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Harrison's

PRINCIPLES
OF INTERNAL
MEDICINE
Eleventh Edition

Editors
EUGENE BRAUNWALD, A.B., M.D., MA.
(Hon.), M.D. (Hon.) Hersey Professor of the Theory
and Practice of Physic and Herman Ludwig Blumgart
Professor of Medicine, Harvard Medical School;
Chairman, Department of Medicine, Brigham and
Women's and Beth Israel Hospitals, Boston

KURT J. ISSELBACHER, A.B., M.D.


Mallincrodt Professor of Medicine, Harvard Medical
School; Physician and Chief, Gastrointestinal Unit,
Massachusetts General Hospital, Boston

ROBERT G. PETERSOORF, A.B., M.D., MA.


(Hon.), D.Sc. (Hon.), M.D. (Hon.), LH.D. (Hon.)
Professor of Medicine, Dean and Vice Chancellor,
Health Sciences, University of California School of
Medicine, San Diego, La Jolla

JEAN D. WILSON, M.D.


Professor of Internal Medicine, The University of Texas
Southwestern Medical School, Dallas
J O S E P H B. M A R T I N , M.D,, Ph.D.. F.R.C.P.(C),
M.A. (Hon.) Julieanne Dorn Professor of Neurology,
Harvard Medical School; Chief, Neurology Service,
Massachusetts General Hospital, Boston

ANTHONY S. FAUCI, M.D.


Chief, Laboratory of Immunoregulation and Director,
National Institute of Allergy and Infectious Diseases,
National Institutes of Health, Bethesda

MCGRAW-HILL BOOK COMPANY


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410804000024
039(01)93

7092

ISBN 5225005993
ISBN 0071001344

54.1

1987 by McGraw - Hill Book Company


3. . , . . , . . , . . , . . , . . , . . ,;
, 1993

26

1. ()

27

2. .
(Lee Goldman)

36

I.

51

3. . , . (Raymond Maciewicz,
Joseph . Martin)

4.

51

(Eugene Braunwald)
5. . (William Silen) .

62
.

75

6. . . , .
(Raymond D. Adams, Joseph . Martin)
7. . . ,

82

. (Henry J. Mankin, Raymond D. Adams)

101

2.

123

8. . . ,
. (Robert G. P.etersdorf, Richard . Root)
9. . . ,

123

. (Robert G. Petersdorf, Richard . Root)


3.

10.
. . (Joseph . Martin) . .
11.
. . (Edwin H.
Cassem)
12. , , . .
, . (Raymond D. Adams, Joseph .
Martin)

138
155
155
160
170
5

13. . .
(Shirley H. Wray)

14. . .
(Robert . Daroff)

199

15. . X. , . (John H. Growdon, Robert R. Young) . .

205

16. ,
(Sid Gilman)

231

17. , , .
. (Robert . Griggs)

240

18. ,
. (Arthur . Asbury)

247

19. , .
. , . ( J a m e s . Snow, Joseph .
Martin)

257

20. . .
, . , . (William J.
Schwartz, John W. Stakes, Joseph B. Martin)

267

21. . . , . (Allen H . Ropper, Joseph . Martin) . . . .

278

184

22. . . ,
. (Jay P. Mohr, Raymond D. Adams)

294

23. , , .
, . (Maurice Victor, Raymond D.
Adams)

309

24. .
. , (Raymond D. Adams, Maurice
Victor)

327

4.

335

25. . . , .
( G e n n a r o M. Tisi, Eugene Braunwald)

335

26. . X. , ., . (Roland H . Ingram, Jr., Eugene Braunwald) . . . .

341

27. , . . (Eugene
Braunwald)

350

28. . . (Eugene Braunwald)

360

29. . . ,
X. (Eugene Braunwald, Gordon H. Williams)
30. - .
. , . (Barton E. Sobel, Eugene Braunwald)

378

5.

391

368

31. . ( P a u l
Goldhaber)

391

32. . . (Raj . Goyal)

409

33. . . ,
. (Lawrence S. Friedman, Kurt J.
Isselbacher)

114

34. , . . (Kurt J.
Isselbacher)

421

35. . .
(Daniel U. Foster)

425

36. , .
. (Stephen E. Goldfinger)

430

37. , . . , . (Kurt J. Isselbacher, James


M. Richter)

438

38. . . (Kurt
J. Isselbacher)

445

39. . Mi , .
(Robert M. Glickman,, Kurt J. Isselbacher) . .

457

6.

465

40. . . (Frederick L.
)

465

41. . . (Norman G.
Levinsky)

483

42. . . (Norman G. Levinsky)

508

7.

528

43.
. . , . (Bruce R. Carr,
Jean D. Wilson)

523

44. . . , .
(Patrick . Walsh, Jean D. Wilson)

528

45. . (Peter
Reich)

536

46. . . , .
(William J. Kovacs, Jean D. Wilson)

545

551

Raymond D. Adams, . A., M. A., M. D., M. A. (Hon.), D. Sc. (Hon.), M. D.


(Hon.)
Bullard Professor of Neuropathology, Emeritus, Harvard Medical School; Consultant Neurologist and formerly Chief of Neurology Service, Massachusetts General
Hospital, Emeritus Director, Eunice K. Shriver Research Center, Boston; Meedecin
Adjoint, L'H6pital Cantinale de Lausanne, Lausanne
John W. Adamson, M. D.
Professor of Medicine and Head, Division of Hematology, Department of Medicine,
University of Washington School of Medicine, Seattle
Elliot Alpert, M D.
Professor of Medicine and Chief, Divison of Gastroenterology, Baylor College of
Medicine, Houston
Joseph S. Alpert, M. D.
Professor of Medicine, University of Massachusetts Medical School; Director, Division of Cardiovascular Medicine, University of Massachusetts Medical Center,
Worcester
Robert J. Anderson, M. D.
Associate Professor of Medicine, University of Colorado Health Sciences Center,
Denver
Jack P. Antel, M. D.
Associate Professor of Neurology, University of Chicago Pritzker School of Medicine, Chicago
Paul M. Arnow, M. D.
Associate Professor of Medicine, Section of Infectious Disease, University of Chicago Hospital and Clinics, Chicago
Arthur K. Asbury, M. D.
Ruth Wagner Van Meter and J. Ray Van Meter Professor of Neurology, University of Pennsylvania School of Medicine and Hospital of the University of Pennsylvania, Philadelphia
K. Frank Austen, M. D.
Theodore B. Bayles Professor of Medicine, Harvard Medical School; Physicianin-Chief, Robert B. Brigham Division and Chairman, Department of Rheumatology
and Immunology, Brigham and Women's Hospital, Boston
Robert Austrian, M. D., D. Sc. (Hon.)
John Iierr Musser Professor and Chairman, Department of Research Medicine,
University of Pennsylvania School of Medicine, Philadelphia
Bernard M. Babior, M. D., Ph. D.
Head, Division of Biochemistry, Department of Basic and Clinical Research, Scripps
Clinic and Research Foundation, La Jolla
Jeffrey P. Baker, M. D., F.R.C.P. (C)
Assistant Professor of Medicine, University of Toronto; Consultant Staff Gastroenterologist, Toronto Western Hospital, Toronto
8

M. Flint Beal, M. D.
Assistant Professor, Harvard Medical School; Assistant Neurologist, Massachusetts General Hospital, Boston
Harry N. Beaty, M. D.
Professor of Medicine and Dean, Northwestern University Medical School, Chicago
Arthur L. Beaudet, M. D.
Investigator, Howard Hughes Medical Institute; Professor of Pediatrics and Cell
Biology, Baylor College of Medicine, Houston
John E. Bennett, M. D.
Head Clinical Mycology Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda
Jeffrey D. Bernhard, M. D.
Assistant Professor of Medicine, Director, Division of Dermatology, and Director
of Phototherapy Center, Department of Medicine, University of Massachusetts
Medical Center, Worcester

Edwin L. Blerman, M. D.
Professor of Medicine and Chief, Division of Metabolism, Endocrinology, and Nutrition, University of Washington School of Medicine, Seattle
Alan B. Bisno, M. D.
Professor of Medicine and Chief, Division of Infectious Diseases, University of
Tennessee Center for the Health Sciences, Memphis
Henry R. Bourne, M. D.
Chairman, Department of Pharmacology, School of Medicine, University of California, San Francisco
Walter G. Bradley, D. M., F. R. . .
Chairman and Professor of Neurology, University of Vermont College of Medicine;
Chairman, Department of Neurology, University Health Center, Burlington
David L. Braff, M. D.
Associate Professor, Department of Psychiatry, School of Medicine, University
of California at San Diego; Director, Psychiatric Impatient Services, U.C. S. D.
Medical Center, San Diego
Eugene Braunwald, . ., M. D., M. A. (Hon.), M. D. (Hon.)
Hersey Professor of the Theory and Practice of Physic and Herrman Ludwig
Blumgart Professor of Medicine, Harvard Medical School; Chairman, Department
of Medicine, Brigham and Women's and Beth Israel Hospitals, Boston
Barry M. Brenner, B. S., M. 0., M. A. (Hon.)
Samuel A. Levine Professor of Medicine, Harvard Medical School; Senior Physician
and Director, Renal Division, Brigham and Women's Hospital, Boston
Karen Thatcher Britten, M. D., Ph. D.
Assistant Professor of Psychiatry, School of Medicine, University of California
at San Diego, La Jolla
Samuel Proder, M. D.
Associate Director, Clinical Oncology Program, Division of Cancer Treatment
and Deputy Clinical Director, National Cancer Institute, National Institutes of
Health, Bethesda
Michael S. Brown, M. D.
Paul J. Thomas Professor, Department of Molecular Genetics, The University of
Texas Health Science Center, Dallas
H. Franklin Bunn, M. D.
Professor of Medicine, Harvard Medical School; Senior Physician and Director,
Hematology Research, Brigham and Women's Hospital; Investigator, Howard
Hughes Medical Institute, Boston

John Burton, M. D.
Associate Professor of Medicine, Johns Hopkins University School of Medicine;
Deputy Director of Department of Medicine, Director of Division of Geriatric Medicine, Francis Scott Key Medical Center, Baltimore
Alfred E. Buxton, M. D.
Assistant Professor of Medicine, University of Pennsylvania School of Medicine;
Director, Cardiac Electrophysiology Laboratory, Hospital of the University of
Pennsylvania, Philadelphia
Charles B. Carpenter, M. D.
Professor of Medicine, Harvard Medical School; Senior Physician, Brigham and
Women's Hospital, Boston
Charles C. J. Carpenter, M. D.
Professor of Medicine, Brown University; Physician-in-Chief, The Miriam Hospital,
Providence
Bruce R. Carr, M. D.
Associate Professor, Department of Obstetrics and Gynecology and Cecil and Ida
Green Center for Reproductive Biology Sciences, The University of Texas Health
Science Center, Dallas
Edwin Cassem, M. D.
Associate Professor of Psychiatry, Harvard Medical School; Chief, Psychiatric
Consultation Liason Service, Massachusetts General Hospital, Boston
Richard Champlin, M. D.
Associate Professor of Medicine and Director, Leukemia/Bone Marrow Transplant
Service, School of Medicine, University of California at Los Angeles
Keith H. Chiappa, M. D.
Assistant Professor of Neurology, Harvard Medical School; Director, EEG and
Evoked Potentials Unit of the Clinical Neurophysiology Laboratory and Department of Neurology, Massachusetts General Hospital, Boston
Wallace A. Clyde. Jr., M. D.
Professor of Pediatrics and Microbiology, University of North Carolina School
of Medicine, Chapel Hill
Fredric L. , . D.
Professor of Medicine and Physiology and Chief, Nephrology Program, University
of Chicago Pritzker School of Medicine, Chicago
Alan S. Cohen-, M. D.
Chief of Medicine and Director, Thorndike Memorial Laboratory, Boston City Hospital; Conrad Wesselhoeft Professor of Medicine, Boston University School of
Medicine, Boston
Harvey R. Cotten, M. D.
Professor and Chairman, Department of Pediatrics, Washington University School
of Medicine, St. Louis
Wilson S. Colucci, M. D.
Assistant Professor of Medicine, Harvard Medical School; Associate Physician,
Brigham and Women's Hospital, Boston
Patricia Come, M. D.
Assistant Professor of Medicine, Harvard Medical School; Director, Noninvasive
Cardiovascular Diagnostic Laboratory, Beth Israel Hospital, Boston
Max D. Cooper, M. D.
Professor of Pediatrics and Microbiology, Cellular Immunobiology Unit, The
University of Alabama in Birmingham, Birmingham
Richard A. Cooper, M. D.
Dean and Professor of Medicine, Medical College of Wisconsin, Milwaukee

Lawrence Corey, M. D.
Professor of Laboratory Medicine and Microbiology and Adjunct Professor of
Medicine and Pediatrics, University of Washington School of Medicine, Seattle
Ronarld G. Crystal, M. D.
Chief, Pulmonary Branch, National Heart, Lung and Blood Institute, National
Institutes of Health, Bethesda
John J. Cush, M. D.
Fellow in Rheumatology, Department of Internal Medicine, The University of Texas
Health Science Center, Dallas
David Dale, M. D.
Professor of Medicine and Dean, University of Washington School of Medicine,
Seattle
James E. Dalen M. D.
Professor and Chairman, Department of Medicine, University of Massachusetts Medical School; Physician-in-Chief, University of Massachusetts Hospital, Worcester
Thomas M. Daniel, M. D.
Professor of Medicine, Case Western Reserve University School of Medicine; Physician, University Hospitals of Cleveland, Cleveland
Gilbert H. Daniels, M. D.
Associate Professor of Medicine, Thyroid Unit, Massachusetts General Hospital,
Boston
Robert B. Daroff, M. D.
Gilbert W. Humphrey Professor and Chairman, Case Western Reserve University
School of Medicine, Director, Department of Neurology, University Hospitals of
Cleveland; Neurology Service, Cleveland Veterans Administration Medical Center, Cleveland
John R. David, M. D.
Professor of Medicine, Harvard Medical School; Chief, Division of Tropical Medicine, Robert B. Brigham Division of Brigham and Women's Hospital; John LaPorte Given Professor and Chairman, Department of Tropical Public Health,
Harvard School of Public Health, Boston
G. Robert DeLong, M. D.
Assistant Professor of Neurology, Harvard Medical School; Associate Neurologist
and Associate Pediatrician, Massachusetts General Hospital, Boston
Vincent T. DeVita, Jr., M. D.
Director, National Cancer Institute, National Institutes of Health, Bethesda
Marc A. Dichter, M. D., Ph. D.
Professor of Neurology, University of Pennsylvania School of Medicine, Philadelphia
Jules L. Dienstag, M. D.
Associate Professor of Medicine, Harvard Medical School; Assistant Physician,
Massachusetts General Hospital, Boston
Robert G. Dluhy, M. D.
Associate Professor of Medicine, Harvard Medical School; Associate Program
Director of the Clinical Research Center, Brigham and Women's Hospital, Boston
Raphael Dolin, M. D.
Professor of Medicine and Head, Infectious Diseases Unit, University of Rochester
School of Medicine and Dentistry, Rochester
Andrew G. Engel, M. D.
Professor of Neurology, Mayo Medical School; Department of Neurology, Mayo
Clinic, Rochester
Kenneth H. Falchuk, M. D.
Associate Professor of Medicine, Harvard Medical School; Bringham and Women's
Hospital, Boston
11

Anthony S. Fauci, M. D.

Chief, Laboratory;of Immunoregulation and Director, National Institute of Allergy


and Infectious Diseases, National Institutes of Health, Bethesda
Murray J. Favus, M. D.
Associate Professor of Medicine, University of Chicago Pritzker School of Medicine,
Chicago
Ralph D. Feigin, M. D.
Professor and Chairman, Department of Pediatrics, Baylor College of Medicine;
Physician-in-'Chief, Texas Children's Hospital, Houston
:
Bernard N. Fields, M. D.
Adele Lehman Professor and Chairman, Department of Microbiology and Molecular Genetics, Harvard Medical School; Professor of Medicine, Division of Infectious Diseases, Brigham and Women's Hospital, Boston
Alfred P. Fishman, M. D.
William Maul Measey Professor of Medicine, University of Pensylvania; Director,
Cardiovascular-Pulmonary Division, Hospital of the University of Pennsylvania,
Philadelphia
Thomas B. Fitzpatrick, M. D., Ph. D.
Edward Wigglesworth Professor of Dermatology and Chairman Department of
Dermatology, Harvard Medical School; Chief, Dermatology Service, Massachusetts
General Hospital, Boston
Daniel W. Foster, M. D.
Professor of Internal Medicine, The University of Texas Health Science Center,
Dallas
Michael M. Frank, M. D.
Chief, Laboratory of Clinical Investigation and Clinical Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda
Stanley D. Freedman, M. D.
Head, Division of Infectious Diseases, Scripps Clinic and Research Foundation;
Associate Clinical Professor of Medicine, University of California at San Diego, La
Jolla
Laurence S. Friedman, M. D.
Assistant Professor of Medicine, Jefferson Medical College and Thomas Jefferson
University Hospital, Philadelphia
Paul A. Friedman, M. D.
Associate Professor of Medicine and Pharmacology, Harvard Medical School; Associate Physician, Beth Israel Hospital, Boston
William F. Friedman, M. D.
J. H. Nicholson Professor of Pediatrics and Executive Chairman Department of
Pediatrics, Los Angeles Medical Center, University, of California, Los Angeles
Lawrence A. Frohman, M. D.
Professor of Medicine, Director of Division of Endocrinology and Metabolism, University of Cincinnati College of Medicine, Cincinnati
John I. Gallin, M. D.
Scientific Director, National Institute of Allergy and Infectious Diseases, National
Institutes of Health, Bethesda
Robert Gallo, M. D.
Chief, Laboratory of Tumor Cell Biology, Division of Cancer Treatment, National
Cancer Institute, National Institutes of Health, Bethesda
Pierce Gardner, M. D.
Professor of Medicine and Pediatrics, University of Chicago Pritzker School of
Medicine; Director, Infectious Diseases Training Program, University of Chicago
Medical Center, Chicago
12

Marc . Garnick, M. D.
Associate Professor of Medicine, Dana-Farber Cancer Institute, Harvard Medical
School; Associate Physician, Brigham and Women's Hospital, Boston
James L. German III, M. D.
Professor' (Genetics), Department of Pediatrics, Cornell University Medical College; Senior investigator and Director, Laboratory of Human Genetics, The New
York Blood Center, New York
Eloise R. Giblett, M. D.
Research Professor of Medicine, University of Washington School of Medicine;
Executive Director, Puget Sound Blood Center, Seattle
Bruce Gilllland, M. D.
Professor of Medicine and Laboratory Medicine, University of Washington School
of Medicine; Chief of Medicine, Pacific Medical Center, Seattle
J. Christian Gillin, M. D.
Professor of Psychiatry, University of California at San Diego, La Jolla
Sid Gilman, M. D.
Professor and Chairman, Department of Neurology, The University of Michigan
Medical Center, Ann Arbor
Richard J. Glassock, M. D.
Professor of Medicine, School of Medicine, University of California at Los Angeles;
Chairman, Department of Medjcine, Harbor-UCLA Medical Center, Torrance
Robert M. Glickman, M. D.
Samuel Bard Professor of Medicine, Columbia University College of Physicians
and Surgeons; Director, Medical Service, Presbyterian Hospital, New York
David W. Golde, M. D.
Professor of Medicine and Chief, Division of Hematology/Oncology, School of Medicine, University of California at Los Angeles, Los Angeles
Stephen E. Goldfringer, M. D.
Associate Professor of Medicine and Associate Dean of Continuing Education, Harvard Medical School; Physician, Gastrointestinal Unit, Massachusetts General Hospital, Boston
Paul Goldhaber, D. D. S.
Dean and Professor of Perinatology, Harvard School of Dental Medicine, Boston
Lee Goldman, M. 0.
Associate Professor of Medicine, Harvard Medical School; Assistant Physician-inChief, Brigham, and Women's Hospital, Boston
Joseph L. Goldstein, M. D.
Paul J. Thomas Professor and Chairman, Department of Molecular Genetics, The
University of Texas Health Science Center, Dallas
Raj K. Goyal, M. D.
Rabb Professor of Medicine, Harvard Medical School; Chief, Division of Gastroenterology, Beth Israel Hospital, Boston
John W. Graff, M. D.
Assistant Clinical Professor, Harvard Medical School; Director, The Lead/Toxicology Clinic, The Children's Hospital, Boston
Igor Grant, M. D.
Professor of Psychiatry, School of Medicine, University of California at San Diego,
La Jolla
:
Harry B. Greenberg, M. D.
Associate Professor of Medicine, Department of Medicine, Stanford University
Medical School; Palo Alto Veterans Administration Medical Center, Palo Alto

13

Norton J. Greenberger, M. D.
Peter T. Bohan, Professor and Chairman, Department of Medicine, University of
Kansas School of Medicine, Kansas City
James E. Griffin III, M. D.
Associate Professor of Internal Medicine, The University of Texas Health Science
Center, Dallas
Robert Griggs, M. D.
Professor of Neurology and Medicine, University of Rochester School of Medicine
and Dentistry, University of Rochester Medical Center, Rochester
John H. Growdon, M. D.
Associate Professor of Neurology, Harvard Medical School; Associate Neurologist,
Massachusetts Genetal Hospital, Boston
Richard L. Guerrant, M. D.
Professor of Medicine and Head, Division of Geographic Medicine, University of
Virginia School of Medicine, Charlottesville
Bevra Hannahs Hahn, M. D.
Professor of Medicine and Chief of Rheumatology, University of California, Los
Angeles
Robert I. Handin, M. D.
Associate Professor of Medicine, Harvard Medical School; Director, Hematology
Division, Brigham and Women's Hospital, Boston
H. Hunter Handsfield, M. D.
Director, Sexually Transmitted Disease Control Program, Seattle-King County
Department of Public Health; Associate Professor of Medicine, University of Washington School of Medicine, Seattle
James P. Harnish, M. D.
Clinical Associate Professor of Medicine, University of Washington School of Medicine; Chief of Dermatology, Pacific Medical Center, Seattle
Donald H. Harter, M. D.
Benjamin and Virginia T. Boshes Professor of Neurology and Chairman Department
of Neurology, Northwestern University Medical School; Chairman, Department
of Neurology, Northwestern Memorial Hospital, Chicago
Barton F. Haynes, M. D.
Associate Professor of Medicine and Assistant Professor of Microbiology and
Immunology, Duke University School of Medicine, Durham
Harley A. Haynes, M. D.
Associate Professor of Dermatology, Harvard Medical School; Director, Dermatology Division, Department of Medicine, Brigham and Women's Hospital; Chief,
Dermatology, West Roxbury Veterans Administration Hospital, Boston
William R. Hazzard, M. D.
Professor and Chair, Department of Medicine, Bowman-Gray School of Medicine,
Wake Forest University; Chief of Medicine, North Carolina Baptist Hospital, Winston-Safem
Steven C. Hebert, M. D.
Assistant Professor of Medicine, Harvard Medical School; Associate Physician,
Brigham and Women's Hospital, Boston
Fred J. Hendler, M. D., Ph. D.
Assistant Professor of Internal Medicine, Division of Hematology Oncology, The
University of Texas Health Science Center, Dallas
Jane Ellen Henney, M. D.
Associate Vice Chancellor and Associate Professor of Medicine, Division of Clinical
Oncology, Department of Medicine, University of Kansas Medical Center, Kansas
City
14

Raymond L. Hintz, M. D.
Professor of Pediatrics and Head, Division of Pediatric Endocrinology, Stanford
University School of Medicine, Stanford
Martin S. Hirsch, M. D.
Associate Professor, Harvard Medical School; Associate Physician,
Disease Unit, Massachusetts General Hospital, Boston

Infectious

Jan V. Hlrschmann, M. D.
Assistant Chief, Medical Service, Seattle Veterans Administration Medical Center,
Associater Professor of Medicine, University of Washington School of Medicine,
Seattle.
Fred Hochberg, M. D.
Associate Professor of Neurology, Harvard Medical School; Associate Neurologist,
Massachusetts General. Hospital, Boston
Paul D. Hoeprich, M. D
Professor of Medicine and Chief, Section of Medical Mycology, Department of
Internal Medicine, Division of Infectious and Immunologic Diseases, School of
Medicine, University of California, Davis
John H. Holbrook, M. D.
Associate professor of Medicine, Division of General Internal Medicine, Department of Medicine, University of Utah Medical Center, Salt Lake City
Michael F. Holick, M. D., Ph. D.
Professor of Physiology and Nutrition and Director of Vitamin D and Bone Metabolism Laboratory, U.S. Department of Agriculture/Human Nutrition Research
Center, Tufts University, Boston
Norman K. Hollenberg, M. D.
Professor of Radiology, Harvard Medical School; Physician, Brigham and Women's
Hospital, Boston
King K. Holmes, M. D., Ph. D.
Professor and Vice Chairman, Department of Medicine, University of Washington
School of Medicine; Chief of Medicine, Harborview Medical Center, Seattle
Thomas M. Hostetter, M. D.
Associate Professor of Medicine, University of Minnesota School of Medicine; Director, Division of Renal Diseases, University Hospital, Minneapolis
Leighton Y. Huey, M. D.
Associate Professor of Psychiatry, University of California at San Diego; Chief of
Psychiatry Service, San Diego Veterans Administration Medical Center, San Diego
Gary W. Hunninghake, M. D.
Professor of Internal Medicine and Director, Pulmonary Division, University of
Iowa College of Medicine, Iowa City
Sidney H. Ingbar, M. D., D. Sc.
William Bosworth Castle Professor of Medicine, Harvard Medical School; Director,
Thorndike Laboratory, Beth Israel Hospital, Boston
Roland H. Ingram, Jr., M. D.
Parker B. Francis Professor of Medicine, Harvard Medical School; Director, Respiratory Division, Brigham and Women's Hospital, Boston
Kurt J. Isselbacher, . ., . D.
Mallinckrodt Professor of Medicine, Harvard Medical School; Physician and Chief,
Gastrointestinal Unit, Massachusetts General Hospital, Boston
Khursheed N. Jeejeebhoy, M. B. B. S., Ph. D., F. R. P. (Lond.), F. R. P.
(Edin.), F. R. . ().
Professor of Medicine, University of Toronto; Director, Division of Gastroenterology, Toronto General Hospital, Toronto
15

Mark E. Josephson, M. D.
Professor of -Medicine, University of Pennsylvania School of Medicine; Chief, Cardiovascular Section, Hospital of the University of Pennsylvania, Philadelphia
Lewis L. Judd, M. D.
Professor and Chairman, Department of Psychiatry, School of Medicine, University of California at San Diego, LaJolla
Dennis L. Kasper, M. D.
Professor of Medicine, Harvard Medical School; Chief, Division of Infectious Diseases, Beth Israel Hospital; Associate Director, Channing Laboratory, Brigham
and Women's Hospital, Boston
Satish Kathpalia, M. D.
Assistant Professor of Medicine, University of Chicago Pritzker School of Medicine,
Attenting Physician, Michael Reese Hospital and Medical Center, Chicago
Donald Kaye, M. D., P. . . .
Professor and Chairman, Department of Medicine, Medical College of Pennsylvania; Chief of Medicine, Hospital of the Medical College of Pennsylvania, Philadelphia
William N. Kelley, M. D.
John G. Searle Professor and Chairman, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
Philip Kirby, M. D.
Instructor in Medicine, Division of Dermatology, University of Washington School
of Medicine, Seattle
J. Phillip Kistler, M. D.
Associate Professor of Neurology, Haevard Medical School; Associate Neurologist,
Massachusetts General Hospital, Boston
Raymond S. Koff, M. D.
Professor of Medicine, Boston University School of Medicine; Chief of Hepatology
Section, Boston University Medical Center; Chief of Medicine, Framinghani Union
Hospital, Framingham
William J. Kovacs, M. D.
Assistant Professor of Medicine, Division of Endocrinology, Vanderbit University
School of Medicine, Nashville
Stephen M. Krane, M. D.
Professor of Medicine, Harvard Medical School; Physician and Chief, Arthritis
Unit, Massachusetts General Hospital, Boston
J. Thomas LaMont, M. D.
Professor of Medicine, Boston University Medical Center, Chief, Gastrointestinal
Section, University Hospital, Boston
Lewis Landsberg, M. D.
Professor of Medicine, Harvard Medical School; Director, Division of Endocrinology
and Metabolism, Beth Israel Hospital, Boston
H. Clifford Lane, M. D.
Senior Investigator, Laboratory of Immunoregulation and Deputy Clinical Director, National Institute of Allergy and Infectious Diseases, National Institutes of
Health, Bethesda
Thomas J. Lawley, M. D.
Senior Investigator, Dermatology Branch, National Cancer Institute, National
Institutes of Health, Bethesda
Alexander R. Lawton, M. D.
Professor of Pediatrics and Microbiology, Division of Pediatric Immunology, Vanderbilt University School of Medicine, Nashville
16

J. Michael Lazarus, M. D.
Associate Professor of Medicine, Harvard Medical School; Physician, Brigham
and Women's Hospital, Boston
Norman G. Levinsky, M. D.
Wade Professor and Chairman, Division of Medicine, Boston University School
of Medicine; Physician-in-Chief and Director, Evans Memorial Department of Clinical Research, University Hospital, Boston
Peter E. Lipsky, M. D.
Professor of Internal Medicine and Microbiology and Chief, Division of Immunologic and Rheumatologic Diseases, Department of Internal Medicine; Director,
Harold Simmons Arthritis Research Center, The University of Texas Health
Science Center, Dallas
Richard M. Locksley, M. D.
Assistant Professor of Medicine, University of San Francisco; Chief of Infectious
Diseases, University of San Francisco Medical Center, Moffitt-Long Hospital, San
Francisco
Dan L. Longo, M. D.
Associate Director, Biological Response Modifiers Program, Division of Biology
and Diagnosis, National Cancer Institute-Frederick Cancer Research Facility, Frederick
Frederick H. Lovejoy, Jr., M. D.
Associate Professor, Harvard Medical School; Associate Physician-in-Chief, The
Children's Hospital; Director, Massachusetts Poison Control System, Boston
Sheila A. Lukehart, Ph. D.
Research Assistant Professor, Division of Infectious Diseases, University of Washington School of Medicine, Seattle
Walter MacDonald, M. D.
Chairman, GI Tumor Group, Cancer Control Agency of British Columbia, Vancouver
Raymond Maciewicz, M. D.
Assistant Professor of Neurology, Harvard Medical School; Assistant Neurologist,
Massachusetts General Hospital, Boston
Henry J. Man kin, M. D.
Edith M. Ashley Professor of Orthopedic Surgery, Harvard Medical School; Chief,
Orthopedic Services, Massachusetts General Hospital, Boston
Francis E. Marchlinski, M. D.
Assistant Professor of Medicine, University of Pennsylvania School of Medicine;
Director, Arrhythmias Evaluation Center, Hospital of the University of Pennsylvania, Philadelphia
Joseph B. Martin, M. D., Ph. D., F. R. . (), . A. (Hon.).
Julieanna Dorn Professor of Neurology, Harvard Medical School; Chief, Neurology Service, Massachusetts General Hospital, Boston
Henry Masur, M. D.
Deputy Chief, Critical Care Medicine, Clinical Center, National Institutes of Health, Bethesda
Roger J.' May, M. D.
Instructor in Medicine, Harvard Medical School; Assistant in Medicine, Beth Israel
Hospital, Boston
E. R. McFadden, Jr., M. D.
Argyl J. Beams Professor of Medicine and Director, Asthma and Allergic Disease
Center, Case Western Reserve University, Cleveland
James E. McGuigan, M. D.
Chairman, Department of Medicine, University of Florida College of Medicine,
Gainesville
17

Rima McLeoq , M. D.
Associate Professor of Medicine, University of Chicago Pritzker School of Medicine;
Attending Physician, Michael Reese Hospital and Medical Center, Chicago
Mark S. McPhee, M. D.
Clinical Associate Professor of Medicine and Director, Gastrointestinal Endoscopy
Unit, University of Kansas, Kansas City
Nancy K. Mello, Ph. D.
Professor of Psychology, Department of Psychiatry, Haevard Medical School; CoDirector, Alcohol and Drug Abuse Research Center, McLean Hospital, Belmont
Jerry R. Mendell, M. D.
Professor of Neurology, Ohio State University College of Medicine, Columbus
John Mendelsohn, M. D.
Chairman, Department of Medicine and Head, Division of Medical Oncology, Memorial Sloan-Kettering Cancer Center, Professor of Medicine, Cornell University
Medical College, New York
Jack H. Mendelson, M. D.
Professor of Psychiatry, Harvard Medical School; Co-Director Alcohol and Drug
Abuse Research Center, McLean Hospital, Belmont
Urs A. Meyer, M. D.
Professor of Pharmacology and Chairman, Department of Pharmacology, Biocenter of the University of Basel, Basel Switzerland
Martin Mihm, Jr., M. D.
Professor of Pathology, Harvard Medical School; Chief, Dermatopathology Unit;
Massachusetts General Hospital, Boston
Edgar L. Milford, M. D.
Assistant Professor of Medicine, Harvard Medical School; Associate Physician,
Brigham and Women's Hospital, Boston
Myron Miller, M. D.
Professor of Medicine; Division of Infectious Diseases, Pacific Medical Center,
Seattle
John D. Minna, M. D.
Chief, NCI-Navy Medical Oncology Branch, National Cancer Institute, National
Institutes of Health; Professor of Medicine, Uniformed Services University for
the Health Sciences, Naval Hospital, Bethesda
Jay P. Mohr, M. D.
Sciarra Professor of Clinical Neurology, College of Physicians and Surgeons of
Columbia University Neurological Institute, New York
Kenneth M. Moser, M. D.
Professor of Medicine, School of Medicine, University of California at San Diego;
Director, Pulmonary and Critical Care Division, U. C. S. D. Medical Center, San
Diego
Arnold M. Moses, M. D.
Professor of Medicine and Director, Clinical Research Center, State University of
New York Upstate Medical Center; Chief, Endocrinology Section, Veterans Administration Medical Center, Syracuse
David B. Mosher, M. D.
Clinical Instructor in Dermatology, Harvard Medical School; Assistant in Dermatology, Massachusetts General Hospital, Boston
Haralampos M. Moutsopoulos, M. D., F. A. C. P.
Professor and Head of Medicine, Medical School, University of
Ioannina, Greece
Frederick M. Murphy, M. D.
Fellow in Neonatology, Baylor School of Medicine, Houston
18

Ioannina,

John F. Murray, M. D., D. Sc. (Hon.)


Professor of Medicine, University of California at San Francisco; Chief, Chest
Service, San Francisco General Hospital, San Francisco
Robert J. Myerburg, M. D.
Professor of Medicine and Physiology and Director, Division-of Cardiology, University of Miami Medical Center, Miami
Theodore E. Nash, M. D.
Senion Scientist, Laboratory of Parasitic Diseases, National Institute of Allergy
and Infectious Diseases, National Institutes of Health, Bethesda
Paul Neiman, M. D.
Professor of Medicine, University of Washington School of Medicine; Member and
Associate Director for Basic Sciences, Fred Hutchinson Cancer Research Center,
Seattle
Harold Neu, M. D.
Professor of Medicine and Pharmacology and Chief, Division of Infectious Diseases, College of Physicians and Surgeons, Columbia University, New York
John A. Oates, M. D.
Professor and Chairman, Department of Medicine, Vanderbilt University School of
Medicine; Physician-in-Chief, Vanderbilt University Hospital, Nashvilla
Jerrold M. Olefsky, M. D.
Professor of Medicine and Head, Division of Endocrinology and Metabolism,
School of Medicine, University of California at San Diego, La Jolla
Robert A. O'Rourke, M. D.
Charles Conrad and Anna Sahm Brown Professor of Medicine, University of Texas;
Director, Division of Cardiovascular Diseases, The University of Texas Health
Science Center, San Antonio
Thomas D. Palella, M. D.
Assistant Professor of Internal Medicine, Division of Rheumatology, University of
Michigan Medical School, Ann Arbor
Darwin L. Palmer, M. D.
Professor of Medicine and Chief, Division of Infectious Disease, University of
New Mexico School of Medicine; Chief, Infectious Disease Section, Veterans Administration Medical Center, Albuquerque
John A. Parrish, M. D.
Professor of Dermatology, Harvard Medical School; Director, Wellman Research
Laboratory, Massachusetts General Hospital, Boston
A. William Pasculle, D. Sc.
Associate Professor of Pathology, University of Pittsburgh School of Medicine;
Associate Director of Microbiology, Presbyterian-University Hospital, Pittsburgh
Richard Pasternak, M. D.
Assistant Professor of Medicine, Harvard Medical School; Assistant Physician and
Director, Coronary Care Unit, Beth Israel Hospital, Boston
Maghukar A. Pathak, M. S., Ph. D.
Senior Associate in Dermatology, Harvard Medical School; Dermatology Service,
Massachusetts General Hospital, Boston
Richard D. Pearson, M. D.
Associate Professor of Medicine and Pathology, Division of Geographic Medicine,
University of Virginia School of Medicine, Charlottesville
Lawrence L. PelMier, Jr., M. D.
Professor of Medicine, University of' Kansas School of Medicine; Chief, Medical,
Service, Wichita Veterans Administration Medical Center, Wichita
Peter L. Perine, M. D., M. P. H.
Professor and Director, Division of Tropical Public Health and Professor of Medi19

cine, Uniformed Services University of the Health Sciences School of Medicine,


Bethesda

.
Robert G. Petersdorf, M. 0., M. A. (Hon.), D. Sc. (Hon.). M. D. (Hon.), L. H. D.
(Hon.)
;
Dean and Professor of Medicine and Vice Chancellor, Health Sciences, School of
Medicine, University of California at San Diego, La Jolla
Kirk L. Peterson, M. D.
,
. ,
Professor of Medicine, University of California at San Diego; Director, Cardiology
Service, U. S. D. Medical Center, San Diego
;

James J. Plorde, M. D.
< ;>
Professor, Departments of Medicine and Laboratory Medicine and Chief, .Clinical
Microbiology Laboratory, Veterans Administration Medical Center, .Seattle
Francis Allan Plumer, M. D., F. R. P. (C)
.
, , , , ...
Assistant Professor, Departments of Medicine and Medical Microbiology and Division of Community Medicine, University of Manitoba, Winnipeg
:
Daniel K . Podolsky, M . D .
.
.
.
Associate Professor of Medicine, Harvard Medical School; Assistant Physician,
Gastrointestinal Unit, Massachusetts General Hospital, Boston
John T. Potts, Jr., M. D.
Jackson Professor of Clinical Medicine, Harvard Medical School; Chief of the Generaf
Medical Service, Massachusetts General Hospital, Boston
Lawrie W. Powell, M. D.
,
Professor of Medicine, University of Queensland; Physician, Royal Brisbane Hospital, Brisbane, Australi
Darwin J. Prockop, . D., Ph. D.
Professor and Chairman, Department of Biochemistry, Jefferson Medical College of
Thomas Jefferson University; Director, Department of Biochemistry, Jefferson
Institute of Molecular Medicine, Philadelphia
Amy Pruitt, M. D.
Assistant Professor of Neurology, Harvard Medical School; Associate Neurologist,
Massachusetts General Hospital, Boston
.
Paul G. Ramsey, M. D.
Associate Professor of Medicine, Department of Medicine, .Univer'sity of Washington School of Medicine, Seattle
Joel M. Rappeport, M. D.
Associate Professor of Medicine, Harvard Medical School; Physician, Brigham and
Women's Hospital, Boston
George Ray, M. D.
Professor of Pathology and Pediatrics and Chief, Clinical Virology-Serology and
Pediatrics Infectious Diseases Sections, University of Arizona College ot Medicine,
Tucson
Peter Reich, M. D.
Professor of Psychiatry, Harvard Medical School; Chief of Psychiatry, Brigham
and Women's Hospital, Boston
Richard Reichman, M. D.
;;
Associate Professor of Medicine, Infectious Diseases Unit, University of Rochester
School of Medicine and Dentistry, Rochester
Jack S. Remington, M. D.
Chairman, Department of Immunology and Infectious Diseases, Research Institute,
Palo Alto Medical Foundation; Professor of Medicine, Division of Infectious Diseases, Stanford University School of Medicine, Palo Alto .
20

Edward P. Richardson, Jr., M. D.


Bullard Professor of Neuropathology, Harvard Medical School; Neurologist, Massachusetts General Hospital, Boston
Hal B. Richerson, M. D.
Professor of Internal Medicine and Director, Allergy-Immunology Division, University of Iowa College of Medicine, Iowa City
'
James M. Richter, M. D.
Assistant Professor of Medicine, Harvard Medical School, Assistant Physician,
Gastrointestinal Unit, Massachusetts General Hospital, Boston
Craig Risch, M. D.
Associate Professor of Psychiatry, School of Medicine, University of California at
San Diego, La Jolla
L. Jackson Roberts II, M. D.
Associate Professor of Medicine, Pharmacology, and Clinical Pharmacology, Vanderbilt University School of Medicine, Nashville
R. Paul Robertson, M. D.
Professor of Medicine, Director of Clinical Research Center, and Director, Diabetes
Center, University of Minnesota, Minneapolis
Allan R. Ronald, M. D.
H. F. Sellers Professor and Chairman, Department of Medicine, University of
Manitoba; Physician-in-Chief, Department of Medicine, Health Sciences Centre,
Winnipeg
Richard K. Root, M. D.
Professor and Chairman, Department of Medicine, University of California, San
Francisco
Allan H. Ropper, M. D.
Associate Professor of Neurology, Harvard Medical School; Director of Neurological/Neurosurgical Intensive Care Unit and Assistant Neurologist, Massachusetts
General Hospital, Boston
Leon E. Rosenberg, M. D.
Dean and C. N. H. Long Professor of Human Genetics, Medicine, and Pediatrics,
Yale University School of Medicine, New Haven
Michael Rosenblatt, M. D.
Vice President for Biological Research, Merck, Sharp and Dohme Research Laboratories, Wes Point
John Ross, Jr., M. D.
Professor of Medicine and Head, Division of Cardiology, School of Medicine, University of California at San Diego; Attending Physician, U. S. D., Medical Center, San Diego
Arthur H. Rubensteln, M. O.
Professor and Chairman, Department of Medicine, University of Chicago Pritzker
School of Medicine, Chicago
Cyrus E. Rubin, M. D.
Professor of Medicine and Adjunct Professor of Pathology, Division of Gastroenterology, University of Washington School of Medicine, Seattle
Daniel Rudman, M. D.
Chief, Geriatric Medicine Division and Chief of Staff, Veterans Administration
Medical Center; Professor of Medicine, University Health Science Center, Chicago
Medical School, Chicago
Arthur I. Sagalowsky, M. 0.
Associate Professor of Urology and Surgical Director of Renal Transplantation,
The University of Texas Health Science Center, Dallas
21

Jay P. Sanford, M. D.

Professor of Medicine and Dean, F. Edward Hebert School of Medicine; President,


Uniformed Services University of the Health Sciences, Bethesda
. Dennis R. Schaberg, M. D.
Associate Professor of Medicine, University of Michigan, Ann Arbor
Andrew I. Schafer, M. D.

Assistant Professor of Medicine, Harvard Medical School; Associate Physician,


Brigham and Women's Hospital, Boston
I. Herbert Scheinberg, M. D.
Professor of Medicine and Head, Division of Genetic Medicine, Albert Einstein
College of Medicine; Attending Physician, Hospital of the Albert Einstein College
of Medicine, New York
Alan L. Schiller, M. D.

Associate Professor of Pathology, Harvard Medical School; Associate Pathologist


and Chief, Autopsy Pathology and Bone Laboratory, Massachusetts General Hospital, Boston
Rudi Schmid, M. D.

Professor of Medicine and Dean, School of Medicine, University of California, San


Francisco
R. Neil Schimke, M. D.

Professor of Pediatrics and Internal Medicine and Director, Division of Metabolism,


Endocrinology, and Genetics, The University of Kansas College of Health Sciences,
Kansas City
Robert T. Schooley, M. D.

Assistant Professor of Medicine, Harvard Medical School; Massachusetts General


Hospital, Boston
Robert W. Schrier, M. D.

Professor and Chairman, Department of Medicine, University of Colorado School of


Medicine, Denver
Marc A. Schuckit, M. D.

Professor of Psychiatry, School of Medicine, University of California at San Diego;


Director, Alcohol Research Center, San Diego Veterans Administration Medical
Center, San Diego
William J. Schwartz, M. D.
Assistant Professor of Neurology, Harvard Medical School; Assistant Neurologist,
Massachusetts General Hospital, Boston
David S. Segal, Ph. D.
Professor of Psychiatry, School of Medicine, University of California at San Diego,
La Jolla
Julian L. Seifter, M. D.

Assistant Professor of Medicine, Harvard Medical School; Associate Physician,


Brigham and Women's Hospital, Boston

Andrew P. Selwyn, M. D.

Associate Professor of Medicine, Harvard Medical School; Director, Cardiac Catheterization Laboratory, Brigham and Women's Hospital, Boston
Bhagwan T. Shahani, M. ., . S.

Associate Professor of Neurology, Harvard Medical School; Associate Neurologist,


Massachusetts General Hospital, Boston
Gordon Sharp, M. D.
Professor of Medicine and Pathology and Director, Division of Rheumatology,
University of Missouri-Columbia School of Medicine, Columbia

22

Elizabeth M. Short, M. D.
Director, Division of Biomedical Research and Faculty Development, American
Association of Medical Colleges, Washington, DC
William Silen, M. D.
Johnson and Johnson Professor of Surgery, Harvard Medical School; Surgeonin-Chief, Department of Surgery, Beth Israel Hospital, Boston
Fred E. Silverstein, M. D.
Associate Professor of Medicine, Division of Gastroenterology, University of Washington School of Medicine, Seattle
James B. Snow, Jr., M. D.
Professor and Chairman, Department of Otorhinolaryngology and Human Communication, University of Pennsylvania School of'Medicine, Philadelphia
Burton E. Sobel, M. D.
Lewin Professor of Medicine, Washington University School of Medicine; Director, Cardiovascular Division, Barnes Hospital, St. Louis
Arthur J. Sober, 1. D.
Associate Professor of Dermatology, Harvard Medical School; Associate Dermatologist, Massachusetts General Hospital, Boston
Frank E. Speizer, M. D.
Professor of Medicine, Harvard Medical School; Director, Occupational and Environmental Health Center, Brigham and Women's Hospital, Boston
John W. Stakes, M. D.
Instructor in Neurology, Harvard Medical School; Assistant Neurologist, Massachusetts General Hospital', Boston
Walter E. Stamm, M. D.
Professor of Medicine, University of Washington School of Medicine; Head Division of Infectious Disease, Harborview Medical Center, Seattle
Allen Steere, M. D.
Associate Professor of Medicine, Yale University School of Medicine, New Haven
Kari Stefansson, M. D.
Assistant Professor of Neurology and Pathology (Neuropathology), University
of Chicago Pritzker School of Medicine, Chicago
Gene H. Stollerman, M. 0.
Professor of Medicine, Boston University School of Medicine; Attending Physician,
University Hospital, Boston
D. E. Standness, Jr., M. D.
Professor of Surgery, University of Washington School of Medicine; University
Hospital, Seattle
David H. P. Streeten, M. ., D. Phil, F. R. . .
Professor of Medicine and Head, Section of Endocrinology, State University of
New York Upstate Medical Center, Syracuse
E. Donnall Thomas, M. D.
Professor, Department of Medicine, University of Washington School of Medicine;
Associate Director for Clinical Programs, Fred Hutchinson Cancer Research Center, Seattle
Gennaro M. Tisi, M. D.
Professor of Medicine, Pulmonary and Critical Care Division, School of Medicine,
University of California at San Diego; U. S. D. Medical Center, San Diego
Phillip P. Toskes, M. 0.
Professor of Medicine and Director, Division of Gastroenterology, Hepatology, and
Nutrition, University of Florifa Colledge of Medicine; Veterans Administration Medical Center, Gainesville
23

Marvin Turck, M. D.
Professor of Medicine and Associate Dean, University of Washington School of
Medicine; Medical Director, Harborview Medical Center, Seattle
Kenneth L. Tyler, M. D.
Assistant Professor of Neurology, Harvard Medical School; Clinical Assistant
in Neurology, Massachusetts General Hospital, Boston
John E. Ultmann, M. D.
Professor of Medicine, Department of Medicine; Director University of Chicago,
Cancer Research Center; Dean for Research and Development, Division of the
Biological Sciences, University of Chicago Pritzker School of Medicine, Chicago
Maurice Victor, M. D.
Professor of Neurology, Case Western Reserve University School of Medicine;
Director, Neurology Service, Cleveland Metropolitan Qenera.l Hospital, Cleveland
James F. Wallace, M. D.
Professor of Medicine, University of Washington Schoel of Medicine; Associate
Physician-in-Chief, University Hospital, Seattle
Patrick Walsh, M. D.
David Hall McConnell Professor and Director, Department of Urology, The John
Hopkins University School of Medicine; Urologist-in-Chief, James Buchanan Brady
Urological Institute, The Johns Hopkins Hospital, Baltimore
Peter D. Walzer, M. D.
Associate Professor of Medicine, University of Cincinnati College of Medicine;
Chief, Infectious Diseases Section, Cincinnati Veterans Administration Medical
Center, Cincinnati
Jack R. Wands, M. D.
Associate Professor of Medicine, Harvard Medical School; Associate Physician,
Gastrointestinal Unit, Massachusetts General Hospital, Boston
Louis Weinstein, M. D., Ph. D., Sc. D. (Hon.)
Lecturer in Medicine, Harvard Medical School; Senior Consultant in Medicine,
Brigham and Women's Hospital, Boston
John B. West., M. D., Ph. D. f D. S c , F. R. P., F. R. . . .
Professor of Medicine and Physiology, School of Medicine, University of California
at San Diego; Physician, U. C. S. D. Medical Center, San Diego
Nicholas J. White, M. D., M. R. . .
Tropical Medicine Unit, Nuffield Department of Clinical Medicine, Oxford University England; Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
Richard J. Whitley, M. D.
Professor of Pediatrics and Microbiology, School of Medicine, University of Alabama in Birmingham, Birmingham
Grant R. Wilkinson, M. D.
Professor of Pharmacology, Vanderbilt University School of Medicine, Nashville
Gordon H. Williams, M. D.
Professor of Medicine, Harvard Medical School; Chief, Endocrinology-Hypertension
Division. Brigham and Women's Hospital, Boston
Jean D. Wilson, M. D.
Professor of Internal Medicine, The University of Texas Health Science Center,
Dallas
Sheldon M. Wolff, M. D.
Endicott Professor and Chairman, Department of Medicine, Tufts University
School of Medicine; Physician-in-Chief, New England Medical Center, Boston
Alastair J. J. Wood, M. D., M. ., Ch. ., . R. . .
Associate Professor of Medicine and Associate Professor of Pharmacology, Van24

derbilt University School of Medicine; Attending Physician, Vanderbilt University


Hospital, Nashville
Theodore, E. Woodward, B. S., M. D., D. Sc. (Hon.)
Professor of Medicine Emeritus, University of Maryland School of Medicine; Distinguished Physician; Veterans Administration Hospital, Baltimore
Shirley H. Wray, M. D., Ph. D., F. R. . .
Associate Professor of Neurology, Harvard Medical School; Director, Unit for
Neurovisual Disorders, Department of Neurology, Massachusetts General Hospital,
Boston
Joshua Wynne, M. D.
Professor of Internal Medicine and Chief, Division of Cardiology, Wayne State
University School of Medicine; Chief Section of Cardiology, Harper-Grace Hospital, Detroit
James B. Young, M. D.
Professor of Medicine, Harvard Medical School; Associate Physician, Beth Israel
Hospital, Boston
Robert R. Young, M. D.
Professor of Neurology, Harvard Medical School; Neurologist and Director, Clinical Neurophysiology Laboratory, Massachusetts General Hospital, Boston

40- , 1950 1991 ., 12 . , , , , . .



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Goldman L. et al. Comparative reproducibility and validity of systems for assessing
cardiovascular functional class: Advantages of a new specific activity scale.
Circulation, 1981, 64, 1227.
Greenfield S. et al. Efficiency and cost of primary care by nurses and physician
assistants. N. Engl. J. Med., 1978, 305, 982.
McNeil B. J. et al. Speech and survival: Trage offs between quality and quantity
of life in laryngeal cancer. N. Engl. J. Med., 1981, 298, 305.
Ransohoff D. F., Feinstein A. R. Problems of spectrum and bias in evaluating the
efficacy of diagnostic tests. N. Engl. J. Med., 1978, 299, 926.
Roberts S. D. et al. Cost-effective care of end-stage renal diasease: A billion
dollar question. Ann. Intern. Med., 1980, 92, 243.
Schoenbaum S. C. et al. Benefit-cost analysis of rubella vaccination policy.
N. Engl. J. Med., 1976, 294, 303.
Weinstein M. C, Feineberg H. V. Clinical Decision Analysis. Philadelphia:
Saunders, 1980.

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Aronoff G. . Psychological. aspects of nonmalignant chronic pain. In: Evaluation and Treatment of Chronic Pain/Ed. G. M. Aronoff. Baltimore: Urban
and Schwarzenberg, 1985.
Asbury" A., Field H. L. Pain due to peripheral nerve damage: a hypothesis.
Neurology, 1984, 34, 15871590.
Basbaum A. I., Fields H. L. Endogenous pain control systems: brainstem spinal
pathways and endorphin circuitry. Ann. Rev. Neurosci., 1984, 7, 309338.
Blumer D., Heilbronn. Chronic pain as a variant of depressive disease. J. Nerv.
and Mental Dis., 1982, 170, 381406.
Fields H. L. Pain II: new approaches to management. Ann. Neurol., 1981, 9, 101.
Hackett T. P. The pain patient: evaluation and treatment. In: Massachusetts
General Hospital Handbook of General Hospital Psychiatry/Ed. T. P. Hackett,
1978, 4163.
Hannington-Kiff J. G. Antisympathetic drugs in limbs. In: Textbook of Pain/Eds.
P. D. Wall, R. Melzach. Edinburgh: Churchill Livingstone, 1983.
Maciewicz R., Fields H. L. Pain pathways. In: Diseases of the Nervous System/Eds. A. Asbury, G. McKann. London: Saunders, 1986.
Sweet W. H., Poletti . . Causalgia. In: Evaluation and Treatment of Chronic
Pain/Ed. G. M. Aronoff. Baltimore: Urban and Schwarzenberg, 1985.
Tasker R. R. Deafferentation. In: Textbook of Pain/Ed. P. Wall, Edinburgh,
Churchill Livingstone, 1984, 119132.
Taub A., Collins W. F. Observations on the treatment of de nervation dysesthesia
with psychotropic drugs: postherpetic neuralgia, anesthesis dolorosa, peripheral neuropathy. In: Adv. Neurol./Ed. J. J. Bonica. New York: Raven,
1974, 309315.
White J. C, Sweet W. H. Pain and Neurosurgeon A Forty Year's Experience.
Springfield, Illinois, Charles C. Thomas, 1969.
Yaksh T. L., Hammond D. L. Peripheral and central substrates involved in the
rostrad transmission of nociceptive information. Pain, 1982, 13, 185.

61


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Areskog N. ., Tibbling L. Differential diagnostic aspects of chest pain.
Acta
;i
med. scand. (SuppL), 1980, 644.
Braunwald E. Control of myocardial oxygen consumption. Physiological and clinical considerations. Amer. J. Cardiol., 1971, 27, 416.
Christie L. G. et al. Systematic aproach to evaluation of angina-like chest pain.
Pathophysiology and clinical testing with emphasis on objective documentation
of myocardial ischemia. Amer. Heart J., 1981, 102, 897.
Cohn P. F., Braunwald E. Chronic ischemic heart disease. In: Heart Disease,
2nd ed./Ed. E. Braunwald. Philadelphia, -Saunders, 1984, Chap. 39, 1334.
Constant J. The clinical diagnosis of nonanginal chest pain. The differentiation
angina from nonanginal chest pain. The differentiation of angina from nonanginal chest pain by hystory. Clin. Cardiol., 1983, 6, 11.
DeMeester et al. Esophagial function in. patients with angina-type chest pain and
normal coronary angiograms. Annu. Surg., 1982, 196, 488.
Dressier W. Clinical Aids in Cardiac Diagnosis. New York, Grune and Strattori,
1970.
Goldschlager N. Use of treadmill test in the diagnosis of coronary artery disease
in patients with chest pain.Annu. Intern. Med., 1982, 97, 383.
Hurst J. W. e.t al. The history. Past events and symptoms related to cardiovascular
disease. In: The Hert. 6th ed./Ed. J. W. Hurst. New York, McGraw-Hill,
986, 113.
Levine D. L. Chest Pain. Philadelphia, Lea and Febiger, 1977, 203.
Patterson D. R. Diffuse esophagial spasm in patients with undiagnosed chest
pain. J. Clin. Gastroenterol., 1982, 4, 415.

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De Dotnbal F. . Acute abdominal pain. Scand. J. Qastroenterol. (Suppl.),
' 1979, 14, 29.
Lee P W /J.The plain X-ray in the acute abdomen: a surgeon's evaluation. Brit.
J. Surg., 1976, 63, 763.
Leek B. F. Abdominal and pelvic visceral receptors. Brit. Med. Bull., 1977,
33, 163.
Silen W. Cope's Early Diagnosis of the Acute Abdomen. 16 th ed. London,
Oxford Press, 1983.
Stanland J. R. et al. Clinical presentation of acute abdomen: Study of 600 patients. Brit. Med. J., 1972, 2, 393.
Valman H. B. Acute abdominal pain. Brit. Med. J., 1981, 282, 1858.
6

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Appenzeller . Pathogenesis and treatment of Headache. New York, Spectrum,
1976.
Bickerstaff E. R. Basilar artery migraine. Lancet, 1961, 1, 15.
Bogduk N.. Lance J. W. Pain and pain syndrome including headache. - In: Current Neurology/Ed. S. F. Appel. New York, Wiley, 1981, 3, 14.
Caviness V. S., O'Brien P. Headache. New Engl. J. Med., 1980, 302, 446.
Couch J. R., Hassaneim R. S. Platelet aggregability in migraine. Neurology,
1977, 27, 843.
Crilchley M. et al. (Eds.) Advances in Neurology. Vol. 33: Headache: Physiopathological and Clinical Aspects. New York, Raven Press, 1982.
Diamond S. Prolonged benign exertional headache. Headache, 1982, 22, 96.
Ehyai A., Fenichel G. M. Natural history of acute confusional migraine. Arch.
Neurol., 1978, 35, 368.
Fisher . . Transient migranous accompaniments of late onset. Stroke, 1979,
10, 96.
Gelmers H.' J. Nimodipine, a new calcium antagonist, in the prophylactic treatment
of migraine. Headache, 1983, 23 (3), 106.
Hakkareinen H. et al. Tolfenamic acid is an effective as ergotamine during migraine attacks. -- Lancet, 1979, 2, 326.
Hockaday J. M. Basilar migraine in children. Dev. Med. and Child. Neurol.,
1979, 21, 455.
Kayan A., Hood J. D. Neuro-otological manifestations of migraine. Brain, 1984,
107, 1123.
Lake A., Rainey J., Papsdorf J. D. Biofeedback and rational-emotive therapy in the
management of migraine headache. Appl. Behav. Anal., 1979, 12, 127.
Lance J. W. Headache. Ann. Neurol., 1981, 10,1.

Lance 1. W. Headache related to sexual activity. J. Neurol. and Neurosurg.


Psychiatr., 1976, 39, 1226.
Moskowitz M. Neurobiology of vascular head pain. Ann. Neurol., 1984, 16, 157.
Oleson J. et al. Focal hyperemia followed by spreading oligemia in classic migraine. Ann. Neurol., 1981, 9, 344.
Perouika J. The pharmacology of calcium channel antagonist: Novel class of antimigraine agents? Headache, 1983, 23, 278.
Raskin N. H., Schwartz P. M. Icepick-like pain. Neurology, 1979, 29, 550.
Vijayan N., Dreyfus P. M. Posttraumatic dysautonomic cephalgia: Clinical observations and treatment. Arch. Neurol., 1976, 32, 649.
Vinken P. J., Bruyn G. W. (Eds.) Handbook of Clinical Neurology, 5: Headache
and Cranial Neuralgias. Amsterdam, North-Holland Publ., 1968.


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Armstrong J. R. Lumbar Disc Lesions. 3d ed. Baltimore, Williams and Wilkins,
1965.
Bogduk N. The innervation of the lumbar spine. Spine, 1983, 8, 286.
Brady L. P. et a!. An evaluation of the electromyogram in the diagnosis of lumbar
disk lesion. J. Bone Joint Surg., 1969, 51A, 539.
Chevetz N. I. et al. Recognition of lumbar disk herniation with NMR. Amer.
J. Radiol., 1983, 141, 1153.
Collier B. Treatment for lumbar sciatic pain in posterior articular lumbar joint
syndrome. Anesthesia, 1979, 344, 202.
Coxhead C. E. et al. Multicenter trial of physiotheipapy in the management of
sciatic symptoms. Lancet, 1981, 1, 1065.
Edeiken J., Pitt M. J. The radiologic diagnoses of disk disease. Orthop. Clin.
North Amer., 1971, 2, 405.
Fredenberg . .. Miller W. T. Degenerative disk disease of the cervical spine.
J. Bone Joint Surg., 1963, 45A, 1171.
Grabias S. L, Mankin H. J, Pain in lower back. Bull. Rheum. Dis., 1980, 30, 1040.
Mikhael M. N. et al. Neurological evaluation of lateral recess syndrome. Radiology, 1981, 140, 97.
Murphy R. W. Nerve roots and spinal nerve in degenerative disk disease. Clin.
Orthop., 1977, 129, 46.
Naylor A. The changes in the humarf interveitebral disk in degeneration and
nuclear prolapse. Orthop. Clin. Nort Amer., 1971, 2, 343.
Reskin S. P. Computerized tomographic findings in lumbar disk disease. Orthopedics, 1981, 5, 419.
Reynolds A. V. et at. Lumbar monoradiculopathy due to unilateral facet hypertrophy.Heurosurgery, 1982, 10, 480.
Rothman R. C, Simeone F. Lumbar disk Desease.Philadelphia, Saunders, 1975,
443-458.
Williams A. L. et al. Computed 1 tomography in the diagnosis of herniated nucleus
pulposus. Radiology, 1980, 135, 95.
Wilson E. S., Brill R. F. Spinal stenosis: The narrow lumbar canal syndrome.
Clin. Orthop., 1977, 122, 244.


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E2 release by leucocyte pyrogen (interleukin-1): A mechanism for increased
degradation of muscle during fever. N. Engl. J. Med., 1983, 308, 553.
Bullen J. J. The significance of iron infection. Rev. Infect. Dis., 1981, 3, 1127.
Dinarello A. Interleukin-1 and the pathogenesis of the acute phase response.
N. Engl. J. Med., 1984, 311. 1413.
Dinarello A. Interleukin-1. ~- Rev. Infect. Dis., 1984, 6, 41.
Kreuger J. M. et a). Sleep promoting effects of endogenous pyrogen (interleukin-I). Am. J. Physiol. (in.press).

Britt . A. Etiology and pathophysiology of malignant hyperthermia. Fed.
Proc., 1979, 38, 44.
Clowes G.H.A. Jr., O'Donnel T. F. Jr. Current concepts: Heat stroke. N. Engl.
J. Med., 1974, 291, 564.
Costrini A. M. et al. Cardiovascular and metabolic manifestations of heat stroke
and severe heat exhaustion. Am. J. Med., 1979, 66, 296.
Downey G. P. et al. Neuroleptic malignant syndrome. Patient with unique clinical
and physiologic features. Am. J. Med., 1984, 77, 338.
Gronert G. 4. Malignant hyperthermia. Anesthesiology, 1980, 54, 395.
137

Hanson P. , Zimmerman S. W. Exertional heat stroke in novice runners. -J.A.M.A., 1979, 242, 159.
McPherson E. W., Taylor A. Jr. The King syndrome: Malignant hyperthermia,
myopathy and multiple anomalies. Am. J. Med. Genet., 1981, 8, 159.
Shibolet S. et al. Heat stroke: A review. Aviat Space environ. Med., 1976, 47, 280.
Sprung C. L. et al. The metabolik and respiratory alterations of heat stroke.
Arch. Intern. Med., 1980, 140, 665.
Willner J. H. et al. Increased myoposphorylase A in malignant hyperthermia.
N. Engl. J. Med., 1980, 303, 138.
Willner J. H. et al. High skeletal muscle adenylate cyclase in malignant hyperthermia. - J. din. Invest., 1981, 68, 1119.
Wyndham . . Heat stroke and hyperthermia in marathon runners. Ann. N. Y.
Acad. Sci., 1977, 301, 128.

Bouwman D. L. et al. Early sympathetic blockade for frostbite Is it of value?
J. Trauma, 1980, 20, 744.
Gage A. M. Frostbite. Trauma and Emergency Med., 1981, 7, 25.
MacLean D. et al. Metabolic aspects of spontaneous recovery in accidental hypothermia and hypothermic myxedema.
Q. J. Med. (n.s.), 1974, 43, 371.
Southwick F. S., Dalgtish P. H. Jr. Recovery after prolonged asystolic cardiac
arrest in profound hypothermia. J.A.M.A., 1980, 243, 1250.
Vaughn P. B. Local cold injury Menace to military operations: A review.
Milit. Med., 1980, 143, 305.
Whittle J. L., Bates J. H. Thermoregulatory failure secondary to acute illness:
Complications and treatment.
Arch, intern. Med., 1979, 139, 418.
Wickslrom P. et al. Accidental hypothermia. - Amer. J. Surg., 1976, 131, 622.
9


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Aduan R. P. et al. Factitious fever and self-induced infection. Ann. intern. Med.,
1979, 90, 230.
Bujak J. S. et al. Juvenile rheumatoid arthritis present in the adult as fever of
unknown origin. Medicine, 1973, 52, 431.
Dinarello C. A., Wolf A. S. Fever. Current concepts. Kalamazoo. The Upjohn
Company, 1980, pp. 338.
Fauci A. S. et al. The spectrum of vasculitis: Clinical patologic, immunologic and
therapeutic considerations. Ann. intern. Med., 1978, 89, 660.
Ghose M. K. et al. Arteritis of the aged (giant cell arteritis) and fever of unexplained origin. Amer. J. Med., 1976, 60, 429.
Jacoby G. A., Swartz M. N. Fever of undetermined origin,N. Engl. J. Med.,
1973, 289, 1407.
Klatskin G. Hepatic granulomata; Problems in interpretation. Mt. Sinai J. Med.,
1977, 44, 798.
Larson E. B. et al. Fever of undetermined origin: Diagnosis and follow-up of
105 cases, 1970 1980. Medicine, 1982, 61, 269.
Malmvall . . et al. The clinical pictures of giant cell arteritis: Temporal arteritis,
polymyalgia rheumatica and fever of unknown origin. Postgrad. Med.,
1980, 67, 141.
McDougall 1. R. et al. Evaluation of ' " I n leucocyte whole body scanning.
Amer. J. Roentgenol., 1979, 133, 849.
McNeil B. J. et al. A prospective study of computed tomography, ultrasound and
gallium imaging in patients with fever. Radiology, 1981, 139, 647.
Mitchell D. P. et al. Fever of unknown Origin: Assessment of the value of percutaneous liver biopsy. Arch, intern. Med., 1977, 137, 1001,.
Petrsdorf R. G., Beeson P. B. Fever of unexplained origin: Report of 100 cases.
Medicine, 1961, 40, 1.
Quinn M. J. et al. Computed tomography of the abdomen in evaluation of patients
with fever of unknown origin. Radiology, 1980, 136, 407.
Simon H. ., Wolff S. M. Granulomatous hepatitis and prolonged fever of unknown
origin: A study of 13 patients. Medicine, 1973, 52, 1.
Wolff S. M. et al. Unusual etiologies of fever and their evaluation. Ann. rev.
Med., 1975, 26, 277.

10



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Adams R. D., Victor M. Principles of Neurology. New York: McGraw-Hill,
3d ed., 1985.
De Jong R. N. The Neurologic Examination. New York: Harper and Row, 1979.
Swanson P. D. Symptoms and Signs in Neurology. Philadelphia: Lippincott,
1984.
11



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American Psychiatric Association: Diagnostic and Statistic Manual of Mental
Disorders (DSM III). 3d ed.Washington, 1980.
Cummings i. L. Organic delusions: Phenomenology, anatomical correlations,
and review. Brit. J. Psychiat., 1985, 146, 184.
Greden 1. F. Laboratory tests in psychiatry. In: Comprehensive Textbook of
Psychiatry IV/Eds. H. I. Kaplan, B. J. S.adock. Baltimore: Williams and
Wilkins, 1985, vol. 11, 20282033.
Kaplan H. /., Sadock B. J. Typical signs and symptoms of psychiatric illness.
In: Comprehensive Textbook of Psychiatry IV/Eds. H. I. Kaplan, B. J. Sadock.
Baltimore: Williams agd Wilkins, 1985, vol. 1, 499501.
Ludwing A. M. Principles of Clinical Psychiatry. New York, Free Press, 1980.
Robins L. N. et al. Lifetime prevalence of specific psychiatric disorders in three
sites. Arch. gen. Psychiarty, 1984, 41, 949.
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W. . Neuronal mechanisms of seizure initiation. In: Antiepileptic Drugs:
Mechanisms of action/Eds. G. H. Glaser et al. New York: Raven Press, 1980,
p. 169.
Day S. C. et al. Evaluation and outcome of emergency room patients with transient
loss of consciousness. Amer. J. Med., 1982, 73, 15.
DiMarco J. P. et al. Intracardiac electrophysiologic techniques in recurrent syncope
of unknown cause. Ann. Intern. Med., 1981, 95, 542.
Ector H. et al. Bradicardia, ventricular pauses, syncope and sports. Lancet,
1984, 1, 591.
Ewlng D. J. et al. The natural history of diabetic autonomic neuropathy. Quart.
J. Med., 1980, 49, 95.
Hickler R. Fainting. In: Signs and Symptoms. 6th ed./Ed. R. S. Blacklow.
Philadelphia: Lippincott, 1977, chap. 33.
Johnson R. #., Spaulding /. M. K. Disorders of the autonomic Nervous System.
Philadelphia: Davis, 1974.
Kapoor W. N. et al. A prospective evaluation and follow-up of patients with syncope. New Engl. J. Med, 1983, 309, 197.
Lee J. E. et al. Episodic unconsciousness. In: Diagnostic Approaches in Presenting Syndromes/Ed. J. A. Barondess. Baltimore: Williams and Wilkins,
1971, pp. 133167,
Polinsky R. J. et al. Pharmacologic distinction of different orthostatic hypotension
syndromes. Neurology, 1981, 31, 1.
Richards A. M. et al. Syncope in aortic valvular stenosis. Lancet, 1984, 1, 1113.
Silverstein M. D. et al. Patients with syncope admitted to medical intensive :care
units. J.A.M.A., 1982, 248, 1185.
Steeter D. H. P. et al. Hyperbradykinism: A new orthostatic syndrome, Lancet,
1972, 2, 1048.
Sutherland J M., Eadie M. J. The epilepsies. 3d e'd. Edinburgh: Churchill Living-.
stone, 1980.
Weisster A. M.. Warren J. V. Syncope and Shock. In: The Heart. 4th ed./Eds.
J. W. Hurst et al New York: McGraw-Hill, 1978, 705.
Wright K. E. Jr., Mclntosh M. D. Syncope. Review of pathophysiological mecha-.
nisms. Progr. cardiovasc. Dis., 1971, 13, 580. _
Young R. R. et al. Pure pandysautonomia with recovery. Description and discussion
of diagnostic criteria. Brain, 1975, 98, 613.

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Anderson D. R. Testing the Field of Vision. St. Louis: Mosby, 1982.
Burde R. M. et al. Clinical Decisions in Neuro-ophthalmology. St. Louis: Mosby,
1985.
Cogan D. Ophthalmic Manifestations of Systemic Vascular Disease. Philadelphia: Saunders, 1974, vol. 3.
Leigh R. J., Zee D. S. The Neurology of Eye Movement. Philadelphia: Davis,
1983.
Pavan-Langston (Ed.) Manual of Ocular Diagnosis and therapy. 2 ed. Boston:
Little, Brown, 1985.
Rose F. The Eye in General Medicine. London: Chapman and Hall, 1983.
Wall M., Wray S. H. The -and-half syndrome a unilateral disorder of the
pontine tegmentum. A study of 20 cases and a review of the literature.
Neurology, 1983, 33, 971.
Wray S. H. Neuro-ophthalmologic diseases. In: The Clinical Neurosciences/
Eds. R. N. Rosenberg et al. New York: Churchill Livingstone, 1983.
Wray S. H. Neuro-ophthalmology: Visual fields, optic nerve, and pupil., In: Manual of Ocular Diagnosis and Therapy. 2 ed./Ed. D. Pavan-Langston. Boston:
Little, Brown, 1985.
14


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Philadelphia: Davis, 1984.
Brandt ., Daroff R. B. The multisensory physiological and pathological vertigo
syndromes. Ann. Neurol., 1980, 7, 195.
Hinchctiffe F. R. Hearing and Balance in the Elderly. New York: Churchill
Livingstone, 1983, sect. II, 227488.
Leigh R. 1., Zee D. S. The neurology of Eye Movements. Philadelphia: Davis,
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Deloag M. /?., Georgopoulos A. P. Motor functions of the basal ganglia. In:
Handbook of Physiology/Ed. V. B. Brooks, sect. 1.: The Nervous System,
vol. II: Motor Control, part 2. Bethesda: Amer. Physiol. Society, 1981, 1017
1062.
Delwaide P. J'., Young R. R. (Eds.) Restorative Neurology, vol. I. Clinical Neurophysiology in Spasticity. Amsterdam: Elsevier, 1985.
Emson P. (Ed.) Chemical Neuroanatomy. New York: Raven Press, 1983.
Feldman R. G. et al. (Ed.) Spasticity: Disordered Motor Control Chicago: Year
Book Medical Publishers, 1980.
Geschwind N. The apraxias: Neural mechanisms of disorders of learned movements. Airier. Sci., 1975, 63, 188.
Growdon I. H., Scheife R. T. Medical Treatment of extrapyramidal diseases.
In: Update III: Harrison's Principles of Internal Medicine/Eds. K. J. Isselbacher et al. New York: McGraw-Hill, 1982, 185208.
Kuypers H. G. J. M. Anatomy of the descending pathways. In: Handbook of
Physiology, Sect. I, The Nervous System, vol. II, Motor Control, part I/Ed..
V. B. Brooks. Bethesda: Amer. Physiol. Society, 1981, 597666.
Lawrence D. G., Kuypers H. G. J. M. The functional organisation of the motor
system in the monkey. Brain, 1968, 91, 1.
Marsden D. The mysterious motor function of the basal ganglia. * Neurology,
1982, 32, 514.
Martin J. B. Huntington's disease: New approaches to an old. problem. Neurology, 1984, 34, 1059.
.
,
Young R. /?., Shahani . . Asterixis: One type of negative myoclpnus. In:
Myoclonus/Eds. S. Fahnet ai. New Vork: Raven Press, 1985,123ftYoung R. /?., Delwaide P. J. Drug therapy: Spasticity. New pngl. J,.Med., 1981,
304, 2o. - .
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Gilman S. Gait disorders. In: Merritt's Textbook of Neurology/Ed. L. P. Rowland. Philadelphia: Lea and Febiger, 1984, 4448.
Gilman S. et. al. Disorders of the Cerebellum. Philadelphia: Davis, 1981.
Grillner S. Neurobiological bases of rhythmic motor acts in vertebrates. Scince,
1985, 228, 143.
Ito M. Cerebellum and Neural Control. New York: Raven, 1984.
Katzman R., Terry R. The Neurology of Aging. Philadelphia: Davis, 1983.
Knutsson ., Lying-Tunell U. Gait apraxia in normal-pressure hydrocephalus: Patterns of movement and muscle activation. Neurology, 1985, 35, 155.
17

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Auger R. G. et al. Hereditary form of sustained muscle activity of peripheral nerve
origin causing generalized myokymia and muscle stiffness. Ann. Neurol.,
1984, 15, 13.
Clark S. et al. Clinical characteristics of fibrositis. II. A "blinded", controlled
study using standard physiological tests. Arthr. and Rheum., 1985, 28, 132.
Griggs R. C. The myotonic disorders and the periodic paralysis. Adv. Neurol.,
1977, 17, 143.
Layzer R. B. Muscle pain, cramps and fatigue. In: Myology/Eds. A. G. Engel,
B. Q. Banker. New Fork: McGraw-Hill, 1986.
Saenz-Lope E. et al. Hyperekplexia: A syndrome of pathological startle responses.
Ann. Neurol., 1985, 15, 36.
18

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Culp W., Ochoa J. L. (Eds.) Abnormal Nerves and Muscles as Impulse Generators. New York: Oxford University, 1982.
Dyck P. J. et al. Detection threscholds of cutaneous sensation in humans. In.:
Peripheral Neuropathy, 2d ed./Eds. P. J. Dyck et al. Philadelphia: Saunders,
1984, 11031138.
Lindblom U., Ochoa J. L. Somatosensory function and dysfunction. In: Diseases
of the Nervous System/Eds. A. K. Asbury, G. M. McKhann, W. I. McDonald.
Philadelphia: Saunders, 1986.
Mackel R. Singel unit analysis of regenerated cutaneous afferents in man. Ann.
Neurol., 1985, 18, 165.
Vallbo A. B. et al. Somatosensory, proprioceptive, and sympathetic activity in
human perypheral nerve. Physiol. Rev., 1979, 59, 919.

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Dallos P. The Auditory Periphery: Biophysics and Physiology. New York: Academic
Press, 1973.
Doty R. L. A review of olfactory disfunctions in man. Amer. J. Otolaryng., 1979,
1, 57.
266

Doty R. L. et al. Smell identification ability: Changes with age. Science, 1984,
226, 1441.
Jerger J. R. Modern Developments in Audiology. 2d ed. New York: Academic
Press, 1973.
Konigsmark B. W. Hereditary diseases of the nervous system with hearling loss. -In: Handbook of Clinical Neurology/Eds. P. J. Vinken, G. W. Briryn. Amsterdam: Elsevier, 1975. vol. 22. chap. 23, 499526.
Nakashima T. et al. Structure of human fetal and adult olfactory neuroepithelium. Arch. Otolaryng., 1984, 110, 641.
Norgren R. The gustatory system in mammals. Amer. J. Otolaryng., 1983, 4,
234.
Rintelman W. F. Hearing Assessment. Baltimore: Baltimore University, 1979.
Snow J. B. Sudden deafness. In: Otolaryngology 2d, ed., Eds., M. M. Paprella,
D. A. Shumrick. Philadelphia: Saunders, 1980, 17511767.
Snow J. B. et al. Central auditory imperception. Laryngoscope, 1977, 87, 1450.
Snow J. B. Clinical problems is chemosensory disturbances. Amer. J. Otolaryng.,
1983, 4, 224.

20

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Coleman R. et al. Sleep-wake disorders based on a polysomnographic diagnosis.
J. A. M. A., 1982, 247, 997.
Guilleminault C. (Eds.) Sleeping and Waking Disorder: Indications and Techniques. Menlo Park, Calf, Addison-Wesley, 1981.
Hauri P. The Sleep Disorders. Kalamazoo, Mich, Upjohn, 1977.
Hobson J. A., Brazier M. A. B. (Eds.) The Reticular Formation Revisited.
New York: Raven, 1980.
Kales A. et al. Insomnia and other sleep disorders. Med. Clin. N. Amer., 1982,
66, 971.
McGinty D. J., Siegel J. M. Sleep States. In: Handbook of Behavioral Neurobiology, vol. 6, Motivation/Eds. E. Satinoff, P. Teitelbaum. New York: Plenum,
1983, 105.
Moore-Ede M. C. et al. Circadian timekeeping in health and disease. N. Engl.
J. Med., 1983, 530, 309, 469.
Orem J., Barnes C. D. (Eds.) Physiology in Sleep. New York: Academic, 1980.
Roffwarg H. Diagnostic classification of sleep and arousal disorders. Sleep,
1979, 2, 1.
Weitzman E. D. Sleep and its disorders, Ann. Rev. Neurosci., 1981, 4, 381.
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Finkelstein S., Ropper A. The diagnosis of coma: Its pitfalls and limitations.
Heart Lung, 1979, 8, 1059.
Fisher M. The neurological examination of the comatose patient. Acta neurol.
scand., 1969, 45 (Suppl. 6), 1.
Ivan I., Bruce D. Coma. Springfield, III, Charles Thomas, 1982.
Jennet B. et al. Prognosis of patients with severe head injury. Neurosurgery,
1979, 4, 283.
Levy D. et al. Prognosis in non-traumatic coma. - Ann. Intern. Med., 1981,
94, 229.
Plum F., Posner J. The Diagnosis of Stupor and .Coma. 3d ed. Philadelphia:
Davis, 1980.
Ropper A. H. Coma and acutely raised intracranial pressure. In: Diseases of
the Nervous System/Eds. A. Asbury, G. McKhann, I. McDonald. Philadelphia:
Saunders, 1986.
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Demasic A. /?., Geschmind N. The neural basis of language.Ann. Rev. Neurosci.,


. 1984, 7, 127.
Geschwind N. Disconnection syndromes in animals and man.Brain, 1965, 88, 237.
Kertesz A. Localisation in Neuropsychology.-~New York: Academic, 1983.
Lecours A. R. et al. Aphasiology.London: Bailliere Tindall, 1983.
Mohr J. P.' Broca's area and Broca's aphasia. In: Studies in Neurolinguistics/
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Mohr . P., Sidman M. Aphasia: Behavioral aspects,In: American Handbook of
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Adams R. D., Victor M. Principles of Neurology. 3e ed. New York: McGrawHill, 1985.
Benson F. D:-, Blumer D. Psychiatric Aspects of Neurologic Disease. New York:
Grune and Stratton, 1975, chap. 2.
BlessedG. et al. The association between quantitative rheasures of dementia and of
senile change in the cerebral grey matter of elderly subjects. Brit. J. Psychiat., 1968, 114, 797.
'

Butters N.. Miliotis P. Amnestic disorders. In: Clinical Neuropsychology/Eds.


K. Heilman, E. Valenstein. London: Oxford, 1985, 403451.
Engel G. L., Romano I. Delirium, a syndrome of cerebral insufficiency. J. chron.
Dis., 1959, 9, 260.
Fisher Ci M:, Adams R. D. Episodic global amnesia. Acta Neurol. Scand., 1964,
40 (Suppl. 19).
Graff-Radford N. R. et al. Nonhaemorrhagic thalamic infarction: Clinical, neuropsychological and electrophysiologicai findings in tout anatomical groups
defined by computerized tomography.Brain, 1985, 108, 485.
Lipowski Z. L. Delirium: Acute' Brain Failure in Man. Springfeld, HI,' Charles
C. Thomas, 1980.
Lishrnan W. A. Organic Psychiatry: The Psychological Consequences of Cerebral
Disorders. Oxford: Blackwell, 1978.
Terry R: D., Katzman R. Senile dementia of the Alzheimer type. Ann. Neurol.,
1983, 14, 497;
Tomlinson B. E. The pathology of dementia. In: Dementia/Ed. . . Wells.
Philadelphia: Davis, 1977, chap. 6.
Wells . . Dementia, 2d ed. Philadelphia: Davis, 1977.
Welts E. Treatable forms of dementia. In: Update II: Harrison's Principles
of Internal Medicine/Eds. K- J. Isselbacher et al. New York: McGraw-Hill
1981..
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3J3

Brodal A. Neurological Anatomy in relation to Clinical Medicine. 3d ed.


New York: Oxford University Press, 1981.
B/own 1. W. Frontal lobe syndromes. In.: Handbook of Clinical Neurology/
Ed. J. A. M. Frederiks: Amsterdam: Els'evier Science, 1985, .vol. 45, chap. 3.
Ditnond S. J. The disconnection syndromes. In: Modern Trends in Neurology/
Ed. D. Williams. London: Butterworth, 1975.
Geschwind N. Disconnection syndromes in animals and man. Brain, P965, 585,
88, 237.
. Hacaen H., Albert M. L. Disorders of mental functioning related to the frontal
lobes. In: Modern Trends in neurology/Ed. D. Williams. London: Butterworth, 1975.
Luria A. R. The Working Brain: An Introduction to Neuropsy chology. New York:
Basic Books (translation Penguin Books Ltd), 1973.
Walsh K. W. Neuropsychology: A Clinical Approach. London: Churchill Livingstone, 1978.

25


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(Gennaro M. Tisi, Eugene Braunwald)

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Adelman M. et al. Cryptogenic Hemoptysis: Clinical features, bronchoscbpic findings, and natural history in 67 patients. Ann. intern. Med., 1985, 102, 829.
Boushey H. A. et al. Medical staff conference: Evaluating and treating intractable
cough. West J. Med., 1985, 143, 223.
Conlan A. A. Massive hemoptysis: Diagnostic and therapeutic implications.
Surg. Ann., 1985, 17, 337.
Corrao W.M.C. Chronic cough as the sole presenting manifestation of bronchial
asthma. N. Engl. J. Med., 1979, 300, 633.
Gross N. J. et al. Anticholinergic, antimuscarinic bronchodilators. Am. Rev.
Resp. Dis., 1984, 129, 856.
lrwin R. S. et al. Persistent cough in the edult: The spectrum and frequency of
causes and successful outcome of specific therapy. Am. Rev. Resp. Dis.,
1981, 123, 413.
Leith D. E. The development of cough. 1985, 131, S39.
Williams M. H. Management of massive hemoptysis. Pulmonary Perspectives.
A publication of the American College of Chest Physicians, 1984, 1, 3.

26


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Ayres S. M. Mechanism and consequences of pulmonary edema.- Am. Heart J.,
1982, 103, 97.
Feshman A. P., Renkin E. M. Pulmonary Edema.Washington, DC/American
Physiological Society, 1979.
Ingram R. H., Braunwald E. Pulmonary edema: Cardiogenic and noncardiogenic. In: Heart Disease/Ed. E. Braunwald. Philadelphia: Saunders, 1984,
560.
Killian K. J., Campbell E. J. M. Dyspnea and exercise. Ann. Rev. Physiol.,
1983, 45, 465.
Malik A. B. Mechanisms of neurogenic pulmonary edema. - Circ. Res., 1985, 57, 1.
McFadden E. R., Ingram R. H. Relationship between diseases of the heart and
lung. In: Heart Disease/Ed. E. Braunwald. Philadephia: Saunders, 1984,
1782.
Rasanen J. et al. Continuous positive airway pressure by face mask in acute cardiogenic pulmonary edema. Am. J. Cardiol., 1985, 55, 296.1
Roussos C, Macklem P. T. Disorders of the respiratory muscle function. In:
Harrison's Principles of Internal Medicine/Eds. K. J. Isselbacher et al. New
York: McGraw-Hill, 1982, 83.
Sniderman A. et al. Pulmonary blood flow: A potential factor in pathogenesis of
pulmonary edema.J. Thorac. Cardiovasc. Surg., 1984, 87, 130.
Staub N. C. The pathogenesis of pulmonary edema. Prog. Cardiovasc. Dis.,
1980, 23, 53.

27

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Intern. Med., 1985, 102, 786.
Ersley A. J. Erythrocytosis (sec 17, Chaps 7375). In: Hematology 3d Ed/Ed.
W. J. Williams. New York: McGraw-Hill, 1983, 673.
Hurtado A. Some clinical aspects of life at high altitudes. Ann. Intern. Med.,
1960, 53, 247.
Lanken P. N., Fishman A. P. Clubbing and hypertrophic osteoarthropathy. In:
Pulmonary Diseases and Disorders/Ed. A. P. Fishman. New York: McGrawHill, 1980, 84.
Lupinetti F. M. et al. Pathophysiology of chronic cyanosis in a canine model..Functional and metabolic response to global ischemia. J. Thorac. Cardiovasc.
Surg., 1985, 90, 291.
Rosenthall A., Tyler D. Effect of red cell volume reduction or pulmonary blood
flow in polycythemia pf cyanotic heart disease. Am. J. Cardiol., 1974, 33,
410.
Smith J. /?., Landaw S. A. Smokers' polycythemia. N. Engl. J. Med., 1978, 298, 6.

28

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Buckalew V. AT, Gruber - A. Natriuretic hormone. Ann. Rev. Rhysiol., 1984,
46, 343.
Golden M. H. N: Protein deficiency, energy deficiency and the oedema of malnutrition. Lancet, 1982, 1, 1261.
Hricik D. ., Kassirer J. P. The nephrotic syndroms. In: Disease-A-Month/Ed.
N. J. Cotsonas et al. Chicago: Year Book Medical, 1982, 5.
Needleman P. et al. Atriopeptins as cardiac hormones. Hypertension, 1985, 7,
469.
Seifter J. L. et al. Control of extracellular fluid volume and pathophysiology of
edema formation. In: The Kidney/Ed. B. M. Brener, F. C. Rector. Philadelphia: Saunders, 1986, 343.
Skorecki K. L., Brenner . . Boly fluid homeostasis in congestive heart failure
cirrhosis with ascites. Am. J. Med., 1982, 72, 325.
Staub N. C, Taylor A. E. Edema. New York: Raven, 1984.
29


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(Eugene Braunwatd, Gordon H. Williams)

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Abboud F. M. Pathophysiology of hypotension and shock. In: The Heart/Ed.
J. W. Hurst. New York: McGraw-Hill, 1986, 370.
Abbruzzese J. L. et at. Postural hypotension. John Hopkins Med: J., 1981, 148,
127.
Bernton E. W. et al. Opioids and neuropeptids: Mechanisms in circulatory shock.
Fed. Proc!, 1985, 44, 290.
Genest 1. Hypertension: Psysiopathology and treatment. New York: McGrawHill, 1983.
Gyuton A. C. Circulatory shock and physiology od its treatment. In: Textbook
of Medical Physiology. Philadelphia: Saunders, 1986, 326.
Holcroft J. W., Blaisdell F. W. Shock: Causes and management of circulatory
collapse. In: Davis-Christopher Textbook of Surgery/Ed. D. C. Sabiston.
Philadelphia: Saunders, 1986, 38.
Kaplan N. M. Systemic hypertension: Therapy. In: Heart Diseaese/Ed. E. Braunwald. Philadelphia: Saunders, 1984, 902.
Kirkendall W. M. et al. AHA Committee Report: Recomendations for human blood
pressure determination by sphygmomanometers. Circulation, 1980, 62,
1146A.
30

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Befa-Blocker Heart Attack Trial Research Group. A randomized trial of propranolol in patients with acute myocardia! infarction. JAMA, 1982, 247, 1707.
Bigger J. T. et al. The Multicenter Post-Infarction Research Group: The relationships among ventricular arrhythmias, left ventricular dysfunction and
mortality in the 2 years after myocardial infarction. - Circulation, 1984,
62, 250.
Chandra N. et al. Simultaneous chest compression and ventilation at high airway
pressure during cardiopulmonary resuscitation. Lancet, 1980, 1, 197.
Cobb L. A. et al. Sudden cardiac death, A decade's experience with out of hospital
resuscitation. Mod. Concepts Cardiovasc. Dis., 1980, 49, 31.
Davies M. J., Thomas A. V. Thrombosis and acute coronary artery lesions in
sudden cardiac ischemic death. N. Engl. J. Med., 1984, 310, 1137.

390

31


(Paul Goldhaber)

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Beitman R. G. Oral manifestations of gastrointestinal disease. Dig. Dis. Sci. 26,
741, 1981.
Goldman H. S., Marder M. Z. Physician's Guide to Disease of the Oral Cavity. Oradell, NJ, Medical Economics, 1982.
Lynch M. A. et al. Burket's Oral Medicine, Diagnosis and Treatment, 8 th ed.
Philadelphia,- Lippincott, 1984.
Rose L. F., Kaye D. Internal Medicine for Dentistry. St Louis, Mosby, 1983.
Shafer W. G. et al. A Textbook of Oral Pathology, 4th ed. Philadelphia, Saun
ders, 1983.
Shklar G. Oral Cancer: The Diagnosis, Therapy, Management, and Rehabilitation
of the Oral Cancer Patient. Philadelphia, Saunders, 1984.
Sonis S. T. et al. Principles and Practice of Oral Medicine. - Philadelphia, Saunders, 1984.
Wood N. K-, Goas P. W. Differential Diagnosis of Oral Lesions. -- St. Louis,
Mosby, 1980.

32

. (Raj . Go at)
, .
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Castell D. ., Johnson I. F. Esophageal Function in Health and Disease.
New York, Elsevier Biomedical, 1983.
Enterline H., Thompson 1. Pathology of the Esophagus. New York, SpringerVerlag, 1984.
Gidda J. ., Goyal R. K- Regional gradient of initial inhibition and refractoriness
in esophageal smooth muscle. Gastroenterology 89, 843, 1985.
Goyal R. K., Cobb B. W. Motility of pharynx, esophagus and esophageal sphincter,
in Physiology of the Gastrointestinal Tract/Ed. L. R. Johnson. New York,
Raven Press, 1981, 359391.
Schulze-Delnieu K., Christensen I. The esophagus. In the Gastroentorology
Annual/Eds. F. Kern. A. Blum. New York, Elsevier Science, .1985, 128.
33


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(Lawrence S. Friedman, Kurt J. Isselbacher)

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Bond J. H., Levitt M. D. Gaseousness and intestinal gas. Med. Clin North Am,
62, 155, 1978.
Health and Public Policy Committee, American College of Physicians: Endoscopy
in the evaluation of dyspepsia. Ann. Intern. Med., 102, 266, 1985.
Horrocks J. C, DeDombal F. T. Clinical presentation of patients with dyspepsia. Gut, 19, 19, 1978.
Lasser R. B. et al. The role of intestinal gas in functional abdominal pain.
N. Engl. J. Med. 293, 524, 1975.
Levitt M. D. Intestinal gas production recent advances in flatology. N. Engl.
Med. J. 302, 1474, 1980.
Mead G. M. et al. Use of barium meal examination in dyspeptic patient under 50.
Br. Med. J., 1, 1460, 1977.
34

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Steisenger, J. S. Fordtren. Philadelphia, Saunders, 160177.
Herzog D. ., Copeland P. M. Eating disorders. N. Engl. J. Med. 313, 295, 1985.
Smith G. P. Satiety effect of gastrointestinal hormones, in Polypeptide Hormones/
Eds. R. F. Beers, E. G. Bassett. New York, Raven Press, 1980. 413420.
Weser E. Anorexia and obesity in Gastrointestinal Disease, 34 ed/Eds. M. H. Sleisenger, J. S. Fordtran. Philadelphia, Sauders, 1983, 135144.
35


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work in a low calorie carbohydrate diet. J. Appl. Physiol- 10412, 1957.
Foster D. W. Eating disorders: Obesity and anorexia .nervosa, in Williams Textbook
. of Endocrinology, 7th ed/Eds. J. D. Wilson, D. W. Foster. Philadelphia,
Saunders, 1985, 1081.
Garfinkel P. E. et al. Differential diagnosis ot emotional disorders that cause weight
loss. Can. MetLAssoc. J., 129, 939, 1983.
Khoury P. et al. Weight change since age 18 years in 30- to 50-year-old whites
and blacks. Associations with lipid values, lipoprotein levels, and blood-pressure. JAMA, 250, 3179, 1983.
Konishi F. Food energy equivalents of various activities. J. Am. Diet Assoc.
46, 186, 1965..
.

Marton K. I. et al. Involuntary weight loss: Diagnostic and prognostic significance. Ann. Intern. Med. 95, 568, 1981.
Perez M. M. et al. Assesment of weight loss, food intake, fat metabolism, malabsorption, and treatment of pancteatic insufficiency in pancreatic cancer.
Cancer, 52, 346, 1983.
Runcie ]., Hilditch . E. Energy provision, tissue utilization and weight loss in
prolonged starvation. Br. Med. J. 2, 352, 1973.
Yang M.-U., Van Itallie T: B. Composition of weight loss during short-term
weight reduction. Metabolic responses of obese subjects to starvation and low
calorie ketogenic and non-ketogenic diets. J. Clin. Invest. 58, 722, 1976.

A B A 36

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Blacklow N. R., Cukor G. G. Viral gastroenteritis. N. Engl. Med. 304, 397, 1981.
Christensen 1. Motility of the colon, in Physiology of the Gastrointestinal Tract/
Eds. L. R. Johnson et al. New York, Raven, Press, 1981, 1, 14.
Drossman D. A. et al. The irritable bowel syndrome. Gastroenterology, 73, 811,
1977.
Field M. et al (eds) Secretory Diarrhea, Clinical Physiology Series. Bethesda, Md,
American Physiological Society, 1980.
Gershon M. D., Erde S. M. The nervous system of the gut. Gastroenterology,
80, 1571, 1981.
Lieberman D. A. Common anorectal disorders Ann. Intern. Med., 101, 837,
1984.
Plotkin G. R. et al. Gastroenteritis: Etiology, pathophysiology and clinical manifestations. Medicine, 58 95, 1979.
Read N. W. et al. Chronic diarrhea of unknown origin. Gastroenterology 78,
2644, 1980.
437

Schultz S. G. Ion transport by mammalian large intestine, in Physiology of the


Gastrointestinal Tract/Eds. L. R. Johnson et al. - New York, Raven Press,
1981, 2, 38.
Snooks S. I. et al. Damage to the innervation of the pelvic floor musculature in
chronic constipation. Gastroenterology, 89, 977, 1985.
Wolfson J. S. et al. Cryptosporidiosis in immunocompetent patients. N. Engl.
J. Med., 312, 1278, 1985.

37

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Athanasoulis . A. Angiography. Its contribution to the emergency management of
gastrointestinal hemorrhage. -Radio). Clin. North Am., 1976, 14:265.
Cello J. P. et al. Endoscopic sclerotherapy versus portocaval shunt in patients with
severe sirrhosis and variceal hemorrhage.N. Wngl. J. Med., 1984, 311:1589.
Chojkier M. et al. A controlled comparison of continuous intraarterial and intravenous infusions of vasopressin in hemorrhage from esophageal varices.
Gastroenterology, 1979, 77:540.
Fleischer D. Endoscopic therapy of upper gastrointestinal bleeding.Gastroenterology, 1986, 90:217.
Lichtenstein J. L. Accuracy and reliability of endoscopy and .x-ray in upper gastrointestinal bleeding.Dig. Dis. Sc, 1981, 26:70s.
Luk G. D. et al. Gastric aspiration in localization on gastrointestinal hemorrage.
JAMA, 1979, 241:576.
Peterson W. L. et al. Routine early endoscopy in upper gastrointestinal tract
bleeding:A randomized, controlled trial.N. Engl. J. Med., 1981, 304:925.
Priebe H. J. et al. Antacid versus cimetidine in preventing acute gastrointestinal
bleeding. A randomized trial in 75 critically ill patients.N. Engl. J. Med.,
1980, 302:426.
Richter J. M. et al. Angiodysplasia. Clinical presentation and colonoscopic
diagnosis.Dig. Dis. Sci, 1984, 29:481.
Steer M. L., Silen W. Diagnostic procedures in gastrointestinal hemorrhage.
N. Engl. J. Med., 1983, 309:646.
38

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Berlin N.. Berk P. Quantitative aspects of bilirubin metabolism for hematologists. Blood, 1981, 57:983.
Blankaert N... Schmid R. Physiology and pathophisiology of bilirubin metabolism. In: Hepatology: A Textbook of liver disease/Eds. D. Zakim, T. Boyer. Philadelphia: Saunders, 1982, pp. 246296.
McDonagh A. F. et al. Blue light and bilirubin excretion. Science, 1980, 208:145.
Van Hootegem P. et al. Serum bilirubins in hepatobiliary disease: Comparison
with other liver function tests. Hepatology, 1985, 5:112.
Weiss J. S. et al. The clinical importance of a protein-bound fraction of serum
bilirubin in patients with hyperbilirubinemia. N. Engl. J. Med., 1983,
309:147.
Wolkoff A. W. et al. Hereditary jaundice and disorders of bilirubin metabolism.
In: The Metabolic Basis of Inherited Disease/Eds. J. B. Stanbury et al.
5 th ed. New York: McGraw-Hill, 1983, pp. 13851420.
39


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Bar-Meir S. Analysis of ascitic fluid in cirrhosis. Dig. Dis. Sci., 1979, 24:136.
Cattan . L., Jr. et al. The accuracy of the physical examination in the diagnosis of
suspected ascites. JAMA, 1982, 247:1146.
Conn H. O. Spontaneous bacterial peritonitis: Multiple revisitations. Gastroenterology, 1976, 70:455.
Garcia-Tsao G. et al. The diagnosis of bacterial peritonitis. Hepatology, 1985,
5:91.
Grake T.M.S. et al. Peritoneoscopy on the diagnosis of tuberculous peritonitis.
Gastrointest. Endosc, 1981, 27:66.
Rector W. G., Jr., Reynolds . . Superiority of the serum: Ascites albumin difference over the ascites total protein concentration in separation of transudative and exudative ascites. Am. J. Med., 1984, 77:83.

40


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Abuelo J. G. Proteinuria: Diagnostic principles and procedures. Ann. Intern.


Med., 1983, 98, 186.
Brenner B. M. et al. Molecular basis of proteinuria of glomerular origin. N. Wngl.
J. Med., 1978, 298, 826.
Bridges C. R. et al. Glomerular charge alteration in human minimal charge nephropathy. Kidney Int., 1982, 22, 677.
Glassock R. J. et al. Primary glomerular disease. - In.: The Kidney/Eds.
B. M. Brenner, F. Rector. Jr. 3d ed. Philadelphia: Saunders, 1986,
929.
Kurtzman M. A. (ed.). Seminars in nephrology: Acute renal failure/Ed. J. P. Knochel (guest ed.). New York: Grune and Stratton, 1981.
Kurtzman N. A. (ed.). Seminar in nephrology: Chronic renal failure/Ed. G. Eknoyan
(guest e d ) . New York: Grune and Stratton, 1981.
482

Oken D. E. On the differential diagnosis of acute renal failure. Am. J. Med.,


1981, 71, 916.
Pardo V. et al. Benign primary hematuria: Clinicopathologic study of 65 patients.
Am. J. Med., 1979, 57, 817.

Bert . (ed.). Disorders of water metabolism. In: Seminars in nephrology.
New York: Grune and Stratton, 1984, 4. 285.
Robertson G. L, Berl W. Phathophysiology of water metabolism. In: The
kidney/Eds. B. M. Brenner, F. C. Rector, Jr. Philadelphia: Saunders,
1986, 385.
Schrier R. W., Bichei D. G. Osmotic and nonosmotic control of vasopressin release
and the pathogenesis of impaired water .excretion in adrenal, thyroid, and
edematous disorders. J. Lab. Clin. Med., 1981, 98, 1.
Zerbe R. L., Robertson G. L. A comparison of plasma vasopressin measurements
with a standard indirect test in the differential diagnosis of polyuria.
N. Engl. J. Med., 1981, 305, 1539.
, ,
,
Bradley W. E. Diagnosis of urinary bladder dysfunction in diabetes mellitus.
Ann. Intern. Med., 1980, 92, 323.
Bradley W. E., Scott F. B. Physiology of the urinary bladder. In: Urology/Eds.
J. H. Harrison et al. 4th ed. Philadelphia: Saunders, 1978, 1, 87.
DeGroat W. C, Booth A. M. Physiology of the urinary bladder and urethra.
Ann. Intern. Med., 1980, 92, 312.
Hlndmarsh H. R., Byrne P. O. Adult enuresis: A symptomatic and urodynamic
assessment. Br. J. Urol., 1980, 52, 88.
Meares E. M., Jr. Prostatitis syndromes: New perspectives about old wies.
J. Urol., 1980, 123, 141.
7
Mikkelsen E. J., Rapoport J. L. Enuresis: Psychopathology, sleep stage, and drug
response. Urol. Clin. North. Am. 1980, 7, 361.
Platt R. Quantitative definition of bacteriuria. Infectious diseases symposium.
July 28, 1983, p. 44, Supplement to Am. J. Med.
Turner-Warwick R., Whiteside C. G. (eds.). Symposium on clinical urodynamics:
The urologic clinics of North America. Philadelphia; Saunders, 1979, vol. 6.
Williams M. E., Pannell P. Urinary incontinence in the eldeply. Ann. Intern.
Med., 1982, 97, 895.
41

. (Norman G. Levinsky)

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Bartter F. . The syndrome of inappropriate secretion of antidiuretic hormone


(SIADH). Dis. Month. Nov., 1973.
Berl T. et al. Clinical disorders of water metabolism. Kidney Int., 1976, 10,
117.
Miller M.; Moses A. M. Drug-induced states of impaired excretion Kidney.
Int., 1976, 10, 96.
Narins R. G. et al. Diagnostic strategies in disorders of fluid electrolyte and
acid-base homeostasis. Am. J. Med., 1982, 72, 496.
Robertson G. L. Thirst and vasopressin function in normal and disorders states
of water balance. J. Lab. Clin. Med., 1983, 104, 351.
Robertson G. L., Berl T. Pathophysiology of water metabolism. In: Kidney/
Eds. B. M. Brenner, F. C. Rector. 3d ed. Philadelphia: Saunders, 1986,
p. 385.
Weiner M., Epstein F. H. Signs and symptoms of electrolyte disorders. Yale J.
Biol. Med., 1970, 43, 76.
Zerbe R. et al. Vasopressin function in the syndrome of inapropriate diuresis.
Ann. Eev. Med., 1980, 31, 315.

Bia M. J., DeFronzo R. A. Extrarenal potassium homeostasis. Am. J. Physio!.,


1981, 240, F257.
Hollenberg N. K., Brown R. S. (eds.). Electrolyites and cardiovascular disease.
Am. J. Med., 1984, 77 (5A), 1.
Knochel J. P. The syndrome of hyporeninemic hypoaldosteronism. Am. Rev.
Med., 1979, 30, 145.
Knochel J. P. Neuromuscular manifestations of electrolyte disorders. Am. J. Med.,
1982, 72, 521.
Richardson R. M. A., Kunau R. ., Jr. Renal regulation of potassium: Abnormal.
In: The Kidney: Physiology and Pathophysiology/Eds. D. W. Seldin, G. Geibisch.-^ 2d ed. New York:Raven Press, 1985, p. 1251.
Sterns R. H. et al. Internal potassium balance and the control of the plasma
potassium concentration. Medicine, 1981, 60, 339.
Wright F, S. Sites and mechanisms of potassium transport along the renal tubule.
Kidney Int., 1977, II, 415.
507

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Arbus G. S. An in vitro acid-base nomogram for clinical use. Can. Med. Assoc.
J., 1973, 109, 291.
Battle D. C, Ku.rtzm.an N. A. Renal regulation of acid-base homeostasis: Intergrated
response. In: The Kidney: Physiology and pathophysiology/Eds. D. W. Seldin, G. Geibisch. - 2d ed. New York: Raven Press, 1986, p. 1539.
Battle D. C. et al. Clinical and pathophysiologic spectrum of acquired distal renal
tubular acidosis. Kidney Int., 1981, 20, 398.
Cogan M. G., Rector F. C, Jr. Acid-base disorders. In: The Kidney/Eds. . .
Brenner, F. Rector Jr. 3d ed. Philadelphia: Saunders, 1986, p. 457.
Emmett M., Narins R. G. .Clinical use of the anion gap. Medicine, 1977, 56, 38.
Kassirer J. P., Madias N. E. Respiratory acid-base disorders. Hosp. Practice,
1980, 15, 57.
521

Levy L. H. et al. Ketoacidosis associated with alcoholism in -diabetic subjects.


Ann. Intern. Med., 1973, 78, 213.
Narins R. G., Emmett M. Simple and mixed acid-base disorders: A practical approach. Medicine, 1980, 59, 161.
Schwartz W.B., Belman A. S. A critique of the parametrs used in the evalution of
acid-base disorders. N. Engl. J. Med., 1963, 268, 1382.
Stinebaugh B. J. et al. Pathogenesis of distal renal tubular acidosis. Kidney
Int., 1981, 19, 1.
Tanner R. L. Control of acid excretion by the Kidney. Ann. Rev. Med., 1980,
31, 35.

43

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Fordnet) D. S. Syspareunia and vaginismus. - Clin. Obstet. Gynaecol., 1978,
21:205.
Hatcher R. A. et al. Contraceptive Technology 19841985. New York: Irvington,
.1984.
Kase N. G. et al. Principles and Practice of Clinical Gynecology. New York:
Wiley, 1983.
Masters W., Johnson V. Human Sexual Response. Boston: Little Brown, 1970.
Pritchard J. H. et al. Williams Obstetrics, 17th ed. Norwalk Ct.: Appleton
CenturyCrofts, 1985.
Speroff L. et al. Clinical Gynecologic Endocrinology and Infertility. 3d ed.
Baltimore: Williams and Wilkins, 1983.
44


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Benson G. S. Mechanisms of penile erection.Invest. Urol., 1981, 19:65.


Buvat J. et al. Comparative investigations in 26 impotent and 26 nonimpotent
diabetic patients.J. Urol., 1985, 133:34.
Cole N.J. Drugs that influence sexual expression.Consultant, 1980, 20:3281.
Davidson J. M. et al. Effects of androgen on sexual behavior in hypogonadal
man.J. Clin. Endocrinol:, 1979, 48;955.
Ercole J.I. et al. Changing surgical concepts in the treatment of priapism.
J. Urol., 1981, 125:210.
Fishman J. E. et al. Experience with inflatable penile prosthesis. Urology,
1984, 23:86.
Furlow W. L. (ed). Male sexual dysfunction.Urol. Clin. North. Am., 1981, 8:1.
Levine S. B. Marital sexual dysfunction : Ejaculation disturbances.-Ann. Intern.
Med., 1976, 84:575.
Lue T. F. et al. Hemodynamics of erection in monkey. J. Urol., 1983, 130:1237.
Marshall P. G. et al. Nocturnal penile tumescence with stamps: A comparative
study under sleep laboratory conditions. J. Urol., 1983, 130:88. .
Meyer J. Disorders of sexual function. *In%: Williams Textbook of Endocrinology/
Eds. J. D. Wilson, D. M. Foster. Vol. 7. Philadelphia: Saunders, 1985,
pp. 476491.
Nath R. L. et al., The multidisciplinary approach to vasculogenic impotence.
Surgery, 1981, 89:124.
,

535

Newman H. F. et al. Mechanism of human penile erection: An overview.


Urology, 1981, 17:399.
Spark R. F. et al. Impotence is not always psychogenic. JAMA, 190, 243:750.
Van Arsdalen K. N. et al. Erectile physiology, dysfunction and evaluation:
1. Physiology of erection. Monogr. Urol., 1983, 4:137156.
Watsh P. et al. Impotence following radical prostatectomy: Insight into etiology
and prevention. J. Urol., 1982, 128:492.
Winter . . Priapism. Urol. Surv., 1978, 28:163.
Zogniotti A. W. Auto-injection of the corpus cavernosum with a vasoactive drug
combination for vascular impotence. J. Urol., 1985, 133:39.

Amelar R. D. et al. Male Infertility. Philadelphia: Saunders, 1977, p. 153.


Greenbe'rg S.H. et al. Experience with 425 subfertile male patients. J . Urol.,
1970, 119:507.
Sherins R. J. et al. Male infertility. In: Cambell's Urology/Eds. P. Walsh et
al. 5th ed. Philadelphia: Saunders, 1985, vol. 1, ch. 12.
45


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Bell A. P. et al. Sexual Preference: Its Development in Men and Women.
Bloomington: Indiana University Press, 1981.
Ende J. et al. The sexual history in general medicine practice. Arch. Intern. Med.,
1984, 144:558.
Frank E. et al. Frequency of sexual dysfunction in normal couples.N. Engl.
J. Med., 1978, 299:111.
Group for the Advancement of Psychiatry, Committee on Medical Education:
Assessment of Sexual Function. New York: Jason Aronson, 1974.
Kolodny R. et al. Textbook of Sexual Medicine. Boston: Little, Brown, 1979.
Lief H.I. et al. Sexual Problems in Medical Practice. American Medical
Association, 1981.
Ludeman K. The sexuality on the older person: Review of the literature.Gerontologist, 1981, 21:203.
Maggee M.C. Psychogenic impotence: A critical review. Urology, 1980, 15:435.
Meyer J. Disorders of sexual function.In: William's Textbook of Endocrinology/
Eds. J. D. Wilson, D. W. Foster. 7th ed. Philadelphia: Saunders, 1985,
p. 312.
Munjack D. J., Ozier L. J. Sexual Medicine and Counseling in the Office Practice: A Comprehensive Treatment Guide. Boston: Little, Brown, 1980.
Stagg M. F. et al. Impotence in medical clinic outpatients.JAMA, 1983, 249:1736.

46


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Camming D. . et al. Treatment of hirsutism with spironolactone. J. Am. Med.
Assoc., 1982, 247:1295.
Givens J. R. Normal and abnormal androgen metabolism. Clin. Obstet. Gynecol.,
1978, 21:115.
Kirschner M. A. et al. Idiopathic hirsutism an ovarian abnormality. N. Engl.
J. Med., 1976, 294:637.
Kuttenn F. et al. Late-onset adrenal hyperplasia in hirsutism. N. Engl. J. Med.,
1985, 313:224.
Lucky A. W. et al. Plasma androgens in women with acne vulgaris. J. Invest.
Dermatol., 1983, 81:70.
Raj S.G. et al. Normalisation of testosterone levels using a low estrogen containing
oral contraceptive in women with polycystic ovary syndrome. Obstet.
Gynecol., 1982, 60:15.
Rubens R. Androgen levels during cyproterone acetate and ethynil
oestradiol
treatment of hirsutism.Clin. Endocrinol., 1984, 20:313.
Williams G.H. Hirsutism. I n : Office Practice of Medicine/ Ed. W. T. Branch.
Philadelphia: Saunders, 1986, in press.

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