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ISBN: 978-1-4160-6383-4 Order your copies today! 1-800-545-2522 www.elsevierhealth.com ANDREOLI and CARPENTER’S C e c i l E s s e n t i a l s o f MEDICINE 8th EDITION This page intentionally left blank ANDREOLI and CARPENTER’S C e c i l E s s e n t i a l s o f MEDICINE 8th EDITION Editor-in-Chief THOMAS E. ANDREOLI, MD, MACP, FRCP (Edin.), FRCP (London), ScD (hon.), Docteur (hon.), MD (hon.)† Distinguished Professor Nolan Chair Emeritus Department of Internal Medicine Department of Physiology and Biophysics University of Arkansas College of Medicine Little Rock, Arkansas (†Deceased) Editors Ivor J. Benjamin, MD, FACC, FAHA Professor of Medicine Adjunct Professor of Biochemistry Christi T. Smith Endowed Chair for Cardiovascular Research Director, Center for Cardiovascular Translational Biomedicine University of Utah School of Medicine Salt Lake City, Utah Robert C. Griggs, MD, FACP, FAAN Professor of Neurology, Medicine, Pediatrics, and Pathology and Laboratory Medicine University of Rochester School of Medicine and Dentistry Rochester, New York Edward J. Wing, MD, FACP, FIDSA Dean of Medicine and Biological Sciences The Warren Alpert Medical School of Brown University Providence, Rhode Island 1600 John F. Kennedy Blvd. Ste 1800 Philadelphia, PA 19103-2899 ANDREOLI AND CARPENTER ’ S CECIL ESSENTIALS OF MEDICINE ISBN: 978-1-4160-6109-0 International Edition ISBN: 978-0-8089-2428-9 Copyright © 2010 Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher ’ s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions . This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notices Knowledge and best practice in this fi eld are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identifi ed, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Previous editions copyrighted 2007, 2004, 2001, 1997, 1993, 1990, 1986 by Saunders, an imprint of Elsevier Inc. Library of Congress Cataloging-in-Publication Data Andreoli and Carpenter ’ s Cecil essentials of medicine / editor-in-chief, Thomas E. Andreoli; editors, Ivor J. Benjamin, Robert C. Griggs, Edward J. Wing. — 8th ed. p. ; cm. Includes bibliographical references and index. ISBN 978-1-4160-6109-0 1. Internal medicine — Textbooks. I. Andreoli, Thomas E., 1935-2009 II. Cecil, Russell L. (Russell La Fayette), 1881-1965. III. Title: Cecil essentials of medicine. IV. Title: Essentials of medicine. [DNLM: 1. Internal Medicine. WB 115 A559 2010] RC46.C42 2010 616 — dc22 Cover: Hemoglobin subunit: Phantatomix / Photo Researchers, Inc.; False-color (computer graphics) photograph of a resin cast of the human bronchial tree, the network of airways serving both lungs: Alfred Pasieka / Photo Researchers, Inc.; DNA: Dr. A. Lesk, MRC-LMB / Photo Researchers, Inc.; Osteoarthritis of foot, X-ray: DR P. MARAZZI / Photo Researchers, Inc. Acquisitions Editor: James Merritt Managing Editor: Rebecca Gruliow Publishing Services Manager: Linda Van Pelt Project Manager: Sharon Lee Design Direction: Steven Stave Printed in China Last digit is the print number: 9 8 7 6 5 4 3 2 1 Working together to grow libraries in developing countries www.elsevier.com | www.bookaid.org | www.sabre.org 2009027158 Dedication Thomas E. Andreoli When Dr. Thomas Andreoli died of a cere- bral hemorrhage on April 14, 2009, he had nearly completed the editorial oversight of this, the eighth edition of the textbook he co-founded in 1986. In many ways this text- book epitomizes his career as an educator, clinical scientist, and international leader of the medical profession. As an outstanding, life-long investigator in his chosen field of nephrology, Dr. Andreoli served as president of both national and international medical societies and was rec- ognized by honorary doctoral degrees from both European and American universities. As a dedicated bedside clinician and teacher, Dr. Andreoli served as an outstanding chair of medicine, and endowed chairs in his name were established at both the University of Alabama School of Medicine and the University of Arkansas College of Medicine. His superlative teaching was recognized by his receiving, inter alia, the Louis Pasteur Award from the University Louis Pasteur, Mastership of the American College of Physicians, and the Robert H. Williams Distinguished Chair of Medicine Award from the Association of Professors of Medicine. Perhaps Dr. Andreoli’s most distinguished contribution was his lifelong Oslerian devotion to translating medical science from bench to bedside. Despite his major national and international commitments, he continued throughout his career to hold morning resident teaching rounds five times weekly, maintaining a broad knowledge of all aspects of internal medicine and genuinely and gently transmitting that knowledge to two generations of medical students. He was uniquely qualified for, and committed to, imparting his wisdom and skill as a physician, which provided the basis for his serving as a founding editor of Essentials of Medicine, and editor-in-chief of its last three editions. We feel immensely privileged to have been his co-editors and friends, and we dedicate this text to Dr. Thomas Andreoli. Charles C. J. Carpenter, MD, MACP Professor of Medicine Brown Medical School Director, Brown University AIDS Center Providence, Rhode Island Clementine M. Whitman No tribute to Dr. Andreoli’s accomplishments would be complete without acknowledging the contributions of Clementine Whitman, his personal assistant of 40 years, who moved with him from Alabama to Texas and to Arkansas. Clementine was the hub of Dr. Andreoli’s professional and personal life, meticulously handling every detail. Dr. Andreoli, a man as demanding of others as of himself, was indeed blessed and fortunate to have such a talented, dedicated, loyal, and hard-working person by his side. Sudhir V. Shah, MD, FACP Professor of Medicine Director, Division of Nephrology University of Arkansas College of Medicine Little Rock, Arkansas Chief, Renal Section, Medicine Service John L. McClellan Memorial Veterans Hospital Little Rock, Arkansas This page intentionally left blank Andreoli and Carpenter’s Cecil Essentials of Medicine International Advisory Board NAME DISCIPLINE COUNTRY Professor J. S. Bajaj Chief Consultant and Director Department of Diabetes, Endocrine and Metabolic Medicine Batra Hospital and Medical Research Centre New Delhi, India