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Handbook of Liver Disease

Gastroenterology/Hepatology No Responses Sep 232010

Heres instant access to the symptoms, signs, differential diagnosis, and treatment for the full range of liver disorders. Written by an international whos who of hepatology-and now in full color-this new 2nd Edition provides readers with top-notch, authoritative guidance they can count on! * Discusses the hottest topics in the field, such as non-alcoholic steatohepatitis (NASH) and the latest information on liver transplantation. * Includes expanded coverage of chronic hepatitis C, most notably the use of combination therapy with peginterferon and ribavirin and improvements in the management of the side effects of antiviral therapy. * Offers the most recent therapeutic options for the management of chronic hepatitis B and advances in the understanding of the molecular biology of this virus. * Updates the approach to the diagnosis of many liver diseases due to newer tests based on molecular techniques and advances in imaging. * Features over 340 full-color illustrations. * Uses a redesigned templated, outline format that makes reference a snap. * Presents a concise, in-depth clinical summary-in an outline format-of the current practice of hepatology for each major disease entity. * Provides a liberal use of tables, algorithms, and figures, rendering complex concepts understandable.

* Includes key point boxes at the beginning of each chapter, providing at-a-glance access to vital information. * Includes alert symbols that highlight information thats critical to patient safety
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Oxford American Handbook of Cardiology - Sept 2010 Edition

Cardiovascular No Responses Sep 232010

Despite major advances in prevention and treatment, cardiovascular disease remains the leading cause of death in the United States. The vast number of patients with cardiovascular disease coupled with ongoing clinical advances makes the Oxford American Handbook of Cardiology a must-buy for residents, fellows, and students, as well as an excellent reference guide for general practitioners. The reader will find here all the essential practice guidelines and management strategies as well as a unique chapter on preventive cardiology and a useful summary of recent major clinical trials in cardiology. Common cardiac conditions, including coronary artery disease, arrhythmias, valvular and congenital heart disease, cardiomyopathies, and heart failure, are covered comprehensively yet concisely
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Oxford American Handbook of Cardiology (Oxford American Handbooks in Medicine) (Paperback)

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The Intensive Care Manual

Anaesthesiology, Critical Care No Responses Sep 232010

With up-to-date guidance that is easy to find and practical, this original sourcebook helps ICU staff solve problems of critically ill patients quickly and effectively. Filled with convenient summary approaches, diagnostics, treatments, and needed lab standards and algorithms, The Intensive Care Manual simplifies finding ICU answers on: Respiratory failure, oxygen delivery, and mechanical ventilation Intravascular access and hemodynamic monitoring Shock Renal failure Infectious diseases Nutritional Cardiac arrhythmias and acute myocardial infarction Endocrine disease and hematologic disorders Gastrointestinal problems Coma Sedation and airway management
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By (author) Michael J. Apostolakas, Peter J. Papadakos List Price: $48.95 USD New From: Used from: $7.50 In Stock $0.81 In Stock

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2. HEADACHE
(SOURCE : http://webcampus.drexelmed.edu/interactive/headache/) About headache.interactive: This program might be used for educational purposes free of charge and with no royalties inflicted. The original (German) version of "Headache Interactive" was develped at the Dept. for Educational Media at the Institute for Medical Education at the University of Berne, Switzerland with funding provided by Astra-Zeneca AG and GlaxoSmithKline AG. The English version was done by the authors in their spare time without any monetary support. Copyright 2005 - 2009 by Christof Daetwyler and Marco Mumenthaler.

Dedication: I dedicate this work to my parents, who always supported me. (Christof Daetwyler)

Awards: "Headache interactive" received the prestigeous European Academic Software Award 2000 (EASA2000) in Rotterdam and the highest honor "summa cum laude" at the MediKinale International in Munich in 2000.

Credits: The English abbreviated version was developed, produced and implemented by:

Christof Daetwyler, MD Drexel University College of Medicine Educational Design and Project Management, Production and Implementation Marco Mumenthaler, MD Former Director of the Dept. for Neurology at the University of Berne Hospital Content Development and Physician on Camera Mo Levin, MD Dept. for Neurology at Dartmouth Hitchcock Medical Center in Lebanon, NH Editor of the American Versio Willi R. Hess, M.A. Dept. for Educational Media at the Institute for Medical Education at the University of Berne, Switzerland Scientific Illustrator The model used for hedache.interactive is based on doc.com - an online tool for teaching/learning medical communicatioon skills which was developed at the Drexel University College of Medicine for the AACH (American Academy on Communication in Healthcare).

3. UROLOGY
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Benign Prostatic Hypertrophy Cancer, Adrenals, Kidney, and Ureter Cancer, Bladder, Penis, and Urethra Cancer, Prostate Cancer, Testicle Cancer, Wilms Tumor and Neuroblastoma Common Problems of the Penis Common Problems of the Testicle Common Problems of the Urethra Congenital Urologic Conditions Dermatological Disorders Erectile Dysfunction, Premature Ejaculation, and Sexual Disorders Fistulas Hydronephrosis and Ureter Disorders Incontinence Infections and Related Inflammatory Conditions Interstitial Cystitis Male Infertility Neurogenic Bladder and Overactive Bladder Stones Strictures Surgery Trauma

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Urology Articles
Sort: Alphabetically | by Section Benign Prostatic Hypertrophy Interstitial Laser Coagulation of the Prostate * Prostate Hyperplasia, Benign

Simple Prostatectomy* Transurethral Microwave Thermotherapy of the Prostate (TUMT) Transurethral Needle Ablation of the Prostate (TUNA) * Transurethral Resection of the Prostate *

Cancer, Adrenals, Kidney, and Ureter Urothelial Tumors of the Renal Pelvis and Ureters

Cancer, Bladder, Penis, and Urethra Bladder Cancer Carcinoma In Situ of the Urinary Bladder

Cystectomy, Partial* Cystectomy, Radical<*/li> Extragonadal Germ Cell Tumors* Penile Cancer Surveillance for Recurrent Bladder Cancer Urethral Cancer

Cancer, Prostate Controversies in Prostate Cancer Precancerous Lesions of the Prostate

Prostate Cancer - Biology, Diagnosis, Pathology, Staging, and Natural History

Prostate Cancer - Brachytherapy (Radioactive Seed Implantation Therapy) Prostate Cancer - Cryotherapy Prostate Cancer - External Beam Radiotherapy Prostate Cancer - Management of Localized Disease Prostate Cancer - Metastatic and Advanced Disease Prostate Cancer - Neoadjuvant Androgen Deprivation Therapy Prostate Cancer - Nutrition Prostate Cancer - Radical Perineal Prostatectomy Prostate Cancer - Radical Retropubic Prostatectomy Prostate-Specific Antigen

Cancer, Testicle Leydig Cell Tumors Nonseminomatous Testicular Tumors

Orchiectomy, Partial* Orchiectomy, Radical* Testicular Cancer* Testicular Choriocarcinoma Testicular Seminoma

Cancer, Wilms Tumor and Neuroblastoma Neuroblastoma Wilms Tumor

Common Problems of the Penis Balanitis* Balanitis Circumscripta Plasmacellularis*

Balanitis Xerotica Obliterans* Balanoposthitis* Dorsal Slit of the Foreskin*

Paraphimosis Pearly Penile Papules* Peyronie Disease Phimosis, Adult Circumcision, and Buried Penis Priapism

Common Problems of the Testicle Cryptorchidism Epididymitis

Hydrocele Manual Detorsion of the Testes* Spermatocele Testicular Torsion Torsion of the Appendices and Epididymis* Varicocele

Common Problems of the Urethra Urethral Caruncle Urethral Diverticula

Urethral Prolapse Urethral Syndrome Urethral Warts Urethritis

Congenital Urologic Conditions Cystic Diseases of the Kidney Horseshoe Kidney

Prune Belly Syndrome

Dermatological Disorders Dermatologic Diseases of the Male Genitalia, Malignant Dermatologic Diseases of the Male Genitalia, Nonmalignant

Erectile Dysfunction, Premature Ejaculation, and Sexual Disorders Erectile Dysfunction Hematospermia

Penile Prosthesis Implantation Premature Ejaculation

Fistulas Enterovesical Fistula Renoalimentary Fistula

Vesicovaginal and Ureterovaginal Fistula Vesicovaginal Fistula*

Hydronephrosis and Ureter Disorders Hydronephrosis and Hydroureter Megaureter and Other Congenital Ureteral Anomalies

Obstructed Megaureter Retroperitoneal Fibrosis Ureterocele Ureteropelvic Junction Obstruction Urinary Tract Obstruction Vesicoureteral Reflux

Incontinence Artificial Urinary Sphincter Injectable Bulking Agents for Incontinence

Pubovaginal Sling* Urinary Incontinence, Medical and Surgical Aspects *

Urinary Incontinence, Nonsurgical Therapies Urinary Incontinence, Surgical Therapies

Infections and Related Inflammatory Conditions Acute Bacterial Prostatitis and Prostatic Abscess Chronic Bacterial Prostatitis

Chronic Pelvic Pain Syndrome and Prostatodynia Cystitis, Nonbacterial Emphysematous Pyelonephritis Epididymal Tuberculosis Fournier Gangrene Gonococcal Infections* Hemorrhagic Cystitis, Noninfectious Hydrocele, Filarial Lymphogranuloma Venereum (LGV)* Nonbacterial Prostatitis Orchitis* Papillary Necrosis Papillomavirus* Pediatrics, Urinary Tract Infections and Pyelonephritis * Perinephric Abscess Prostatitis, Bacterial Prostatitis, Tuberculous Pyonephrosis Radiation Cystitis Renal Corticomedullary Abscess Syphilis* Trigonitis

Tuberculosis of the Genitourinary System Ureaplasma Infection* Uric Acid Nephropathy* Urinary Tract Infection, Females* Urinary Tract Infection, Males* Urinary Tract Infections in Pregnancy Xanthogranulomatous Pyelonephritis

Interstitial Cystitis Interstitial Cystitis

Male Infertility Infertility, Male Sertoli-Cell-Only Syndrome

Vasovasostomy and Vasoepididymostomy*

Neurogenic Bladder and Overactive Bladder Neurogenic Bladder Overactive Bladder - Etiology, Diagnosis, and Impact

Overactive Bladder in Children Overactive Bladder - Treatment

Other

Alport Syndrome* Azotemia* Bartholin Gland Diseases* Enterocele and Massive Vaginal Eversion* Granular Cell Tumors* Pericarditis, Uremic* Proteinuria*

Pyelonephritis, Chronic* Relaxed Vaginal Outlet* Uremia* Uremic Encephalopathy* Uterine Prolapse*

Stones Bladder Stones Cystinuria

Extracorporeal Shockwave Lithotripsy* Hypercalciuria Hyperoxaluria Hyperuricosuria and Gouty Diathesis Hypocitraturia Intracorporeal Lithotripsy Nephrocalcinosis* Nephrolithiasis Nephrolithiasis, Acute Renal Colic Percutaneous Endourology Pregnancy and Urolithiasis Pyelolithotomy* Struvite and Staghorn Calculi

Strictures Ureteral Stricture Urethral Strictures

Surgery Adrenal Surgery* Anesthesia, Testicle & Epididymis*

Augmentation Cystoplasty* Laparoscopic and Robotic Radical Prostatectomy * Laparoscopic Pelvic Lymph Node Dissection * Lasers in Urology Lymph Node Dissection, Pelvic* Lymph Node Dissection, Retroperitoneal* Nephrectomy, Partial* Nephrectomy, Radical* Nephroptosis Nephrostomy* Nerve Block, Dorsal Penile* Nerve Block, Dorsal Penile, Neonatal * Paraphimosis Reduction* Penile Injection & Aspiration* Pyeloplasty* Robotic and Laparoscopic Renal Surgery * Suprapubic Catheterization* Techniques of Local Anesthesia for Prostate Procedures and Biopsies * Transperitoneal Laparoscopic Radical Nephrectomy * Transureteroureterostomy* Ureterocalicostomy* Ureterolithotomy* Ureteroscopy* Urethral Catheterization, Men* Urinary Diversions and Neobladders* Vasectomy, No Scalpel* Zipper Injuries*

Trauma Bladder Trauma Penile Fracture and Trauma

Renal Trauma Scrotal Trauma Testicular Trauma Ureteral Injury During Gynecologic Surgery Ureteral Trauma Urethral Trauma

Urologic Imaging Bedside Ultrasonography, Obstructive Uropathy * Transrectal Ultrasonography (TRUS) of the Prostate *

Urologic Imaging Without X-rays - Ultrasound, MRI, and Nuclear Medicine

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Erik T Goluboff, MD Leonard Gabriel Gomella, MD, FACS Michael Grasso, MD Alex Jacocks, MD Edward David Kim, MD, FACS Peter Langenstroer, MD Raymond Rackley, MD Daniel B Rukstalis, MD Edmund Sabanegh, MD Richard A Santucci, MD, FACS Bradley Fields Schwartz, DO, FACS Allen Donald Seftel, MD Martha K Terris, MD, FACS

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4. HYSTOLOGY ATLAS
(SOURCE : http://www.anatomyatlases.org/MicroscopicAnatomy/MicroscopicAnatomy.sh tml)

Home | Search | About Us | FAQ | Reviews | Contact Us

Atlas of Microscopic Anatomy - A Functional Approach: Companion to Histology and Neuroanatomy: Second Edition

Editors: Ronald A. Bergman, PhD Professor of Anatomy Department of Anatomy Adel K. Afifi, M.D. Professor of Pediatrics, Neurology, and Anatomy Department of Anatomy Paul M. Heidger, Jr., Ph.D. Professor of Anatomy The University of Iowa
Peer Review Status: Externally Peer Reviewed First Published: 1999 Last Revised: 1999

Table of Contents

Preface Preface to the First Edition Introduction

Section 1. Cells (Plates 1.1 to 1.14)

Section 2. Epithelial Tissue (Plates 2.15 to 2.26) Section 3. Connective Tissue (Plates 3.27 to 3.51) Section 4. Blood (Plates 4.57 to 4.62) Section 5. Muscular Tissue (Plates 5.63 to 5.83) Section 6. Nervous Tissue (Plates 6.84 to 6.132)

Section 7. Integument (Plates 7.133 to 7.147) Section 8. Cardiovascular System (Plates 8.148 to 8.161) Section 9. Lymphatic System (Plates 9.162 to 9.175) Section 10. Digestive System (Plates 10.176 to 10.220) Section 11. Respiratory System (Plates 11.221 to 11.230) Section 12. Urinary System (Plates 12.231 to 12.244) Section 13. Female Reproductive System (Plates 13.245 to 13.261) Section 14. Male Reproductive System (Plates 14.262 to 14.278) Section 15. Endocrine Glands (Plates 15.279 to 15.296) Section 16. Special Senses (Plates 16.297 to 16.315) Section 17. Central Nervous System (Plates 17.316 to 17.364) Appendices
Appendix I: How to Study a Microscope Slide Appendix II: The Preparation of Cells and Tissue for Microscopic Study Appendix III: Methods of Fixation and Study Appendix IV: Comments on Color Groups, Stains, and the Staining Mechanism Appendix V: Nervous System Glossary of Terms

References This Site's Awards, Reviews and Comments

Home | Search | About Us | FAQ | Reviews | Contact Us
Anatomy Atlases is curated by Ronald A. Bergman, Ph.D. Please send us comments by filling out our Comment Form. All contents copyright 1995-2010 the Author(s) and Michael P. D'Alessandro, M.D. All rights reserved. "Anatomy Atlases", the Anatomy Atlases logo, and "A digital library of anatomy information" are all Trademarks of Michael P. D'Alessandro, M.D. Anatomy Atlases is funded in whole by Michael P. D'Alessandro, M.D. Advertising is not accepted. Your personal information remains confidential and is not sold, leased, or given to any third party be they reliable or not. The information contained in Anatomy Atlases is not a substitute for the medical care and advice of your physician. There may be variations in treatment that your physician may recommend based on individual facts and circumstances. URL: http://www.anatomyatlases.org/ This site complies with the HONcode standard for trustworthy health information: verify here.

5.

Cancer medicine

(source: http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi? book=cmed) Search for

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NCBI Bookshelf Holland-Frei Cancer Medicine

See "Cancer Medicine, 6th Edition"

Holland-Frei Cancer Medicine, 5th edition Edited by Robert C Bast, Jr, MD,1 Donald W Kufe, MD,2 Raphael E Pollock, MD, PhD,3 Ralph R Weichselbaum, MD,4 James F Holland, MD, ScD (hc),5 and Emil Frei, III, MD2 1University of Texas, MD Anderson Cancer Center, Houston, Texas 2Dana-Farber Cancer Institute, Harvard Medical School Boston, Massachusetts 3Department of Surgical Oncology, University of Texas, MD Anderson Cancer Center, Houston, Texas 4Department of Radiation and Cellular Oncology, University of Chicago Hospital, Chicago Tumor Institute, University of Chicago, Chicago, Illinois 5Derald H Ruttenberg Cancer Center, Mount Sinai School of Medicine, New York, New York Hamilton (ON): BC Decker; 2000. ISBN: 1-55009-113-1

Cancer Medicine is the best known and respected work in the field of oncology and was the first comprehensive textbook devoted to reporting and assessing the rapid and continuous development in the diagnosis and treatment of cancer. Cancer Medicine is widely recognized as a leading reference resource for medical oncologists, radiation oncologists, internists, surgical oncologists, and others who treat cancer patients. Cancer Medicine e.5 continues this high standard while providing updated information in all areas of oncology - including molecular biology, pathology, imaging interventional radiology, endoscopy, surgical oncology, radiation oncology, and medical oncology.

Table of Contents

Editors Contributors Preface Section 1 Cancer Biology

o

Chapter 1 Molecular Biology Barrett J Rollins, MD, Todd R Golub, MD, Kornelia Polyak, MD, and Charles D Stiles, PhD

Overview: Gene Structure General Techniques Gene Analysis: DNA Gene Expression: MRNA Transcript Analysis

Gene Expression: Protein Analysis Miscellany References

Chapter 2 Cell Proliferation, Differentiation, and Apoptosis Michael Andreeff, MD, David W Goodrich, MD, and Arthur B Pardee, MD

Proliferation Differentiation Apoptosis References

Chapter 3 Growth Factor Signal Transduction in Cancer Paolo Fedi, MD, Alec Kimmelman, MD, and Stuart A Aaronson, MD

Background Growth Factor Receptors with Tyrosine Kinase Activity Classification of Growth Factors and Their Receptors Abnormalities Associated with Growth Factors in Cancer Cells Aberrations Affecting GrowthFactor Receptors in Tumor Cells Signaling Pathways of Tyrosine Kinase Receptors Implications for Cancer Therapy References

Chapter 4 Oncogenes Marco A Pierotti, MD, Steven A Schichman, MD, Gabriella Sozzi, and Carlo M Croce, MD

Discovery and Identification of Oncogenes Mechanisms of Oncogene Activation Oncogenes in the Initiation and Progression of Neoplasia Summary and Conclusions References

Chapter 5 Tumor Suppressor Gene Defects in Human Cancer Eric R Fearon, MD and Bert Vogelstein, MD

Genetic Basis for Tumor Development Somatic Cell Genetic Studies of Tumorigenesis

RetinoblastomaA Paradigm for Tumor Suppressor Gene Function The p53 Gene The INK4a Locus and the p16INK4a and p19ARF Genes The APC Gene The BRCA1 and BRCA2 Genes The WT1 Gene The NF1 and NF2 Genes The VHL Gene DNA Repair Pathway Genes Candidate Tumor Suppressor Genes Summary References

Chapter 6 Recurring Chromosome Rearrangements in Human Cancer Olufunmilayo I Olopade, MD, Olatoyosi M Sobulo, MD, and Janet D Rowley, MD

Myeloproliferative Disorders Malignant Lymphoproliferative Diseases Acknowledgment References

Chapter 7 Biochemistry of Cancer Raymond W Ruddon, MD

Historical Perspectives What Makes a Cancer Cell a Cancer Cell? Acknowledgments References

Chapter 8 Invasion and Metastases Lance A Liotta, MD and Elise C Kohn, MD

TumorHost and TumorStromal Interactions Adhesion Proteolysis

Tumor Cell Migration Angiogenesis Genetic Regulation of Invasion and Metastasis Novel Technologies for Identification of Metastasis and InvasionPromoting Genes and Gene Products Metastasis as a Therapeutic Target Summary References

Chapter 9 Tumor Angiogenesis Judah Folkman, MD

Dependence of Tumors on Angiogenesis: The Beginning of the Field of Angiogenesis Research Summary and Future Directions References

Section 2 Tumor Immunology

o

Chapter 10 Tumor Immunology Jeffrey Schlom, PhD and Scott I Abrams, PhD

Targets for Immunotherapy Issues Problem Areas in Immunotherapy Cancer Vaccines Antibody Therapy Adoptive Transfer Cytokines Conclusion Acknowledgments References

Section 3 Cancer Etiology

o

Chapter 11 Genetic Predisposition to Cancer Marcia S Brose, MD, Tom Smyrk, MD, Barbara Weber, MD, and Henry T Lynch, MD

Genetic Basis of Cancer Syndromes

Cancer-Associated Genodermatoses Other Cancers with Familial Clusterings Application Conclusions/Future Directions References

Chapter 12 Chemical Carcinogenesis Ainsley Weston, PhD and Curtis C Harris, MD

Multi-stage Carcinogenesis GeneEnvironment Interactions and Interindividual Variation Carcinogen Metabolism DNA Damage and Repair Biologic Response to Tumor Promoters Oncogenes and Tumor-Suppressor Genes Clonal Evolution Chemical and Viral Interactions Implications for Molecular Epidemiology, Risk Assessment, and Cancer Prevention References

Chapter 13 Hormones and the Etiology of Cancer Brian E Henderson, MD, Leslie Bernstein, PhD, and Ronald K Ross, MD

Breast Cancer Endometrial Cancer Ovarian Cancer Prostate Cancer Adolescent and Young Adult Genital Cancer Cervical Cancer Thyroid Cancer Osteosarcoma Conclusion References

Chapter 14 Ionizing Radiation John B Little, MD

Development of Radiation Injury Principal Cellular and Tissue Effects of Radiation Neoplastic Transformation in Vitro by Radiation Stages in Neoplastic Transformation Molecular Mechanisms Experimental Radiation-Induced Carcinogenesis Human Epidemiologic Studies Risk Assessment References

Chapter 15 Ultraviolet Radiation Carcinogenesis James E Cleaver, PhD and David L Mitchell, PhD

Historical Perspective Epidemiology Genetic Factors in Skin Carcinogenesis Xeroderma Pigmentosum Cockayne Syndrome Trichothiodystrophy Basal Cell Nevus Syndrome and Basal Cell Cancers Familial melanoma Carcinogenesis References

Chapter 16 Physical Carcinogens Cesare Maltoni, MD, Franco Minardi, MD, and James F Holland, MD

Known Physical Carcinogens Mechanisms of Carcinogenesis Electromagnetic Fields Conclusions References

Chapter 17 Trauma and Inflammation John F Gaeta, MD

Mechanisms Of Possible Traumatic Causation Interactions of Trauma and Tissue Repair References

Chapter 18 Tumor Viruses Howard A Fine, MD and Joseph G Sodroski, MD

Classification Structure Life Cycle Mechanisms of Oncogenesis Immunodeficiency Endogenous Retroviruses Retroviral Vectors Conclusion References

Chapter 19 Herpesviruses Jeffrey I Cohen, MD

Properties of Herpesviruses Oncogenic Features of Herpesviruses Epstein-Barr Virus: An Oncogenic Human Herpesvirus Human Herpesvirus 8 and Malignancies Oncogenic Potential of Other Human Herpesviruses References

Chapter 20 Papillomaviruses and Cervical Neoplasia Catherine M McLachlin, MD and Christopher P Crum, MD

Definitions, Mechanisms, and Pathobiology of Genital HPV Infection HPV and Human Genital Neoplasia References

Chapter 21 Hepatitis Viruses Max W Sung, MD, Swan N Thung, MD, and George Acs, MD

Hepatitis A Virus Hepatitis B Virus Hepatitis C Virus Hepatitis D Virus Hepatitis E Virus Hepatitis of Unknown Etiology: the Role of the HFV, HGV, and TTV Clinical Significance of Viral Hepatitis to Hepatocellular Carcinoma References

Chapter 22 Parasites Piero Mustacchi, MD

Schistosomiasis and Cancer of the Bladder Schistosomiasis and Cancer of Other Sites East Asian Distomiasis Malaria American Burkitts Lymphoma Cancer in Animals References

Section 4 Cancer Epidemiology

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Chapter 23 Cancer Epidemiology Michael J Thun, MD and Phyllis A Wingo, PhD

Surveillance of Cancer in the Population Temporal Trends in Cancer Occurrence in the United States Survival of Patients with Cancer Types of Observational Epidemiologic Studies Descriptive Studies Analytic Epidemiology Measures of Association Case-Control Studies What Constitutes Proof in Epidemiologic Studies?

IARC Classification of Carcinogens Summary References

Section 5 Theory and Practice of Clinical Trials

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Chapter 24 Theory and Practice of Clinical Trials Marvin Zelen, PhD

Types of Clinical Trials Planning Clinical Trials Reporting of Clinical Trials Statistical Models Meta-Analysis Falsification of Data References Additional Reading

Section 6 Cancer Prevention

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Chapter 25 Prevention of Tobacco-Related Cancers Paul F Engstrom, MD, Margie Clapper, PhD, Robert A Schnoll, PhD, and C. Tracy Orleans, PhD

Physiochemical Composition of Tobacco Smoke Carcinogenic and Genotoxic Effects of Tobacco Constituents Genetic Variation in Cancer Susceptibility Strategies for Cessation Smokeless Tobacco Tobacco Addiction Prevention of Tobacco Use Summary References

Chapter 26 Nutrition in the Etiology and Prevention of Cancer Steven K Clinton, MD, Elizabeth C Miller, MS, and Edward L Giovannucci, MD

Methodologic Issues in Diet, Nutrition, and Cancer Studies

Nutrition and the Etiology of Common Cancers Summary of Research Efforts Focusing on Specific Nutrients References

Chapter 27 Chemoprevention of Cancer Michael B Sporn, MD and Scott M Lippman, MD

Agents for Chemoprevention and Their Mechanism of Action Chemoprevention Trials Chemoprevention and Overall cancer Incidence References

Section 7 Cancer Screening and Early Detection

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Chapter 28 Cancer Screening and Early Detection Harmon J Eyre, MD, Robert A Smith, PhD, and Curtis J Mettlin, PhD

Key Criteria in the Decision to Screen Methodologic Issues in the Evaluation of Early-Detection Programs Breast Cancer Colorectal Cancer Lung Cancer Prostate Cancer Testicular Cancer Cervical Cancer Endometrial Cancer Ovarian Cancer Melanoma and Nonmelanoma Skin Cancer Oral Cancer The Cancer-Related Checkup Conclusion References

Section 8 Principles of Cancer Pathology

Chapter 29 Principles of Cancer Pathology James L Connolly, MD, Stuart J Schnitt, MD, Helen H Wang, MD, Ann M Dvorak, MD, and Harold F Dvorak, MD

Solid Tumor Structure and Tumor Stroma Generation Role of the Surgical Pathologist in the Diagnosis and Management of the Cancer Patient Role of the Cytopathologist Role of the Immunohistochemist Role of the Electron Microscopist Role of the Clinical Pathologist Role of the Autopsy Pathologist Summary and Conclusions References

Section 9 Principles of Imaging

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Chapter 30 Principles of Imaging Richard J Steckel, MD Chapter 30A Imaging Cancer of Unknown Primary Site A. Robert Kagan, MD and Richard J Steckel, MD Chapter 30B Imaging Neoplasms of the Head and Neck and Central Nervous System Robert B Lufkin, MD

Magnetic Resonance Imaging CT- and MRI-Guided Aspiration Cytology References

Chapter 30C Imaging Neoplasms of the Thorax Poonam V Batra, MD

Lung Cancer Mediastinal Masses Pleural Cancers Conclusion References

Chapter 30D Imaging Neoplasms of the Abdomen and Pelvis Robert A Halvorsen Jr, MD and William M Thompson, MD

Diagnosis

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Staging Post-treatment Surveillance Gastrointestinal Tract: Hollow Organs Liver Metastases Biliary Obstruction and Lesions of the Pancreas Kidney Tumors of the Female Reproductive Tract Prostate Conclusion References

Chapter 30E Cross-Sectional Imaging of Musculoskeletal Neoplasms Leanne L Seeger, MD Chapter 30F Imaging the Breast Lawrence W Bassett, MD

Types of Mammography Examinations Standardized Mammography Reporting The Normal Mammogram The Abnormal Mammogram Mammography of the Postsurgical Breast Mammography for Staging Ultrasonography Imaging-Guided Needle Biopsy of the Breast Other Breast Imaging Modalities References

Chapter 30G Ultrasound in Cancer Medicine Edward G Grant, MD

Central Nervous System Ultrasonography Head and Neck Ultrasonography Thoracic Ultrasonography Breast Ultrasonography Abdominal Ultrasonography

Intraoperative Ultrasonography Retroperitoneal Ultrasonography Pelvic and Endovaginal Ultrasonography Prostatic and Transrectal Ultrasonography Testicular Ultrasonography Venous Ultrasonography Subcutaneous Ultrasonography Summary References

Chapter 30H Radionuclide Imaging in Cancer Medicine Randall A Hawkins, MD

Gamma Camera Methods Including SPECT Positron Emission Tomography Conclusion References

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Chapter 30I Perspectives in Imaging Richard J Steckel, MD Chapter 31 Interventional Radiology for the Cancer Patient Marshall Hicks, MD, Chusilp Charnsangavej, MD, and Michael Wallace, MD

Intra-arterial Therapy Biopsy Intratumoral Gene Therapy Mechanical Devices References

Section 10 Principles of Surgical Oncology

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Chapter 32 Principles of Surgical Oncology Raphael E Pollock, MD and Donald L Morton, MD

Historical Considerations The Contemporary Role of Surgical Oncology Combined Modality Therapy

Cancer Management Surgical Therapy Surgical Oncology in the Future References

Chapter 33 Vascular Access in Cancer Patients Michail Shafir, MD

Indications for Central Venous Access in Oncology Techniques for Placement of Central Venous Access Catheters Complications of Long-term Central Venous Access Prevention of Complications Treatment of Complications Results of Long-term Central Venous Catheters in Cancer Patients Conclusion References

Section 11 Principles of Radiation Oncology

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Chapter 34 Physical and Biologic Basis of Radiation Oncology Arno J Mundt, MD, John C Roeske, PhD, and Ralph R Weichselbaum, MD

Physical Basis of Radiation Therapy Treatment Planning and Delivery Biologic Basis of Radiation Therapy Future Directions References

Chapter 35 Principles of Hyperthermia Daniel S Kapp, PhD, George M Hahn, PhD, and Robert W Carlson, MD

Historical Perspective Biologic Rationale Physics and Physiology of Heating Clinical Experience References

Chapter 36 Photodynamic Therapy of Cancer Tayyaba Hasan, PhD, Anne C E Moor, PhD, and Bernard Ortel, MD

History Overview Light Absorption and PDT-Relevant Photochemistry Photosensitizers Photosensitizer Transport and Distribution Biologic Mechanisms of PDT Photodynamic Therapy and Oxygen Photodynamic Therapy with Molecular Delivery Systems Perspectives Acknowledgments References

Section 12 Principles of Medical Oncology

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Chapter 37 Principles of Medical Oncology James F Holland, MD, Emil Frei III, MD, Donald W Kufe, MD, and Robert C Bast Jr, MD

The Medical Oncologists Role Clinical Responsibilities Cancer Prevention Clinical Research Fundamental Science, Clinical Science, and Medical Art Chemotherapy Trials Adjuvant and Neoadjuvant Chemotherapy Surrogate End Points Palliative Therapy Laws of Therapeutics Truth Telling Resuscitation Burnout

Nomenclature: Systeme Internationale (SI) Units Summary References

Section 13 Principles of Chemotherapy

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Chapter 38 Cytokinetics Teresa Ann Gilewski, MD, Chau Dang, MD, Antonella Surbone, MD, and Larry Norton, MD

Cell Proliferation Growth Curve Analysis Conclusion Acknowledgment References

Chapter 39 Drug Resistance and Its Clinical Circumvention Charles S Morrow, MD and Kenneth H Cowan, MD

General Mechanisms of Drug Resistance Resistance to Multiple Drugs Resistance Factors Unique to Tumor Cells In Vivo: Host-TumorDrug Interactions Approaches to Overcoming Resistance to Specific Groups of Drugs Conclusion and Future Directions References

Chapter 40 Principles of Dose, Schedule, and Combination Chemotherapy Emil Frei III, MD and Karen H Antman, MD

Dose Schedule of Drug Administration Combination Chemotherapy Holotherapy References

Chapter 41 Regional Chemotherapy Maurie Markman, MD

Pharmacokinetic Rationale for Regional Chemotherapy

Mathematical Model (Describing Regional Anticancer Drug Delivery) Theoretical Concerns Practical Issues Clinical Examples Conclusion References

Chapter 42 Animal Models in Developmental Therapeutics Samir N Khleif, MD and Gregory A Curt, MD

The Role of Animal Models Animal Tumor Models Limitations of Animal Models Animal Models in Cancer Drug Development Other Animal Models Conclusion References

Chapter 43 In Vitro and In Vivo Predictive Tests A. R Hanauske, MD

In Vitro Techniques Summary References

Chapter 44 Pharmacology Mark J Ratain, MD and William Plunkett, MD

General Mechanisms of Drug Action Principles of Pharmacokinetics Principles of Pharmacodynamics References

Chapter 45 Toxicology by Organ System Michael R Grever, MD and Charles K Grieshaber, PhD

Basic Principles of Preclinical Toxicology Evaluation of Toxicity in Humans Effect of Variation in Drug Metabolism on Toxicity

Complexity of Assessing Treatment-Related toxicity in Context of Human Disease Toxicity Associated with Chemotherapy by Organ System Conclusion References

Section 14 Chemotherapeutic Agents

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Chapter 46 Folate Antagonists Barton A Kamen, MD, Peter D Cole, MD, and Joseph R Bertino, MD

Historical overview Mechanism of Actions Biological Chemistry Pharmacokinetics of MTX Inadvertent Drug Interactions Clinical Application: Dosage Schedules Current Uses for MTX in the Treatment of Neoplastic Disease Adverse Effects Resistance to Antifolates Strategies to overcome resistance to MTX References

Chapter 47 Pyrimidine and Purine Antimetabolites Giuseppe Pizzorno, MD, Robert E Handschumacher, MD, and Yung-Chi Cheng, MD

Pyrimidine Analogues Purine Analogues References

Chapter 48 Alkylating Agents and Platinum Antitumor Compounds D. Michael Colvin, MD

Alkylating Agents References

Chapter 49 Anthracyclines and DNA Intercalators/Epipodophyllotoxins/DNA Topoisomerases Eric H Rubin, MD and William N Hait, MD

Topoisomerase Biology How Drugs Poison Topoisomerases Cellular Response to Topoisomerase-Mediated DNA Damage Mechanisms of Resistance to Topoisomerase Targeting Intercalating Topoisomerase-Targeting Drugs Nonintercalating Topoisomerase-Targeting Drugs References

Chapter 50 Microtubule-Targeting Anticancer Drugs Derived from Plants and Microbes: Vinca Alkaloids, Taxanes, and Epothilones William T Beck, PhD, Carol E Cass, PhD, and Peter J Houghton, PhD

Vinca Alkaloids Taxanes: Paclitaxel (Taxol) and Docetaxel (Taxotere) Epothilones Summary References

Chapter 51 Asparaginase JoAnne Kurtzberg, MD

Mechanism of Action, Chemistry, and In Vitro Activity Conclusions References

Section 15 Principles of Endocrine Therapy

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Chapter 52 Steroid Hormone Binding and Hormone Receptors Eugene R DeSombre, PhD and Elwood V Jensen, PhD

Receptor Proteins in Steroid Hormone Action Measurement of Estrogen and Progestin Receptors Receptors and Response to Endocrine Therapy Receptors and Prognosis for Cancer Recurrence Summary References

Chapter 53 Hypothalamic and Other Peptide Hormones Andrew V Schally, PhD and Ana Maria Comaru-Schally, MD

Analogues of Peptide Hormones Agonists of LHRH LHRH Antagonists Mode of Action of LHRH Analogues Somatostatin Analogues Antagonists of Bombesin and Gastrin-Releasing Peptide Antagonists of Growth HormoneReleasing Hormone Treatment of Various Tumors with Peptide Analogues References

Chapter 54 Corticosteroids Lorraine I McKay, PhD and John A Cidlowski, PhD

Hormones of the Adrenal Cortex Control of Corticosteroid Secretion Pharmacokinetics of Corticosteroids Steroid Synthesis Inhibitors Pharmaceutical Derivatives Physiologic and Pharmacologic Effects of Corticosteroids Corticosteroids in the Treatment of Neoplasms References

Chapter 55 Estrogens and Antiestrogens V. Craig Jordan, PhD

Tamoxifen New Agents Conclusion References

Chapter 56 Clinical Use of Aromatase Inhibitors in Breast Carcinoma Harold A Harvey, MD

Biology of Aromatase Historical Development of Aromatase Inhibitors Development of Improved Aromatase Inhibitors

Classification Selection of Patients for Aromatase Inhibition Therapy Future Perspectives in the Clinical Development of Aromatase Inhibitors Summary References

Chapter 57 Progestins Kenneth S McCarty Jr, MD and Kenneth S McCarty Sr, PhD

Pharmacology Clinical Observations on Progestin Receptor and Target Tissue Responses to Progestins Conclusion References

Chapter 58 Androgen Deprivation Strategies in the Treatment of Advanced Prostate Cancer Samuel R Denmeade, MD and John T Isaacs, PhD

Cellular Organization of the Normal Prostate Definition of Androgen Responsiveness on a Cellular Basis Mechanism of Androgen Action Overview of Regulation of Systemic Androgen Levels Pharmacological Approaches to Lower Circulating Androgen Androgen Deprivation Strategies for the Treatment of Recurrent and Metastatic Prostate Cancer Intermittent Androgen Suppression Conclusion References

Chapter 59 Paraneoplastic Syndromes William D Odell, MD

Tumor Production of Protein Hormones or Their Precursors Metabolism of Steroids Tumor Production of Enzymes or Fetal Proteins Tumor Production of Cytokines

Tumor Stimulation of Antibody Production Miscellaneous Syndromes Endocrine Syndromes Caused by Cancer Paraneoplastic Syndromes of the Nervous System Dermatologic Syndromes of Cancer Glomerulonephritis Hematologic Syndromes Other Syndromes Fever and Cancer Tumor Production of Other Proteins Conclusion References

Section 16 Principles of Biotherapeutics

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Chapter 60 Immunostimulants Robert C Bast Jr, MD and Donald L Morton, MD

Contact Allergens Bacillus Calmette-Gurin Chemically Defined Components of Mycobacterial Immunostimulants CORYNEBACTERIUM PARVUM (PROPIONIBACTERIUM ACNES) Other Bacterial Vaccines Levamisole Conclusion References

Chapter 61 Active Specific Immunotherapy with Vaccines Mepur H Ravindranath, PhD and Donald L Morton, MD

Tumor-Host Interaction Whole Cells as Cancer Vaccines Clinical Trials of Tumor Vaccines Current Status of Vaccine Therapy for Human Cancers

Future Directions Conclusions References

Chapter 62 Interferons Ernest C Borden, MD and Bryan R G Williams, PhD

Molecules: Their Induction, Receptors, and Gene Regulation Angiogenesis Inhibition Antitumor Effects in Humans Perspective References

Chapter 63 Cytokines: Biology and Applications in Cancer Medicine Elizabeth A Grimm, PhD

Interleukin-2 Interleukin-12 Tumor Necrosis Factor- Interleukin-1 Interleukin-6 Interleukin-4 Colony-Stimulating Factors Interleukin-10 Interleukin-13 Interleukin-15 Conclusion Acknowledgements References

Chapter 64 Hematopoietic Growth Factors Razelle Kurzrock, MD

Hematopoiesis and the Role of Growth Factors Erythropoietin Granulocyte Macrophage Colony-Stimulating Factor

Granulocyte Colony-Stimulating Factor Macrophage Colony-Stimulating Factor Stem Cell Factor Thrombopoietin Interleukin-1 Interleukin-2 Interleukin-3 Interleukin-4 and Interleukin-13 Interleukin-5 Interleukin 6 Interleukin-7 Interleukin-8 Interleukin-9 Interleukin-10 Interleukin-11 Interleukin-12 Interleukin-15 Interleukin-16 Interleukin-17 Interleukin-18 Other Hematopoietic Growth Factors Use of Hematopoietic Growth Factors after Chemotherapy Hematopoietic Growth Factors in the Transplantation setting Thrombopoietic Agents in the Clinic: an Overview Hematopoietic Growth Factors in Bone Marrow Failure States Future Perspectives References

Chapter 65 Monoclonal Serotherapy Robert C Bast Jr, MD, Michael R Zalutsky, PhD, Robert J Kreitman, MD, Edward A Sausville, MD, and Arthur E Frankel, MD

Therapy with Unmodified Monoclonal Antibodies Elimination of Malignant Cells from Bone Marrow Ex Vivo Therapy with DrugMonoclonal Antibody Conjugates Radiolabeled Monoclonal Antibodies Targeted Toxins Conclusions References

Section 17 Principles of Gene Therapy

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Chapter 66 Cancer Gene Therapy Donald W Kufe, MD, Sunil Advani, MD, and Ralph Weichselbaum, MD

Gene Delivery Systems Retroviruses Therapeutic Genes Selective Gene Expression Viral Oncolysis References

Section 18 Principles of Bone Marrow Transplantation

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Chapter 67 Autologous Bone Marrow and Stem Cell Transplantation William P Peters, MD, Caroline Hamm, MD, and Roy D Baynes, MD

Rationale and Requirements for Autologous Hematopoietic Stem Cell Transplantation Principles Dose intensity Combination Chemotherapy Volume of Disease Procedure Specific Diseases

NonHodgkins Lymphoma Immune Function Following Transplantation Organ Toxicity Future Directions References

Chapter 68 Transplantation of Allogeneic Hematopoietic Cells for the Treatment of Malignancies Richard J OReilly, MD, Esperanza B Papadopoulos, MD, and Trudy N Small, MD

Biology of Allogeneic Marrow Transplants Applied to the Treatment of Hematological Neoplasia Late Complications of Marrow Transplantations HLA-Matched Marrow Transplants for Leukemia Marrow Transplantation for Acute Myelogenous Leukemia Marrow Transplantation for Acute Lymphoblastic Leukemia Marrow Transplantation for Chronic Myelogenous Leukemia Marrow Transplantations for Myelodysplastic Syndromes Marrow Transplantation for Lymphoma Marrow Transplantation for Multiple Myeloma Nonmyeloablative Regimens Used with Peripheral Blood Stem Cells Marrow Transplantation for Patients Lacking an HLA-Identical Sibling Donor T CellDepleted HLA-Nonidentical Related and HLA-Compatible Unrelated Marrow Grafts References

Section 19 Principles of Psycho-Oncology

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Chapter 69 Principles of Psycho-Oncology Jimmie C Holland, MD and Jane Gooen-Piels, PhD

Historical Perspective Hearing the Diagnosis Factors in Adaptation to Cancer

Psychosocial Problems Guidelines for Recognition of Psychosocial Distress Psychiatric Disorders Psychiatric and Psychosocial Interventions Blurring of Conventional Psychosocial and Behavioral Interventions with Alternative/ Complementary Therapies Quality-of-Life Assessment Family Issues Grief in Surviving Family Members Summary References

Section 20 Principles of Oncology Nursing

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Chapter 70 Principles of Oncology Nursing Mary Johnson, RN and Connie Henke Yarbro, RN

Oncology Nursing as a Specialty Role of the Oncology Nurse Nursing Care Related to Specific Cancer Therapies Supportive Care Survivorship Summary References

Section 21 Principles of Cancer Rehabilitation Medicine

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Chapter 71 Principles of Cancer Rehabilitation Medicine Kristjan T Ragnarsson, MD and David C Thomas, MD

Application of Rehabilitation Concepts The Cancer Rehabilitation and Adaptation Team Functional Assessment The Rehabilitation Process Cancer of the Brain Cancer of the Spine

Cancer of the Head and Neck Cancer of the Lung Cancer of the Breast Cancer of the Gastrointestinal Tract Cancer of the Genitourinary System Cancer of the Limbs Conclusion References

Section 22 Principles of Multidisciplinary Management

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Chapter 72 Principles of Multidisciplinary Management James F Holland, MD, Emil Frei III, MD, Donald W Kufe, MD, Robert C Bast Jr, MD, Raphael E Pollock, MD, and Ralph R Weichselbaum, MD

The Primary Physician The Radiologist The Pathologist The Surgical Oncologist The Anesthesiologist The Medical Oncologist The Radiation Oncologist The Gynecologic Oncologist The Pediatric Oncologist The Psycho-oncologist The Rehabilitation Specialist The Nurse Oncologist The Oncology Pharmacist Other Support Personnel

Chapter 73 Palliative Care Alan C Carver, MD and Kathleen M Foley, MD

The Role of the Oncologist Suffering in the Patient, Family, and Physician

Guidelines in the Care of the Dying Patient A Legal Mandate for Palliative Care Conclusion: The Need for Education and Training in End-of-Life Care References

Section 23 Principles of Societal Oncology

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Chapter 74 Ethical Aspects of Caring for Patients with Cancer Ezekiel J Emanuel, MD and Steven Joffe, MD

Informed Consent Human Subjects Research Terminating Medical Care Assisted Suicide and Euthanasia Financial Incentives Ethical Issues in Human Cancer Genetics References

Chapter 75 Legal Aspects of Cancer Joseph M Taraska, PA

Elements of Liability Preventing Legal Complications Consent For Whose Acts Must the Physician Respond? The Physician as an Expert Witness Managed Care Withdrawing Life Support/Physician-Assisted Suicide and Euthanasia References

Chapter 76 The Government and Cancer Medicine John E Ultmann, MD, Marguerite Donoghue Baxter, RN, and Terry Lierman

Legislative History of the National Cancer Institute Federal Budget Process Public Policy Factors Affecting Medical Research

Public Policy Factors Affecting Costs of Treating and Preventing Cancer Tobacco And Research THE MARCH: Coming Together to Conquer Cancer National Dialogue on Cancer Analysis A Call to Action Epilogue References

Chapter 77 Clinical Oncology in a Changing Healthcare Environment Martin N Raber, MD and Joseph S Bailes, MD

Effects of Managed Care on Providers Effects of Managed Care on Insurers Effects of Managed Care on Employers Effects of Managed Care on Government Programs Effects of Managed Care on Patients and Patient Care Implications for Cancer Care Demands of Patients Facing Terminal Illnesses Current Strategies for the Delivery of Cancer Care Future Directions in Health-Care Reform References

Chapter 78 Outcomes Assessment Jane C Weeks, MD

Historic Perspective Outcome Measures Study Designs Outcomes Studies in Oncology Outcomes Management Summary References

Chapter 79 Questionable Cancer Therapies Barrie R Cassileth, PhD

The Evolution of Questionable Cancer Therapies Terminology and Definitions Impact on the Health Care System CAM Use and Users Mainstream Acceptance of CAM CAM Costs and Insurance Coverage CAM Therapies and Practitioners CAM Practitioners and Practices CAM Research Issues References Recommended Books

Section 24 Neoplasms of the Central Nervous System

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Chapter 80 Neoplasms of the Central Nervous System Michael D Prados, MD

Epidemiology and Risk Factors Molecular Genetics Familial Syndromes Pathology Grading Systems Clinical Presentation Diagnostic Neuroimaging Surgical Diagnosis and Resection Cortical Mapping and Interactive Image-Guided Resections Postoperative Imaging Clinical Trials Glioblastoma Multiforme and Anaplastic Astrocytoma Anaplastic Oligodendroglioma Low-Grade Gliomas Ependymoma

Brainstem Glioma Spinal Cord Tumors Medulloblastoma and Primitive Neuroectodermal Tumors Other Primary Tumors of the Central Nervous System Disease Metastatic to the Central Nervous System Spinal Metastases Neoplastic Meningitis Future Directions References

Section 25 Neoplasms of the Eye

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Chapter 81 Neoplasms of the Eye David H Abramson, MD, Ira J Dunkel, MD, and Beryl McCormick, MD

Ophthalmic Oncology in Children Adult Ocular Tumors Ophthalmic complications of radiation and chemotherapy References

Section 26 Neoplasms of the Endocrine Glands

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Chapter 82 Pituitary Neoplasms Aviva Abosch, MD and Charles B Wilson, MD

Prolactinomas Growth Hormone-Secreting Pituitary Adenomas Mixed Adenomas Adrenocorticotropic Hormone-Secreting Adenomas Endocrine-Inactive Pituitary Neoplasms References

Chapter 83 Neoplasms of the Thyroid Steven I Sherman, MD and Ann M Gillenwater, MD

Diagnostic Evaluation of the Solitary Thyroid Nodule Differentiated Thyroid Carcinoma

Medullary Thyroid Cancer Anaplastic Thyroid Carcinoma References

Chapter 84 Neoplasms of the Adrenal Cortex David E Schteingart, MD

Pathogenesis Diagnosis Differential Diagnosis Imaging Characterization of Adrenal Masses Staging Pathologic Diagnosis Management of Adrenal Cortical Carcinoma Long-Term Treatment Outcome The Use of Inhibitors of Adrenal Function in Patients with Functioning Adrenal Cortical Carcinoma Future Prospects References

Chapter 85 Neoplasms of the Neuroendocrine System and Neoplasms of the Gastroenteropancreatic Endocrine System Larry K Kvols, MD, Roger R Perry, MD, Aaron I Vinik, MD, Li-teh Wu, MD, Phillippe Chaninian, MD, Stephen B Baylin, MD, and Norman W Thompson, MD

Neuroendocrine Neoplasms of the Gastroenteropancreatic System Parathyroid Carcinomas, Pheochromocytomas, and Multiple Endocrine Neoplasia Syndromes References

Section 27 Neoplasms of the Head and Neck

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Chapter 86 Head and Neck Cancer Gary L Clayman, MD, Scott M Lippman, MD, George E Laramore, MD, and Waun Ki Hong, MD

Etiology and Epidemiology Biology Chemoprevention Approaches

Anatomy Pathology Diagnosis Treatment Chemotherapy Approaches in HNSCC References

Chapter 87 Odontogenic Tumors George Thomas Gallagher, DMD and Gerald Shklar, DDS

Clinical, Radiographic, and Histologic Features References

Section 28 Neoplasms of the Thorax

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Chapter 88 Cancer of the Lung Ara A Vaporciyan, MD, Jonathan C Nesbitt, MD, Jin Soo Lee, MD, Craig Stevens, MD, Ritsuko Komaki, MD, and Jack A Roth, MD

Historical Note Smoking and Lung Cancer Environmental Causes of Lung Cancer Familial Predisposition to Lung Cancer Molecular Pathogenesis Cancer Screening and Early Detection Age and Lung Cancer Pathology of Lung Cancer Natural History Diagnosis and Staging Performance Status General Guidelines for Management Results Therapy for NSCLC Radiotherapy Special Considerations

Chemotherapy for NSCLC Management of SCLC Conclusion and Future Prospects References

Chapter 89 Malignant Mesothelioma A. Philippe Chahinian, MD and Harvey I Pass, MD

Historical Perspective Incidence and Epidemiology Etiology Other Etiologic Factors Pathology Clinical Features Prognostic Factors Other Types of Malignant Mesotheliomas Benign Mesotheliomas Differential Diagnosis Treatment Prospectus and Prevention References

Chapter 90 Thymomas and Thymic A. Philippe Chahinian, MD

Epidemiology and Etiology Anatomic Pathogenesis Clinical Features Associated Paraneoplastic Syndromes Diagnosis Differential Diagnosis Staging Therapy References

Chapter 91 Tumors of the Heart and Great Vessels A. Philippe Chahinian, MD, David E Gutstein, MD, and Valentin Fuster, MD

Cardiac Tumors Tumors of the Great Vessels References

Chapter 92 Primary Germ Cell Tumors of the Thorax John D Hainsworth, MD and F. Anthony Greco, MD

Benign Teratomas of the Mediastinum Malignant Germ Cell Tumors Poorly Differentiated Carcinoma of the Mediastinum References

Chapter 93 Metastatic Tumors in the Thorax Donald L Morton, MD and Perry Shen, MD

Molecular and Genetic Basis for Pulmonary Metastases Diagnosis and Imaging Nonsurgical Treatment of Pulmonary Metastases Surgical Treatment of Pulmonary Metastases Pediatric Tumors Summary References

Section 29 Neoplasms of the Alimentary Canal

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Chapter 94 Neoplasms of the Esophagus Mark K Ferguson, MD

Anatomy and Histology Etiology Epidemiology Presentation Diagnosis Staging Evaluation Therapy

Palliative Therapy of Esophageal Obstruction References

Chapter 95 Neoplasms of the Stomach Howard W Bruckner, MD, John C Morris, MD, and Paul Mansfield, MD

History Demographics Etiology Clinical Manifestations Laboratory Tests Surgery for Gastric Cancer Treatment of Gastric Cancer Adjuvant Biologic Response Modifier Therapy of Gastric Cancer Regional Chemotherapy Radiation for Gastric Cancer Perspectives References

Chapter 96 Primary Neoplasms of the Liver Paul F Engstrom, MD, Elin Sigurdson, MD, and Alison A Evans, PhD

Epidemiology Risk Factors Molecular Pathogenesis Prevention Clinical Presentation Pathologic Diagnosis Staging and Prognosis Imaging Modalities Management Other Primary Hepatic Neoplasms References

Chapter 97 Treatment of Liver Metastases Nancy E Kemeny, MD and Yuman Fong, MD

Imaging Techniques Liver Resection Adjuvant Chemotherapy Systemic Chemotherapy Hepatic Arterial Chemotherapy Cryosurgery Radiofrequency Ablation Embolization Chemoembolization Radiation Therapy Percutaneous Ethanol Injection Summary References

Chapter 98 The Gallbladder Steven A Curley, MD

Gallbladder Carcinoma References

Chapter 99 Diagnosis and Management of Biliary Tract Cancer Steven A Curley, MD

Causative Factors Clinical Presentation Pathology Diagnostic Studies Treatment of Intrahepatic Cholangiocarcinoma Hilar Bile Duct Cholangiocarcinoma References

Chapter 100 Neoplasms of the Ampulla of Vater Douglas B Evans, MD and Robert A Wolff, MD

Diagnostic Evaluation

Treatment Associated Syndromes Conclusions References

Chapter 101 Neoplasms of the Exocrine Pancreas Robert A Wolff, MD, James L Abbruzzese, MD, and Douglas B Evans, MD

Epidemiology Pathology Molecular Biology of Pancreatic Cancer Symptom Patterns Diagnostic Imaging Biliary Drainage Treatment of Localized, Potentially Resectable Disease Treatment of Locally Advanced Disease Treatment of Metastatic Disease References

Chapter 102 Neoplasms of the Small Intestine, Vermiform Appendix, and Peritoneum Erik Barquist, MD and Michael Zinner, MD

Tumors of the Small Intestine Tumors of the Appendix Neoplasms of the Peritoneum References

Chapter 103 Adenocarcinoma of the Colon and Rectum Howard W Bruckner, MD, John Pitrelli, MD, and Marnin Merrick, MD

Pathology Staging Epidemiology of Colorectal Cancer Tumor Markers Screening Clinical Approach

Principles of Colorectal Surgery Radiation Therapy Summary Summary References Additional Reading

Chapter 104 Neoplasms of the Anus Brenda Shank, MD, Warren E Enker, MD, and Marshall S Flam, MD

Gross and Microscopic Anatomy Epidemiology Etiology Pathology Diagnosis Staging Treatment Melanoma References

Section 30 Neoplasms of the Genitourinary Tract

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Chapter 105 Renal Cell Carcinoma Jerome P Richie, MD, Philip W Kantoff, MD, and Charles L Shapiro, MD

Pathogenesis Incidence Etiology Molecular Biology Clinical Features Radiographic Evaluation Staging and Grading Surgical Treatment Adjuvant Therapy

Treatment of Metastatic Disease Future Directions in Therapy Surgical Considerations for Metastatic Disease Sarcomas of Renal Origin Wilms Tumor (Nephroblastoma) Renal Oncocytoma References

Chapter 106 Neoplasms of the Renal Pelvis and Ureter Jerome P Richie, MD and Philip W Kantoff, MD

Molecular Changes Histopathology Diagnosis Staging Treatment Secondary Tumors of the Ureter References

Chapter 107 Bladder Cancer Philip W Kantoff, MD, Anthony L Zietman, MD, and Kenneth Wishnow, MD

Epidemiology Biology Pathology Signs and Symptoms Diagnostic Evaluation Staging Superficial Bladder Carcinoma Muscle-Invasive Bladder Cancer Chemotherapy for Metastatic Disease References

Chapter 108 Neoplasms of the Prostate William K OH, MD, Mark Hurwitz, MD, Anthony V DAmico, MD, Jerome P Richie, MD, and Philip W Kantoff, MD

Introduction Epidemiology and Risk Factors Biology of Prostate Cancer Screening for Prostate Cancer Diagnosis and Staging of Prostate Cancer Prognostic Factors in Localized Prostate Cancer Management of Localized Prostate Cancer Radical Prostatectomy Radiation Therapy Comparison of Treatment Options Management of Locally Advanced Prostate Cancer Management of Disseminated Cancer Hormone Refractory Prostate Cancer New Approaches to Prostate Cancer Therapy References

Chapter 109 Neoplasms of the Penis Victor A Marcial, MD, A. Puras, MD, and V. A Marcial-Vega, MD

Epidemiology Etiology Anatomic Pathogenesis Intraepithelial Epidermoid Carcinoma Invasive Epidermoid Carcinoma Radiotherapy Chemotherapy Prognosis Prevention Conclusions

References

Chapter 110 Neoplasms of the Testis Craig R Nichols, MD, Robert Timmerman, MD, Richard S Foster, MD, Bruce J Roth, MD, and Lawrence H Einhorn, MD

Epidemiology Pathology Clinical Presentation Staging Therapy Treatment Versus Cancer Stage Therapy for Disseminated Disease Treatment of Good-Risk Disseminated Germ Cell Tumors Treatment of Patients with Poor-Risk Disseminated Disease High-Dose Chemotherapy Treatment of Multiply Recurrent Germ Cell Cancer Special Situations Long-Term Toxicity of Chemotherapy Long-Term Toxicity of Radiation Therapy Extragonadal Germ Cell Tumors References

Section 31 Neoplasms of the Female Reproductive Organs

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Chapter 111 Neoplasms of the Vulva and Vagina Jacob Rotmensch, MD and Arthur L Herbst, MD

The Vulva Carcinoma of the Vagina References

Chapter 112 Neoplasms of the Cervix J. Taylor Wharton, MD and Guillermo Tortolero-Luna, MD

Epidemiology Diagnosis and Treatment

Current Practice Future Opportunities References

Chapter 113 Endometrial Cancer Carmel J Cohen, MD, Gillian M Thomas, MD, and George S Hagopian, MD

Risk Factors Pathology Diagnosis Staging Prognostic Factors Oncogene activation and Loss of Tumor Suppressor Function Treatment of Primary Disease Treatment of Recurrent Disease Future References

Chapter 114 Neoplasms of the Fallopian Tube Carmel J Cohen, MD, Gillian M Thomas, MD, and George S Hagopian, MD

Incidence and Epidemiology Clinical Presentation Preoperative Diagnosis Clinicopathologic Classification and Staging Patterns of Spread Prognostic Factors Treatment Prognosis Other Malignant Fallopian Tube Neoplasms References

Chapter 115 Ovarian Cancer Jonathan S Berek, MD, Gillian M Thomas, MD, and Robert F Ozols, MD

Epithelial Ovarian Cancer

Epithelial Ovarian Cancer Nonepithelial Ovarian Cancer Sex Cord-Stromal Tumors Uncommon Ovarian Tumors Metastatic Tumors References

Chapter 116 Gestational Trophoblastic Disease Ross S Berkowitz, MD and Donald P Goldstein, MD

Historical Perspective Epidemiology Histopathologic Classification of GTD Molecular Pathogenesis Natural History Diagnosis Staging Therapy Results of Therapy Subsequent Pregnancies Second Cancers References

Chapter 117 Gynecologic Sarcomas Carmel J Cohen, MD, Gillian M Thomas, MD, and George S Hagopian, MD

Clinical Profile Diagnosis Sarcoma-Like Variants Patterns of Spread Prognostic Factors and Prognosis Nonuterine Gynecologic Sarcomas Surgical Treatment

Postsurgical Therapy for Gynecologic Sarcomas Hormone Therapy Radiation Therapy for Leiomyosarcoma Radiation Therapy for Malignant Mixed Mllerian Tumors Chemotherapy References

Section 32 Neoplasms of the Breast

o

Chapter 118 Neoplasms of the Breast Richard G Margolese, MD, Bernard Fisher, MD, Gabriel N Hortobagyi, MD, and William D Bloomer, MD

Pathology Relation of Tumor Characteristics to Outcome Epidemiology Risk Factors Breast Cancer Biology Natural History and Prognostic Markers Diagnosis and Screening Psychosocial Aspects of Breast Cancer Surgical Biology Systemic Adjuvant Therapy Issues for Further Study Regarding Therapy Management of Metastatic Breast Cancer New Drugs Prevention of Invasive Breast Cancer in Women with Intraductal Carcinoma in Situ (DCIS) Prevention of Invasive Breast Cancer in Women at Increased Risk Perspectives References

Section 33 Neoplasms of the Skin

Chapter 119 Neoplasms of the Skin Thomas B Fitzpatrick, MD

The Ozone Layer Ultraviolet Radiation in the Carcinogenesis of Skin Cancers Tumors Arising from the Epidermis Tumors Arising from Mucosa Tumors Arising from Dermal Connective Tissues Tumors Arising from Appendages Metastatic Carcinoma Lymphomas and Leukemias References

Section 34 Malignant Melanoma

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Chapter 120 Malignant Melanoma Donald L Morton, MD, Richard Essner, MD, John M Kirkwood, MD, and Robert C Wollman, MD

History of Melanoma Epidemiology and Etiology Precursor Lesions Clinical Characteristics Prognostic Features of Clinically Localized Disease Prognostic Features of Regional Lymph Node Metastases Prognostic Features of Distant Metastases Management of Primary Melanoma Management of Regional Lymph Nodes Management of Distant Metastases Future Horizons References

Section 35 Neoplasms of the Bone and Soft Tissue

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Chapter 121 Bone Tumors Gerald Rosen, MD, Charles A Forscher, MD, Henry J Mankin, MD, and Michael T Selch, MD

Classification of Benign and Malignant Bone Tumors

Staging of Bone Tumors Bone-Producing Tumors Fibrous Lesions of Bone Cartilage Tumors of Bone Bone Tumors of Vascular or Uncertain Histogenesis Malignant Vascular Lesions of Bone References

Chapter 122 Sarcomas of Nonosseous Tissues Peter W T Pisters, MD, Brian OSullivan, MD, and George D Demetri, MD

Etiology and Screening Clinical Presentation, Classification, and Diagnosis Staging and Prognostic Factors Treatment of Localized Primary Soft-Tissue Sarcoma Treatment of Locally Advanced Disease Treatment of Metastatic Soft-Tissue Sarcoma Specific Clinical Situations Special Issues in Soft-Tissue Sarcoma Management Summary References

Section 36 Neoplasms of the Hematopoitic System

o

Chapter 123 Myelodysplastic Syndrome Lewis R Silverman, MD

History Classification Etiology Pathobiology Clinical and Laboratory Features Pathogenesis and Relation to Leukemic Transformation Treatment Clinical Management

Future Directions References

Chapter 124 Acute Myeloid Leukemia in Adults Charles A Schiffer, MD and Richard M Stone, MD

Pathogenesis and Etiology Morphologic Classification and Clinical and Laboratory Correlates Presenting Signs and Symptoms Therapy New Approaches Complications Summary References

Chapter 125 Chronic Myeloid Leukemia Richard T Silver, MD

Incidence and Epidemiology Etilogy Clinical and Hematologic Characteristics Terminal Chronic Myeloid Leukemia Pathophysiology Cytogenetics Fluorescence In Situ Hybridization (FISH) Test Molecular Biology of CML Treatment Treatment of Blast Crisis Bone Marrow Transplantation Cytogenetic and Molecular Follow-Up Future Directions References

Chapter 126 Acute Lymphocytic Leukemia in Adults Charles A Schiffer, MD and Richard A Larson, MD

Biologic Differences Between Adult and Childhood ALL Therapy Future Prospects References

Chapter 127 Chronic Lymphocytic Leukemia Kanti R Rai, MD and Michael J Keating, MD

Historical Perspective Incidence and Epidemiology Immunobiology and Immunophenotype of CLL Cells Clinical Consequences of Defective B- and T-Cell Functions Natural History and Terminal Events Clinical Staging and Other Prognostic Features Conclusion References

Chapter 128 Hairy-Cell Leukemia Harvey M Golomb, MD and James Vardiman, MD

Epidemiology and Etiology Diagnosis: Morphologic and Immunophenotypic Features Clinical Manifestations Differential Diagnosis Treatment Future Prospects References

Chapter 129 Hodgkins Disease Peter Mauch, MD and James O Armitage, MD

History Epidemiology and Etiology Pathology Treatment of Stage I-II Hodgkins Disease Treatment of Advanced Hodgkins Disease

Summary References

Chapter 130 NonHodgkins Lymphomas Arnold S Freedman, MD and Lee M Nadler, MD

Epidemiology and Etiology Pathology, Immunobiology, and Natural History Differential Diagnosis and Sites of Disease at Presentation Staging and Disease Detection Disease Parameters Which Influence Prognosis and Assessment of Disease Response Therapeutic Approaches According to Real References

Chapter 131 Mycosis Fungoides and the Szary Syndrome Youn H Kim, MD and Richard T Hoppe, MD

Epidemiology and Etiology Pathology/Pathogenesis Natural History Diagnosis Staging and Prognosis Therapy References

Chapter 132 Plasma Cell Tumors Kenneth C Anderson, MD

Multiple Myeloma Other Plasma Cell Dyscrasias References

Chapter 133 Mast Cell Leukemia and Other Mast Cell Neoplasms Richard M Stone, MD and Steven H Bernstein, MD

Mast Cell Biology Mast Cell Leukemia and Other Mast Cell Neoplasms References

Chapter 134 Polycythemia Vera and Essential Thrombocythemia Scott Murphy, MD

Pathophysiology Clinical Features Laboratory Findings and Differential Diagnosis Natural History and Therapy References

Section 37 Neoplasms in AIDS

o

Chapter 135 Neoplasms in Acquired Immunodeficiency Syndrome David T Scadden, MD

Epidemiology Kaposis Sarcoma NonHodgkins Lymphoma (NHL) Hodgkins Disease Squamous Cell Neoplasia References

Section 38 Neoplasms of Unknown Primary Site

o

Chapter 136 Neoplasms of Unknown Primary Site John D Hainsworth, MD and F. Anthony Greco, MD

Poorly Differentiated Neoplasms Adenocarcinoma of Unknown Primary Site Squamous Carcinoma of Unknown Primary Site Poorly Differentiated Carcinoma of Unknown Primary Site Neuroendocrine Carcinoma of Unknown Primary Site Summary References

Section 39 Neoplasms in Children

o o

Chapter 137A Principles and Practice of Pediatric Oncology Michael A Weiner, MD Chapter 137B Incidence, Origins, Epidemiology Leslie L Robison, PhD

Acute Leukemia Central Nervous System Tumors Lymphomas Neuroblastoma Retinoblastoma Wilms Tumor Bone Tumors Rhabdomyosarcoma References

Chapter 137C Principles of Pediatric Radiation Oncology John C Breneman, MD and Ashwatha Narayana, MD

Psychosocial Issues Technical Considerations Biologic Issues References

Chapter 137D Late Effects of Treatment of Cancer in Children and Adolescents Daniel M Green, MD

Central Nervous System Vision Hearing Teeth and Salivary Glands Heart Lungs Kidneys Bladder Liver Intestine Musculoskeletal System Endocrine System

Second Malignant Tumors References

Chapter 138A Childhood Acute Lymphoblastic Leukemia Paul S Gaynon, MD, Michael E Trigg, MD, and Fatih M Uckun, MD

Heterogeneity Response and Outcome Advances in Primary Therapy Treatment After Relapse Conclusion References

Chapter 138B Pediatric Acute Myeloid Leukemia Richard Aplenc, MD and Beverly Lange, MD

Epidemiology Etiology Classification and Diagnosis Presentation Therapy Prognosis Supportive Care Conclusion References

Chapter 138C Hodgkins Disease in Children and Adolescents Allen Chauvenet, MD, Cindy L Schwartz, MD, and Michael A Weiner, MD

Clinical Presentation and Staging Biology Treatment Late Effects of Childhood Hodgkins Disease Conclusion References

Chapter 138D Non-Hodgkins Lymphoma in Children Mitchell S Cairo, MD and Sherrie Perkins, MD

Introduction/Epidemiology Clinical Presentation/Staging Summary/Future Consideration References

Chapter 138E Langerhans Cell Histiocytosis Kara M Kelly, MD

The Histiocytic Disorders References

Chapter 139A Hepatic Tumors Marcio Henrique Malogolowkin, MD

Pathologic Characteristics Clinical Presentation and Diagnosis Treatment Perspectives References

Chapter 139B Renal Tumors of Childhood Paul E Grundy, MD, Daniel M Green, MD, Norman E Breslow, PhD, Michael L Ritchey, MD, and Patrick R M Thomas, MB

Epidemiology Molecular Biology and Genetics Pathology Clinical Presentation Preoperative Evaluation Staging Therapy Prognostic Factors Acknowledgment References

Chapter 139C Germ Cell Tumors Barbara Cushing, MD and Neyssa Marina, MD

Pathology Molecular Biology and Genetics Clinical Presentation Treatment and Outcome References

Chapter 139D Neuroblastoma Katherine K Matthay, MD and Darrell J Yamashiro, MD

Epidemiology Molecular Pathogenesis Prognostic Markers Diagnosis and Staging Treatment Conclusions and Future Plans References

Chapter 139E Soft Tissue Sarcomas of Childhood Leonard H Wexler, MD and Lee J Helman, MD

Rhabdomyosarcoma Nonrhabdomyosarcoma Soft Tissue Sarcomas Conclusion References

Section 40 Complications of Cancer and its treatment

o

Chapter 140 Management of Cancer Pain Alan C Carver, MD and Kathleen M Foley, MD

Scope of the Problem Barriers to Cancer Pain Management Mechanisms of Cancer Pain Neurophysiology of Pain Types of Pain Common Pain Syndromes in Patients with Cancer Strategy for Assessment and Treatment

Pharmacologic Approaches Psychological and Behavioral Approaches Anesthetic Approaches Neurosurgical Approaches Sedation in the Imminently Dying References

Chapter 141 Anorexia and Cachexia Takao Ohnuma, MD

Introduction and Historical Perspective Incidence Etiology Manifestations of Cachexia Treatment of Cachexia Epilogue References

Chapter 142 Antiemetic Therapy Richard J Gralla, MD

Physiology and Pharmacology in Controlling Emesis Emetic Problems Control of Emesis and Patient Characteristics Treatment of Acute Chemotherapy-Induced Emesis Controlling Emesis in Special Situations Pharmacoeconomics, Quality of Life, and Antiemetics Conclusion References

Chapter 143 Neurologic Complications Lisa M DeAngelis, MD and Jerome B Posner, MD

Metastases Nonmetastatic Complications References

Chapter 144 Dermatologic Complications of Cancer Chemotherapy Narin Apisarnthanarax, MD and Madeleine Duvic, MD

Alopecia Stomatitis Nail Reactions Extravasation Reactions Hyperpigmentation Radiation-Associated Reactions Photosensitivity Reactions Inflammation of Keratoses Hypersensitivity Reactions Acral Erythema Neutrophilic Eccrine Hidradenitis Eccrine Squamous Syringometaplasia Cutaneous Eruption of Lymphocyte Recovery Cytokine and Miscellaneous Reactions References

Chapter 145 Skeletal Complications Samuel Kenan, MD and Gabriel N Hortobagyi, MD

Skeletal Metastases Steroid-Induced Skeletal Complications Methotrexate-Induced Osteopathy Skeletal Complications Secondary to Radiation Therapy References

Chapter 146 Hematologic Complications and Blood Bank Support Kenneth C Anderson, MD

Normal Hematopoiesis Hematopoiesis Causes of Pancytopenia Abnormalities of Red Cells and Red Cell Support

Abnormalities of White Cells and White Cell Support Abnormalities of Platelets and Platelet Support Other Therapeutic Modalities Effects of Transfusion on the Immune System Transfusion-Associated Graft-Versus-Host Disease Transfusion-Related Infectious Diseases Future Directions in Blood Component Therapy Conclusion References

Chapter 147 Coagulopathic Complications of Cancer Sabine Eichinger, MD and Kenneth A Bauer, MD

Cancer-Related Coagulopathic Complications Treatment-Related Coagulopathic Complications References

Chapter 148 Urologic Complications Christopher J Logothetis, MD and Jose E Sarriera, MD

Complications Resulting from Primary Cancer Progression Hemorrhagic Cystitis Radiation Nephritis Diagnosis, Treatment, and Prevention of Nephrotoxicity of Cancer Therapeutic Agents Monitoring for Drug-Induced Nephrotoxicity References

Chapter 149 Cardiac Complications Michael S Ewer, MD and Robert S Benjamin, MD

Evaluation of the Cardiovascular System in the Cancer Patient Metastatic Involvement of Cardiac Structures Cardiac Effects of Mediator Release from Tumors Cardiac Dysrhythmia in the Cancer Patient Cardiac Complications of Cancer Treatment

Acknowledgments References

Chapter 150 Respiratory Complications Roy B Jones, PhD

Pulmonary Evaluation Specific Complications Conclusion and Perspective References

Chapter 151 Liver Function and Hepatotoxicity in Cancer Laurie D DeLeve, MD

Alterations in Hepatic Metabolism of Drugs Liver Toxicity and Hematopoietic Stem Cell Transplantation Hepatotoxicity by Anticancer Therapy References

Chapter 152 Gastrointestinal Complications Frank A Sinicrope, MD and Bernard Levin, MD

Esophageal Carcinoma Esophagitis Upper Gastrointestinal Bleeding Pseudomembranous Colitis Typhlitis Chemotherapy-Related Ileus Acute Colonic Pseudo-Obstruction Diarrhea Hepatic Complications of Bone Marrow Transplantation Infectious Hepatitis Acute Pancreatitis Radiation Coloproctitis and Proctitis Anorectal Complications References

Chapter 153 Oral Complications Stephen T Sonis, DMD

Pretreatment Assessment Oral Complications of RadioTherapy Oral Complications of Cancer Chemotherapy Oral Complications Associated with Bone Marrow Transplantation References

Chapter 154 Gonadal Complications Catherine E Klein, MD

The Hypothalamic-Pituitary-Gonadal Axis Historical Background Preclinical Studies Effects of Chemotherapy on Gonadal Function Effects of Radiation Therapy on Gonadal Function Protective Measures Outcome of Pregnancy Psychosocial Issues References

Chapter 155 Endocrine Complications S. Jim Yeung, MD and Robert F Gagel, MD

Hypothalamic-Pituitary Dysfunction Thyroid Disorders Diabetes Mellitus Metabolic Bone Diseases Adrenal Diseases Disorders of Growth Hormone Secretion and Growth Disorders of Electrolyte/Mineral Metabolism Disorders of Lipid Metabolism Sexual Dysfunction References

Chapter 156 Secondary Cancers: Incidence, Risk Factors, and Management Susan R Rheingold, MD, Alfred I Neugut, MD, and Anna T Meadows, MD

Incidence of Secondary Cancer Clinical Characteristics Shared Environmental Risk Factors Genetic Risk Factors Therapy-Related Secondary Cancers Conclusion References

Section 41 Infections in Patients with Cancer

o

Chapter 157 Infections in Patients with Cancer Kenneth V I Rolston, MD and Gerald P Bodey, MD

Factors Responsible for increased Susceptibility to Infections Bacterial Infections Fungal Infections Viral Infections Protozoal Infections Other Parasitic Infections Abdominal Infection Perianal Infections Skin Infections Therapy of Infections in Neutropenic Patients Infection Prevention Perspectives References

Section 42 Oncologic Emergencies

o

Chapter 158 Oncologic Emergencies John C Morris, MD and James F Holland, MD

Sudden Death

Malignant Pericardial Tamponade Pulmonary Embolism Syncope in the Cancer Patient Superior Vena Cava Syndrome Bleeding in the Cancer Patient Chemotherapy Extravasation Respiratory Emergencies Tumor Lysis Syndrome Cytokine Release Syndrome References

Section 43 Oncology and the Information Revolution

o

Chapter 159 Oncology and the Information Revolution Edward P Ambinder, MD

Healthcare Policy and Information Technology Medical and Oncologic Informatics Information Overload Overview of Computers Personal Digital Assistant Internet Information Management Major Medical Databases of Interest to the Oncologist Clinical and Research Uses of Computers in Medical Oncology Oncology office and Hospital Information Systems References

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An approved publication of the American Cancer Society Associate Editor: Ted S Gansler, MD, MBA, American Cancer Society, Atlanta, Georgia

Notice: The authors and publisher have made every effort to ensure that the patient care recommended herein, including choice of drugs and drug dosages, is in accord with the accepted standard and practice at the time of publication. However, since research and regulation constantly change clinical standards, the reader is urged to check the product information sheet included in the package of each drug, which includes recommended doses, warnings, and contraindications. This is particular important with new or infrequently used drugs.
Copyright 2000, BC Decker Inc Bookshelf NCBI NLM NIH Help Contact Help Desk Copyright and Disclaimer

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Headache online
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(source: http://webcampus.drexelmed.edu/interactive/headache/) About headache.interactive: This program might be used for educational purposes free of charge and with no royalties inflicted. The original (German) version of "Headache Interactive" was develped at the Dept. for Educational Media at the Institute for Medical Education at the University of Berne, Switzerland with funding provided by Astra-Zeneca AG and GlaxoSmithKline AG. The English version was done by the authors in their spare time without any monetary support. Copyright 2005 - 2009 by Christof Daetwyler and Marco Mumenthaler.

Dedication: I dedicate this work to my parents, who always supported me. (Christof Daetwyler)

Awards: "Headache interactive" received the prestigeous European Academic Software Award 2000 (EASA2000) in Rotterdam and the highest honor "summa cum laude" at the MediKinale International in Munich in 2000.

Credits: The English abbreviated version was developed, produced and implemented by: Christof Daetwyler, MD Drexel University College of Medicine Educational Design and Project Management, Production and Implementation Marco Mumenthaler, MD Former Director of the Dept. for Neurology at the University of Berne Hospital Content Development and Physician on Camera Mo Levin, MD Dept. for Neurology at Dartmouth Hitchcock Medical Center in Lebanon, NH Editor of the American Version Willi R. Hess, M.A. Dept. for Educational Media at the Institute for Medical Education at the University of Berne, Switzerland Scientific Illustrator The model used for hedache.interactive is based on doc.com - an online tool for teaching/learning medical communicatioon skills which was developed at the Drexel University College of Medicine for the AACH (American Academy on Communication in Healthcare).

7.

Biochemistry online

(source: http://employees.csbsju.edu/hjakubowski/classes/ch331/bcintro/d efault.html)

Biochemistry Online can also be found in the following dig libraries! Click on the logos.

Biochemistry Online:

An Approach Based on Chemical Logic

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Table of Contents
Check-in Place your cursor over the icons on the left for a description to appear here. Preface

WHY CHEMICAL LOGIC? UPDATES INTRODUCTION TO BIOCHEMISTRY BIOCHEMISTRY/MOLECULAR BIOLOGY DICTIONARIES REVIEW: THE CELL PERMISSIONS

Pre-Class Questions

Moodle Quiz

Molecular Modeling

Chapter 1: LIPID STRUCTURE A. Lipid Structure B. Lipids in Water : Structure C. Dynamics of Membrane Lipids

SUPPLEMENT: MOLECULAR MECHANICS AND DYNAMIC

REVIEW THERMODYNAMICS

XCel, Mathcad Spreadsheet

D. Lipids in Water: Thermodynamics

E. Why do Single Chain Amphiphiles form Micelles not Bil and Double Chain Amphiphiles from Bilayers and not M

Java Applet

F. Lipids as Biological Signals

Lipid Structure: Literature Learning Module

Chapter 2: PROTEIN STRUCTURE A. The Structure and Property of Amino Acids B. Composition, Sequence and Conformational Analyis of Proteins; C. Understanding Protein Conformation D. Proteins Folding - In Vivo and In Vitro

Lit. Learning Module

E. Laboratory Determination of Go for Protein Folding/Un F. Thermodynamics and IMF's in Protein Stability

G. Predicting Protein Properties Using Computational Biolo Bioinformatics - Proteomics H. Protein Aggregates - Not Just Junk

Protein Structure: Literature Learning Module

Chapter 3: CARBOHYDRATES A. Monosaccharides and Disssacharides B. Complex Oligosaccharides

C. Jeopardy | (scrambled list of all Jeopardy answers for w you supply the correct question) D. Glycoproteins: Biosynthesis and Function

Chapter 4: DNA, GENOMICS, AND PROTEOMICS A. The Structure of DNA B. The Central Dogma of Biology C. The Language of DNA

D. Genomes and Other Omes (not Gnomes)

Chapter 5: BINDING A. Reversible Binding I: Equations and Curves B. Reversible Binding II: Experimental Binding Curves, Kd Error Analysis C. A Model Binding System: Myoglobin. Hemoglobin, and Dioxygen D. Binding and the Control of Gene Transcription: E. New Methods in Drug Development

Binding: Literature Learning Module

Chapter 6: TRANSPORT AND KINETICS A. Passive and Facilitated Diffusion B. Steady State and Rapid Equilibrium Kinetics C. Models of Enzyme Inhibition D. More Complicated Enzymes

Transport and Kinetics: Literature Learning Module

Chapter 7: CATALYSIS REVIEW: ORGANIC CHEMISTRY A. Methods of catalysis B. Mechanisms of enzyme-catalyzed reactions C. Cofactors and Electron Pushing: Sources and Sinks D. Enzyme catalyzed reactions in organic solvents E. Ribozymes and the RNA World

Catalysis: Literature Learning Module

Chapter 8: OXIDATION/PHOSPHORYLATION A. The Chemistry of Dioxygen B. Biological Oxidation Reactions - Dehydrogenases, Mon Dioxygenases, and Oxidases

C. ATP and Oxidative Phosphorylation Reactions D. Photosynthesis: The Light Reaction

Oxidation/Phosphorylation: Literature Learning Module

Chapter 9: SIGNAL TRANSDUCTION A. Energy Transduction: Uses of ATP B. Signal Transduction: Neurochemistry C. Signal Transduction at Cell Membranes: Protein Kinases/Phosphatases

D. Apoptosis - Programmed Cell Death and Signal Transd E. Memory and Learning in Apylsis

Capstone: The Origin of Life

Appendices List of Figures List of Tables

3/12/10

List of Moodle Quizzes Chime and Jmol Files Experimental Techniques

Additional Web Links Biochemistry, 2nd Edition. Garret and Grisham Lehninger's rinciples of Biochemistry - 4th ed. Cox/Nelson

Biochemistry by Matthews, van Holde, and Ahern

Biochemistry, 5th Edition, by Berg, Tymoczko and Stry

Searchable Biochemistry/Molecular Biology Books from NCBI

Useful Reference: Molecular Cell Biology by Lodish, et 5th Edition Free Web Version. Martindale's Biochemistry Biophysical Resources Medical Biochemistry

Common mistakes found in Biochemistry textbooks! Physical Chem/Life Sciences: Atkins et al. Searchable Biochemistry concepts from Mathews, van and Ahern EverythingBio Resource

A link to all Biochemistry books from the Journal of Che Education

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8.

Embryo image

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Units of Embryo Images

9.

Genetics

(source : http://www.merck.com/mmpe/sec22/ch327/ch327a.html)

The Merck Manual of Diagnosis and Therapy

The Merck Manual--Home Edition The Merck Manual of Health & Aging The Merck Manual of Geriatrics The Merck/Merial Manual for Pet Health The Merck Veterinary Manual The Merck Index

Section on Special Subjects Subject General Principles of Medical Genetics

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Introducti

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Introduction Clinical Uses of Genetics Ethical Controversies Factors Affecting Gene Expression Genetic Diagnostic Technologies Mitochon Topics DNA Abnormalities Multifactorial (Complex) Inheritance Single-Gene Defects Unusual Aspects of Inheritance

undefined Section Sympto Index s ms ABCDE FGHI J KLMN OPQR STUV WXYZ

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In This Topic Introduction Structure Gene Function Traits and Inheritance

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Patterns Construction of a family pedigree

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A gene, the basic unit of heredity, is a segment of DNA containing all the info necessary to synthesize a polypeptide (protein). Protein synthesis determines m body's structure and function. Structure

Humans have about 20,000 genes. Genes are contained in chromosomes in the and mitochondria. In humans, somatic (non-germ) cell nuclei, with certain exc RBCs), normally have 46 chromosomes in 23 pairs. Each pair consists of one from the mother and one from the father. Twenty-two of the pairs, the autosom usually homologous (identical in size, shape, and position and number of gene pair, the sex chromosomes (X and Y), determines a person's sex. Women have chromosomes (which are homologous) in somatic cell nuclei; men have one X chromosome (which are heterologous). The X chromosome carries genes resp many hereditary traits; the small, differently shaped Y chromosome carries ge initiate male sex differentiation, as well as a few other genes. Because the X c has many more genes than the Y chromosome, many X chromosome genes in not paired. A karyotype is the full set of chromosomes in a person's cells.

Germ cells (egg and sperm) undergo meiosis, which reduces the number of ch to 23half the number in somatic cells. In meiosis, the genetic information in a person's mother and father is recombined through crossing over (exchange b homologous chromosomes). When an egg is fertilized by a sperm at conceptio normal number of 46 chromosomes is reconstituted.

Genes are arranged linearly along the DNA of chromosomes. Each gene has a location (locus), which is typically the same on each of the two homologous chromosomes. The genes that occupy the same locus on each chromosome of inherited from the mother and one from the father) are called alleles. Each gen a specific DNA sequence; 2 alleles may have slightly different or the same DN sequences. Having a pair of identical alleles for a particular gene is homozygo

whereas having a pair of nonidentical alleles is heterozygosity. Gene Function

Genes consist of DNA. The length of the gene depends on the length of the pr which the gene codes. DNA is a double helix in which nucleotides (bases) are adenine (A) is paired with thymine (T) and guanine (G) is paired with cytosin is transcribed during protein synthesis. When DNA replicates itself during cel one strand of DNA is used as a template against which messenger RNA (mRN RNA has the same base pairs as DNA, except that uracil (U) replaces thymine mRNA travel from the nucleus to the cytoplasm and then to the ribosome, wh synthesis occurs. Transfer RNA (tRNA) brings each amino acid back to the ri where it is added to the growing polypeptide chain in a sequence determined b mRNA. As a chain of amino acids is assembled, it folds upon itself to create a dimensional structure under the influence of nearby chaperone molecules.

The code in DNA is written in triplets of the four possible nucleotides. Specif acids are coded by specific triplets. Because there are 4 nucleotides, the numb possible triplets is 43 (64). Because there are only 20 amino acids, there are ex combinations. Some triplets code for the same amino acids as other triplets. Y triplets may code for things such as instructions to start or stop protein synthe what order to combine and assemble amino acids.

Genes consist of exons and introns. Exons code for amino acid components of protein. Introns contain other information that affects control and speed of pro production. Exons and introns together are transcribed onto mRNA, but the se transcribed from introns are later spliced out. Transcription is also controlled b RNA, which is synthesized from the DNA strand that is not transcribed into m chromosomes also consist of histones and other proteins that affect gene expre (which proteins and how many proteins are synthesized from a given gene).

Genotype refers to genetic composition; it determines which proteins are code production. Phenotype refers to the entire physical, biochemical, and physiolo of a personie, how the cell (and thus the body) functions. Phenotype is dete the types and amounts of proteins actually synthesized, ie, how the genes are a expressed. Gene expression depends on factors such as whether a trait is domi recessive, the penetrance and expressivity of the gene (see General Principles Genetics: Factors Affecting Gene Expression), the degree of tissue differentia (determined by tissue type and age), environmental factors, unknown factors, expression is sex-limited or subject to chromosomal inactivation or genomic i Factors that affect gene expression without changing the genome are epigenet

Knowledge of the biochemical mechanisms that mediate gene expression is gr rapidly. One mechanism is variability in intron splicing, also called alternative Because introns are spliced out, the exons may also be spliced out, and then th

be assembled in many combinations, resulting in many different mRNAs capa coding for similar, but different, proteins. The number of proteins that can be by humans is > 100,000 even though the human genome has only about 20,00 Other mechanisms mediating gene expression include DNA methylation and h reactions such as methylation and acetylation. DNA methylation tends to silen Histones resemble spools around which DNA winds. Histone modifications su methylation can increase or decrease proteins synthesized from a particular ge acetylation is associated with decreased gene expression. The strand of DNA transcribed to form mRNA may also be used as a template for synthesis of RN controls transcription of the opposite strand. Traits and Inheritance Patterns

A trait may be as simple as the color of the eyes or as complex as susceptibilit diabetes. Expression of a trait may involve one gene or many genes. Some sin defects cause abnormalities in multiple tissues, an effect called pleiotropy. Fo osteogenesis imperfecta (a connective tissue disorder that often results from a in a single collagen gene) may cause fragile bones, deafness, blue-colored scle dysplastic teeth, hypermobile joints, and heart valve abnormalities (see also B Connective Tissue Disorders in Children: Osteogenesis Imperfecta).

Construction of a family pedigree: The family pedigree (family tree) can be us diagram inheritance patterns. It is also commonly used in genetic counseling. uses conventional symbols to represent family members and pertinent health i about them (see Fig. 1: General Principles of Medical Genetics: Symbols for c a family pedigree. ). Some familial disorders with identical phenotypes have patterns of inheritance. Fig. 1 Symbols for constructing a family pedigree.

In the pedigree, symbols for each generation in the family are placed in a row numbered with Roman numerals, starting with the older generation at the top with the most recent at the bottom (see Fig. 2: General Principles of Medical G Autosomal dominant inheritance. , Fig. 3: General Principles of Medical Ge Autosomal recessive inheritance. , Fig. 4: General Principles of Medical Ge linked dominant inheritance. , and Fig. 5: General Principles of Medical Gen linked recessive inheritance. ). Within each generation, people are numbered right with Arabic numerals. Siblings are usually listed by age, with the oldest Thus, each member of the pedigree can be identified by 2 numbers (eg, II, 4). also assigned an identifying number.

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Kidney transplantation

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Kidney Transplantation
Author: David Hatch, MD, Chief, Section of Pediatric Urology, Professor of Urology & Pediatrics, Departments of Urology and Pediatrics, Foster G McGaw Hospital and Loyola University of Chicago

Coauthor(s): Rekha Agrawal, MD, Director, Division of Pediatric Nephrology, Professor, Department of Pediatrics, Loyola University Medical Center Contributor Information and Disclosures Updated: Mar 24, 2009

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Introduction
Approximately 1 in 65,000 children develops end-stage renal disease (ESRD) each year. Before the 1950s, this condition was essentially untreatable. However, because of advances in surgical techniques and suppression of the immune system, the mortality rate of children with chronic renal failure has dramatically declined. Kidney transplantation has become the primary method of treating ESRD in the pediatric population.

Management of end-stage renal disease in US children aged 0-19 years by age group. Data from US Renal Data Systems, 2008. [ CLOSE WINDOW ]

Management of end-stage renal disease in US children aged 0-19 years by age group. Data from US Renal Data Systems, 2008. For excellent patient education resources, visit eMedicine's Kidneys and Urinary System Center. Also, see eMedicine's patient education article Kidney Transplant.

History of the Procedure

Until the 1950s, ESRD from any cause was uniformly lethal. Hope for treating renal failure grew with the development of surgical techniques that allowed the anastomosis of blood vessels in the early 20th century.

In 1902, Ullman demonstrated the successful autotransplant of a canine kidney to the dog's neck. Following anastomosis of the artery and vein, the kidney made urine.1 That same year, Carrel reported an improved method of suturing vessels together, work that eventually won him a Nobel Prize.2 In 1906, Jaboulay, in whose laboratory Carrel had worked, performed the first human kidney transplant, a xenograft between a pig and human. This kidney made urine for only a short time.3 In 1909, Ernst Unger transplanted an ape's kidney to a young girl with renal failure. The

failure of this attempt convinced Unger that a nonsurgical barrier to transplantation existed.4 Other early attempts at the transplantation of kidneys were unsuccessful. Within hours or days, transplanted kidneys became swollen, ceased urine production, became ischemic, and, in some cases, ruptured. In a series of experiments, Medawar and colleagues demonstrated that skin grafts from nonidentical rabbits were rejected and sloughed by a reaction involving leukocyte invasion of the graft.5 This reaction increased in severity and rapidity when the recipient received a previous transplant from the same donor. Researchers began to look for ways to prevent this response. Ionizing radiation, known to suppress bone marrow production of leukocytes, was used in an attempt to prevent the immune reaction to allografting. Armed with new information about the immune response to allografting, researchers revived interest in renal transplantation. In 1954, a kidney transplant was performed between identical twins, thus skirting the problems of immune compatibility.6 Several transplants between twins followed. However, the possibility of kidney transplantation for patients with renal failure who did not have a twin donor remained unrealized.7 In the early 1960s, Calne found that a derivative of 6-mercaptopurine (azathioprine) increased the success of experimental kidney transplantation in dogs.8 Human use of azathioprine followed, and long-term graft survival from nonidentical donor kidneys became a possibility. The success of kidney transplantation increased significantly when Goodwin and Starzl added prednisolone to azathioprine.9,10 Encouraged by this success, transplant centers began performing nonidentical living donor kidney transplantation. Simultaneously, dialysis became available as a pretransplant therapy for patients with ESRD and as a life-preserving measure for recipients of transplants whose kidneys failed. This increased the number of individuals who were candidates for kidney transplantation. Terasaki reported a marked decrease in early allograft failure from hyperacute rejection when a crossmatch between donor lymphocytes and recipient serum was performed.11 A negative crossmatch (no reaction against donor lymphocytes when incubated with recipient serum) indicated that no antibody was present in the recipient, directed against the donor's organ. In 1968, the Harvard Committee on Irreversible Coma described the features of brain death and made the important observation that patients who had lost basic brainstem function were dead despite the persistence of a heartbeat sustained by artificial ventilator support.12 In 1970, Kansas became the first state to enact legislation defining brain death. Within several years, such statutes were widely established. This provided a legal framework for families to donate the organs of deceased loved ones for use in transplantation. The number of kidney transplants dramatically increased because of the combination of this legislation and the contemporary advances in immunosuppression. Concurrently, in 1973 the Medicare program in the United States was expanded to provide insurance coverage for patients with ESRD, meaning that individuals were provided renal transplantation or dialysis regardless of their health insurance coverage or their ability to pay.

From a relatively rare procedure performed in research centers, kidney transplantation became available in most major cities. During the 1970s, a 1-year allograft survival rate of 75% was typical for kidneys donated by living relatives; a rate of 50% was typical for organs from cadavers.13 Improvement in graft survival followed the routine use of human leukocyte antigen (HLA) tissue matching14 and the use of antilymphocyte antibodies as a temporary adjunct to immunosuppression regimens. In 1978, Calne reported improvement in allograft survival with the use of a new immunosuppressive agent, cyclosporine.15 Widespread use of cyclosporine led to a dramatic improvement in allograft survival. New protocols incorporating cyclosporine and other drugs have increased the specificity of immunosuppression and decreased the prevalence of infection complications in transplant recipients.

Frequency
Approximately 1200 children (aged 0-19 y) in the United States develop ESRD each year.16 This represents approximately 16 cases per 1 million children.

Etiology
The most common cause of renal failure in children (<19 y) is glomerulonephritis (see image below).

Etiology of end-stage renal disease in children aged 0-18 years by age group. Data from North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) Annual Report, 2007. [ CLOSE WINDOW ]

Etiology of end-stage renal disease in children aged 0-18 years by age group. Data from North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) Annual Report, 2007. Other etiologies are demonstrated in all children in the first image below and by age group in the second image below.

Etiology of end-stage renal disease in North American children. Data from Annual Report North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS), 2007. [ CLOSE WINDOW ]

Etiology of end-stage renal disease in North American children. Data from Annual Report North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS), 2007.

Etiology of end-stage renal disease in children aged 0-18 years by age group. Data from North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) Annual Report, 2007. [ CLOSE WINDOW ]

Etiology of end-stage renal disease in children aged 0-18 years by age group. Data from North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) Annual Report, 2007. Treatment options include hemodialysis, peritoneal dialysis, and renal transplantation. In the late 1990s, about two thirds of children with ESRD received a kidney transplant. Although kidney transplantation is considered to be the management option of choice in children with ESRD, a shortage of available organs has led to a decline in the proportion of patients who receive a kidney transplant (see below).

Management of end-stage renal disease in US children aged 0-19 years by age group. Data from US Renal Data Systems, 2008. [ CLOSE WINDOW ]

Management of end-stage renal disease in US children aged 0-19 years by age group. Data from US Renal Data Systems, 2008.

Pathophysiology

Despite numerous attempts and prolific experimentation, kidney transplantation between nonidentical twins was not successful until the 1960s. Early experimenters understood the outcome of the unmodified response to allografting (ie, a rapid or gradual decrease in urine output and ultimate demise of the transplanted kidney) but not its mechanism.

In the 1940s, through a series of elegant animal experiments, Medawar demonstrated that skin grafts between nonidentical rabbits were ultimately sloughed.5 He found that this reaction occurred much more rapidly in animals that had previously been grafted from the same donor and that the process involved a leukocytic infiltration in the allograft. Medawar reasoned that exposure to foreign tissue resulted in an activation of the immune system and that it induced specific memory that allowed rapid reaction to subsequent exposure to similar grafts. Modulation of that response became the goal of transplant investigators in the subsequent decades. Although understanding of the immune response to allografts has dramatically increased over the 50 years since Medawar's experiments, it remains incomplete. The description that follows is a simplified schema intended primarily to assist in the reader's understanding of currently used immunosuppressive agents. Histocompatibility antigens are glycoproteins found on the cell membrane of all nucleated cells. These antigens (ie, HLAs) widely vary between individuals and are coded by genes located on the short arm of chromosome 6. Following allografting, the recipient is exposed to foreign HLAs from the graft. Macrophages or dendritic cells process these foreign antigens and present them to T-helper lymphocytes. Thus activated, the T-helper lymphocytes produce lymphokines that stimulate maturation of other reactive cells. Interleukin (IL)2 stimulates production of cytotoxic T lymphocytes. IL-4 induces transformation of B lymphocytes into plasma cells that produce antibody directed specifically against foreign HLAs. In addition, T-helper lymphocytes can be stimulated directly by the secretion of IL-1 from macrophages (see below).

Simplified diagram of the immune response to nonidentical major histocompatability complex (MHC) antigens. Foreign antigens are processed by macrophages or dendritic cells (antigen-presenting cell) and then presented to T-helper lymphocytes. Release of interleukin-1 from macrophages activates T-helper lymphocytes. Thus activated, these T-helper lymphocytes produce cytokines (interleukin-2) that stimulate production of cytotoxic T lymphocytes, antibody-producing B lymphocytes, and natural killer cells. Diagram provided by David A. Hatch, MD, copyright 2001, used with permission. [ CLOSE WINDOW ]

Simplified diagram of the immune response to nonidentical major histocompatability complex (MHC) antigens. Foreign antigens are processed by macrophages or dendritic cells (antigen-presenting cell) and then presented to T-helper lymphocytes. Release of interleukin-1 from macrophages activates T-helper lymphocytes. Thus activated, these T-helper lymphocytes produce cytokines (interleukin-2) that stimulate production of cytotoxic T lymphocytes, antibody-producing B lymphocytes, and natural killer cells. Diagram provided by David A. Hatch, MD, copyright 2001, used with permission.

Once stimulated, the immune response results in a rapid or gradual attack on the vascular endothelium of the allograft, resulting in rejection. If an individual is exposed to an organ expressing antigens against which the recipient already has developed antibodies, the rejection occurs rapidly. This is called hyperacute rejection, and it can cause swelling, rupture, and loss of the allograft within minutes or hours. Currently used pretransplant cross-matching techniques (between recipient serum and donor lymphocytes) have dramatically reduced the occurrence of this type of rejection. Stimulated cytotoxic T lymphocytes, specifically directed against the mismatched tissue, and natural killer cells attack target cells, causing acute rejection. This response can vary in severity from mild allograft dysfunction to a dramatic rise in serum creatinine with loss of urine output. Some recipients of transplants experience a gradual reduction in allograft function, called chronic rejection, typified by a gradual obliteration of the lumen of small arteries in the graft caused by endothelial thickening. This response occurs more commonly, but not exclusively, in recipients who have experienced an acute rejection. Therefore, chronic rejection may be a longterm consequence of acute rejection, a low-grade indolent immune reaction, or a combination of both processes.

Relevant Anatomy
See Pathophysiology.

Contraindications
Obtain a thorough history from all potential pediatric recipients of kidney transplants. Children with acute or chronic active infection and those with malignancy are not generally candidates for kidney transplantation. Most centers consider transplantation in a child who has been disease free for 2 years following treatment of cancer. Transplantation is also contraindicated in any child or family with a history or high likelihood of noncompliance with a prescribed medication regimen. Active systemic lupus erythematosus and Goodpasture disease are also contraindications to transplantation because these processes can damage an allograft. Children with renal failure from focal segmental glomerulosclerosis,

membranoproliferative glomerulonephritis, systemic lupus erythematosus, hemolytic-uremic syndrome, and Henoch-Schnlein purpura are at increased risk of recurrence following transplantation. Although this increased risk does not necessarily contraindicate transplantation, it can have a significant impact on organ survival and function. Counsel families accordingly. The success rate of renal transplantation in very young children, especially those younger than 1 year, is significantly less than that in older children. Therefore, carefully evaluate all alternatives for treatment of end-stage renal disease (ESRD). Generally, continuous ambulatory peritoneal dialysis (CAPD) is the preferred method of treatment of children younger than 1 year. However, CAPD may not be possible because of peritoneal scarring. Hemodialysis is difficult in very small children. In such persons, transplantation may be the best option.

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References
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43. Chugh KS, Sakhuja V, Jain S, et al. Fungal infections in renal allograft recipients. Transplant Proc. Oct 1992;24(5):1940-2. [Medline]. 44. Tolkoff-Rubin NE, Rubin RH. Opportunistic fungal and bacterial infection in the renal transplant recipient. J Am Soc Nephrol. Jun 1992;2(12 Suppl):S264-9. [Medline]. 45. Neu AM, Fivush BA. Recommended immunization practices for pediatric renal transplant recipients. Pediatr Transplant. Nov 1998;2(4):263-9. [Medline]. 46. Enke BU, Bokenkamp A, Offner G, et al. Response to diphtheria and tetanus booster vaccination in pediatric renal transplant recipients. Transplantation. Jul 27 1997;64(2):237-41. [Medline]. 47. [Best Evidence] Mathew JL, El Dib R, Mathew PJ, Boxall EH, Brok J. Hepatitis B immunisation in persons not previously exposed to hepatitis B or with unknown exposure status. Cochrane Database Syst Rev. Jul 16 2008;CD006481. [Medline]. 48. American Academy of Pediatrics. Report of the committee on infectious diseases. Pickering LK, Baker CJ, McMillan M, Long S (Editors). Red Book. 27th Edition. 2006. 49. Penn I. Incidence and treatment of neoplasia after transplantation. J Heart Lung Transplant. Nov-Dec 1993;12(6 Pt 2):S328-36. [Medline]. 50. Mongeau JG, Clermont MJ, Robitaille P, et al. Study of psychosocial parameters related to the survival rate of renal transplantation in children. Pediatr Nephrol. Oct 1997;11(5):542-6. [Medline]. 51. Birk PE, Matas AJ, Gillingham KJ, et al. Risk factors for chronic rejection in pediatric renal transplant recipients--a single-center experience. Pediatr Nephrol. Aug 1997;11(4):395-8. [Medline]. 52. Pape L, Offner G, Ehrich JH, et al. Renal allograft function in matched pediatric and adult recipient pairs of the same donor. Transplantation. Apr 27 2004;77(8):11914. [Medline]. 53. Benfield MR, McDonald R, Sullivan EK, et al. The 1997 Annual Renal Transplantation in Children Report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). Pediatr Transplant. May 1999;3(2):152-67. [Medline]. 54. Davis ID, Bunchman TE, Grimm PC, et al. Pediatric renal transplantation: indications and special considerations. A position paper from the Pediatric Committee of the American Society of Transplant Physicians. Pediatr Transplant. May 1998;2(2):11729. [Medline].

55. Goldstein SL, Somers MJ, Lande MB, et al. Acyclovir prophylaxis of varicella in children with renal disease receiving steroids. Pediatr Nephrol. Apr 2000;14(4):3058. [Medline]. 56. Hatch DA, Belitsky P, Barry JM, et al. Fate of renal allografts transplanted in patients with urinary diversion. Transplantation. Oct 1993;56(4):838-42. [Medline]. 57. Whitaker RH. Methods of assessing obstruction in dilated ureters. Br J Urol. Feb 1973;45(1):15-22. [Medline].
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Further Reading
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Keywords
kidney transplantation, transplant, kidney transplant, end-stage renal disease, ESRD, renal transplant, renal transplantation, kidney donation, dialysis, hemodialysis, glomerulonephritis, histocompatibility antigens, HLAs, kidney rejection, nephrectomy, systemic lupus erythematosus, Goodpasture syndrome, Goodpasture disease, focal segmental glomerulosclerosis, membranoproliferative glomerulonephritis, hemolytic-uremic syndrome, Henoch-Schnlein purpura, continuous ambulatory peritoneal dialysis, CAPD, treatment, kidney failure, renal failure
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Contributor Information and Disclosures

Author

David Hatch, MD, Chief, Section of Pediatric Urology, Professor of Urology & Pediatrics, Departments of Urology and Pediatrics, Foster G McGaw Hospital and Loyola University of Chicago David Hatch, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Society of Transplant Surgeons, and American Urological Association Disclosure: Nothing to disclose.
Coauthor(s)

Rekha Agrawal, MD, Director, Division of Pediatric Nephrology, Professor, Department of Pediatrics, Loyola University Medical Center

Rekha Agrawal, MD is a member of the following medical societies: American Society of Pediatric Nephrology and International Society of Nephrology Disclosure: Nothing to disclose.
Medical Editor

Casimir F Firlit, MD, PhD, Attending Urologist, Department of Urology, Cardinal Glennon Children's Medical Center; Surgical Director, Pediatric Urology Specialists, PC, Cardinal Glennon Children's Medical Center Casimir F Firlit, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Society of Transplant Surgeons, American Urological Association, and Illinois State Medical Society Disclosure: Nothing to disclose.
Pharmacy Editor

Mary L Windle, PharmD, Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine Disclosure: Nothing to disclose.
Managing Editor

Brian F Gilchrist, MD, Surgeon-in-Chief of Pediatric Surgery, The Floating Hospital for Children at Tufts-New England Medical Center; Associate Professor, Department of Surgery, Tufts University School of Medicine Brian F Gilchrist, MD is a member of the following medical societies: American College of Surgeons, American Pediatric Surgical Association, and Society for Surgery of the Alimentary Tract Disclosure: Nothing to disclose.
CME Editor

Ron Shapiro, MD, Professor of Surgery, Robert J Corry Chair in Transplantation Surgery, Director, Kidney, Pancreas, and Islet Transplantation, Thomas E Starzl Transplantation Institute, University of Pittsburgh Medical Center Ron Shapiro, MD is a member of the following medical societies: American College of Surgeons, American Society of Transplant Surgeons, Association for Academic Surgery, Central Surgical Association, and Society of University Surgeons Disclosure: Astellas Honoraria Speaking and teaching; Brystol Meyer Squibb StemCell Data Monitoring Committee Consulting fee Review panel membership; Wyeth Honoraria Speaking and teaching; Stem Cells, Inc Consulting fee Review panel membership; Up To Date contracted Author; Medscape contracted Video Blogger

Chief Editor

Stuart M Greenstein, MD, Professor of Surgery, Albert Einstein College of Medicine; Consulting Surgeon, Department of Surgery, Division of Transplantation, Montefiore Medical Center Stuart M Greenstein, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Surgeons, American Society of Transplant Surgeons, American Society of Transplantation, Association for Academic Surgery, International College of Surgeons, Medical Society of New Jersey, National Kidney Foundation, New York Academy of Sciences, and Southeastern Surgical Congress Disclosure: Nothing to disclose.

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