Alarm Bells in Medicine DangerSymptoms inMedicine,Surgery andClinicalSpecialties Alarm Bells in Medicine Danger Symptoms in Medicine, Surgery and Clinical Specialties Nadeem Ali SpecialistRegistrar RoyalVictoriaInfirmary,Newcastle-upon-Tyne (cid:1)2005byBlackwellPublishingLtd BMJBooksisanimprintoftheBMJPublishingGroupLimited, usedunderlicence BlackwellPublishing,Inc.,350MainStreet,Malden,Massachusetts 02148-5020,USA BlackwellPublishingLtd,9600GarsingtonRoad,OxfordOX42DQ,UK BlackwellPublishingAsiaPtyLtd,550SwanstonStreet,Carlton,Victoria 3053,Australia TherightoftheAuthortobeidentifiedastheAuthorofthisWorkhasbeenasserted inaccordancewiththeCopyright,DesignsandPatentsAct1988. Allrightsreserved.Nopartofthispublicationmaybereproduced,storedina retrievalsystem,ortransmitted,inanyformorbyanymeans,electronic,mechanical, photocopying,recordingorotherwise,exceptaspermittedbytheUKCopyright, DesignsandPatentsAct1988,withoutthepriorpermissionofthepublisher. Firstpublished2005 LibraryofCongressCataloging-in-PublicationData Alarmbellsinmedicine:dangersymptomsinmedicine,surgery,andclinical specialties/[editedby]NadeemAli. p.;cm. Includesindex. ISBN-13:978-0-7279-1819-2(alk.paper:pbk.) ISBN-10:0-7279-1819-2(alk.paper:pbk.) 1.Symptoms–Handbooks,manuals,etc.2.Diagnosis,Differential–Handbooks, manuals,etc.I.Ali,Nadeem.II.Title. Dangersymptomsinmedicine,surgery,andclinicalspecialties.[DNLM:1.Diagnosis, Differential–Handbooks.2.SignsandSymptoms–Handbooks.3.MedicalHistory Taking–methods–Handbooks.4.PhysicalExamination–methods–Handbooks. WB39A3222005] RC69.A4452005 616.07’5–dc22 2005000980 ISBN-13:978-0-7279-1819-2 ISBN-10:0-7279-1819-2 AcataloguerecordforthistitleisavailablefromtheBritishLibrary Setin9.5/12ptPalatino bySPIPublisherServices,Pondicherry,India PrintedandboundinHarayana,IndiabyReplikaPressPvtLtd CommissioningEditor:MaryBanks DevelopmentEditor:VeronicaPock ProductionController:DebbieWyer ForfurtherinformationonBlackwellPublishing,visitourwebsite: http://www.blackwellpublishing.com Thepublisher’spolicyistousepermanentpaperfrommillsthatoperateasustainable forestrypolicy,andwhichhasbeenmanufacturedfrompulpprocessedusingacid- freeandelementarychlorine-freepractices.Furthermore,thepublisherensuresthat thetextpaperandcoverboardusedhavemetacceptableenvironmentalaccreditation standards. Contents Listofcontributors,viii Introduction,xiii Acknowledgement,xv Abbreviations,xvii Breastsurgery,1 AdeleFrancisandJillDietz Cardiology,5 MuzahirTayebjeeandGregoryLip Cardiothoracicsurgery,10 AhmedEl-GamelandPerttiAarnio Careoftheelderly,15 RoseAnneKenny,AndrewMcLarenandLaurenceRubenstein Dermatology,20 EmmaTophamandRichardStaughton Endocrinology,25 PetrosPerrosandKamalAl-Shoumer ENT,30 AdrianDrake-LeeandPeter-JohnWormald Gastroenterologyandcolorectalsurgery,34 RobertAllan,JohnPlevrisandNigelHall v vi CONTENTS Genitourinarymedicine,39 SimonBartonandRichardHillman Gynaecology,44 MartinNoelFitzGibbonandMarkRoberts Haematology,49 GrahamJacksonandPatrickKesteven Hepatologyandhepatobiliarysurgery,54 PeterHayes,KoshAgarwalandGennaroGalizia HIVmedicine,59 RichardHillmanandSimonBarton Immunology,63 GavinSpickettandJavierCarbone Metabolicmedicine,68 JonathonBodanskyandSadafFarooqi Neurology,73 AndrewLarner,GrahamNiepelandCrisConstantinescu Neurosurgery,78 StanaBojanic,RichardKerr,GuyWynne-JonesandJonathan Wasserberg Obstetrics,83 ChandrimaBiswas,ChristinaCotziasandPhilipSteer Oncology,89 RobinJonesandIanSmith Ophthalmology,93 NadeemAli,PhilipGriffithsandScottFraser Oralandmaxillofacialsurgery,99 JohnLangdonandRobertOrd CONTENTS vii Orthopaedics,104 FarhanAli,MikeHaytonandGaryMiller Paediatrics,109 MarthaFord-AdamsandSueHobbins Paediatricsurgery,115 MarkDavenportandSteinErikHaugen Plasticsurgery,119 SarahPape,NavinSinghandPaulManson Psychiatry,124 NirujAgrawalandStevenHirsch Renalmedicine,129 AndrewFryandJohnBradley Respiratorymedicine,133 ChrisStentonandJeremyGeorge Rheumatology,139 PaulEmery,LoriSiegelandRobertSanders Transplantation,144 DavidTalbotandChasNewstead UpperGIsurgery,149 MichaelGriffinandNickHayes Urology,153 JeremyCrewandBernardBochner Vascularsurgery,158 GerardStansby,ShervanthiHomer-VanniasinkamandMohan Adiseshiah Index,163 List of contributors PerttiAarnio KamalAl-Shoumer Professor, AssociateProfessorofMedicine, UniversityofTurku, KuwaitUniversity, ChiefoftheDepartmentofSurgery, HeadofDivisionofEndocrinology SatakuntaCentralHospital, andMetabolicMedicine, Pori,Finland MubarakAl-KabeerTeaching Hospital,Kuwait MohanAdiseshiah ConsultantVascularSurgeon, SimonBarton UCLHospitals, ClinicalDirector, London DepartmentofHIVandGU Medicine, KoshAgarwal ChelseaandWestminsterHospital, ConsultantHepatologist, London HonoraryClinicalSeniorLecturer, FreemanHospital, ChandrimaBiswas Newcastle-upon-Tyne SpecialistRegistrar, ChelseaandWestminsterHospital, NirujAgrawal London ConsultantNeuropsychiatristand HonorarySeniorLecturer, BernardBochner StGeorge’sHospitalMedical UrologicSurgeon, School,London MemorialSloan-KetteringCancer Center, FarhanAli NewYork,USA ClinicalResearchFellow, WritingtonHospital,Wigan JonathonBodansky ConsultantPhysician, NadeemAli SeniorClinicalLecturer, SpecialistRegistrar, ClinicalDirectorforDiabetesand RoyalVictoriaInfirmary, Endocrinology, Newcastle-upon-Tyne LeedsTeachingHospitalsNHS Trust RobertAllan ProfessorofGastroenterology, StanaBojanic QueenElizabethHospital, SpecialistRegistrar, Birmingham TheRadcliffeInfirmary,Oxford viii LIST OF CONTRIBUTORS ix JohnBradley PaulEmery ConsultantNephrologistandClin- ProfessorandHeadofthe icalDirectorofRenalServices, AcademicUnitofMusculoskeletal Addenbrooke’sHospital, Disease, Cambridge LeedsTeachingHospitalsNHS Trust JavierCarbone ClinicalImmunologist, SadafFarooqi GregorioMaran˜onHospital, ResearchFellow, Madrid Addenbrooke’sHospital, Cambridge CrisConstantinescu ProfessorandHeadofDivisionof MartinNoelFitzGibbon ClinicalNeurology, ConsultantGynaecologist, UniversityHospital, WordsleyHospital, Nottingham Stourbridge ChristinaCotzias MarthaFord-Adams SpecialistRegistrar, ConsultantPaediatrician, ChelseaandWestminsterHospital, King’sCollegeHospital, London London JeremyCrew AdeleFrancis ConsultantUrologist, ConsultantBreastSurgeon, TheChurchillHospital, QueenElizabethHospital, Oxford Birmingham MarkDavenport ScottFraser ConsultantPaediatricSurgeonand ConsultantOphthalmologist, Reader, SunderlandEyeInfirmary King’sCollege,London AndrewFry JillDietz SpecialistRegistrar, AssistantProfessorofSurgery, Addenbrooke’sHospital, WashingtonUniversitySchoolof Cambridge Medicine,USA GennaroGalizia AdrianDrake-Lee AssociateProfessorofSurgery, ConsultantENTSurgeon, SecondUniversityofNaples, QueenElizabethHospital, Italy Birmingham JeremyGeorge AhmedEl-Gamel ConsultantinRespiratory ConsultantCardiothoracicSurgeon, Medicine, King’sCollegeHospital, UCLHospitals, London London x LIST OF CONTRIBUTORS MichaelGriffin SueHobbins ProfessorofGastrointestinal ConsultantPaediatrician, Surgery, PrincessRoyalUniversityHospital, UniversityofNewcastle-upon-Tyne Farnborough PhilipGriffiths ShervanthiHomer- SeniorLecturerandConsultant Vanniasinkam Ophthalmologist, ProfessorofVascularSurgery, RoyalVictoriaInfirmary, LeedsGeneralInfirmary Newcastle-upon-Tyne GrahamJackson SteinErikHaugen ConsultantHaematologist, HeadofPaediatricSurgery, RoyalVictoriaInfirmary, St.Olav’sUniversityHospital, Newcastle-upon-Tyne Trondheim,Norway RobinJones NigelHall SpecialistRegistrar, ConsultantColorectalSurgeon, RoyalMarsdenHospital, Addenbrooke’sHospital, London Cambridge RoseAnneKenny NickHayes ProfessorofCardiovascular ConsultantSurgeon, Medicine, RoyalVictoriaInfirmary, ConsultantinGeriatricMedicine, Newcastle-upon-Tyne RoyalVictoriaInfirmary, Newcastle-upon-Tyne PeterHayes ProfessorofHepatology, RichardKerr LiverUnit, ConsultantNeurosurgeon, RoyalInfirmary,Edinburgh TheRadcliffeInfirmary, Oxford MikeHayton ConsultantOrthopaedicSurgeon, PatrickKesteven WritingtonHospital,Wigan ConsultantHaematologist, FreemanHospital, RichardHillman Newcastle-upon-Tyne SeniorLecturer, SexuallyTransmittedInfections JohnLangdon ResearchCentre, EmeritusProfessor, UniversityofSydney,Australia FormerlyHeadofOraland MaxillofacialSurgery, StevenHirsch King’sCollege,London ProfessorofPsychiatryandHead ofTeachingGovernance, AndrewLarner WestLondonMentalHealthTrust, ConsultantNeurologist, CharingCrossHospital, WaltonCentreforNeurologyand London Neurosurgery,Liverpool