Harrison : Principle of Internal Medicine 17th ed

Harrison : Principle of Internal Medicine 17^th ed

The first edition of Harrison's Principles of Internal Medicine was published almost 60 years ago. Over the decades, the field of internal medicine has evolved greatly and has incorporated the spectacular advances that have occurred in the science of medicine into its armamentarium of diagnosis, prevention, and treatment. This textbook has evolved simultaneously to keep step with these advances while at the same time maintaining an appreciation of the art of medicine and the principles underlying the optimal care of the patient. In shaping and revising this latest edition, the Editors have committed themselves to making the textbook an invaluable resource for students and practitioners coping with the demands of modern medicine.

The seventeenth edition of Harrison's has a full-color format that draws from and extends the excellent appearance of the sixteenth edition to make the content more accessible and pleasant to read. The placement of color illustrations within the chapters rather than in the separate atlas was very favorably received by our sixteenth edition readers and has been continued in the current edition. Many changes to the design of this edition have been made in order to speed the reader's navigation through the textual and visual materials. For example, tables have been shaded for ease of reading, citations in tables and illustrations are now more instantly notable and in color, and our Treatment sections in each chapter have been redesigned to allow even faster access. The new global icons call greater attention to key epidemiologic and clinical differences in the practice of medicine throughout the world.

Part 1, "Introduction to Clinical Medicine," contains a new chapter that lays the framework for appreciating the global issues in medicine and the variations in disease incidence and patterns throughout the world. It sets the stage for the discussion in individual chapters of global issues related to specific diseases, a novel feature in this edition. In addition, there are e-chapters on quality and safety issues in patient care, economics of health care delivery, ethics in clinical medicine, and health care disparities. The last chapter addresses the evidence for racial and ethnic disparities in health care in the United States and globally and offers a variety of approaches for minimizing them.

Part 2, "Cardinal Manifestations and Presentation of Diseases," serves as a comprehensive introduction to clinical medicine as well as a practical guide to the care of patients with these manifestations. Each section focuses on a particular group of disorders, examining the concepts of pathophysiology and differential diagnosis that must be considered in caring for patients with these common clinical presentations. Major symptoms are reviewed and correlated with specific disease states, and clinical approaches to patients presenting with these symptoms are summarized. There are eleven new chapters in this Part. Every chapter that appeared in the sixteenth edition has been updated, and two chapters have new authors. Among the e-chapters are atlases of rashes associated with fever; oral manifestations of disease; renal biopsies and urinary sediments; skin manifestations of internal disease; and peripheral blood and bone marrow. A new chapter on Hypercalcemia and Hypocalcemia provides a succinct overview of the causes, clinical presentations, and management of these conditions as a complement to the more extensive discussion of these topics in Part 15, "Endocrinology and Metabolism." New chapters discuss common clinical presentations such as menstrual disorders and pelvic pain, the pathogenesis and treatment of headache, the clinical approach to imbalance, and the causes of confusion and delirium.

Part 3, "Genetics and Disease," has been extensively updated, reflecting the remarkable impact of the human genome project and its implications for clinical medicine. The material included in this edition is strongly geared toward clinical practice, in which genetic information increasingly comes into play. A new chapter on gene transfer in clinical medicine addresses the principles and strategies for this novel, but still experimental, therapeutic area.

Part 4, "Regenerative Medicine," is a new part initiated for this edition. It contains chapters on Stem Cell Biology, Applications of Stem Cell Biology in Clinical Medicine, Hematopoietic Stem Cells, and Tissue Engineering. These chapters summarize the state of the science in these emerging fields and outline the future directions for clinical applications of stem cell biology in regenerative medicine.

Part 5, "Nutrition," covers topics critical to clinical medicine, whether dealing with undernutrition in the context of chronic starvation or acute illness or the implications of overfeeding in industrialized nations. New authors with global expertise in nutrition have prepared the chapters on protein-energy malnutrition and enteral and parenteral nutrition therapy. A new chapter on the Management of Obesity and a complementary chapter on the Biology of Obesity address the explosion of new knowledge about pathways that regulate body weight and composition and the urgent need to provide effective means to prevent and treat the global epidemic of obesity and its complications.

The core of Harrison's continues to encompass the disorders of the organ systems and is contained in Parts 6 through 17. These sections include succinct accounts of the pathophysiology of diseases involving the major organ systems as well as infectious diseases, with an emphasis on clinical manifestations, diagnostic procedures, differential diagnosis, and treatment strategies and guidelines.

Part 6, "Oncology and Hematology," includes 11 chapters by new authors, including a completely revised section on Disorders of Hemostasis. A new e-chapter on Thymoma has also been added. As novel therapies are being added at a record pace to the armamentarium for oncologic and hematologic disorders, the mechanisms of action, pharmacology, clinical uses, and toxicities of these new agents have been included. Recent progress in the treatment of renal cell cancer, colorectal cancer, and breast cancer is highlighted. Revised chapters include the impact of genetic factors on cancer development and the use of gene expression data to define prognostic disease subsets.

Part 7, "Infectious Diseases," presents an overview of the latest information on disease epidemiology, pathogenesis, and genetics while focusing on the needs of clinicians who must accurately diagnose and treat infections under time pressure and cost constraints. Abundant illustrations offer key information in an easily accessible format to assist clinicians with these challenges. The expert authors of each chapter make specific recommendations regarding therapeutic regimens, including the drug(s) of choice, doses, durations, and alternatives. Current trends in antimicrobial resistance are discussed fully in light of their impact on therapeutic choices. In line with the international emphasis of this edition, the infectious diseases section includes expanded information on disease prevalences, distributions, features, and management in different regions of the world.

A total of 17 chapters have been completely rewritten by new authors, covering the latest advances in the management of important diseases such as pneumonia, shigellosis, and rabies and of infections due to Pseudomonas, Bartonella, Listeria, corynebacteria, and parvovirus. The section on fungal infections is entirely new and encompasses the expertise of current authorities on specific mycoses. Health care–associated infections, an area of enormous significance in terms of patient care in general and antimicrobial resistance in particular, are addressed by Robert Weinstein in a thorough, highly practical chapter. Another topic of ever-increasing importance—infections with gram-negative enteric bacilli, including Escherichia coli—is dealt with by Thomas Russo and James Johnson in a substantially reworked and updated chapter. The superb chapter on human papillomaviruses by Richard Reichman includes the latest information and recommendations regarding the recently licensed and widely publicized HPV vaccine. Finally, the chapter on HIV infection and AIDS by Anthony S. Fauci and H. Clifford Lane has once again been completely revised, with an emphasis on therapeutic strategies. This chapter is widely considered to be a classic in the field; its clinically pragmatic focus in combination with its comprehensive and analytical approach to the pathogenesis of HIV disease has led to its use as the sole complete reference on HIV/AIDS in medical schools.

New in this edition is a chapter on babesiosis, an important emerging infection that can cause severe disease in immunodeficient and elderly patients. Three additional new chapters of substantial clinical relevance appear in the electronic version of the textbook: an atlas of rashes associated with fever, an atlas of blood smears showing the various stages of the parasites causing malaria and babesiosis, and a chapter detailing the pharmacology of antiparasitic agents.

Terrorist attacks in various forms have become a frightening reality throughout the world. Important among these is the threat of bioterror attacks involving microbes or their toxins, chemicals, and radiation. This has become of particular concern in light of the anthrax attacks in the United States shortly after the September 11, 2001, airplane attacks on the World Trade Center in New York City and the Pentagon in Washington, DC. In the sixteenth edition, the editors developed a new Part on Bioterrorism and Clinical Medicine. Part 8 in the current edition has been updated with descriptions of the most recent countermeasures that have been developed as part of the United States preparedness plan against bioterror attacks. Edited by Harrison's Anthony S. Fauci, these chapters are written succinctly and include easily readable charts, tables, and algorithms; their goal is to confer an understanding of the pathogenesis, diagnosis, treatment, and prognosis of the diseases in question.

Part 9, "Disorders of the Cardiovascular System," is now co-edited by two of the most preeminent experts in the field, Eugene Braunwald and Joseph Loscalzo, the newest addition to the team of Harrison editors. There are new chapters on the epidemiology of cardiovascular disease with an overview of the global nature of the growing pandemic, the basic biology of the cardiovascular system (written by Braunwald, Libby, and Loscalzo), and principles of electrophysiology. A new chapter on the metabolic syndrome summarizes the clinical features and complications of this disorder, which reflects the rapidly rising prevalence of obesity and insulin resistance. In addition, there are new echapters that provide atlases of basic electrocardiography, arrhythmias, noninvasive imaging, and percutaneous revascularization. Finally, every chapter has been revised to reflect the latest information on approaches to the diagnosis and treatment of specific cardiovascular diseases, and eight of these chapters have been written by new authors.

Part 10, "Disorders of the Respiratory System," includes a new echapter on chest imaging that provides an atlas of chest radiographs and computed tomographic studies of a wide range of chest diseases. In addition, three chapters have been written by new authors, including a superb chapter on asthma by Peter Barnes and an excellent chapter on pneumonia by Lionel Mandell.

With advances in health care delivery and pressures aimed at cost containment, critical care units account for a growing percentage of hospital beds. Part 11, "Critical Care Medicine," was first introduced as a separate Part for the sixteenth edition of Harrison's. It is devoted to the provision of optimal care in this medical setting of growing importance and deals with four main areas: respiratory critical care, shock and cardiac arrest, neurologic critical care, and a new section on oncologic emergencies.

Part 12, "Disorders of the Kidney and Urinary Tract," has undergone extensive revision and reorganization under the guidance of new editor Joseph Loscalzo. There is an outstanding new chapter on the cellular and molecular biology of the kidney by Eric Neilson, as well as a new e-chapter atlas of urinary sediments and renal pathology. In addition to a thorough updating of each revised chapter, five have new authors who bring a unique, contemporary perspective to their subject.

Part 13, "Disorders of the Gastrointestinal System," includes two new atlases of endoscopic findings, both static photographs and movies. New chapters have been added on mesenteric vascular insufficiency and common disorders of the colon and ano-rectum, and new authors have written two other chapters. The chapter on Cirrhosis and Its Complications has been completely rewritten by a new author, Bruce Bacon, who is also the new author for the chapter on Infiltrative, Genetic, and Metabolic Diseases Affecting the Liver. An Atlas of Liver Biopsies has been added as a new e-chapter.

Part 14, "Disorders of the Immune System, Connective Tissue, and Joints," has been extensively revised. The chapter on Introduction to the Immune System has been thoroughly updated. It has become a classic in its field and is often used as the textbook of immunology in postgraduate and medical school courses. This chapter combines an in-depth description and analysis of the principles of basic immunology with an easy flow into the application of these principles to clinical disease states. Its description of the relationship of innate to adaptive immunity is a model for understanding the intricacies of the human immune system. A new e-chapter written by Max Cooper on Primary Immunodeficiencies Associated with or Secondary to Other Diseases has been added to complement his printed book chapter on Primary Immunodeficiencies. The chapter on Systemic Sclerosis (Scleroderma) and Related Disorders has been rewritten by a new author. An Atlas of Clinical Imaging in the Vasculitis Syndromes has been added as a new e-chapter. The chapters on Sarcoidosis, Amyloidosis, Osteoarthritis, and Gout and Other Crystal Arthropathies have been rewritten by new authors. A highly skilled, academic, and clinical rheumatologist (Carol Langford) has joined the team as an author and has co-authored the chapters on the Vasculitis Syndromes, Relapsing Polychondritis, Fibromyalgia, and Arthritis Associated with Systemic Disease and Other Arthritides.

Part 15, "Endocrinology and Metabolism," includes several new authors, including those for the chapter on pheochromocytoma, which highlights recent advances in the genetic causes of these catecholamine-secreting tumors, as well as updated strategies for diagnosis and management. The chapter on the Ovary has a new author who integrates traditional hypothalamic-pituitary regulation of the menstrual cycle with the identification of multiple ovarian growth factors that regulate follicle development. Identification of these pathways has provided insight into the causes of premature ovarian failure and infertility. There have been rapid changes in the clinical management of many endocrine diseases, especially diabetes, lipoprotein disorders, and the menopause. These and other chapters have been updated extensively. A new Atlas of Metabolic Disorders has been added as an e-chapter.

Part 16, "Neurologic Disorders," has been extensively rewritten to highlight the many advances that have taken place in the understanding, diagnosis, treatment, and prevention of neurologic and psychiatric diseases. Notable are new chapters on essential tremor and movement disorders, peripheral neuropathy, and neurologic problems in hospitalized patients. Many illustrative neuroimaging figures appear throughout the section, and a new atlas of neuroimaging findings has been added. Knowledge of the dementias, Parkinson's disease, and related neurodegenerative disorders has been transformed by new findings from genetics, modular imaging, cell biology, and clinical research. The very latest information has been included, providing a practical guide to diagnosis and appropriate use of the latest treatments. New therapies are also revolutionizing the care of patients with stroke and multiple sclerosis, and these are also discussed in an evidence-based fashion that will be useful to all practitioners and not only to specialists. Another new chapter, authored by Stephen Hyman and Eric Kandel, reviews progress in deciphering the pathogenesis of common psychiatric disorders and discusses the remaining challenges to development of more effective treatments.

Part 17, "Poisoning, Drug Overdose, and Envenomation," focuses on topics most relevant to internal medicine.

Part 18 is a new feature to Harrison's and represents four brand new e-chapters from our International Advisory Editors. Dr. Peter Barnes addresses the emerging use of pulmonary biomarkers in COPD. This state of the art summary will be useful to clinicians and researchers alike. Chagas' disease continues to cause significant morbidity in Central and South America, and the long period between infection and cardiovascular complications can make the etiologic aspects of its diagnosis difficult. The cardiovascular pathologies and sequelae, as well as current approaches to diagnosis and treatment, are clearly described by Dr. Sposito and Dr. Ramires. Chapter e38 by Dr. Reddy, Dr. Naik, and Dr. Roy addresses the potential benefits and challenges of a polypill for multiple cardiovascular risk factors, an issue of global interest in light of increases in cardiovascular disease worldwide. Interest in the mitochondrial role in human health and disease has advanced considerably in recent years, and Chapter e39 by Dr. Skorecki and Dr. Mandel sets forth the current understanding of the role of the mitochondria in a large number of diseases and approaches to diagnosis and treatment.

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Harrison : Principle of Internal Medicine