Dennis L. Kasper Eugene Braunwald Anthony S. Fauci Stephen L. Hauser Dan L. Longo J. Larry Jameson
ISBN: 0071402357 Copyright year: 2005
Book Preface
Preface to Harrison's Principles of Internal Medicine, 16th Edition
The first edition of Harrison's Principles of Internal Medicine was published more than half a century ago. Over the decades, this textbook has evolved to reflect the continuing advances in the field of internal medicine and to meet the growing information base required of medical students and clinical practitioners. The users of this sixteenth edition of Harrison's will not even have to open the volume to see that it marks a transition point in the book's history. The new cover is only the most obvious indication of a new direction for Harrison's.
In shaping and revising this new version, the Editors have committed themselves to making the textbook as useful as possible to students and practitioners coping with the demands of modern medicine. The growth of evidence-based medicine, the prominence of managed care, and the explosion of information in fundamental areas such as the genetics of disease are only three of the many factors that make these demands different from those faced by physicians only a decade ago. Just as the cover retains key elements of the classic book, the content of the sixteenth edition retains the essential facts that remain clinically useful and important. However, through modifications in both its format and its content, the new Harrison's addresses the changing needs of its readers.
The sixteenth edition of Harrison's has a full-color format that facilitates quick reference and allows the inclusion of hundreds more high-quality illustrations than in previous editions. We expect that the reader's convenience will be well served by the placement of color illustrations within the chapters rather than in the separate color atlas used in earlier editions. While providing the basic-science information that is critical to an understanding of biology and pathophysiology, this edition focuses more directly and extensively than ever on crucial aspects of clinical practice. Areas of emphasis include the approach to the patient, differential diagnosis, state-of-the-art treatment options, and disease prevention. Key topics, such as the immune system and HIV infection/AIDS, are covered in chapters amounting to "mini-textbooks." New sections offer information on the formidable challenges posed by critical care medicine and by the threat of bioterrorism. New chapters provide coverage of highly relevant clinical topics such as disease screening, perimenopausal management and hormone replacement therapy, and end-of-life care. Virtually every chapter in this edition has been substantially rewritten, and 46 chapters either are entirely new or have new authors.
These are only highlights of the changes that the Editors hope will make the new Harrison's a helpful tool-not only for the student who needs an expert source of basic knowledge in internal medicine, but also for the pressured practitioner who needs a clear, concise, and balanced distillation of the best information on which to base daily clinical decisions.Part One, "Introduction to Clinical Medicine," contains a new chapter that provides practical information about the screening approaches that every internist should consider for routine health maintenance. This chapter discusses the principles and guidelines used in screening for common conditions such as cancer, hypertension, lipid disorders, and osteoporosis. Another new chapter offers a pragmatic approach to the medical evaluation of patients who are about to undergo surgical procedures. In light of the growth of the hospice movement and the increased awareness of the sensitive issues-physical, mental, social, and existential-that surround end-of-life care, a new chapter on this complex topic provides insights, information, and guidance to practitioners dealing with dying patients and their families. The chapter on women's health has been entirely revised and offers a broad overview of the approach to disorders that affect women disproportionately.Part Two, "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. Every chapter has been updated, and three chapters have new authors. The chapter on sexual dysfunction now addresses disorders in both men and women.
Given the rapid advances in human genetics over the past several years, Part Three, "Genetics and Disease," has once again been completely updated. The material included in this edition is strongly geared toward clinical practice, in which genetic information increasingly comes into play. The new chapter on stem cell and gene transfer in clinical medicine addresses a timely and controversial topic, defining different types of stem cells and discussing their potential clinical applications.Part Four, "Nutrition," covers nutritional considerations related to clinical medicine. Areas of focus include nutritional and dietary assessment, nutritional requirements, protein-energy malnutrition, eating disorders, obesity, and enteral and parenteral nutrition therapy.
The core of Harrison's continues to encompass the disorders of the organ systems and is contained in Parts Five through Sixteen. 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 Five, "Oncology and Hematology," includes four chapters by new authors. An increasing proportion of patients who develop cancer are being cured. It is important to detect late consequences as early as possible in their natural history to optimize outcome. The chapter on the late consequences of cancer and its treatment helps physicians following such patients to know what to look for in addition to a recurrence of the cancer. Advances in the management of many cancers are highlighted-for example, the dramatic impact of imatinib mesylate (Gleevec) on chronic myeloid leukemia and gastrointestinal stromal cell tumors and the role of rituximab in the management of lymphoma and autoimmune diseases. The chapter delineating the principles of radiation therapy has been entirely rewritten by Eli Glatstein and is a companion piece to this author's chapter on radiation bioterrorism in Part Seven (see below). The hematology section features the World Health Organization's new classification of lymphoid and myeloid neoplasms. One of the most rapidly expanding areas of medicine is the development of novel agents to interfere with blood coagulation. With a new author who is an expert in this field, the chapter on anticoagulant, fibrinolytic, and antiplatelet therapy reviews all these new products and their indications.Part Six, "Infectious Diseases," summarizes the latest information on pathology, genetics, and epidemiology while focusing sharply on the needs of clinicians who must accurately diagnose and treat infections under time pressure and cost constraints. In particular, the inclusion of dozens more illustrations in full color provides easily accessible information to assist clinicians with these challenges. Specific recommendations are provided for therapeutic regimens, including the drug of choice, dose, duration, and alternatives. Current trends in antimicrobial resistance are presented and considered in light of their impact on therapeutic choices. A new chapter offers key information on the management of the complex clinical issues raised by Clostridium difficile-associated disease, including pseudomembranous colitis. New authors cover the latest advances in the management of diseases caused by staphylococci and nontuberculous mycobacteria, viral gastroenteritis, and brucellosis. The superb chapter by Raphael Dolin on common viral respiratory infections has been expanded to include thorough coverage of severe acute respiratory syndrome (SARS). Now placed in a separate section with the overview of the human retroviruses, the chapter on HIV infection and AIDS by Anthony S. Fauci and H. Clifford Lane has been completely revised and updated, 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 allowed its use as the sole complete reference on HIV/AIDS in medical schools.
In recent years, physicians have found themselves on the front line of response to bioterrorist attacks around the world. Since the attacks on the United States on September 11, 2001, and the subsequent anthrax attacks, the nation has been preparing for the further attacks that will inevitably come. Part Seven, "Bioterrorism and Clinical Medicine," consists of entirely new material written by authorities in three areas of bioterrorism: microbial, chemical, and radiation. Edited by Harrison's editor Anthony S. Fauci, who leads the United States government's biomedical effort on national preparedness against bioterrorism, 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 Eight, "Disorders of the Cardiovascular System," is once again edited by the preeminent expert in the field, Eugene Braunwald. A new chapter covers the clinically important topics of unstable angina and non-ST-segment elevation myocardial infarction; three other chapters have new authors; and every chapter has been revised to reflect the latest trends and strategies for management. These include primary percutaneous coronary intervention for ST-segment elevation myocardial infarction as well as new drugs and devices for the treatment of heart failure.
Enormous strides have been made in the use of lung transplantation for selected patients with end-stage, irreversible, pulmonary parenchymal and vascular disease. Part Nine, "Disorders of the Respiratory System," includes a chapter by a new author that focuses on the selection of patients for this intervention. New authors have also taken on the broad topic of pneumonia and lung abscess, providing focus and a clinical perspective to help the reader grasp the central issues involved in the diagnosis and management of both community-acquired and nosocomial disease.
With advances in health care delivery and pressures aimed at cost containment, critical care units account for a growing percentage of hospital beds. Part Ten, "Critical Care Medicine," is a new section of Harrison's; that is devoted to the provision of optimal care in this medical setting of growing importance. Incorporating both new chapters and refocused chapters on topics covered in previous editions, this part deals with three main areas: respiratory critical care, shock and cardiac arrest, and neurologic critical care. The approach to the patient and the central tenets underlying critical care are at the heart of this part of the sixteenth edition.Part Eleven, "Disorders of the Kidney and Urinary Tract," includes contributions from several new authors and, as in previous editions, provides a thorough overview of the urinary-tract disorders encountered in internal medicine.Part Twelve, "Disorders of the Gastrointestinal System," includes a new chapter on familial Mediterranean fever. The chapter on the approach to the patient with gastrointestinal disease has been completely reworked by a new author, as has the chapter on diverticular and vascular disease of the bowel. The chapters on the various categories of viral hepatitis have been extensively revised and updated to reflect breakthrough advances in treatment.
The first chapter in Part Thirteen, "Disorders of the Immune System, Connective Tissue, and Joints," provides an introduction to the immune system that 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. Once again, the authors have extensively revised this chapter to bring it up to date with regard to recent rapid advances in both basic and clinical immunology. In the section on disorders of immune-mediated injury, the spondyloarthropathies have been grouped together in one chapter that clearly and comprehensively discusses the similarities and dissimilarities among the various diseases in this category. The breakthrough advances in immunomodulatory therapy that have been realized in rheumatology over the past few years are captured in the spondyloarthropathy chapters and in the extensively revised chapters on rheumatoid arthritis and systemic lupus erythematosus. A new chapter covers fibromyalgia, arthritis associated with systemic disease, and other arthritides.Part Fourteen, "Endocrinology and Metabolism," includes six chapters with new authors as well as a timely new chapter on the perimenopause transition and hormone replacement therapy. The writing of the latter chapter coincided with publication of results from the Women's Health Initiative that unexpectedly showed an increased risk of cardiovascular disease among women who received estrogen treatment. The author reviews the literature in this area and provides practical algorithms for the management of patients during this transition. The new authors of the chapter on disorders of sexual differentiation highlight novel insights derived from elucidation of the genetic basis of sex determination. The outstanding new review of bone and mineral metabolism lays a superb foundation for an understanding of the pathophysiology and treatment of various metabolic bone diseases. The newly authored version of the chapter on disorders of lipoprotein metabolism offers a much sharper focus on the classification, diagnosis, and treatment of disorders of cholesterol and triglyceride metabolism, emphasizing the use of statins for the reduction of cardiovascular risk. The new chapter on Wilson's disease reports on the substantially modified treatment recommendations for this entity.Part Fifteen, "Neurologic Disorders," has been extensively updated. A comprehensive new chapter on Alzheimer's disease and related dementias summarizes the recent explosion of knowledge on this topic, highlighting the new understanding of the genetics of these dementias and the molecules that trigger them as well as providing a clinical guide to diagnosis, differential diagnosis, and the latest treatments. The new chapter on Parkinson's disease reviews the recent genetic findings and provides an authoritative approach to therapy, including surgical options. The chapter on cerebrovascular diseases has been extensively rewritten, offering an evidence-based approach to the treatment and prevention of stroke, the third leading killer in the Western world. The updated chapter on multiple sclerosis presents the most recent advances in therapy and a practical approach to management of different stages of the disease. Finally, the recognition of bovine spongiform encephalopathy in many regions of the world has focused the global health care community on the biology and clinical manifestations of prion diseases; the 16th edition of Harrison's includes a comprehensive review of this subject by Nobel Laureate Stanley Prusiner. Part Sixteen, "Poisoning, Drug Overdose, and Envenomation," has been thoroughly revised and streamlined to focus on the topics most relevant to internal medicine.
In view of the requirements for continuing education for licensure and relicensure as well as the emphasis on certification and recertification, a revision of the Pre-Test Self-Assessment and Review will again be published with this edition. This volume is in the capable hands of a new author, Dr. Charles Wiener from Johns Hopkins. It consists of several hundred questions based on the sixteenth edition of Harrison's, along with answers and explanations for the answers. The Companion Handbook, which was pioneered as a supplement to the eleventh edition of Harrison's, has been reworked as a concise quick-reference clinical manual; the Manual of Medicine will appear shortly after the publication of this edition, along with a PDA version, Harrison's OnHand. In 1998, Harrison's went online to provide a "living" textbook of internal medicine. In addition to permitting full search capabilities of the text, Harrison's Online offers frequent updates, reports of clinical trials, practice guidelines, online lectures, and concise reviews of timely topics as well as additional and updated references (with links to MEDLINE abstracts) and illustrations.
We wish to express our appreciation to our many associates and colleagues, who, as experts in their fields, have helped us with constructive criticism and helpful suggestions. We acknowledge especially the contributions of the following individuals: Joseph Alpert, Michael Bray, Mark D. Carlson, Daniel H. Lowenstein, Lawrence C. Madoff, Thomas R. Martin, Chung Owyang, Alice Pau, and Mary Wright.
We thank in particular Kenneth and Elaine Kaye, who gathered many high-quality illustrations of infectious disease manifestations. We also express our gratitude to Eileen J. Scott, who has applied her editorial expertise to the past six editions of Harrison's, and Marsha Cohen, who has been the text and cover designer for the past five editions.
This book could not have been edited without the dedicated help of our co-workers in the editorial offices of the individual editors. We are especially indebted to Patricia L. Duffey, Gregory K. Folkers, Sarah Matero, Julie B. McCoy, Jaylyn Olivo, Elizabeth Robbins, Leslie Runnels, Kathryn Saxon, Marie Scurti, and Sue Anne Tae.
Finally, we continue to be highly indebted to three outstanding members of the McGraw-Hill organization: Mariapaz Ramos Englis, Senior Managing Editor; Robert Laffler, Production Director; and Martin J. Wonsiewicz, Publisher. They are an effective team who have given the Editors constant encouragement and sage advice. They have been instrumental in guiding the many changes instituted with this edition of Harrison's and in bringing this volume to fruition in a timely manner.
2005 McGraw-Hill Professional