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1
Rhein, Linda D. Skin, hair and nail structure and function and associated diseases. [New York]: Society of Cosmetic Chemists, 1997.
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2
Reflexology and associated aspects of health: A practitioner's guide. Berkeley, Calif: North Atlantic Books, 2005.
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3
Song, Young-Ho. The targeting of phospholipid liposomes to oral and skin-associated bacteria and their use forbactericide delivery. Manchester: University of Manchester, 1994.
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4
Sanderson, Neil Michael. Interaction of cationic liposomes with the skin-associated bacteria Staphylococcus epidermis for the delivery of antibacterial agents. Manchester: University of Manchester, 1996.
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5
Great Britain. Associate Parliamentary Group on Skin. Report on the enquiry into skin diseases in elderly people: A report of the Associate Parliamentary Group on Skin. London: Great Britain, Associate Parliamentary Group on Skin, 2000.
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6
Foundation, Mammoth Lakes, and Mammoth Ski Museum, eds. Tracks of passion: Eastern Sierra skiing, Dave McCoy, and Mammoth Mountain : a photo essay. Mammoth Lakes, CA: Mammoth Lakes Foundation, 2008.
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7
Estwanik, Joseph J. Sportsmedicine for the combat arts. Charlotte, NC: Boxergenics Press, 1996.
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8
Bundy, Christine. Visible Difference Associated With Disease: Skin Conditions. Oxford University Press, 2012. http://dx.doi.org/10.1093/oxfordhb/9780199580521.013.0029.
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9
Eluri, Swathi. Catheter-Associated Infections. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199976805.003.0020.
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Catheter-associated infections, which often present as sepsis, include primary bloodstream infections that occur in the presence of intravascular catheters. They are not related to an infection at another site and are defined as a primary bloodstream infection with documented colonization of the device and microbiologically proven, device-related bloodstream infection. Multiple hospitals have started to implement standardized quality control interventions to minimize catheter-related bloodstream infections. Ultrasound-guided line placement results in a decrease in mechanical complication and the number of attempts, which in turn reduces the risk of infection. Preparing the skin with 0.5% chlorhexidine or alcohol containing chlorhexidine solutions has been shown to reduce line-related infections. Antimicrobial lock solutions should be used in patients with recurrent catheter-associated infections and high-risk groups, such as those on total parenteral nutrition, dialysis, or oncologic patients. The preservation of skin integrity surrounding the device decreases the risk of infection.
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Shaibani, Aziz. Skin Signs. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190661304.003.0027.
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Many neuromuscular diseases are expressed by skin manifestations such as dermatomyositis. Skin changes of dermatomyositis can be of many types and be subtle in dark skin. They include heliotropes, periungual telangiectasia, and thickening and fissuring of the skin. Unlike SLE rash, dermatomyositis rash affects the knuckles. Many systemic inflammatory diseases are associated with neuromuscular disease, such as vasculitis, systemic lupus erythematosus (SLE), and scleroderma. Steroids may lead to acne like skin lesions that should be differentiated from the rash of the underlying disease. This chapter provides examples of skin signs that are associated with neuromuscular diseases.
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Shaibani, Aziz. Skin Signs. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199898152.003.0027.
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Many neuromuscular diseases are expressed by skin manifestations such as dermatomyositis. Skin changes of dermatomyositis are of many types and can be subtle in dark skin. Skin rash may be the only finding in dermatomyositis (amyopathic dermatomyositis). Many systemic inflammatory diseases are associated with skin lesions and neuromuscular involvement such as vasculitis, SLE, and scleroderma. Steroids may lead to acne-like skin lesions that should be differentiated from the rash of the underlying disease. Since the skin and nervous system are both ectodermal in origin, many hereditary and congenital disorders affect both (neurocutaneous syndromes). This chapter provides examples of skin signs that are associated with neuromuscular diseases.
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Tapp, Loren C., and Boris D. Lushniak. Skin Disorders. Oxford University Press, 2017. http://dx.doi.org/10.1093/oso/9780190662677.003.0028.
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This chapter describes skin disorders primarily associated with hazardous workplace exposures. These exposures include physical insults, chemical substances, and biological agents that effect the skin by direct contact. Chapter sections feature contact dermatitis, contact urticaria, dermatologic infectious diseases, and skin cancer. All sections include a discussion of public health importance, populations at risk, diagnosis, etiologic agents, and prevention based on a recent review of the scientific literature. National data sources provided incidence and prevalence rates for each of these major categories of skin disorders, although some categories had limited data. Contact dermatitis is the most common occupational skin disorder and has been studied more extensively than the other skin disorders. Thus, the contact dermatitis section is more detailed than the other sections and includes data on economic impact and prognosis of occupational contact dermatitis.
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Sybert, Virginia. Genetic Skin Disorders. Oxford University Press, 2012. http://dx.doi.org/10.1093/med/9780195397666.001.0001.
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This lavishly-illustrated resource represents a comprehensive survey of well over 300 distinct inherited dermatologic conditions. Each disease entry follows a consistent format, containing sections devoted to dermatologic features, associated clinical abnormalities, histopathology, biochemical and molecular information, treatment, mode of inheritance and recurrence risk, prenatal diagnosis, and information on differential diagnosis. Any clinician faced with a patient in whom the possibility for a genetic disorder of the skin exists will find this book a practical tool of immense interest.
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Powell, Jenny. Investigation in skin disease. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0245.
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When taking a history and examining the patient do not provide all the information required, further investigation is possible. This may be to provide a diagnosis, to add to prognostic information, to help with treatment required, or to find an associated systemic disorder or underlying genetic disorder.
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Sybert, Virginia P. Genetic Skin Disorders. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190276478.001.0001.
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This book is a readable, reliable guide to the diagnosis and differential of inherited skin disorders to which generalists, paediatricians, dermatologists, and geneticists can refer during an examination. The new edition reflects the most up-to-date understanding of the molecular and genetic bases of heritable skin diseases. Each chapter describes the signs and symptoms of heritable skin diseases and enumerates pertinent associated clinical features and differential diagnoses. Non-dermatological signs are symptoms round out the information on each condition. Where appropriate, descriptions of histopathology at both the light and electron microscopic levels are included. Over 800 full-colour photographs illustrate the concepts discussed in the text. Annotated bibliographies at the end of each section direct readers to more extensive sources, and an updated listing of support groups for patients and their families supplements the resources for medical professionals.
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Soon, Christine. Skin infection and infestation. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0246.
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An infection of the skin means a breach of the skin barrier has resulted in an organism gaining an opportunity to infect the area and causing inflammation, pain, erythema, and swelling. There can be associated systemic unwellness such as pyrexia, tachycardia, and hypotension. An infestation occurs when creatures inhabit the skin, lay eggs, and multiply. These creatures are usually dependent on their host for food and transmission to others. They typically cause intense pruritus in the affected areas.
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Grocott, Patricia, Georgina Gethin, and Sebastian Probst. Skin problems in palliative care. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199656097.003.0111.
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Nursing aspects of palliative wound care are driven by patient and family goals integrated with three components of wound management: the management or palliation of the underlying cause of the wound, management of wound-related symptoms, and management of the wound and peri-wound skin. Wounds most commonly found include pressure ulcers, fungating malignant wounds, and fistulae. Patients with blistering skin conditions, inherited and acquired, have extensive longstanding wounds and palliative care needs. In addition, meticulous skin care for patients of all ages with debilitating long-term conditions is crucial to prevent unnecessary skin breakdown. The symptoms and local problems associated with broken skin and wounds include odour, exudate, excoriation, maceration, bleeding, pain, and pruritus, and key clinical interventions include the application of wound dressings and skin care products. Unless these are managed effectively and consistently, body image and feelings of self-worth are affected together with the ability to socialize and maintain employment.
18
United States. Environmental Protection Agency. Risk Assessment Forum and Eastern Research Group Inc, eds. Summary report for the workshop on issues associated with dermal exposure and uptake: U.S. Environmental Protection Agency, Bethesda, MD, December 10-11, 1998. Washington, DC: Risk Assessment Forum, U.S. Environmental Protection Agency, 2000.
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19
Little, Mark P. Environmental radiation. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0340.
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Risks associated with ionizing radiation have been known for almost as long as ionizing radiation itself. Within a year of the discovery of X-rays by Röntgen, skin burns had been reported and, within 7 years, a case of skin cancer was observed, all associated with high-dose X-ray exposure. In general, the risks associated with ionizing radiation can be divided into what have been termed (by the International Commission on Radiological Protection) stochastic effects (e.g. genetic risks in offspring, and somatic effects (cancer) in the directly exposed population), and deterministic, or tissue-reaction, effects. Deterministic effects are typically associated with high-dose exposures, and will not be considered further here.
20
Bewley, Anthony. Psychocutaneous medicine. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0262.
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The links between the mind and the skin have long been recognized. The skin has been described as the mirror of the mind, and so it is not surprising that the interface between dermatology and psychiatry (‘psychocutaneous medicine’ or ‘psychodermatology’) is emerging as a specific subspeciality of dermatology. Psychodermatological conditions can be classified as either primarily psychiatric disorders which manifest via skin disease, for example delusional infestation, or primarily dermatological disorders, for example psoriasis, which may be caused by, or associated with profound psychiatric morbidity (e.g. anxiety, depression).
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Banerjee, Ashis, and Clara Oliver. Dermatology. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198786870.003.0016.
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Dermatology encompasses a large number of conditions including both primary skin diseases as well as multisystem disease. This chapter covers the pertinent areas of dermatology required for the Intermediate FRCEM examination. It is highly possible that skin conditions could appear in the short-answer question (SAQ) paper and therefore this chapter provides candidates with the tools to describe a rash in terms of nomenclature as well as constructing a differential diagnosis and management plan. This chapter covers the common life-threatening rashes such as Steven-Johnson syndrome, as well as rashes associated with multisystem disease such as erythema nodosum and primary skin conditions.
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Krueger, Darcy A., and Jamie Capal. Familial CNS Tumor Syndromes. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199937837.003.0136.
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Tuberous sclerosis complex is an autosomal dominant multi-system disease that involves the skin, brain, heart, lungs, and kidneys and is associated with seizures including infantile spasms, intellectual disability, autism and pulmonary and heart disease. Skin lesions can be particularly disfiguring and infantile spasms can be associated with marked cognitive decline. The outlook for patients has improved markedly with the recognition that TSC is caused by upregulation of the mammalian target of rapamycin (mTOR) enzyme, which connects energy needs and supply with cellular and neuronal growth. mTOR is upregulated in TSC because of mutations in hamartin or tuberin, which normally serve as a brake on mTOR. The drug rapamycin is commonly used as an immunosuppressive for patients undergoing kidney transplants; it has also found a new use in patients with TSC. Although the drug is immunosuppressive for non-TSC patients, careful titration of the drug in TSC patients corrects its upregulation but is not particulary immunosuppressive. Additional mTOR inhibitors such as everolimus have been developed and have been shown to be effective for pulmonary disease associated with TSC. Rapamycin in ointment form is dramatically effective in suppressing skin lesions of TSC and studies are underway to test the effect of mTOR inhibitors on seizures, brain tubers, intellect, and features of autism. Infantile spasms associated with TSC are very responsive to vigabatrin.
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Lynch, Bernadette, and Aine Burns. The patient with scleroderma. Edited by Giuseppe Remuzzi. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0165.
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Scleroderma is tightness, thickening, and non-pitting induration of skin. Two forms of the skin disease are described. Limited cutaneous systemic sclerosis (lcSSc) which occurs distal to the wrists (or ankles) and/or over the face and neck, often associated with longstanding Raynaud’s phenomenon, and diffuse cutaneous systemic sclerosis (dcSSc) where truncal as well as acral skin involvement occurs as well as tendon friction rubs. In this latter condition the onset of the skin changes occurs within 1 year of onset of Raynaud’s phenomenon; however, the skin involvement may precede onset of vascular symptoms.The skin manifestations are the outward manifestation of a systemic disease, systemic sclerosis. Lung, heart, and gut involvement are frequent. Scleroderma renal crisis, usually presenting as accelerated hypertension and acute kidney injury, is one of the most severe complications of this disease. Autoantibodies against RNA polymerase are associated with scleroderma renal crisis. It occurs in 12% of dcSSc and 2% of lcSSc patients (men and women) and carries a high morbidity and mortality although careful supportive care and blood pressure management using angiotensin converting enzyme inhibitors (ACEI) or angiotensin-II receptor blockers have improved short-term outcomes. In general, beta blockers should be avoided in the early management.Approximately two-thirds of patients require dialysis, of these many recover enough function to come off dialysis. Higher blood pressure and younger age at presentation have a better prognosis. ACEIs should be continued even after dialysis is established as the latter increases the chance of late recovery. Average time to coming off dialysis is 11 months but recovery is uncommon after 24 months. After a crisis renal function continues to improve for several years.
24
Sybert, Virginia P. Other Disorders. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190276478.003.0009.
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Chapter 9 covers Congenital Erosive and Vesicular Dermatosis, Erythermalgia, Michelin Tire Baby, and Stiff Skin. Each condition is discussed in detail, including dermatologic features, associated anomalies, histopathology, basic defect, treatment, mode of inheritance, prenatal diagnosis, and differential diagnosis.
25
Euster, Caren. Infection in the Intravenous Drug User. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199976805.003.0058.
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Injection drug abuse has spread worldwide and is increasing among young adults and adolescents. This chapter focuses on the management of acute infectious consequences of injection drug use (IDU), including skin and soft tissue infections, endocarditis, and systemic infections. The approach to infection is determined based upon etiology: local (injection site) infections, infections distant to the injection site, systemic infections, complications of primary infections, modifying factors, and infections associated with the patient with IDU’s lifestyle. Infections in patients with a history of injection drug use can affect multiple systems. The most commonly affected systems include the skin (eg, abscess), heart (eg, endocarditis), lung (eg, pneumonia), kidney, and brain (eg, septic emboli secondary to endocarditis).
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Holbrook, Anna I. Dystrophic Calcifications. Edited by Christoph I. Lee, Constance D. Lehman, and Lawrence W. Bassett. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190270261.003.0033.
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Dystrophic calcifications are typically large (usually >1 mm), coarse, irregular or plaque-like and associated with lucent centers. They also may be thin, smooth, and round or oval, with lucent centers, called “rim” (previously also known as “eggshell”) calcifications. They form in response to trauma, including surgery or irradiation. They can be seen in association with other findings of breast trauma, including surgical clips, architectural distortion, skin retraction, skin thickening, oil cysts, or trabecular thickening. This chapter, appearing in the section on calcifications, reviews the key imaging and clinical features, imaging protocols, differential diagnoses, and management recommendations for dystrophic calcifications. Topics discussed include findings after breast trauma or surgery/radiation treatment and the evolution of fat necrosis.
27
Esdaile, Ben. Psoriasis. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0249.
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Psoriasis is a common, chronic inflammatory skin disease that is associated with joint disease in approximately 25% of patients. The most common variant of psoriasis is chronic plaque psoriasis (psoriasis vulgaris), which has the hallmark of well-demarcated erythematous plaques covered by silvery scale. There are a number of other variants of psoriasis, including guttate, inverse, palmoplantar, flexural, pustular, and erythrodermic.
28
Bowman, Dwight D. Zoonotic hookworm infections. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780198570028.003.0069.
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Hookworms on occasion cause creeping lesions in the superficial layers of the human skin that have been designated as cutaneous larva migrans for the purpose of contrasting the condition with visceral larva migrans. Currently, the disease is presenting most commonly to physicians specializing in tropical or travel medicine in patients who have just visited a tropical beach and are presenting with serpiginous tracks in their skin. The serpiginous tracts can persist for week, and are often pruritic, may be associated with accompanying bulla, and can rarely lead to secondary sequelae. The larval are likely to penetrate ultimately to deeper tissues, where they may be persisting in the tissues of humans in the same fashion as they would within the tissues of any other vertebrate paratenic host.Most hookworm larvae are capable of penetrating the skin and causing lesions that are similar to cutaneous larvae migrans. However, the geographic distribution of cases still seems to suggest that only one species, A. braziliense, is the offending species. The other species appear to spend less time in the skin of the human host, and if they do cause lesions, they appear to produce lesions that are more vesicular or that cause disease of a markedly shorter duration. It seems that the development of improved molecular methods will ultimately lead to the means of more carefully discrimination the geographical location of the offending species and may someday be able to identify specific larvae from lesions.There are other manifestations of zoonotic hookworm infection. These include the infection of the human intestinal tract with the adults of the canine/feline hookworm Ancylostoma ceylanicum; the induction of cases of eosinophilic colitis in people with the canine hookworm, Ancylostoma caninum; suspected cases of ocular larva migrans due to hookworm larvae, and the rare case of cutaneous larva migrans due to hookworm species that are only rarely associated with human infections.
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Price, Dr Nicholas, and Dr John L. Klein. Infectious diseases and emergencies. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199565979.003.0006.
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Chapter 6 covers infectious diseases and emergencies, including clinical features, history, and examination, the febrile patient with skin lesions or rash, hospital-acquired (nosocomial), infections, classic viral exanthems and mumps, ‘mononucleosis’ syndromes, fungal infections, fever in the returning traveller, fever of unknown origin (FUO), principles and practice of antibiotic use, public health aspects of infectious disease, malaria, meningococcal disease, infections in pregnancy, vascular access device-associated infection, and toxic shock syndrome.
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Shaibani, Aziz. Numbness. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199898152.003.0023.
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Sensory symptoms are the most common symptoms in neuromuscular clinics, yet it is difficult to capture them in videos unless they have a very specific pattern and/or they are associated with objective loss of sensation. Distal sensory loss is a common neuropathic finding. Sensory neuropathies may also present with ataxia or severe pain. Multifocal sensory loss is usually vascular (vasculitis, diabetic amyotrophy). Intercostal pain and numbness are due to radiculopathy (diabetic, zoster, or compressive radiculopathy). Thoracic and abdominal radiculopathies are often misdiagnoses as acute coronary or abdominal emergencies respectively. The distribution of pain and the associated tingling and skin sensitivity to touch are important clues to their neuropathic nature.
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Winkler, Nicole S. Nipple Discharge. Edited by Christoph I. Lee, Constance D. Lehman, and Lawrence W. Bassett. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190270261.003.0044.
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Nipple discharge refers to expressible or spontaneous drainage of fluid from one or more duct orifices of the nipple. Discharge indicates excess fluid secretion into one or more ducts that will drain through an unobstructed duct orifice onto the nipple skin. The fluid content and appearance are important as they have clinical implications. Nipple discharge that is clear or bloody, unilateral (typically uniductal) and spontaneous (fluid discharges without breast or nipple compression) is considered suspicious for malignancy, though most cases are due to benign papillomas. This chapter, appearing in the section on nipple, skin and lymph nodes, reviews the key clinical features, associated imaging findings, imaging protocols and pitfalls, differential diagnoses, and management recommendations for patients presenting with nipple discharge. Topics discussed include clinical evaluation of nipple discharge, sonographic evaluation of ducts and nipple, ductography, intraductal mass, and papilloma.
32
Kakoulle, Toula. Ste Skia Tou Golgotha: Aphegema. S.N., 2003.
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33
Oikonomopoulou, Katerina, and Vinod Chandran. Biomarkers of psoriatic arthritis outcomes. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198737582.003.0022.
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Psoriatic arthritis is an inflammatory musculoskeletal disease that occurs in patients suffering from psoriasis. The disease manifests with symptoms affecting the skin, peripheral and axial joints, and periarticular structures. Diagnosis and management of psoriatic arthritis is challenging due to its heterogeneous presentation. However, early diagnosis and subsequent appropriate treatment reduces disease activity, prevents joint damage, and improves long-term outcome. It is hoped that biomarkers for disease progression and activity will aid in cost-effective clinical management of patients. Potential biomarkers under investigation for psoriatic arthritis are disease-related components derived from skin and articular tissues, biological fluids, such as blood and synovial fluid, and arthritis-associated cell populations. Imaging including ultrasound and MRI are also being evaluated as biomarkers for diagnosis, activity and outcome. Despite the challenge of bringing these new markers into the clinic, many of these markers hold promise for the future management of patients with psoriatic arthritis.
34
Saraiya, Ami, Deep Joshipura, and Alice Gottlieb. Psoriasis treatment. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198737582.003.0026.
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Psoriasis is an immune-mediated skin disease that is associated with various factors, including genetics, stress, infections, and environmental triggers. Numerous treatment options exist for plaque psoriasis including topical therapy, phototherapy, systemic therapy, and biological therapy. In order to select a treatment for a patient, a clinician must consider many aspects. First, one must assess the impact and burden of the disease on a patient as well as a patient’s expectations from therapy. Other important factors to consider include the severity of skin disease, location of psoriatic plaques, comorbidities and presence of psoriatic arthritis, efficacy of different treatments, potential side-effects, safety, and cost. In this chapter, an evidence-based review is presented on the treatment armamentarium for psoriasis as well as new biological treatments and those under investigation. In order to guide practitioners, several treatment algorithms are provided and others are referenced from the literature.
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Smith, Robert M. Other bacterial diseasesErysipeloid. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780198570028.003.0025.
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Erysipeloid is an acute bacterial infection usually causing acute localised cellulitis as a secondary infection of traumatised skin. It is caused by Erysipelothrix rhusiopathiae (insidiosa), a non-sporulating Gram-positive rod-shaped bacterium, ubiquitous in the environment. It is the cause of swine erysipelas and also a pathogen or commensal in a variety of wild and domestic birds, animal and marine species. Human infection primarily associated with occupational exposure to infected or contaminated animals or handling animal products and therefore is commoner in farmers, butchers and abattoir workers and fisherman.Risk factors for the rare human invasive E. rhusiopathiae infection include conditions that affect the host immune response, such as alcoholism, cancer and diabetes. Treatment is with penicillin.Erysipelas can affect animals of all ages but is recognised more frequently in juveniles. Swine exhibit similar stages to the disease in man. Clinical manifestations in swine vary from the classical rhomboid urticaria (diamond skin), the condition of greatest prevalence and economic importance, to sepsis, polyarthritis, pneumonia and death.Prevention is largely a matter of good hygiene, herd management and by raising awareness in those at risk (especially butchers, farmers and fishermen); ensuring that clinicians are aware of E. rhusiopathiae as a possible cause of occupational skin lesions and bacterial endocarditis is important.
36
Takeshita, Junko, and Joel M. Gelfand. Epidemiology of psoriasis. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198737582.003.0002.
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Psoriasis is a common chronic inflammatory disorder of the skin that is associated with multisystem effects. Approximately 125 million people worldwide are affected by psoriasis, nearly one quarter of whom have moderate to severe disease. The majority of patients with psoriasis have a waxing and waning course with variable periods of spontaneous disease improvement or clearance. A rapidly expanding body of epidemiologic literature suggests psoriasis to be associated with a greater comorbid disease burden than patients without psoriasis. In addition to psoriatic arthritis, cardiometabolic diseases, including metabolic syndrome and its component disorders, as well as major adverse cardiovascular events are the most common comorbidities of psoriasis; together they are the primary cause of premature mortality among moderate to severe psoriasis patients. Continued efforts to better understand currently known and identify other emerging comorbidities of psoriasis are critical.
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Waldek, Stephen. Fabry disease. Edited by Neil Turner. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0336.
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Fabry disease is a rare X-linked lysosomal storage disorder in which deficiency of alpha-galactosidase A leads to accumulation of substrate, mostly globotriaosylceramide, which causes a progressive, multiorgan disease affecting predominantly the kidneys, skin, heart, gut, and nervous system. Painful peripheral (‘acral’) neuropathy is characteristic. The disease is commonly diagnosed in children and young men often after some years of usually neuropathic symptoms, with exacerbations (Fabry crises), that commonly elude diagnosis for a long time. These usually occur years in advance of overt involvement of other organs. Diagnosis may also be suspected from renal biopsy, echocardiographic evidence of cardiomyopathy commonly beginning as left ventricular hypertrophy, or characteristic angiokeratomas typically in ‘bathing trunk’ distribution on skin. Renal manifestations are of proteinuria leading to progressive chronic kidney disease associated with deposits in podocytes. Diarrhoea is common. Disordered sweating is typical. Corneal lesions are also typical and there may be tortuosity of retinal vessels. Strokes are increased in frequency, and sensorineural deafness may occur. Women have fewer and later overt manifestations but some develop severe disease.
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Stein, Matthew A. Thrombophlebitis (Mondor Disease). Edited by Christoph I. Lee, Constance D. Lehman, and Lawrence W. Bassett. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190270261.003.0052.
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This chapter, appearing in the section on nipple, skin, and lymph nodes, reviews the key imaging and clinical features, imaging protocols and pitfalls, differential diagnosis, and clinical recommendations of superficial thrombophlebitis of the breast and anterior chest wall (Mondor disease). The condition is quite rare; incidence rates in the literature are reported as being less than 0.1%. Mondor disease is often temporally associated with a history of recent breast surgery, core needle biopsy, inflammatory process, or episode of trauma. Topics in this chapter include discussions of the incidence of Mondor disease, its presumptive pathophysiology, typical and atypical clinical/imaging presentations, and management considerations.
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Bhananker, Sanjay, and Paul Bhalla. Burns. Edited by Kirk Lalwani, Ira Todd Cohen, Ellen Y. Choi, and Vidya T. Raman. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190685157.003.0062.
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Burns injuries are a leading cause of morbidity and mortality in children. A significant burn injury affects every major organ system of the body. Initial management focuses on resuscitation along the ABCDE approach, with particular vigilance for the possibility of airway burn causing progressive edema and narrowing. Smoke inhalation is associated with carbon monoxide poisoning and possible cyanide toxicity. Fluid management depends on accurate estimation on the extent of the burn and use of a formula to calculate infusion rate, with careful monitoring of end-organ perfusion. Significant burn injuries are associated with hypermetabolic changes and a catabolic state, and burn victims are at high risk of developing sepsis. Treatment of a burn injury with debridement and skin grafting can involve multiple visits to the operating room with frequent need for sedation and anesthesia. Providers need a thorough understanding of potential anesthetic issues in burn-injured pediatric patients.
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Winkler, Nicole S. Intracystic/Intraductal Mass. Edited by Christoph I. Lee, Constance D. Lehman, and Lawrence W. Bassett. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190270261.003.0046.
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This chapter, appearing in the section on nipple, skin, and lymph nodes, reviews the key clinical features, associated imaging findings, imaging protocols and pitfalls, differential diagnoses, and management recommendations for intracystic and intraductal masses. The differential diagnoses of intraductal and intracystic masses are similar, with papilloma the most common cause for both. Therefore, we review descriptive terms for both together, with similar implications and management recommendations. Intracystic masses have a higher association with malignancy than intraductal masses, due in part to overlap of imaging appearances of intracystic mass and complex cystic and solid mass. Topics discussed include intraductal and intracystic masses, evaluation of ducts, papilloma, papillary carcinoma and nipple discharge.
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Price, Susan. Genetic bone and joint disease. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0276.
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Genetic conditions affecting the skeleton and supporting structures are individually rare and heterogeneous. This chapter presents an approach to assessing patients with suspected skeletal dysplasia, osteogenesis imperfecta, Marfan syndrome, and Ehlers–Danlos syndrome. Skeletal dysplasias are caused by abnormalities of bone growth and modelling; the commonest non-lethal type is achondroplasia, with an incidence of 1/10 000 to 1/30 000. The typical presentation of osteogenesis imperfecta is with multiple fractures, sometimes prenatally. There may be associated short stature, bone deformity, dentogenesis imperfecta, blue sclera, and hearing loss. Most patients with osteogenesis imperfecta have mutations in COL1A1 or COL1A2. Marfan syndrome is a connective tissue disease with a pattern of symptoms related to the presence of fibrillin in tissues. Typically, affected individuals are of tall, thin stature, with long fingers and toes (arachnodactyly), a pectus deformity, and scoliosis. Between 66% and 91% of individuals with Marfan syndrome have a mutation in fibrillin-1 (FBN1; locus: 15q21). All forms of Ehlers–Danlos syndrome present with variable thinning and fragility of skin, leading to easy bruising and poor scar formation. There is skin and joint laxity. In severe forms, blood vessels and internal organs are affected.
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Saltzman, W. Mark. Tissue Engineering. Oxford University Press, 2004. http://dx.doi.org/10.1093/oso/9780195141306.001.0001.
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Tissue or organ transplantation are among the few options available for patients with excessive skin loss, heart or liver failure, and many common ailments, and the demand for replacement tissue greatly exceeds the supply, even before one considers the serious constraints of immunological tissue type matching to avoid immune rejection. Tissue engineering promises to help sidestep constraints on availability and overcome the scientific challenges, with huge medical benefits. This book lays out the principles of tissue engineering. It will be a useful reference work for those associated with this field and as a textbook for specialized courses in the subject. It is a companion volume to Saltzman's OUP book on drug delivery.
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Balhara, Kamna S., Basem F. Khishfe, and Jamil D. Bayram. Sepsis. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199976805.003.0004.
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Sepsis is a clinical syndrome characterized by systemic inflammation in the presence of infection. The source of infection may be occult. One must be aware of the epidemiology, presenting features and complications, diagnostic considerations and tests, and the organisms involved. Bacteria (gram positive and negative) are most commonly associated with sepsis, although fungi, viruses, and parasites can cause sepsis. Infections in the lungs, urinary tract, abdomen, skin, brain, and other areas can cause bacteremia and lead to sepsis. Treatment includes airway, breathing, and circulation (ABCs) management; aggressive fluid resuscitation; early administration of broad-spectrum antibiotics; and early goal-directed therapy and severe sepsis resuscitation bundle. Diagnosis can be challenging in pediatric and geriatric populations.
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Wittmann, Marc, and Karin Meissner. The embodiment of time: How interoception shapes the perception of time. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780198811930.003.0004.
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Within the framework of the embodiment of time, this chapter presents accumulating evidence of how interoception and associated brain networks process time. Functional MRI studies have shown that climbing neural activation in the posterior insular cortex correlates with stimulus duration in a time-estimation task in the multiple-second range. Given the close connection between the insular cortex and ascending body signals, the authors suggest that the accumulation of physiological changes in body states is the basis for the subjective impression of duration. Psychophysiological findings reveal linearly increasing cardiac periods and decreasing skin-conductance levels during duration-estimation tasks in the multiple-second range. Accordingly, the feeling for the passage of time at the present moment is based on the perception of the bodily self.
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Greco, Francesco, and Paolo Fornara. Inflammation. Edited by Rob Pickard. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199659579.003.0009.
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Fournier’s gangrene (FG) defines a life-threatening necrotizing fasciitis of the external genitalia and perineum with a peak incidence at 50 years of age. It is associated with a mixed bacterial infection with Escherichia coli and Bacteroides spp. predominating. The diagnosis is made clinically with symptoms of skin necrosis, swelling, pain, crepitus, and feculent odour, and local and systemic signs of severe sepsis. Initial resuscitation with fluid replacement, oxygen therapy, and broad-spectrum empirical antibiotics should be rapidly followed by complete and aggressive surgical debridement with postoperative placement of an occlusive dressing. Urinary and faecal diversions are often required. Debridement should be repeated until all necrotic tissue has been excised, allowing later reconstruction. Early diagnosis and immediate therapy is crucial to improve survival in patients with FG.
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Ehmann, Michael. Necrotizing Soft Tissue Infections. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199976805.003.0042.
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Necrotizing soft tissue infections (NSTI) are characterized by extensive and rapidly progressive necrosis that may involve the skin, subcutaneous tissue, fascia, or muscle and are associated with a high degree of morbidity and mortality. Preceding trauma, foreign body penetration, wound contamination, and surgical intervention are all risk factors for NSTI. Clinical examination often reveals extensive tissue involvement with pain but commonly without signs of cellulitis. Crepitant cellulitis occurs most commonly in patients with preexisting lower extremity peripheral arterial disease, decubitus ulcer, or a traumatic wound. Synergistic necrotizing cellulitis (ie, non-clostridial gangrene), in contrast, does involve deeper tissues. Early stabilization, including antibiotics and supportive measures, should be considered; consultation with a surgeon is key. Management must include aggressive resuscitative measures and hemodynamic support.
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Winkler, Nicole S. Nipple Abnormalities. Edited by Christoph I. Lee, Constance D. Lehman, and Lawrence W. Bassett. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190270261.003.0045.
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New nipple retraction and new nipple inversion can be secondary to malignancy, post-surgical change, inflammation, or infection. Paget disease of the nipple is characterized by an inflammatory response of the nipple epidermis to malignant cells extending from ductal carcinoma in the lactiferous sinus. A mass arising within the nipple is rare and usually a variant of a papilloma arising in the nipple (nipple adenoma). This chapter, appearing in the section on nipple, skin, and lymph nodes, reviews the key clinical features, associated imaging findings, imaging protocols and pitfalls, differential diagnoses, and management recommendations for patients presenting with nipple retraction. Topics discussed include imaging features of nipple retraction, both benign and malignant causes of nipple retraction, Paget disease of the nipple, and masses occurring in the nipple.
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Paro, John A. M., and Geoffrey C. Gurtner. Pathophysiology and assessment of burns. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0346.
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Burn injury represents a complex clinical entity with significant associated morbidity and remains the second leading cause of trauma-related death. An understanding of the local and systemic pathophysiology of burns has led to significant improvements in mortality. Thermal insult results in coagulative necrosis of the skin and the depth or degree of injury is classified according to the skin layers involved. First-degree burns involve only epidermis and heal quickly with no scar. Second-degree burns are further classified into superficial partial thickness or deep partial thickness depending on the level of dermal involvement. Damage in a third-degree burn extends to subcutaneous fat. There is a substantial hypermetabolic response to severe burn, resulting in significant catabolism and untoward effects on the immune, gastrointestinal, and renal systems. Accurate assessment of the extent of burn injury is critical for prognosis and initiation of resuscitation. Burn size, measured in total body surface area, can be quickly estimated using the rule of nines or palmar method. A more detailed sizing system is recommended once the patient has been triaged. Appropriate diagnosis of burn depth will be important for later management. First-degree burns are erythematous and painful, like a sunburn; third-degree burns are leathery and insensate. Differentiating between second-degree burn types remains difficult. There are a number of formalized criteria during assessment that should prompt transfer to a burn centre.
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Heidet, Laurence, Bertrand Knebelmann, and Marie Claire Gubler. Alport syndrome. Edited by Neil Turner. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0323.
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The diagnosis of Alport syndrome is suspected from the clinical features and confirmed by identifying the almost pathognomonic ultrastructural changes to the basement membrane in a family member with early disease (so that glomeruli are not too sclerosed), or in modern times by identifying a causative mutation in one or more of the three implicated COL4 genes. Genetic testing is becoming simpler and cheaper, but is still out of the reach of many. Eighty-five per cent of cases are caused by COL4A5 mutations and 10–15% by autosomal recessive disease. A significant proportion of morbidity in X-linked disease occurs in female ‘carriers’ heterozygous for the disease. Changes by light microscopy are non-specific, and can be misleading unless accompanied by electron microscopy. Immunohistology can be helpful but may not be definitive as some causative mutations are not associated with absence of protein product. As COL4A5 is expressed in skin, skin studies are theoretically useful, but they are technically challenging and only a definite negative result is helpful. It is important to distinguish other disorders causing renal disease with deafness, and other causes of glomerular haematuria. Two rare syndromes are caused by extended deletions beyond the COL4A5 gene: X-linked Alport syndrome with diffuse oesophageal leiomyomatosis in which smooth muscle leoimyomas is transmitted in a dominant fashion, and X-linked Alport syndrome with mental retardation.
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Yang, Jingduan, and Daniel A. Monti. Human Energetic Anatomy. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190210052.003.0003.
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This chapter teaches another essential foundation of acupuncture and Chinese medicine, the theory of Jing Luo, the invisible energy channels known as meridians through which Qi circulates. This chapter presents this complex human energy network as an energetic anatomy that include 12 principal channels (Zheng Jing), 8 extra channels (Qi Jing Ba Mai), 12 associated channels (Jing Bie), 12 peripheral channels (Jin Jing), 12 skin areas (Pi Bou), and 15 connecting channels (Luo Mai). The classification, distribution, and function of each is discussed in detail. There is no modern medicine equivalent to these concepts except for the energetic manifestations of mental and physical function that are well observed and described by clinicians and medical textbooks. Structural parallels to the energetic networks in modern medicine are circulatory systems like the nervous, cardiovascular, and lymphatic systems.