Anthony Fauci,
National Institute of Health, Betheseda, MD Eugene Braunwald,
Harvard Medical School, Boston, MA Dennis Kasper,
Harvard Medical School, Boston, MA Stephen Hauser,
University of California, San Francisco, CA Dan Longo,
National Institute of Health, Betheseda, MD J Larry Jameson,
Northwestern University, Feinberg School of Medici Joseph Loscalzo,
Harvard Medical School, Boston, MA
ISBN: 0071466339 Copyright year: 2008
Preface
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.
From the standpoint of physical appearance, one of the most striking
elements of the textbook is the number of new and updated figures.
The seventeenth edition features 300 additional illustrations
(20% more than the previous edition); with the new illustrations included
on the enclosed DVD, this edition has approximately 800 more
images, a 60% increase in the course of just one edition. Many images
have been redrawn by graphic artists working closely with the authors
and editors to illustrate complex concepts, pathways, and algorithms
in a clear and compelling manner. The seventeenth edition also features
many additional plain film, CT, MRI, and ultrasound images, in
recognition of the increased use of radiologic diagnosis in general
medical practice. The notably increased use of pathologic and clinical
photographs completes our concerted approach to a more robustly illustrated
edition of Harrison's.
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.
Evolving information technology enables us to broaden and deepen
the nature, format, and medium of content included under the
Harrison's name. Purchase of this textbook now includes a DVD, which has
allowed the editors to expand the content in Harrison's
by the use of "e-chapters" (38 in number) that space constraints would not allow inclusion
in the textbook. In addition to new chapters in traditional narrative
format, the DVD includes a number of diagnostic and
procedural atlases, which readers should find enormously helpful. The
DVD also includes dozens of motion video clips of endoscopic and
cardiac imaging. These diagnostic approaches have become central to
the practice of medicine, and the video clips show crystal clear depictions
of abnormal anatomy, function, and results.
Globalization of economies and trade has had an enormous impact
on nations throughout the world, both developing and developed. This
phenomenon has underscored the reality of the globalization of medicine.
In this regard, as this textbook is widely used by students and
practitioners throughout the world and as we in the United States are
more frequently confronted with issues related to global health, a special
emphasis has been placed in this edition on global health in individual
chapters together with an over-arching view presented by Dr.
Kim and Dr. Farmer in a new chapter entitled "Global Issues in Medicine."
We have highlighted where appropriate regional differences in
the prevalence, approach, and treatment of diseases that need to be
considered for delivery of the highest quality medical care possible in
various geographic settings. 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.
The seventeenth edition has been enriched by the addition of a
new editor, Joseph Loscalzo, MD, PhD, who joined with our most
senior editor Eugene Braunwald, MD, in contributing to and/or editing
of chapters in the Parts on Disorders of the Cardiovascular System,
Disorders of the Respiratory System, and Disorders of the
Kidney and Urinary Tract. The addition of Dr. Loscalzo provides a
smooth editorial transition in anticipation of the upcoming retirement
from Harrison's of Dr. Braunwald who has served as an esteemed editor for 12 editions.
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 disparities. The latter 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 careassociated
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&emdash;infections with gramnegative
enteric bacilli, including Escherichia coli &emdash;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 echapter
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 discussed the remaining challenges
to development of more effective treatments.
Part 17, "Poisoning, Drug Overdose, and Envenomation," contains
four revised chapters that now appear as e-chapters. They focus on the
topics most relevant to internal medicine.
Within the last 10 years, the Harrison's collection of publications
has expanded as information delivery technology has evolved. Harrison's
On Line(HOL) is now one of the standard informational resources
used in medical centers throughout the United States offering, in
addition to the full text content of the parent text, frequent updates
from and links to the emerging scientific and clinical literature; an expanded
collection of reference citations; audio recordings and "Podcasts"
of lectures by authorities in the various specialties of medicine;
and other helpful supplementary materials such as a complete database
of pharmacologic therapeutics, self-assessment questions for examination
and board review; and an expanded collection of clinical
photographs. The brand new "e-chapters" on the enclosed DVD, including
the video clips of cardiac and endoscopic imaging, are also
available on HOL. Future iterations of HOL will include expanded use
of such supplementary multimedia materials, to illustrate further key
concepts and clinical approaches discussed in the parent text.
In 2006, in recognition of the increasing time pressures placed on
clinicians and the increasing use of electronic medical records systems,
Harrison's Practice of Medicine (HP) made its debut. HP is a comprehensive database of specific clinical topics built from the
ground up to provide authoritative guidance quickly, at the point of
care. HP is highly structured so that physicians and other health professionals
can access the most salient features of any one of more than
700 diseases and clinical presentations within minutes. This innovative
new application is updated regularly, and includes fully integrated,
detailed information on brand name and generic drugs. In addition,
hyperlinks throughout HP enable quick access to the primary literature
via PubMed. HP is available via the Internet and on PDA; and
samples of approximately 20 core topics from HP are included on the
DVD packaged within this book.
The print publications within the Harrison's
family are being revised for publication in new editions. The
Harrison's Manual of Medicine is widely used by students and clinicians worldwide, and like the
parent text is also available in print and digital formats. The PDA version
of the Harrison's Manual provides full text coverage, the full complement
of illustrations and tables from the print edition, and extensive cross-referencing between terms. In view of the requirements
for continuing education for licensure and relicensure as well as
emphasis on certification and recertification, a revision of the
Harrison's Self-Assessment and Board Review will again be published with
this edition. This volume is again in the very capable hands of Dr.
Charles Wiener from Johns Hopkins. It consists of several hundred
questions based on the seventeenth edition of Harrison's, along with
answers and explanations for the answers.
Taken as a portfolio, Harrison's is now available in a wide variety of
formats suitable for all levels of medical education and practice, and
for all varieties of health care settings. It is gratifying that, whether in
print or digital formats, the content within Harrison's remains so highly
used and referenced by students and clinicians throughout medicine
and health care, across the globe.
We wish to express our appreciation to our many associates and
colleagues, who, as experts in their fields, have offered us constructive
criticisms and helpful suggestions. We acknowledge especially the contributions
of the following individuals: Arv Vanagunas, Laura Kulik,
Pat Lynch, Sundeep Khosla, Michael Bray, Mark D. Carlson, Daniel H.
Lowenstein, Lawrence C. Madoff, Chung Owyang, Alice Pau, Mary
Wright, and Gregory K. Folkers.
We thank in particular Kenneth and Elaine Kaye and Lindsey
Baden, 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 Alan Barnett, the text designer for this edition. 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, Elizabeth Robbins, Kathryn Saxon, Marie Scurti, Sue
Anne Tae, Stephanie Tribuna, Karl Cremieux, Amy Camponeschi, and
Kristina Shontz.
Finally, we continue to be highly indebted to the outstanding
members of the McGraw-Hill organization: Mariapaz Ramos Englis,
Senior Managing Editor, who will be retiring after serving the book
and its Editors so well for four editions; Phil Galea and Catherine Saggese,
Production Director and Manager, respectively; Jenna Esposito,
the Editorial Assistant for this edition; James Halston, Digital Editing
Manager; James F. Shanahan, Executive Editor; and Martin J.
Wonsiewicz, Publisher, who recently left McGraw-Hill after serving
as an extremely effective partner to the Editors for 10 years. 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.
2008 McGraw-Hill Professional