energy and Hazardous Waste Committee: Senate bill no. 1070 and Assembly bill no. 1727 (make various changes to ECRA and to other hazardous site remediation programs, impose a surcharge on remediations, establish a loan and grant fund for remediation activities, appropriate bond moneys). Trenton, N.J: The Committees, 1992.
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6
New Jersey. Legislature. Senate. Environment Committee. Committee meeting before Senate Environment Committee and Assembly Energy and Hazardous Waste Committee: Senate bill no. 1070 and Assembly bill no. 1727 (make various changes to ECRA and to other hazardous site remediation programs, impose a surcharge on remediations, establish a loan and grant fund for remediation activities, appropriate bond moneys). Trenton, N.J: The Committees, 1992.
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7
Nigro, Giampiero, ed. Gestione dell'acqua in Europa (XII-XVIII Secc.) / Water Management in Europe (12th-18th centuries). Florence: Firenze University Press, 2018. http://dx.doi.org/10.36253/978-88-6453-700-9.
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Water was a source of wealth which facilitated, fostered or brutally halted economic development in the Ancien Regime. Lack of hygiene meant that water was used less for drinking than other drinks, but as a raw material, source of energy, cooling, rinsing and cleansing agent, water was unequalled. It played a role in public and private relaxation and in health. Water also proved to be an ideal, safe and cheap means of transporting goods and ideas. Urban historians have long pointed to the enormous comparative advantage enjoyed by towns and regions whose favourable maritime or riverine location gave them access to cheap water-borne transport. But water just as often posed a threat to economic development and prosperity, whether due to its absence or its specific composition or level of pollution or to uncontrollable abundance. This duality is still present today in our modern, globalised society. While huge quantities of fresh, potable water are wasted in the West, free or cheap access to fresh and abundant water supplies remains a major challenge for millions of individuals on the planet. Major floods in different parts of the world regularly cause economic damage and endless human suffering. With a Settimana devoted to the management of the water supply, excluding related topics as water consumption, water transport and the use of water in agriculture and industry, the Istituto Datini is seeking to draw attention.
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Hughes, Jim. Orthopaedics. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198813170.003.0008.
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This chapter covers the basic approaches and techniques used in orthopaedic surgery, including the insertion and positioning of hardware and fixators, closed and open techniques (including manipulation under anaesthetic), and the typical imaging requirements for these. The discussion includes elective and trauma cases, as well as emergency procedures that may be performed out of regular working hours. They generally involve either repair to the skeleton and joints after injury (e.g. resiting a dislocated joint or aligning and supporting a fractured long bone) or alterations (such as fusion or replacement of a damaged joint or lengthening of a bone with a growth defect).
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Collins, Graham, and Chris Bunch. Multiple myeloma and related conditions. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0290.
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Multiple myeloma is a cancerous disorder of the bone marrow and arises from a clonal proliferation of plasma cells, resulting in end-organ damage (e.g. renal failure, hypercalcaemia, bone disease, and bone marrow failure). When a plasma cell clone is only detected in one site (either bony or soft tissue), it is termed a plasmacytoma. Monoclonal gammopathy of uncertain significance is also a clonal proliferation of plasma cells but, by definition, does not result in end-organ damage. This chapter addresses the diagnosis and management of multiple myeloma.
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Rees, David. Haemoglobinopathies. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0172.
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Inherited abnormalities of the globin genes are the commonest single-gene disorders in the world and fall into two main groups: thalassaemias and sickle cell disease. Thalassaemias are due to quantitative defects in globin chain synthesis which cause variable anaemia and ineffective erythropoiesis. Thalassaemia was initially thought to be a disease of the bones due to uncontrolled bone marrow expansion causing bony distortion, although this is now unusual with appropriate blood transfusions. Osteopenia, often severe, is a feature of most patients with thalassaemia major and intermedia, caused by bone marrow expansion, iron overload, endocrinopathy, and iron chelation. Treatment with bisphosphonates is generally recommended. Other rheumatological manifestations include arthropathy associated with the use of the iron chelator deferiprone. Sickle cell disease involves a group of conditions caused by polymerization of the abnormal -globin chain, resulting in abnormal erythrocytes which cause vaso-occlusion, vasculopathy, and ischaemic tissue damage. The characteristic symptom is acute bone pain caused by vaso-occlusion; typical episodes require treatment with opiate analgesia and resolve spontaneously by 5 days with no lasting bone damage. The frequency of acute episodes varies widely between patients. The incidence of osteomyelitis is increased, particularly with salmonella, although it is much rarer than acute vaso-occlusion. Avascular necrosis can affect the hips, and less commonly the shoulders and knees. Coincidental rheumatological disease sometimes complicates the condition, particularly systemic lupus erythematosus (SLE) which is more prevalent in populations at increased risk of sickle cell disease.
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Rees, David. Haemoglobinopathies. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199642489.003.0172_update_001.
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Inherited abnormalities of the globin genes are the commonest single-gene disorders in the world and fall into two main groups: thalassaemias and sickle cell disease. Thalassaemias are due to quantitative defects in globin chain synthesis which cause variable anaemia and ineffective erythropoiesis. Thalassaemia was initially thought to be a disease of the bones due to uncontrolled bone marrow expansion causing bony distortion, although this is now unusual with appropriate blood transfusions. Osteopenia, often severe, is a feature of most patients with thalassaemia major and intermedia, caused by bone marrow expansion, iron overload, endocrinopathy, and iron chelation. Treatment with bisphosphonates is generally recommended. Other rheumatological manifestations include arthropathy associated with the use of the iron chelator deferiprone. Sickle cell disease involves a group of conditions caused by polymerization of the abnormal -globin chain, resulting in abnormal erythrocytes which cause vaso-occlusion, vasculopathy, and ischaemic tissue damage. The characteristic symptom is acute bone pain caused by vaso-occlusion; typical episodes require treatment with opiate analgesia and resolve spontaneously by 5 days with no lasting bone damage. The frequency of acute episodes varies widely between patients. The incidence of osteomyelitis is increased, particularly with salmonella, although it is much rarer than acute vaso-occlusion. Avascular necrosis can affect the hips, and less commonly the shoulders and knees. Coincidental rheumatological disease sometimes complicates the condition, particularly systemic lupus erythematosus (SLE) which is more prevalent in populations at increased risk of sickle cell disease.
12
Lories, Rik J., and Georg Schett. Pathology: bone. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198734444.003.0010.
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Axial spondyloarthritis is associated with different types of skeletal damage. Inflammation at the affected sites is linked with both loss of trabecular bone and new bone formation on the cortical side, potentially leading to joint or spine ankylosis. Both aspects of the disease can result in a significant burden for the patient. Bone loss is directly linked to proinflammatory cytokines and activation of osteoclasts. Control of inflammation is therefore the best strategy to prevent loss of bone. The nature of the new bone formation process is less defined. A prominent role for developmental signalling pathways has been proposed. Current therapies have limited or no impact on this process. However, emerging data suggest that early control of disease activity may be part of a window of opportunity to prevent structural damage, as biomechanical factors and instability following inflammation may also play a role.
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Doré-Savard, Louis, Nicolas Beaudet, and Philippe Sarret. Mechanisms of bone cancer pain. Edited by Paul Farquhar-Smith, Pierre Beaulieu, and Sian Jagger. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198834359.003.0037.
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The landmark paper discussed in this chapter focuses on pain arising from malignancy of the bone, which, whether primary or originating from a distant site, is the cause for a majority of cancer pain syndromes. Bone is an innervated organ that can relay nociceptive signals triggered by nerve damage, acidosis, inflammation, and hypoxia. The understanding of the physiopathology of skeletal pain has leaped significantly forwards over the last 15 years. The development of animal models that allowed for the visualization of bone microenvironment modifications by the tumour played an important role in recent advances. One of the most significant discoveries was the contribution of local nerve growth factor (NGF) to nerve remodelling in the bone periosteum presented by Mantyh and colleagues in 2010. NGF remains one the most promising treatment avenues for malignant bone pain, and peripheral innervation has become a therapeutic target in several skeletal pathologies.
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Lories, Rik. Mechanisms of bone destruction and proliferation in psoriatic arthritis. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198737582.003.0008.
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Psoriatic arthritis is a chronic inflammatory joint disease that can affect both the peripheral and axial skeleton. The clinical presentation of psoriatic arthritis is very heterogeneous and different subforms have been described. Structural damage to the joint is a feared complication of psoriatic arthritis. The severity of joint inflammation and subsequent damage can range from mild to extreme. Over the last decade, insights into the molecular and cellular mechanisms that underlie the skeletal changes in psoriatic arthritis have gradually increased although translational validation of concepts using patient-derived materials still lags behind. Current treatment strategies directed against key mediators of inflammation appear to have good effects on joint destruction, but their short and long-term impact on new bone formation and ankylosis is still unclear. The identification of the role that key growth factors play in the latter process identifies new opportunities for therapeutic interventions.
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Lavini, F., C. Dall’Oca, and L. Renzi Brivio. Principles of monolateral external fixation. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199550647.003.012014.
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Monolateral external fixation is a system for the stabilization, reduction, and manipulation of bone segments by means of bone anchorage consisting of pins fastened to an external frame. Monolateral external fixators in their various forms have the advantage that they allow the use of half-pins (bicortical pins that do not penetrate both sides of the soft tissue envelope), thereby avoiding major damage to the neurovascular structures contralateral to the insertion point. The simple structure of monolateral systems permits rapid application and simplified preoperative planning, both of which are features particularly appreciated in traumatology.
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Purdue, Mark P., Jonathan N. Hofmann, Elizabeth E. Brown, and Celine M. Vachon. Multiple Myeloma. Oxford University Press, 2017. http://dx.doi.org/10.1093/oso/9780190238667.003.0041.
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Multiple myeloma (MM) is the most common malignancy arising from plasma cells, fully differentiated B lymphocytes that produce the immunoglobulin (Ig) heavy- and light-chain molecules comprising antibodies. MM is characterized by an overproduction of clonal plasma cells in the bone marrow and, in most cases, monoclonal secretion of IgG, IgA, or light-chain Ig. Symptoms of end organ damage (hypercalcemia [C], renal failure [R], anemia [A], or bone lesions [B]), herein referred to as CRAB features, were traditionally a necessary criterion for diagnosing MM; however, improvements in treatment and diagnostic techniques have led to updated diagnostic criteria, enabling intervention among patients before the onset of organ damage. Multiple myeloma is an important cause of lymphoid malignancy (LM) mortality in Western populations. In the United States in 2015, MM was estimated to account for approximately one in every five newly diagnosed LMs, and one in every three LM-related deaths.
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Douglas, Kenneth. Bioprinting. Oxford University Press, 2021. http://dx.doi.org/10.1093/oso/9780190943547.001.0001.
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Abstract: This book describes how bioprinting emerged from 3D printing and details the accomplishments and challenges in bioprinting tissues of cartilage, skin, bone, muscle, neuromuscular junctions, liver, heart, lung, and kidney. It explains how scientists are attempting to provide these bioprinted tissues with a blood supply and the ability to carry nerve signals so that the tissues might be used for transplantation into persons with diseased or damaged organs. The book presents all the common terms in the bioprinting field and clarifies their meaning using plain language. Readers will learn about bioink—a bioprinting material containing living cells and supportive biomaterials. In addition, readers will become at ease with concepts such as fugitive inks (sacrificial inks used to make channels for blood flow), extracellular matrices (the biological environment surrounding cells), decellularization (the process of isolating cells from their native environment), hydrogels (water-based substances that can substitute for the extracellular matrix), rheology (the flow properties of a bioink), and bioreactors (containers to provide the environment cells need to thrive and multiply). Further vocabulary that will become familiar includes diffusion (passive movement of oxygen and nutrients from regions of high concentration to regions of low concentration), stem cells (cells with the potential to develop into different bodily cell types), progenitor cells (early descendants of stem cells), gene expression (the process by which proteins develop from instructions in our DNA), and growth factors (substances—often proteins—that stimulate cell growth, proliferation, and differentiation). The book contains an extensive glossary for quick reference.
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Sieper, Joachim. Ankylosing spondylitis. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0113.
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Ankylosing spondylitis (AS) is a chronic inflammatory disease predominantly of the sacroiliac joint (SIJ) and the spine. It starts normally in the second decade of life and has a slight male predominance. The prevalence is between 0.2 and 0.8% and is strongly dependent on the prevalence of HLA B27 in a given population. For the diagnosis of AS, the presence of radiographic sacroiliitis is mandatory. However, radiographs do not detect active inflammation but only structural bony damage. Most recently new classification criteria for axial spondyloarthritis (SpA) have been developed by the Assessement of Spondylo-Arthritis international Society (ASAS) which cover AS but also the earlier form of non-radiographic axial SpA. MRI has become an important new tool for the detection of subchondral bone marrow inflammation in SIJ and spine and has become increasingly important for an early diagnosis. HLA B27 plays a central role in the pathogenesis but its exact interaction with the immune system has not yet been clarified. Besides pain and stiffness in the axial skeleton patients suffer also from periods of peripheral arthritis, enthesitis, and uveitis. New bone formation as a reaction to inflammation and subsequent ankylosis of the spine determine long-term outcome in a subgroup of patients. Currently only non-steroidal anti-inflammatory drugs (NSAIDs) and tumour necrosis factor (TNF) blockers have been proven to be effective in the medical treatment of axial SpA, and international ASAS recommendations for the structured management of axial SpA have been published based on these two types of drugs. Conventional disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate are not effective.
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Spence, G., and Deborah M. Eastwood. Physeal injuries. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199550647.003.014002.
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♦ Damage to the physis may lead to slowing or angulation of growth, especially if a bone bar forms♦ Fractures involving the physis may be difficult to diagnose on x-ray♦ The Salter–Harris classification is commonly used♦ Fixation of fractures should not cross the physis if it can be avoided♦ Partial growth arrest may be best treated with a complete epiphysiodesis followed by reconstruction.
20
Doty, Sharon. Sticks and Stones May Break My Bones But Words Can Do Real Damage. MMDK Consulting, LLC, 2005.
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21
Gritzner, K. Adorno and Modern Theatre: The Drama of the Damaged Self in Bond, Rudkin, Barker and Kane. Palgrave Macmillan, 2016.
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22
Sieper, Joachim. Axial spondyloarthropathies. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199642489.003.0113_update_003.
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Axial spondyloarthritis (axSpA) is a chronic inflammatory disease predominantly of the sacroiliac joint (SIJ) and the spine. It starts normally in the second decade of life and has a slight male predominance. The prevalence is between 0.2% and 0.8% and is strongly dependent on the prevalence of HLA-B27 in a given population. AxSpA can be split in patients with radiographic axSpA (also termed ankylosing spondylitis (AS)) and in patients with non-radiographic axSpA (nr-axSpA). For the diagnosis of AS, the presence of radiographic sacroiliitis is mandatory. However, radiographs do not detect active inflammation but only structural bony damage. Most recently new classification criteria for axSpA have been developed by the Assessment of Spondylo-Arthritis International Society (ASAS) which cover AS but also the earlier form of nr-axSpA. MRI has become an important new tool for the detection of subchondral bone marrow inflammation in SIJ and spine and has become increasingly important for an early diagnosis. HLA-B27 plays a central role in the pathogenesis but its exact interaction with the immune system has not yet been clarified. Besides pain and stiffness in the axial skeleton patients suffer also from periods of peripheral arthritis, enthesitis, and uveitis. New bone formation as a reaction to inflammation and subsequent ankylosis of the spine determine long-term outcome in a subgroup of patients. Currently only non-steroidal anti-inflammatory drugs (NSAIDs) and tumour necrosis factor (TNF) blockers have been proven to be effective in the medical treatment of axial SpA, and international ASAS recommendations for the structured management of axial SpA have been published based on these two types of drugs. Conventional disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate are not effective.
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Tort and Insurance Practice Section Staff American Bar Association, David L. Guevara, and Frank J. Deveau. Bona Fide Prospective Purchaser Defense: A Guide for Lawyers. American Bar Association, 2022.
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24
Bunch, Chris. Normal blood function. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0277.
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This chapter reviews normal blood function and disorders of haemopoiesis. Blood consists of cells of three main types, suspended in plasma. The cellular component comprises about 40%–50% of the total volume and consists of red cells (erythrocytes), white cells (leucocytes), and platelets. Blood cells are formed from progenitor cells in the bone marrow by haemopoiesis, a process of proliferation and differentiation. Failure of haemopoiesis usually results from damage to proliferating marrow cells by cytotoxic drugs or radiation, haemopoietic malignancy, or a combination of the two.
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Myles, Chloe. Prime Male : Healthy Muscle Growth & Strong Bone: Increase Testosterone Level, Build & Repair Damage Lean Muscle, Support Stronger Bones, Shed Excess Weight, Boost Libido, Energy & Endurance Level, Enrich Mood, Enhance Cognition, Lower Blood Pressure... Independently Published, 2019.
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26
Bates, David. Cauda equina lesions, radiculopathies, and sphincter disorders. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780198569381.003.0678.
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Pathological processes involving the spinal roots and cauda equina present with symptoms of lower motor neurone and first order sensory neurone damage. Pain is a common, though not inevitable, symptom. Pathological processes may be acute, as with a prolapsed intervertebral disc or chronic and extend over many years, as with spondylotic bony changes or structural diseases such as spondylolisthesis. The cauda equina carries innervation to the bladder, rectum, corpus cavernosum, and seminal vesicles and damage commonly presents with sphincter disturbance and impotence. In general the nerve roots throughout the spine and cauda equina are more resistant to injury and pathological processes than the spinal cord; rapid diagnosis and surgical intervention where indicated, may improve outcome considerably.
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Vodopivec, Ivana, and Tracey A. Cho. Neurobiology of Transverse Myelitis and Infectious Myelopathies. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199937837.003.0153.
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Infectious agents cause spinal cord pathology by three different mechanisms: direct invasion/infection of neural tissues (i.e., infective myelitis), secondary inflammation and tissue bystander damage with or without autoimmune pathogenesis (parainfectious myelitis), or involvement of extra-axial structures (including the pia-arachnoid, the dura, the epidural space, or the adjacent spinal bones or intervertebral discs), resulting in compressive or ischemic myelopathy. This chapter describes the pathogenesis and treatment of these disorders.
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Tillett, William, and Neil McHugh. Plain radiography. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198737582.003.0016.
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Psoriatic arthritis is a destructive inflammatory arthritis that can affect the peripheral and axial skeleton of patients with psoriasis. Plain radiography has formed an important part in defining psoriatic arthritis as a distinct clinical entity, from early work reporting on distinguishing features to more recent inclusion of osteoproliferation in the CASPAR classification criteria. Plain radiography is accessible, inexpensive and remains the standard measure of assessing damage in inflammatory arthritis. Originally considered a benign disease psoriatic arthritis is now recognised to be destructive and progressive, though not as aggressive as rheumatoid arthritis. Peripheral joint damage is characterised by erosions, joint space narrowing, osteoproliferation, osteolysis and ankylosis. Approximately twenty percent of patients have erosive disease at diagnosis progressing to approximately half of all patients by three years disease duration. In its most severe form, psoriatic arthritis mutilans, digits become shortened from gross bone resorption (osteolyisis) leading to severe functional impairment and disability. Spondyloarthritis may affect between 25-70% of patients with PsA. The radiographic features of Psoriatic Spondyloarthritis differ from Ankylosing Spondylitis, in that sacroiliitis is often asymmetrical and less severe, the cervical spine is frequently involved and syndesmophytes are asymmetrical and para-marginal. Overall radiographic features are less severe than ankylosing spondylitis. The natural history of both peripheral and axial radiographic damage in psoriatic arthritis in the modern era of early diagnosis, tight disease control and biologic drugs has yet to be established.
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Lee, Christoph I. Incidental Meniscal Findings on Knee MRI. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780190223700.003.0033.
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This chapter, found in the bone, joint, and extremity pain section of the book, provides a succinct synopsis of a key study examining the frequency of incidental findings on knee magnetic resonance imaging. This summary outlines the study methodology and design, major results, limitations and criticisms, related studies and additional information, and clinical implications. Incidental meniscal damage on MRI was shown to be common in the general population, especially among the elderly, and is not necessarily attributable to patients’ knee symptoms. Authors advise those interpreting MRI reports and planning interventions that there is a high prevalence of incidental tears even among those without knee symptoms. In addition to outlining the most salient features of the study, a clinical vignette and imaging example are included in order to provide relevant clinical context.
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Cassidy, Jim, Donald Bissett, Roy A. J. Spence OBE, Miranda Payne, and Gareth Morris-Stiff. Principles of chemotherapy. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199689842.003.0005.
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Principles of radiation oncology outlines the physical and biological effects of ionising radiation, and its use in clinical oncology. Radiobiology, examining the response of tissue to ionising radiation, is described with regards to normal and malignant tissues. The effect of fractionation, the delivery of radiotherapy in a series of repeated exposures, is examined. The damaging effects on normal tissues are considered, particularly nonreversible late effects including carcinogenesis. Therapeutic exposure to ionising radiation is contrasted between radical and palliative radiotherapy. The physical properties of ionising radiation beams are described for superficial x-rays, megavoltage x-rays, and electrons. The process of treatment planning is summarised through beam dosimetry, target and critical organ outlining, dose planning, treatment verification, prescription and delivery. Computerised tomography is used for outlining and for verification, using cone beam CT. 0ther methods for image guided radiotherapy include fiducial markers. Increasingly intensity modulated radiotherapy is proving beneficial in reducing normal tissue damage during radical treatment. Stereotactic radiotherapy is used in the radical treatment of small unresectable malignancies. The clinical use of electron therapy, brachytherapy and intraoperative radiotherapy is described. Nuclear medicine uses unsealed radionuclides in imaging primary malignancies and their metastases, and in targeted radiotherapy. Examples include PET scanning, bone scanning, and radio iodine therapy. Whole body irradiation is used to improve outcomes after high-dose chemotherapy with stem cell or bone marrow transplantation.
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James, Edward. Disability and Genetic Modification. University of Illinois Press, 2017. http://dx.doi.org/10.5406/illinois/9780252039324.003.0006.
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This chapter examines the theme of disability, including attitudes toward disability and ideas about deviations from the bodily norm, that Bujold explores in her fictional work. While disability is rarely treated in science fiction and fantasy, it is ubiquitous in Bujold's work. Most visible is Miles Vorkosigan himself, whose fetus was damaged by an insurgent's attack and who struggles with his brittle bones and other problems throughout the early decades of his life. But to Miles can be added many other characters whose physical or mental disabilities are a crucial part of the narrative, from the brain-damaged Dubauer in Shards of Honor to the one-handed Dag in the Sharing Knife sequence, and Cazaril, with a mutilated hand and a demonic stomach tumor, in the first Chalion book. Bujold has declared that she was never writing books about issues: they are about character. The disabilities with which her characters have to cope “do not comprise the sums of their characters nor the reasons for their existences, but are just plot-things that happen to them and with which they must deal, daily or otherwise,” and she adds that the letters she gets from disabled readers suggest that they prefer that approach.
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Baloh, Robert W. Schuknecht and His Breakthrough on Benign Paroxysmal Positional Vertigo. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780190600129.003.0017.
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In 1949, Harold Schuknecht completed his residency in John Lindsay’s Otolaryngology Department at the University of Chicago and stayed first as a clinical instructor and then as an assistant professor. Schuknecht reviewed the temporal bone specimens from the patient reported by his mentor, John Lindsay, and from patients reported by Charles Hallpike and colleagues and was struck by the similarity in the pathologic changes. He concluded that in each case damage to the labyrinth resulted from occlusion of the anterior vestibular artery. Schuknecht believed that the delayed positional vertigo that occurred in these cases must have originated from the posterior semicircular canal. He reasoned that with degeneration of the superior vestibular labyrinth, otoconia would be released from the otolithic membrane of the utricular macule and that, in certain positions of the head, the otoconia would respond to gravity and thereby activate the cupula of the posterior semicircular canal.
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Abdulkader, Rita, and Richard A. Watts. Mycobacterial diseases. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0103.
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The main diseases caused by mycobacterial infection are tuberculosis (TB) and leprosy. Despite a fall in the prevalence of these diseases over the last decade, they are still significant causes of morbidity and mortality worldwide. Atypical mycobacterial infections are encountered less frequently. Immigration patterns, the frequency of human immunodeficiency infection, and the increased numbers of patients on immunosuppressive treatments render mycobacterial infections relevant not only to physicians in the developing world where they traditionally occurred but also in the developed world. Skeletal TB occurs in 1–3% of cases of TB infection, and is more frequently encountered in the immunocompromised. A high index of suspicion is required, diagnosis relies on a combination of clinical features and radiological, histological, and microbiological tests. Multidrug regimens are required for treatment with surgery in selected cases. Leprosy is caused by M. leprae infection. The disease is still a leading cause of disability worldwide. Diagnosis is usually clinical. The course of the disease is indolent but may be interrupted by acute inflammatory reactions, which contribute to nerve damage and disability. Treatment aims at eliminating the mycobacteria using multidrug regimens, and management of complications including leprosy reactions and long-term nerve damage. Atypical mycobacterial infections affecting bone and joints are uncommon; they usually follow direct inoculation of the pathogen. Haematogenous dissemination is encountered in immunocompromised patients. These microorganisms are not usually susceptible to the same drug regimens used in the treatment of tuberculosis.
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Hughes, Jim. Distal femur and knee. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198813170.003.0014.
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The knee is one of the main load-bearing joints of the body, and injuries to it can involve damage to the joint or articular surfaces, or fractures to the long bones in case of high-energy trauma. The position of the contralateral leg can cause difficulty in positioning for imaging, but good positioning and technique should allow demonstration of the region for intervention. This chapter covers a selection of orthopaedic procedures involving the distal femur and knee, covering distal femoral plating and LISS plates, tension band wiring of the patella, and cerclage wiring of the patella. Each procedure includes images that demonstrate the position of the C-arm, patient, and surgical equipment, with accompanying radiographs demonstrating the resulting images.
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Sun, Lisa, and Michael V. Johnston. Rickettsial Diseases. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199937837.003.0157.
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Tick-borne rickettsioses are emerging as more important health problems throughout the world. The spotted fever group including Rickettsia rickettsia can cause encephalopathy, meningitis and brain damage by selectively targeting capillary endothelial cells in the brain, and stimulating inflammation, capillary leakage, hemorrhage, and intravascular coagulation. Rickettsia are are arthropod-borne gram-negative coccobacilli bacteria and are obligate intracellular organisms that do not survive in artificial medium. In North and South America, the most common rickettsial disorder is rocky mountain spotted fever (RMSF) transmitted by the dog tick Dermacentor variabilis or the wood tick Dermacentor andersoni. A characteristic “starry sky” pattern can be seen on MRI imaging of the brain in some patients with RMSF encephalopathy and is thought to reflect the organisms targeting of brain endothelial cells in capillaries the white matter. Early treatment with doxycycline is curative and reverses signs of encephalopathy if given within a few day of onset, but delayed treatment can be associated with permanent neurological disability. The typhus group of rickettsia bacteria include R. prowazekii, which causes epidemic typhus and R. typhi, which causes murine typhus (endemic) typhus in tropical and subtropical parts of the world. Flying squirrels and humans carry R prowazekii and rats are carry R. typhi. Q fever caused by the rickettsia organism Coxiella burnetti is transmitted from farm animals including sheep and is seen throughout the world including the United States.
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Crawford, Laura, and Ruth Kleinpell. Principles and prevention of pressure sores in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0279.
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A pressure ulcer, defined by the National Pressure Advisory Panel and European Pressure Ulcer Advisory Panels as localized injury to the skin or tissue as the result of pressure or pressure in combination with shear, can be an adverse complication of a hospital stay, especially for acute and critically-ill patients. Factors that can contribute to pressure ulcer development include the intensity and duration of pressure, tissue tolerance, shear, and friction. Common anatomical sites for pressure ulcers development are over bony prominences. The National Pressure Advisory Panel and European Pressure Ulcer Advisory Panels define pressure ulcers in six stages according to the degree of tissue damage present in the wound. A risk assessment should be performed to identify the vulnerability of pressure ulcer development and provide guidance for the implementation of preventative interventions. For the critically-ill patient, several specific measures are advocated for preventing pressure ulcers.
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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.
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McDougall, Jason J., and Joel A. Vilensky. The innervation of the joint and its role in osteoarthritis pain. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199668847.003.0007.
Full textAbstract:
Diarthrodial joints possess an extensive network of sensory and sympathetic nerve fibres whose physiological functions are varied and complex. Nerves are primarily located in the synovium but also innervate the subchondral bone, the outer third of menisci, and the superficial surface of tendons and ligaments. Large-diameter, myelinated neurons are involved in joint position sense while small-diameter neurons with thin or no myelin typically sense pain. The small-diameter nerves in conjunction with sympathetic fibres control synovial blood flow and maintain joint homeostasis. In patients with osteoarthritis (OA), the sensory nerves become sensitized and increase their firing rate in response to normal movement. This peripheral sensitization is mediated by numerous algogenic agents released into the OA knee including neuropeptides, eicosanoids, and proteinases. A portion of joint afferents fire in the absence of mechanical stimuli and encode pain at rest. Interestingly, the firing rate of joint afferents does not correlate with OA severity, indicating that pain is a poor predictor of joint pathology. Evidence is accumulating to suggest that a subpopulation of OA patients who are unresponsive to classical non-steroidal anti-inflammatory drugs may be suffering from neuropathic pain in which there is damage to the joint nerves themselves. Better understanding of the biology of joint nerves could help in the development of patient-targeted therapies to alleviate OA pain and inflammation.
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Grassi, Walter, Tadashi Okano, and Emilio Filippucci. Ultrasound in osteoarthritis and crystal-related arthropathies. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199668847.003.0017.
Full textAbstract:
Ultrasonography (US) is a safe and cheap imaging technique which in experienced hands allows for a multiplanar and multisite high-resolution assessment of both morphological and structural features of bone, cartilage, and intra- or periarticular soft tissues. This chapter describes the main applications of US in patients with osteoarthritis (OA) and crystal-related arthropathies. Imaging plays a key role for diagnosis, prognosis, and follow-up in patients with OA. Although conventional radiography is still the gold standard imaging technique in daily clinical practice, US has been revealed to be capable of detecting a wide spectrum of otherwise undetectable details, including cartilage damage, joint effusion, synovial hypertrophy, osteophyte formation, and meniscal protrusion. Crystal visualization by US has the potential to change the diagnostic approach in patients with suspicion of crystal-related arthropathies. The double-contour sign, due to urate crystal deposits on the chondrosynovial interface of the hyaline cartilage, is a highly specific finding for gout as well as the hyperechoic spots within the hyaline cartilage for calcium pyrophosphate dihydrate crystal deposition disease. The potential applications of US in the management of patients with OA and crystal-related arthropathies are not only limited to diagnosis and monitoring. Finally, US guidance allows the real-time visualization of the needle moving through different tissues and reaching the target to aspirate and/or inject. The correct placement of the tip of the needle plays a key role in improving efficacy and reducing side effects of the injection.
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Laggard, Barron. Testogen : A Triple Fast Acting Testosterone Booster: Build & Repair Damage Muscle, Improve Cardiovascular Health & Stronger Bones, Lower Blood Pressure, Boost Libido, Energy & Stamina to Always Perform at Your Peak. Independently Published, 2019.
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Albert, Tyler J., and Erik R. Swenson. The blood cells and blood count. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0265.
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Blood is a dynamic fluid consisting of cellular and plasma components undergoing constant regeneration and recycling. Like most physiological systems, the concentrations of these components are tightly regulated within narrow limits under normal conditions. In the critically-ill population, however, haematological abnormalities frequently occur and are largely due to non-haematological single- or multiple-organ pathology. Haematopoiesis originates from the pluripotent stem cell, which undergoes replication, proliferation, and differentiation, giving rise to cells of the erythroid, myeloid, and lymphoid series, as well as megakaryocytes, the precursors to platelets. The haemostatic system is responsible for maintaining blood fluidity and, at the same time, prevents blood loss by initiating rapid, localized, and appropriate blood clotting at sites of vascular damage. This system is complex, comprising both cellular and plasma elements, i.e. platelets, coagulation and fibrinolytic cascades, the natural intrinsic and extrinsic pathways of anticoagulation, and the vascular endothelium. A rapid, reliable, and inexpensive method of examining haematological disorders is the peripheral blood smear, which allows practitioners to assess the functional status of the bone marrow during cytopenic states. Red blood cells, which are primarily concerned with oxygen and carbon dioxide transport, have a normal lifespan of only 120 days and require constant erythropoiesis. White blood cells represent a summation of several circulating cell types, each deriving from the hematopoietic stem cell, together forming the critical components of both the innate and adaptive immune systems. Platelets are integral to haemostasis, and also aid our inflammatory and immune responses, help maintain vascular integrity, and contribute to wound healing.
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Al-Nahhas, Adil, and Imene Zerizer. Nuclear medicine. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0070.
Full textAbstract:
The application of nuclear medicine techniques in the diagnosis and management of rheumatological conditions relies on its ability to detect physiological and pathological changes in vivo, usually at an earlier stage compared to structural changes visualized on conventional imaging. These techniques are based on the in-vivo administration of a gamma-emitting radionuclide whose distribution can be monitored externally using a gamma camera. To guide a radionuclide to the area of interest, it is usually bound to a chemical label to form a 'radiopharmaceutical'. There are hundreds of radiopharmaceuticals in clinical use with different 'homing' mechanisms, such as 99 mTc HDP for bone scan and 99 mTc MAA for lung scan. Comparing pre- and posttherapy scans can aid in monitoring response to treatment. More recently, positron emission tomography combined with simultaneous computed tomography (PET/CT) has been introduced into clinical practice. This technique provides superb spatial resolution and anatomical localization compared to gamma-camera imaging. The most widely used PET radiopharmaceutical, flurodeoxyglucose (18F-FDG), is a fluorinated glucose analogue, which can detect hypermetabolism and has therefore been used in imaging and monitoring response to treatment of a variety of cancers as well as inflammatory conditions such as vasculitis, myopathy, and arthritides. Other PET radiopharmaceuticals targeting inflammation and activated macrophages are becoming available and could open new frontiers in PET imaging in rheumatology. Nuclear medicine procedures can also be used therapeutically. Beta-emitting radiopharmaceuticals, such as yttrium-90, invoke localized tissue damage at the site of injection and can be used in the treatment of synovitis.
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Lopez, Berenice, and Patrick J. Twomey. Biochemical investigation of rheumatic diseases. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0062.
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It is important for rheumatologists to have an understanding of biochemical tests including an awareness of their limitations. The biological variability of an analyte both within and between individuals, the limitations of the measurement technology, the sensitivity of laboratory internal quality control and external quality assurance procedures, as well as interlaboratory variations in practices including sample collection procedures, may all impact on the interpretation of a result. Biochemical tests are often requested to monitor organ-specific dysfunction arising as an adverse consequence of pharmacotherapy or as a component of a systemic rheumatic disease, although dysfunction may also reflect infection or coincidental pathology. Patients with rheumatic diseases are at high risk of renal and hepatic disease. Serum creatinine and its derivative estimated glomerular filtration rate (eGFR) are the most readily available surrogate markers of GFR and are used to assess renal impairment and monitor its course. However, the use of creatinine alone lacks sensitivity and a substantial loss of function must occur before creatinine levels are increased. Additional biochemical screening for kidney damage can be performed by assessment of glomerular integrity, including proteinuria or albuminuria and haematuria. A wide spectrum of rheumatic diseases can affect the liver with various degrees of involvement and hepatic pathology. These often present with cholestatic or hepatitic biochemical profiles. The medical management of rheumatic diseases also involves medications that are hepatotoxic, and routine monitoring of liver function is recommended. This approach is not problem-free and may be improved by quantitative determinations of non-invasive markers of liver fibrosis in the future. Together with imaging techniques, biochemical tests play an important role in the assessment and differential diagnosis of metabolic bone disease.
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O’Connell, Sue. Lyme borreliosis. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780198570028.003.0009.
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Lyme borreliosis is the most common vector-borne bacterial infection in the temperate northern hemisphere. In the United States of America over 35,000 confirmed or probable cases were reported by state health departments to the Centers for Disease Control and Prevention (CDC) in 2008. It is likely that well over 100,000 cases occur in Europe each year. Lyme borreliosis is caused by several genospecies of Borrelia burgdorferi sensu lato, which are transmitted by ticks of the Ixodes ricinus complex. The infection occurs most commonly in forested, woodland and heathland habitats that support the lifecycles of Ixodes ticks and the small mammals and birds that are reservoir-competent hosts for B burgorferi. The most common presenting feature of Lyme borreliosis is erythema migrans, a slowly spreading rash. The spirochaetes can disseminate through the bloodstream and lymphatics to other organs and tissues and cause later manifestations, most commonly affecting the nervous and musculoskeletal systems. The infection responds to appropriate antibiotic treatment at any stage of disease, with excellent outcomes in most cases, but patients with severe tissue damage from previously untreated late stage disease may recover incompletely. A small proportion of patients can have persistent non-specific symptoms following treatment, without evidence of continuing active infection. This has been termed “post-Lyme syndrome” and appears to be similar to other post-infection syndromes. Prevention relies mainly on personal protection measures against tick bites.
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Food Handlers Manual. Instructor. Organización Panamericana de la Salud, 2017. http://dx.doi.org/10.37774/9789275119020.
Full textAbstract:
[Introduction]. Food-borne diseases (FBDs) are one of the most frequent public health problems in daily life. The hazards that cause FBD may occur in the different stages of the food chain (from primary production to the table). Independently from its origin, once the food reaches the consumer it may have an impact on public health and cause severe economic damage to the establishments devoted to its preparation and sale. These two events may cause loss of confidence and the closing down of a business. Fortunately, the measures for preventing food contamination are very simple and may be applied by anyone who handles food, by following easy rules for hygienic food handling. This Manual’s purpose is to provide to people who handle food, and particularly to food-handlers’ instructors, the information they need to facilitate the teaching of proper procedures to food workers. In addition, it seeks to provide basic information about food safety that Latin American and Caribbean countries may adapt to their own needs. The Manual is organized into three Modules and Appendixes focusing on the following topics: (1) food hazards; (2) FBDs; and (3) hygienic measures to prevent food contamination. The evaluation at the end, forms part of the Manual. Its purpose is to assess the knowledge learned during the course regarding the importance of hygienic food handling for public health.
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Max, O'Brian. Prime Male : Natural Testosterone Booster: Experience Massive Increase on Your Testosterone Level, Energy, Strength, Building of Lean Muscle, Healthy Weight Loss, Stronger Bones, Enrich Mood, Lower Blood Pressure, Boost Libido and Repairs of Damage Muscle. Independently Published, 2019.
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Hayashi, Daichi, Ali Guermazi, and Frank W. Roemer. Radiography and computed tomography imaging of osteoarthritis. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199668847.003.0016.
Full textAbstract:
Osteoarthritis (OA) is the most prevalent joint disorder in the elderly worldwide and there is still no effective treatment, other than joint arthroplasty for end-stage OA, despite ongoing research efforts. Imaging is essential for assessing structural joint damage and disease progression. Radiography is the most widely used first-line imaging modality for structural OA evaluation. Its inherent limitations should be noted including lack of ability to directly visualize most OA-related pathological features in and around the joint, lack of sensitivity to longitudinal change and missing specificity of joint space narrowing, and technical difficulties regarding reproducibility of positioning of the joints in longitudinal studies. Magnetic resonance imaging (MRI) is widely applied in epidemiological studies and clinical trials. Computed tomography (CT) is an important additional tool that offers insight into high-resolution bony anatomical details and allows three-dimensional post-processing of imaging data, which is of particular importance for orthopaedic surgery planning. However, its major disadvantage is limitations in the assessment of soft tissue structures compared to MRI. CT arthrography can be useful in evaluation of focal cartilage defects or meniscal tears; however, its applicability may be limited due to its invasive nature. This chapter describes the roles and limitations of both conventional radiography and CT, including CT arthrography, in clinical practice and OA research. The emphasis is on OA of the knee, but other joints are also mentioned where appropriate.
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Karmali, Mohamed A., and Jan M. Sargeant. Verocytotoxin-producing Escherichia coli (VTEC) infections. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780198570028.003.0008.
Full textAbstract:
Verocytotoxin (VT)-producing Escherichia coli (VTEC), also known as Shiga toxin producing E. coli (STEC), are zoonotic agents, which cause a potentially fatal illness whose clinical spectrum includes diarrhoea, haemorrhagic colitis, and the haemolytic uraemic syndrome (HUS). VTEC are of serious public health concern because of their association with large outbreaks and with HUS, which is the leading cause of acute renal failure in children. Although over 200 different OH serotypes of VTEC have been associated with human illness, the vast majority of reported outbreaks and sporadic cases of VTEC-infection in humans have been associated with serotype O157:H7.VTs constitute a family of related protein subunit exotoxins, the major ones implicated in human disease being VT1, VT2, and VT2c. Following their translocation into the circulation, VTs bind to endothelial cells of the renal glomeruli, and of other organs and tissues via a specific receptor globotriosylceramide (Gb 3), are internalized by a process of receptor-mediated endocytosis, and cause subcellular damage that results in the characteristic microangiopathic disease observed in HUS.The incubation period of VTEC-associated illness is about 3–5 days. After ingestion VTEC (especially of serotype O157:H7) multiply in the bowel and colonize the mucosa of probably the large bowel with a characteristic attaching and effacing (AE) cytopathology. Colonization is followed by the translocation of VTs into the circulation and the subsequent manifestation of disease.The majority of patients with uncomplicated VTEC infection recover fully with general supportive measures. Historically, the case-fatality rate was high for HUS. However, improvement in the treatment of renal failure and the attendant biochemical disturbances has substantially improved the outlook, although long-term sequelae may develop.Ruminants, especially cattle, are the main reservoirs of VTEC. Infection is acquired through the ingestion of contaminated food, especially under-cooked hamburger, through direct contact with animals, via contaminated water or environments, or via personto-person transmission.The occurrence of large outbreaks of food-borne VTEC-associated illness has promoted close scrutiny of this zoonoses at all levels in the chain of transmission, including the farm, abattoir, food processing, packaging and distribution plants, the wholesaler, the retailer and the consumer. While eradication of VTEC O157 at the farm may not be an option, interventions to increase animal resistance or to decrease animal exposure are being developed and validated. Hazard Analysis and Critical Control Programmes are being implemented in the processing sector and appear to be associated with temporal decreases in VTEC serotype O157 illness in humans. Education programmes targeting food handling procedures and hygiene practices are being advocated at the retail and consumer level. Continued efforts at all stages from the farm to the consumer will be necessary to reduce the risk of VTEC-associated illness in humans.