Cecil Medicine

1991·367.89 MB·English

by  Lee Goldman

Goldman: Cecil Medicine, 23rd ed.
Copyright © 2007 Saunders, An Imprint of Elsevier
Cecil MEDICINE
Twenty-Third Edition
EDITED BY:
LEE GOLDMAN, MD
Executive Vice President for Health and Biomedical Sciences, Columbia University
Dean, Faculties of Health Sciences and Medicine, Columbia University Medical Center, New
York, New York
DENNIS AUSIELLO, MD
Jackson Professor of Medicine, Harvard Medical School
Physician-in-Chief, Massachusetts General Hospital, Boston, Massachusetts
SAUNDERS ELSEVIER
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CECIL MEDICINE, 23rd EDITION
ISBN: 978-1-4160-2805-5 (Expert Consult)
978-1-4160-4478-9 (Expert Consult Premium Ed.)
978-0-8089-2377-0 (International Ed.)
Copyright © 2008, 2004, 2000, 1996, 1991, 1988, 1982, 1979, 1975, 1971, 1963, 1959,
1955 by Saunders, an imprint of Elsevier Inc.
Copyright 1951, 1947, 1943, 1940, 1937, 1933, 1930, 1927 by Saunders, an imprint of
Elsevier Inc.
Copyright renewed 1991 by Paul Beeson.
Copyright renewed 1979 by Russell L. Cecil and Robert F. Loeb.
Copyright renewed 1987, 1975, 1971, 1965, 1961, 1958, 1955 by Elsevier Inc.
Page 168
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Notice
Knowledge and best practice in this field are constantly changing. As new research and
experience broaden our knowledge, changes in practice, treatment, and drug therapy
may become necessary or appropriate. 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 Editors assume any liability for any injury and/or damage to persons or property
arising out of or related to any use of the material contained in this book.
The Publisher
Library of Congress Cataloging-in-Publication Data
Cecil medicine / [edited by] Lee Goldman, Dennis Ausiello.—23rd ed.
p.; cm.
Includes bibliographical references and index.
ISBN 987-1-4160-2805-5 [Expert Consult]; 978-1-4160-4478-9 [Expert Consult Premium
Ed.]; 978-0-8089-2377-0 [International Ed.]
1. Internal medicine. I. Cecil, Russell L. (Russell La Fayette), 1881–1965. II. Goldman,
Lee, MD. III. Ausiello, D. A. IV. Title: Textbook of medicine.
[DNLM: 1. Medicine. WB 100 C38888 2008]
RC46.C423 2007
616–de22
Page 169
2006047505
Publishing Director: Kimberly Murphy
Senior Acquisitions Editor: Rolla Couchman
Developmental Editor: Heather Krehling
Publishing Services Manager: Frank Polizzano
Project Manager: Lee Ann Draud
Design Direction: Steve Stave
Printed in the United States of America
Last digit is the print number: 9 8 7 6 5 4 3 2 1
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Goldman: Cecil Medicine, 23rd ed.
Copyright © 2007 Saunders, An Imprint of Elsevier
Associate Editors
WILLIAM P. AREND, MD
Endowed Chair in Rheumatology, University of Colorado School of Medicine, Aurora, Colorado
Principles of Immunology and Inflammation
Diseases of Allergy and Clinical Immunology
Rheumatic Disease
JAMES O. ARMITAGE, MD
Professor, Internal Medicine, Section of Hematology & Oncology, University of Nebraska
College of Medicine, Section of Hematology and Oncology, University of Nebraska Medical
Center, Omaha, Nebraska
Hematologic Diseases
Oncology
DAVID R. CLEMMONS, MD
Chief, Division of Endocrinology and Metabolism, Sarah Graham Kenan Professor of Medicine,
University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
Metabolic Diseases
Nutritional Diseases
Endocrine Diseases
Women's Health
Diseases of Bone and Mineral Metabolism
JEFFREY M. DRAZEN, MD
Distinguished Parker B. Francis Professor of Medicine, Harvard Medical School, Senior
Physician, Brigham and Women's Hospital, Editor-in-Chief, New England Journal of Medicine,
oston, Massachusetts
Respiratory Diseases
Critical Care Medicine
ROBERT C. GRIGGS, MD
Professor and Chair of Neurology, Professor of Medicine, Pediatrics, and Pathology and
Laboratory Medicine, University of Rochester School of Medicine and Dentistry,
Neurologist-in-Chief, Strong Memorial Hospital, Rochester, New York
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Neurology
NICHOLAS LaRUSSO, MD
Chair, Department of Internal Medicine, Charles H. Weinman Endowed Professor of Medicine
and Biochemistry/Molecular Biology, Distinguished Investigator of the Mayo Foundation,
Division of Gastroenterology, Mayo Clinic College of Medicine, Rochester, Minnesota
Gastrointestinal Diseases
Diseases of the Liver, Gallbladder, and Bile Ducts
Coordinating Editors
ELIZABETH FOSTER, Ed.M
Massachusetts General Hospital, Boston, Massachusetts
JANE NEWMAN, MA
Teaching Associate, Harvard Medical School, Director of Special Projects, Department of
Medicine, Massachusetts General Hospital, Boston, Massachusetts
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Goldman: Cecil Medicine, 23rd ed.
Copyright © 2007 Saunders, An Imprint of Elsevier
Preface
The 23rd Edition of Cecil Medicine symbolizes a time of extraordinary advances in
medicine and in technological innovations for the dissemination of information. This
textbook and its associated electronic products incorporate the latest medical knowledge in
formats that are designed to appeal to learners who prefer to access information in a variety
of ways.
The contents of Cecil have remained true to the tradition of a comprehensive textbook of
medicine that carefully explains the why (the underlying normal physiology and
pathophysiology of disease, now at the cellular and molecular as well as the organ level) and
the how (now frequently based on Grade A evidence from randomized controlled trials).
Descriptions of physiology and pathophysiology include the latest genetic advances in a
practical format that strives to be useful to the nonexpert. Medicine has entered an era when
the acuity of illness and the limited time available to evaluate a patient have diminished the
ability of physicians to satisfy their intellectual curiosity. As a result, the acquisition of
information, quite easily achieved in this era, is often confused with knowledge. We have
attempted to counteract this tendency with a textbook that not only informs but also
stimulates new questions and gives a glimpse of the future path to new knowledge. Grade A
evidence is specifically highlighted in the text and referenced at the end of each chapter. In
addition to the information provided in the textbook, the Cecil website supplies expanded
content and functionality. In many cases, the full articles referenced in each chapter can be
accessed from the Cecil website. The website is also continuously updated to incorporate
subsequent Grade A information, other evidence, and new discoveries.
The sections for each organ system begin with a chapter that summarizes an approach to
patients with key symptoms, signs, or laboratory abnormalities associated with dysfunction
of that organ system. As summarized in Table 1-1 , the text specifically provides clear,
concise information regarding how a physician should approach more than 100 common
symptoms, signs, and laboratory abnormalities, usually with a flow diagram or a table, or
both, for easy reference. In this way, Cecil remains a comprehensive text to guide diagnosis
and therapy, not only for patients with suspected or known diseases but also for patients
who may have undiagnosed abnormalities that require an initial evaluation.
Just as each edition brings new authors, it also reminds us of our gratitude to past editors
and authors. Previous editors of Cecil Medicine include a short but remarkably
distinguished group of leaders of American medicine: Russell Cecil, Paul Beeson, Walsh
McDermott, James Wyngaarden, Lloyd H. Smith, Jr., Fred Plum, and J. Claude Bennett.
As we welcome two new associate editors—David Clemmons and Nicholas LaRusso—we
also express our appreciation to Don W. Powell, Gordon N. Gill, and W. Michael Scheld,
editors from the previous edition on whose foundation we have built. We also would like to
thank Steven Calderwood and Scott Hammer, who served as consulting editors for the
Infectious Diseases and HIV/AIDS sections for this edition. Our returning associate editors
—William P. Arend, James O. Armitage, Jeffrey M. Drazen, and Robert C. Griggs—
continue to make critical contributions to the selection of authors and the review and
approval of all manuscripts. The editors, however, are fully responsible for the book as well
as the integration among chapters.
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The tradition of Cecil Medicine is that all chapters are written by distinguished experts in
each field. We are also most grateful for the editorial assistance in San Francisco of
Deborah Airo and Vida Lynum. In addition to editorial support, Jane Newman and
Elizabeth Foster in Boston brought us into the current century by developing a web-based
manuscript submission system that consolidated workflow for both authors and editors,
making our jobs much easier. These individuals have shown extraordinary dedication and
equanimity in working with authors and editors to manage the unending flow of
manuscripts, figures, and permissions. We thank Margaret Chesney, who helped update
Chapter 36 during Dr. Stephen Straus's terminal illness. We also thank Benjamin Lebwohl,
Kirsten O. Healy, Elizabeth C. Verna, and Shepard Weiner for their assistance with the
Grade A references and Suggested Readings. At Elsevier, Rolla Couchman, Heather
Krehling, Lee Ann Draud, and Frank Polizzano have been critical to the planning and
production process under the direction of Kimberly Murphy. Many of the clinical
photographs were supplied by Charles D. Forbes and William F. Jackson, authors of Color
Atlas and Text of Clinical Medicine, Third Edition, published in 2003 by Elsevier Science
Ltd. We thank them for graciously permitting us to include their pictures in our book. We
have been exposed to remarkable physicians in our lifetimes and would like to acknowledge
the mentorship and support of several of those who exemplify this paradigm—George
DeVito, John Ausiello, Robert H. Gifford, and Lloyd H. Smith, Jr. Finally, we would like to
thank our families—Jill, Jeff, Abigail, Daniel, and Robyn Goldman, and the Ausiello famiglia
and its newest member, Mia—for their understanding of the time and focus required to edit
a book that attempts to sustain the tradition of our predecessors and to meet the needs of
today's physician.
LEE GOLDMAN, MD
DENNIS AUSIELLO, MD
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Goldman: Cecil Medicine, 23rd ed.
Copyright © 2007 Saunders, An Imprint of Elsevier
Contributors
Nezam H. Afdhal, MD
Associate Professor of Medicine, Harvard Medical School
Chief of Hepatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
Diseases of the Gallbladder and Bile Ducts
Masood Akhtar, MD
Clinical Professor of Medicine, University of Wisconsin School of Medicine and Public Health
Section Head, Cardiovascular Disease Section, and Director, Clinical Cardiac Electrophysiology
and Cardiovascular Disease Fellowship, Aurora Sinai Medical Center
Director, Arrhythmia Service, Milwaukee Heart Institute, Milwaukee, Wisconsin
Cardiac Arrhythmias with Supraventricular Origin
Cem Akin, MD, PhD
Assistant Professor of Medicine, Department of Internal Medicine, Division of Allergy and
Immunology, University of Michigan Medical School, Ann Arbor, Michigan
Mastocytosis
Ban Mishu Allos, MD
Assistant Professor of Medicine and Preventive Medicine, Vanderbilt University School of
Medicine, Nashville, Tennessee
Campylobacter Infections
David Altshuler, MD, PhD
Associate Professor of Genetics and of Medicine, Harvard Medical School; Department of
Molecular Biology, Center of Human Genetic Research and Diabetes Unit, Massachusetts
General Hospital
Director, Program in Medical and Population Genetics, Broad Institute of Harvard and
Massachusetts Institute of Technology, Boston, Massachusetts
The Inherited Basis of Common Diseases
Michael J. Aminoff, MD, DSc
Professor of Neurology, University of California, San Francisco, School of Medicine
Attending Physician, University of California San Francisco Medical Center, San Francisco,
California
Approach to the Patient with Neurologic Disease; Mechanical and Other Lesions of the Spine,
Nerve Roots, and Spinal Cord
Jeffrey L. Anderson, MD
Professor of Internal Medicine, University of Utah School of Medicine
Associate Chief of Cardiology, LDS Hospital, Intermountain Healthcare, Salt Lake City, Utah
ST Segment Elevation Acute Myocardial Infarction and Complications of Myocardial
Infarction
Karl E. Anderson, MD
Professor, Departments of Preventive Medicine and Community Health, Internal Medicine, and
Pharmacology and Toxicology, University of Texas Medical Branch
Member, Medical Staff, University of Texas Medical Branch Hospital, Galveston, Texas
The Porphyrias
Larry J. Anderson, MD
Director, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases,
Centers for Disease Control and Prevention, Atlanta, Georgia
Coronaviruses
Nicholas Anthonisen, MD, PhD
Professor of Medicine and Dean Emeritus, University of Manitoba Faculty of Medicine;
Respiratory Hospital, Winnipeg, Manitoba, Canada
Chronic Obstructive Pulmonary Disease
Karen Antman, MD
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Provost, Boston University Medical Campus, and Dean, Boston University School of Medicine,
Boston, Massachusetts
Sarcomas of Soft Tissue
Aśok C. Antony, MD, FACP
Professor of Medicine, Indiana University School of Medicine
Attending Physician, Indiana University Hospitals and The Richard Roudebush Veterans Affairs
Medical Center, Indianapolis, Indiana
Megaloblastic Anemias
Michael A. Apicella, MD
Professor and Head, Department of Microbiology, University of Iowa Carver College of
Medicine, Iowa City, Iowa
Meningococcal Infections
Gerald B. Appel, MD
Professor of Clinical Medicine, Columbia University College of Physicians and Surgeons
Director of Clinical Nephrology, New York–Presbyterian Hospital, New York, New York
Glomerular Disorders and Nephrotic Syndromes
Frederick R. Appelbaum, MD
Professor and Head, Division of Medical Oncology, University of Washington School of
Medicine
Member and Director, Clinical Research Division, Fred Hutchinson Cancer Research Center,
Seattle, Washington
The Acute Leukemias
Gordon L. Archer, MD
Associate Dean for Research and Professor of Medicine and Microbiology/Immunology, Medical
College of Virginia Campus of Virginia Commonwealth University School of Medicine,
Richmond, Virginia
Staphylococcal Infections
William P. Arend, MD
Endowed Chair in Rheumatology, University of Colorado School of Medicine, Aurora, Colorado
Approach to the Patient with Rheumatic Disease
Paul M. Arguin, MD
Commander and Medical Epidemiologist, U.S. Public Health Service Commissioned Corps,
Atlanta, Georgia
Approach to the Patient before and after Travel
James O. Armitage, MD
Professor, Internal Medicine, Section of Hematology and Oncology, University of Nebraska
College of Medicine; Section of Hematology and Oncology, University of Nebraska Medical
Center, Omaha, Nebraska
Approach to the Patient with Lymphadenopathy and Splenomegaly; Non-Hodgkin's
Lymphomas; Venomous Snake Bites
Cheryl A. Armstrong, MD
Associate Professor, Department of Dermatology, University of Colorado at Denver and Health
Sciences Center, Denver, Colorado
Examination of the Skin and Approach to Diagnosing Skin Diseases
M. Amin Arnaout, MD
Professor of Medicine, Harvard Medical School
Chief, Nephrology Division, Massachusetts General Hospital, Boston, Massachusetts
Cystic Kidney Diseases
David Atkins, MD, MPH
Chief Medical Officer, Center for Outcomes and Evidence, Agency for Healthcare Research and
Quality, Rockville, Maryland
The Periodic Health Examination
Dennis Ausiello, MD
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Jackson Professor of Medicine, Harvard Medical School
Physician-in-Chief, Massachusetts General Hospital, Boston, Massachusetts
Approach to Medicine, the Patient, and the Medical Profession: Medicine as a Learned and
Humane Profession; Disorders of Sodium and Water Homeostasis
Ricardo Azziz, MD, MPH, MBA
Professor of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA
Chief, Division of Reproductive Endocrinology and Infertility, Cedars-Sinai Medical Center, Los
Angeles, California
Hirsutism
Bruce R. Bacon, MD
James F. King, MD, Endowed Chair in Gastroenterology, Professor of Internal Medicine, and
Director, Division of Gastroenterology and Hepatology, Saint Louis University School of
Medicine, St. Louis, Missouri
Iron Overload (Hemochromatosis)
Grover C. Bagby Jr., MD
Professor of Medicine, Oregon Health & Science University School of Medicine
Director, Oregon Health & Science University Cancer Center
Scientist, Portland Veterans Affairs Medical Center, Portland, Oregon
Leukopenia and Leukocytosis
Dean F. Bajorin, MD
Professor of Medicine, Weill Medical College of Cornell University
Attending Physician, Memorial Sloan-Kettering Cancer Center, New York, New York
Tumors of the Kidney, Bladder, Ureters, and Renal Pelvis
Laurence H. Baker, DO
Professor of Internal Medicine and Pharmacology, University of Michigan Medical School
Chairman, Southwest Oncology Group, Ann Arbor, Michigan
Bone Tumors: Primary and Metastatic Bone Lesions
Mark Ballow, MD
Professor of Pediatrics, School of Medicine and Biomedical Sciences, State University of New
York at Buffalo
Chief, Division of Allergy and Clinical Immunology, Women and Children's Hospital of Buffalo,
Buffalo, New York
Primary Immunodeficiency Diseases
Robert W. Baloh, MD
Professor of Neurology and Head and Neck Surgery, David Geffen School of Medicine at
UCLA
Attending Physician, UCLA Medical Center, Los Angeles, California
Neuro-ophthalmology; Smell and Taste; Hearing and Equilibrium
Alan F. Barker, MD
Professor of Medicine, Oregon Health & Science University School of Medicine, Portland,
Oregon
Bronchiectasis, Atelectasis, Cysts, and Localized Lung Disorders
Anna D. Barker, PhD
Deputy Director, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
Cancer Biomarkers
A. James Barkovich, MD
Professor of Radiology, Neurology, Pediatrics, and Neurosurgery, University of California, San
Francisco, School of Medicine, San Francisco, California
Congenital, Developmental, and Neurocutaneous Disorders
Richard J. Barohn, MD
Professor of Neurology, University of Kansas School of Medicine
Chairman, Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas
Muscle Diseases
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