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1
Facial reactions in response to gustatory and olfactory stimuli in healthy adults, patients with eating disorders, and patients with attention-deficit hyperactivity disorder. Würzburg, Germany: Julius-Maximilians-Universität, 2010.
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BURMER, Karl. Cbd Oil for Asthma: Effective Remedy for Chronic Respiratory Disorder. Independently Published, 2019.
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Hoyles, Rachel K., and Athol U. Wells. Respiratory system. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0020.
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Pulmonary involvement is common in the connective tissue diseases (CTDs) and is associated with significant morbidity and mortality. Improved management of systemic disease has led to increasing numbers of surviving patients with clinically significant pulmonary disease. Screening for pulmonary complications highlights the frequency of subclinical involvement. In this chapter, the pulmonary manifestations of the more common CTDs are detailed, including rheumatoid arthritis (RA), systemic sclerosis (SSc), systemic lupus erythematosus (SLE), polymyositis/dermatomyositis (PM/DM), Sjögren's syndrome (SS), and, more briefly, ankylosing spondylitis (AS). A broad spectrum of pulmonary disorders are seen in association with the CTDs or the drugs used to treat the underlying disorder, including interstitial lung disease, pulmonary infections, airways disease, pulmonary nodules, pleural disease, chest wall pathology and pulmonary vascular disease; the discussion is stratified by pulmonary complication. In many cases, two or more pulmonary manifestations of CTD coexist or there are other concurrent diseases such as asthma and lung cancer, resulting in potentially confusing mixed imaging and pulmonary function abnormalities. This chapter presents a comprehensive approach to the investigation, screening, prognostic evaluation, and treatment decisions in pulmonary disease associated with the CTDs.
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Jou, J. Fay, Lori A. Aronson, and Jacqueline W. Morillo-Delerme. Mitochondrial Disorder for Muscle Biopsy. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199764495.003.0049.
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Mitochondrial disease (mtD) is a genetically, biochemically, and clinically heterogeneous group of disorders that arise most commonly from defects in the oxidative phosphorylation or electron transport chain involved in energy metabolism. These patients have an increased risk for cardiac, respiratory, neurologic, and metabolic complications from anesthesia. Consequently, there are several anesthetic considerations for patients with mtD.
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Kreit, John W. Acute Respiratory Distress Syndrome (ARDS). Edited by John W. Kreit. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190670085.003.0012.
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Acute Respiratory Distress Syndrome reviews the definitions, causes, pathophysiology, and management of this relatively common, life-threatening disorder. This chapter describes how to ensure adequate tissue oxygen delivery while minimizing ventilator-induced lung injury and provides an in-depth review of how to determine the optimum level of positive end-expiratory pressure (PEEP). The first topic addressed is the precipitating factors and pathophysiology of acute respiratory distress syndrome. Next the chapter turns to mechanical ventilation, and covers the subjects of adequate oxygenation, ventilator-induced lung injury, ancillary therapies, ventilatory therapies, and high I:E ventilation. The topics addressed in the area of non-ventilatory therapies include: prone positioning of the patient, neuromuscular blockade, inhaled vasodilators, and extracorporeal membrane oxygenation (ECMO).
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Phillips, Katharine A. Differentiating Body Dysmorphic Disorder from Normal Appearance Concerns and Other Mental Disorders. Edited by Katharine A. Phillips. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190254131.003.0018.
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This chapter discusses differentiation of body dysmorphic disorder (BDD) from disorders that may be misdiagnosed as BDD or that present differential diagnosis challenges: eating disorders, major depressive disorder, obsessive-compulsive disorder, trichotillomania (hair-pulling disorder), excoriation (skin-picking) disorder, illness anxiety disorder, social anxiety disorder, agoraphobia, panic disorder, generalized anxiety disorder, schizophrenia and other psychotic disorders, gender dysphoria, avoidant personality disorder, olfactory reference syndrome, and several other constructs. This chapter also discusses how to differentiate BDD from normal appearance concerns and from problematic preoccupation with obvious physical defects.BDD is commonly misdiagnosed as another mental disorder. Sometimes misdiagnosis occurs because patients are too embarrassed and ashamed to reveal their appearance concerns; in such cases, BDD symptoms that are more readily observable (such as social anxiety) may be assigned an incorrect diagnosis while BDD goes undetected. In other cases, BDD symptoms are recognized but are misdiagnosed as another disorder. BDD must be differentiated from other conditions so appropriate treatment can be instituted.
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Horsley, Alex, Steve Cunningham, and J. Alastair Innes, eds. Cystic Fibrosis (Oxford Respiratory Medicine Library). Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780198702948.001.0001.
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Cystic Fibrosis (CF) is a multi-system disorder, requiring not just respiratory expertise but also management of nutrition, diabetes, musculoskeletal and psychosocial issues. This online resource is a concise companion for all health care professionals who manage patients with CF, and it covers all aspects of care, including both paediatric and adult-specific issues, and summarizes up-to-date literature in a concise and focussed style. There is an emphasis on the practical aspects of management with separate chapters covering the effects of CF in the lung, the microbiology of pulmonary CF, and management of exacerbations. Psychosocial aspects of CF care, end of life care and lung transplantation are also covered, and potential future therapies reviewed. This second edition has been extensively updated to reflect the UK CF Trust Standards of Care, treatment guidelines and Cochrane reviews, and it also includes updates on emerging organisms, an expanded section on physiotherapy, and a new pharmacopeia that covers all common CF medications.
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Langer, Thomas, and Pietro Caironi. Pathophysiology and therapeutic strategy of respiratory alkalosis. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0114.
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Respiratory alkalosis is a condition characterized by low partial pressure of carbon dioxide and an associated elevation in arterial pH caused by an imbalance between CO2 production and removal, in favour of the latter. Conditions that cause increased alveolar ventilation, without having a reduction in pH as input stimulus, will cause hypocapnia associated with a variable degree of alkalosis. The major effect of hypocapnia is the increase in pH (alkalosis) and the consequent shift of electrolytes that occurs in relation to it. As a general law, in plasma, anions will increase, while cations will decrease. The acute reduction in ionized calcium, due to the change in extracellular pH, may cause neuromuscular symptoms ranging from paraesthesias, to tetany and seizures. The effect on urine is an increase in urinary strong ion difference/urinary anion gap and a consequent increase in urinary pH. Finally, acute hypocapnic alkalosis causes a constriction of cerebral arteries that can lead to a reduction of cerebral blood flow. The clinical approach to respiratory alkalosis is usually directed toward the diagnosis and treatment of the underlying clinical disorder.
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Hickey, Thomas, and Jessica Feinleib. Pain Management in the Patient with Substance Use Disorder. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190457006.003.0015.
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Managing pain in the patient with substance use disorder can be challenging. This chapter describes those challenges and provides strategies to address them. Specifically it discusses the prevalence and specific considerations for commonly abused substances, the need for aggressive communication among perioperative clinicians, and a strategy to decrease acute postoperative pain and associated complications using opioid-sparing, multimodal analgesia. It includes a discussion of the concept of equianalgesic opioid doses and management of opioid-related side effects including respiratory depression, with regard to buprenorphine, naltrexone, and methadone. Specific consideration is given to the surgical patient treated with buprenorphine, and a defined clinical plan is outlined.
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Grimaldi, Stephanie J., and Emily R. Stern. Sensory Processing and Intolerance in OCD. Edited by Christopher Pittenger. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190228163.003.0011.
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Patients with obsessive-compulsive disorder (OCD) often exhibit abnormal sensitivity to sensory stimuli and a reduced ability to screen out stimuli that most do not find bothersome. This chapter reviews evidence documenting increased sensitivity to external sensory stimuli (auditory, olfactory, tactile) and reduced sensory gating in patients with OCD. In some individuals such sensitivity can present as a primary symptom. Many patients with OCD also experience sensations that appear to be “internally generated,” including not-just-right experiences, incompleteness, and physical urges; this is the focus of the second half of the chapter. These sensations, termed “sensory phenomena,” cause significant distress and impairment in daily functioning and may require different treatments than fear-based obsessions. The chapter concludes with a brief discussion of directions for future research that may provide further insight into the nature of sensory symptoms as well as potential treatments.
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Tinch, Brian, David Martin, and Junzheng Wu. Cystic Fibrosis. Edited by Erin S. Williams, Olutoyin A. Olutoye, Catherine P. Seipel, and Titilopemi A. O. Aina. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190678333.003.0018.
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Cystic fibrosis is an inherited disorder. The diagnosis should be suspected in an infant who has meconium ileus or infants presenting to the operating room with volvulus. Cystic fibrosis is characterized by frequent mucous plugging in the respiratory tract which may manifest as wheezing and frequent intermittent flare-ups of respiratory decompensation. Optimization of the affected child’s respiratory status prior to elective surgery is mandatory to prevent difficulty with intraoperative ventilation. While the laryngeal mask airway may be used for short procedures, the use of an endotracheal tube facilitates suctioning of the frequently inspissated secretions that accompany cystic fibrosis in order to optimize ventilation.
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Martin, David, and Junzheng Wu. Cystic Fibrosis. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199764495.003.0021.
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Cystic fibrosis (CF) is an inherited chronic disease that affects about 30,000 children and adults in the United States and 70,000 worldwide. CF is the most common fatal inherited disorder affecting Caucasians in the United States. While its presentation can vary in severity, the most common clinical manifestations are progressive lung damage and chronic digestive problems due to exocrine gland dysfunction and the production of thick viscous mucus. Careful perioperative management is important to avoid respiratory complications.
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Walder, Dave, and Paul Reading. Narcolepsy: still sleepy on CPAP. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199657742.003.0011.
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Sleep disorders are an increasingly common reason for referral to the respiratory clinic, and our understanding of the different aetiologies is increasing. The commonest sleep disorder is sleep apnoea, but other sleep disorders can cause similar symptoms. Narcolepsy is a neurological disorder that affects the brain’s ability to regulate the normal sleep-wake cycle and often presents with similar symptoms to obstructive sleep apnoea, daytime hypersomnolence, and disturbed night-time sleeping but is largely underdiagnosed. This chapter discusses a patient who presented with symptoms of daytime somnolence and witnessed apnoeas and details the investigations required for a diagnosis of narcolepsy. It covers the more specialized sleep studies required for a clinical diagnosis and the treatment options available for patients with this condition.
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Hulse, Elspeth J., and Michael Eddleston. Management of pesticide and agricultural chemical poisoning. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0330.
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Poisoning with agricultural chemicals is common in rural Asia-Pacific with up to 300,000 annual deaths from pesticide self-poisoning. The pharmacokinetics and pharmacodynamics of pesticides can vary markedly depending on the chemicals ingested, the pesticide’s lipid solubility, enzyme reactivation, co-ingested toxicants, and extent of decontamination and organ dysfunction. Diagnosis and management is based on clinical signs and standard investigations. Staff should wear standard universal precaution attire for examining and treating patients; nosocomial poisoning is rare. Management of poisonings should include careful airway intervention and administration of oxygen, except in suspected paraquat poisoning. Organophosphorus insecticide poisoning causes a cholinergic crisis with excess airway secretions and acute respiratory failure. Patients should be treated with intravenous atropine and observed for the neuromuscular disorder ‘intermediate syndrome’, which can cause further paralysis and respiratory failure after 24 hours. Few antidotes exist for other agricultural chemical poisonings with the mainstay of treatment being supportive standard ICU care.
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Kreeger, Renee Nierman, and James P. Spaeth. Muscular Dystrophy. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199764495.003.0063.
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Gastrostomy tube placement is typically a routine surgical procedure with little concern for morbidity and mortality. However, in patients with Duchenne muscular dystrophy (DMD), this is not the case. Patients with DMD present a unique clinical dilemma since they often do not require gastrostomy tube placement until their physical status has deteriorated to the point that they have respiratory insufficiency or failure and clinically significant cardiomyopathy. An understanding of the pathophysiology of this disorder and a proactive approach to perioperative management are important to ensure a positive patient outcome.
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Yang, Jingduan, and Daniel A. Monti. Modern Studies of Acupuncture. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190210052.003.0019.
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This chapter presents some examples of modern research on acupuncture. They include studies on the physiological nature of acupuncture points and of acupuncture’s impact on the functions of the immune, endocrine, nerve, cardiovascular, digestive, respiratory, and reproductive systems. It also includes examples of clinical studies on the safety and efficacy of acupuncture on various clinical medical and psychiatric conditions such as asthma, infertility, gastroesophageal reflux disorder (GERD), endometriosis, chronic pain, depression, anxiety, and insomnia. It discusses the confusion in research conclusions caused by methodological deficits in study designs and interventions, and it initiates a discussion on the future direction of studies that benefit advances in modern medicine rather than judging acupuncture using pharmaceutical models of research that are unable to visualize and measure human energy.
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Gibson, K. Michael, Cornelis Jakobs, and Philip L. Pearl. Succinic Semialdehyde Dehydrogenase Deficiency. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199972135.003.0029.
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Succinic semialdehyde dehydrogenase (SSADH) deficiency presents with intellectual disability, disproportionate deficit in expressive language, hypotonia, ataxia, and seizures.1,2 (1 Pearl et al 2011; 2 Vogel et al 2012). A diagnosis of autism spectrum disorder frequently occurs, correlated with neuropsychiatric morbidity (ADHD, OCD, PDD). 1,3 The biochemical hallmark, γ-hydroxybutyric acid (GHB), is elevated in physiological fluids, as is γ-aminobutyrate (GABA) in cerebrospinal fluid (CSF).4,5 Both species are neuroactive. Clinical manifestations are universally present in early childhood, although diagnosis delayed to adulthood has been reported.6 Acute decompensation or complications relate primarily to seizures, intercurrent illnesses sometimes associated with respiratory dysfunction in the setting of hypotonia, or adverse medication responses. Diagnostic confirmation requires urine organic acid analysis (increased GHB) with confirmation via enzyme assay (white cells) and/or molecular characterization of the aldehyde dehydrogenase 5a1 (ALDH5A1) gene.
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Launois, Sandrine H., and Patrick Lévy. Pulmonary disorders and sleep. Edited by Sudhansu Chokroverty, Luigi Ferini-Strambi, and Christopher Kennard. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199682003.003.0041.
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Sleep disorders and pulmonary diseases are closely associated, a fact clearly underestimated in routine patient care, despite evidence that these disorders interact to impact on quality of life as well as on morbidity and mortality. The prevalence of chronic insomnia, sleep-related breathing disorders, and restless leg syndrome is high in patients with chronic pulmonary disorders such as asthma, chronic obstructive pulmonary disease, cystic fibrosis, interstitial lung disease, chest wall and neuromuscular disorders, and chronic respiratory failure. This association may be fortuitous and reflect the impact of a chronic condition on sleep quality, or it may be due to specific sleep-related phenomena adversely affecting an underlying pulmonary disorder. Furthermore, obstructive sleep apnea has been implicated as a risk factor for pulmonary hypertension and pulmonary embolism. This chapter outlines the implications for both pulmonary and sleep specialists, in terms of clinical management and treatment strategies.
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van der Ploeg, Ans T., and Pascal Laforêt. Pompe Disease. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199972135.003.0055.
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Pompe disease, also named acid maltase deficiency and glycogen storage disease type II (GSDII), is a rare autosomal recessive disorder caused by the deficiency of the glycogen-degrading lysosomal enzyme acid α-glucosidase. The clinical spectrum of this disease is broad, varying from a lethal infantile-onset generalized myopathy including cardiomyopathy, to late-onset slowly progressive muscle weakness mimicking limb-girdle muscular dystrophy. Respiratory insufficiency is a frequent complication and the main cause of death. The prognosis of Pompe disease has changed considerably with the use of enzyme replacement therapy using recombinant acid α-glucosidase (alglucosidase alfa), which has been widely available since 2006. Improvements in survival and major motor achievements can be observed in patients with infantile forms, and recent studies demonstrate improvement of walking distance and stabilization of pulmonary function in late-onset forms. A longer-term study of the safety and efficacy of ERT, based on data gathering across the complete spectrum of Pompe disease via national or international patient registries, is needed in order to formulate more precise guidelines for treatment.
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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.