Search Results

The aetiology of hypertension remains obscure in the majority of cases, and treatment, therefore, somewhat empirical. However, abnormalities in the structure and function of the vasculature are increasingly recognized as contributing to the hypertensive state by increasing total peripheral resistance. This chapter briefly reviews some of these abnormalities with particular regard to the way in which they influence treatment, and suggests new therapeutic strategies. A minority of hypertensive individuals have a clearly identified hormonal or structural cause for their elevated pressure (‘secondary hypertension’) and are not specifically considered further here, although some animal models rely on such aetiologies to produce hypertension for experimental purposes.

There is more and more traffic at the junction of genomic and social sciences, creating a complex pattern of intersecting questions, studies, and research possibilities. And it is likely to become only heavier in the near future. What does this mean for such social sciences as psychology and education? This chapter explores these issues using the research on the genetic aetiology of reading ability and disability as an illustration.

This chapter focuses on renal failure, adrenal failure, hypercalcaemia, paraneoplastic syndromes, cachexia, limb oedema, and thrombosis. In it, the epidemiology, aetiology, interventions, and treatment of these diseases are detailed and examined.

This chapter concentrates on the pathophysiology of cardiac cachexia. It also discusses the possible clinical implications, and outlines the potential future development of therapeutic strategies. In particular, it explores the epidemiology and aetiology of cardiac cachexia. It then evaluates the alterations of body composition and the pathogenesis of cardiac cachexia. The therapeutic options include pharmacological treatment, nutritional support, and physical training. With improved knowledge of the underlying pathophysiology, a number of emerging treatment strategies for prevention and treatment are being developed and tested. Although no specific treatment is currently available, several approaches with the use of neurohormonal drugs, nutritional support, ghrelin, and physical training appear to show potential benefits and the results of ongoing clinical trials in cardiac cachexia are awaited.

This chapter starts by addressing the epidemiology and aetiology of heart failure (HF) with cognitive impairment. The clinical features and treatment of cognitive impairment associated with HF are shown. All the available evidence regarding cognitive impairment associated with HF clearly indicates that mortality and readmission rates cannot be considered any longer the only outcome variables in the management of patients with HF. As stated by several authors, research in the field of HF should broaden to a comprehensive view of health outcomes, so yielding evidence that might support clinical decision-making, improve clinical practice, and guide health policy. The course of research on the multidimensional assessment of older patients with HF, that begun nearly twenty years ago, is still far from its end.

This chapter starts by discussing older patients, and by presenting the aspirations of patients with heart failure (HF) and specific age-related problems. The aetiology of HF in the elderly and the significance of the normal aging process are reported. It is more difficult to diagnose the elderly because symptoms are often mild or difficult to interpret and echocardiography is frequently less informative because of the high prevalence of HF with preserved systolic function (HF-PSF). The recommended treatment for HF in the elderly is, as in younger patients, based on national and international guidelines for medication regimes, non-pharmacological advice, and interventional and surgical procedures. In addition, the rationale for guideline-based medications in elderly patients is given. Medication for patients with HF with preserved left ventricular systolic function is then shown. Moreover, the quality of life, hospitalization, disease management programmes, and end-stage HF and end-of-life care are emphasized.

In this chapter, Hankinson discusses the sceptical attacks on dogmatic accounts of cause and explanation, beginning with the Eight Modes of Aenesidemus, before moving on to discuss Sextus Empiricus’ general attack on the very coherence of the notions of causation. Aenesidemus’ Eight Modes (or tropoi, i.e. general patterns of argument) are a set of arguments of varying scope and power against the Aetiology of the Dogmatists; they demonstrate the fundamental difficulties in any attempt to investigate the hidden structures of things, and also raise methodological difficulties. Sextus Empiricus argues that the very concepts of cause and effect are incoherent, and he also criticizes the notions of agent and patient, and the dogmatist account of sign‐inference. Hankinson also discusses the Modes of Agrippa, according to which an explanation is either circular, infinitely regressive, or arbitrary. The sceptical attacks on astrology and divination are also important in that they undermine the claims of pseudo‐science; such arguments, Hankinson adds, contribute to the understanding of the standards towards which genuine science must strive.

This chapter discusses the issues to consider when interpreting data on cancer trends. These include mortality data, cancer registration data, comparison of mortality and incidence trends, consideration of trends at young and older ages, accuracy of denominations, and aetiology.

This chapter reviews two strategies for preventing coronary heart disease. The individual or clinical approach seeks to identify and help those in whom an amalgam of genetic susceptibility and unhealthy lifestyle indicates unusual risk, but the public health approach seeks changes in those features of the population's behaviour or environment which are held responsible for the overall incidence rate. Thus, the individual strategy is a rescue operation for individuals in need, whereas the population strategy is a radical attempt to deal with the underlying causes.

The fact that antagonists at certain 5-HT receptor subtypes are effective in the prophylaxis or treatment of migraine implicates the endogenous amine in a causal role in the condition. On the basis of the properties and selectivities of such antagonists, this chapter discusses the potential significance of 5-HTlc, 5-HT2, and 5-HT3 receptors in the initiation, development, and symptomatology of migraine. The likely source(s) of the 5-HT needed to stimulate these sites are considered, and a hypothesis is proposed to implicate the activity of the 5-HT neurones arising in the mid-brain raphe nuclei in a key role in the aetiology of migraine. The ideas discussed here are developments and extensions of those expressed over a number of years in several review articles and are by no means unique.

Regardless of the many considerations, GR43175 has been shown to be effective when administered subcutaneously and orally as well as when administered intravenously in the treatment of acute migraine. It is now in phase III clinical trials and promises to provide a major breakthrough in migraine therapy. Importantly, further studies on its clinical mechanism of action are in progress and they will, it is hoped, be invaluable in elucidating the pathogenesis of migraine and vascular headache.

Children who become myopic generally do so sometime between seven and thirteen years of age. The aetiology of this school-age myopia has been debated for centuries. The latest research indicates that, although myopia has a genetic component, close-up visual activity, such as reading and playing computer games, also contributes to the genesis and progression of myopia in susceptible eyes. Recent findings from longitudinal studies of refraction indicate that it is now possible to predict whether an infant will become myopic at school age. This chapter reviews some of the new findings relevant to the prediction of myopia in children.

Sweating is an uncommon symptom, but it creates great discomfort in patients with advanced cancer. Sweating is the secretion of fluids, primarily water and sodium chloride, from the sweat glands onto the surface of the skin to maintain homeostasis. In patients with advanced cancer, the rate of sweating exceeds the normal rate. This excessive sweating and production of a large volume of sweat is called hyperhydrosis. This chapter discusses methods for managing sweating in patients with advanced disease. It discusses the physiology and aetiology of sweating to provide a better understanding of it, including the determinants that define severe sweating. The chapter also provides an assessment of sweating and other contributing factors to this symptom. Among the management strategies it describes are: the treatment of sepsis and para neoplastic fever; and the management of sex-hormone insufficiency. Aside from these palliative methods, the chapter also discusses pharmacological measures that can be used when the diagnosis of the cause of the sweating is unclear and when the management designed to address the symptom has failed. Drugs that can aid in managing the symptom are propantheline, thalidomide, and clonidine.

This chapter discusses myelodysplastic syndromes (MDS), which are a spectrum of pre-leukaemic disorders that manifest in the elderly and can have a prolonged course. Patients afflicted with MDS require regular monitoring for evidence of disease progression, infections, and cytopenias that may be alleviated through proper treatment. Decision and administration of interventions such as high-dose chemotherapy or bone marrow transplantation should be guided by the IPSS scoring system. In younger patients, the timing of the administration of such interventions should involve a delicate balance between the risk of progression and their current life situation. In adults, meanwhile, palliation of symptoms and appropriate supportive care should be given more attention, as intensive interventions are not appropriate due to their medical conditions and performance status. In addition to discussing the pathology and aetiology of MDS, the chapter also discusses the classification of MDS, such as the FAB and WHO classifications; the overlapping features of MDS syndromes with other stem cell disorders; and the prognostic factors of MDS.

This chapter discusses and explores the aetiology of and treatment options for complex wounds in head and neck cancer. It examines the symptoms and management of these wounds, as well as the impact they have on the life of the patient. Holistic assessment is important because it focuses on caring for the patient and not just the wound.

An infectious disease, as the name implies, is caused by pathogenic microorganisms such as bacteria, viruses, parasites, and fungi, and it spreads from one person to another through various ways, directly or indirectly. Most, but not all, of such diseases present to the ED with fever. Septic shock, respiratory failure, or central nervous system involvement may occur following an infection and threaten life. Such a situation presenting with tachycardia, reduced BP, tachypnoea, or depressed GCS requires immediate assessment and resuscitation. Following the principles of ABCDE, promptly carry out airway protection, oxygenation, and IV access with collection of blood samples for investigations, and fluid resuscitation. The aetiology of fever may be wide ranging, but a careful history and a detailed physical examination should help in determining the cause in majority of cases presenting to the ED. In addition to this, the initial investigations may help further in establishing the diagnosis. In elderly patients, the source of such infections may be the respiratory system, the genitourinary system or the involvement of the soft tissues, and they are often serious. In the otherwise healthy younger patient, one must keep in mind the other systems such as the central nervous system, as well as abdominal and soft tissue infections. Patients may often present in septic shock. Even if the cause of a fever may not be evident at the outset, the best ‘guestimate’ often helps in determining which antibiotics to start with, which should be given as soon as the culture samples have been collected. One must make every effort to collect appropriate samples of body fluids (blood, urine, stool, sputum, etc.) to find the source of infection so that targeted antimicrobial therapy may be started if the empirical treatment has not worked. A discussion with the on-call microbiologist to properly direct the empirical antibiotic therapy is often most rewarding. A patient with an infectious disease may put others at risk as well, resulting in devastating effects, particularly in hospitals.

Doctors need to be able to combine scientific know­ledge with empathic understanding in order to form a coherent account of their patients, their illnesses, and their difficulties. In this chapter, we will de­scribe how this can be achieved in the assessment of the aetiology (cause or causes) of a patient’s disorder. A knowledge of the causes of psychiatric disorders is important for two main reasons: … ● It helps the doctor to evaluate possible causes of an individual patient’s psychiatric disorder and life difficulties. This is the focus for this chapter. ● It adds to the general understanding of psychiatric disorders, which may contribute to advances in diagnosis, treatment, or prognosis. This is reviewed in subsequent chapters…. When assessing aetiology in a particular patient, we usually structure this by talking of predisposing, precipitating, and perpetuating (often called maintaining) factors (see Fig. 7.1 and Box 7.1). These ‘three Ps’ are often supplemented by a fourth P: protective factors. These terms are used most commonly in psychiatry and related disciplines. However, the principles are broadly applicable in medicine. We therefore recommend that you prac­tise their use in long- term physical conditions such as diabetes, asthma, and vascular disease. Predisposing factors determine vulnerability to other causes that act close to the time of the illness. Many predisposing factors act early in life. Physical factors, for example, include genetic endowment, the environ­ment in utero, and trauma at birth. Psychological and social factors in infancy and childhood are also rele­vant, such as bullying at school, abuse in its various forms, and family stability. Such factors lead to the de­velopment of a person’s ‘constitution’, which leads to wide variability, at a population level, in vulnerability to disorder: some people are highly vulnerable, some are highly resilient, and most are somewhere in be­tween. Some personality traits increase vulnerability to specific disorders— for example, obsessional traits predispose to depressive illness, perhaps because the challenges and uncertainty of everyday life inevitably lead to disappointment for those seeking order and perfection at all times. Precipitating factors are events that occur shortly before the onset of a disorder and appear to have induced it. Again, these may be physical, psy­chological, or social. Physical precipitating causes include diseases such as hypothyroidism, myo­cardial infarction, breast cancer, and stroke, and the effects of drugs taken for treatment or used il­legally.