Problems in Practice – serie

There is ample opportunity and scope for gynaecology in prim­ ary care in general practice. Many conditions and problems can be managed successfully in this context without referral to hos­ pital and specialist care. The first aim of this book is to deal with common problems that are referred for consultant opinion and specialist management to the average District General Hospital by analysing problems of presentation and diagnosis on a symptom-orientated basis. Selection for primary care management as opposed to hospital referral is then considered, following which the wide range of available treatment is evaluated with particular emphasis on the maximum use of up-to-date but proven regimes. The full use of the expertise of the practitioner is highlighted throughout. The second aim is to encourage the practice of primary care gynaecology and to help those doctors who have a special in­ terest in the subject, while hopefully stimulating others to de­ velop a similar one. With this in mind, the approach to the problems is realistic and often dogmatic while opportunities for individual management and for practical procedures are kept to the forefront.

The editors are pleased to present these Proceedings of the V Course of the "International School of Radiation Damage and Pro- tection" of the "E. Majorana Centre", held in Erice (Italy) in No- vember 1983. The lectures and discussions among leading scientists in various disciplines of physics, engineering, biophysics, cellular biology, physiology and medicine from 11 countries are included in this compilation. In this volume we have attempted to explore all aspects of the interaction of static and Extremely Low Frequency (ELF: 0-300 Hz) electric and magnetic fields with biological tissue, systems and whole organisms; we considered dosimetry and what is known or pre- sumed concerning basic interactions, responses from the cellular and molecular level to the whole organism. Discussions of medical appli- cations as well as epidemiologic investigations related to high volt- age transmission were held with critiques of methodologies used and recommendations for future approaches. Consideration was also given to the necessity and principles of setting protection standards for man and the environment.We believe this is the first attempt to put all this informa- tion together into one volume to provide perspective for understand- ing the influence of static and ELF electric and magnetic fields on biological systems. We hope our attempts were successful. Martino Grandolfo Sol M. Michaelson Alessandro Rindi v ACKNOWLEDGEMENTS This is the Fifth Course of the International School of Radia- tion Damage and Protection of the "Ettore Majorana" Centre for Sci- entific Culture directed by Professor A. Zichichi.

This volume contains several contributions among those held at the fourth Course of the International School of Applied Geophysics, Erice, March 15-24, 1982. The content has been arranged according to the three main topics covered during the course: the goedynamic models, the contribution of geophysics to their construction and the optimization and constrains of the exploration methods. At the end of the volume, four short notes are published, written by participants to the course and related to the general subject. It is regrettable that not all the lectures and discussions are available for publication in this volume. However, it is hoped that the papers presented here will stimulate further discussions and suggest new topics for future meetings. R.Cassinis v CONTENTS 1 Introductory note R Cassinis Global seismology and the investigation of deep 5 continental structure G Nolet The relation between superficial and deep structure of 23 the Caucasus region and possible geodynamic model V N Sholpo Seismicity and crustal structure in the Italian region: 53 a preliminary zoning R Cassinis 93 Structure seismology I P Kosminskaya Main features of crustal structures in mediterranean 113 collisional zones P Giese Potentia~ and constraints of near vertical reflection 133 seismics in non-sedimentary deep formations K Helbig and J Schmoll Geoelectrical deep explorations by means of direct currents L Alfano 179 Reflection profiling of the continental crust R Phinney Evidence for a strong crust-mantle boundary undulation in the TYrrhenian sea from a refraction seismic 183 survey C B!)ttcher

This book goes beyond the dos and don'ts of a mechanical set of skills to provide thoughtful and practical guidelines on the effective management of professional relationships. Exercises and case studies are used to pinpoint unsatisfactory aspects of the reader's relationships with colleagues, bosses, students and clients.

This book has been written primarily for general practitioners; it describes the social problems which are presented by patients to their doctors for help and advice. The aim of the book is to help the doctor manage these problems, both through his own interventions and by involving or referring the patient on to other agencies. While the more common problems have been considered in detail, those rarely encountered have been omitted. The book also concentrates on help available from non-medical sources, as these will be less familiar to the general practitioner than other medical or nursing services. There is often a close association between social difficulties and health problems, both physical and psychiatric. It is, there­ fore, vital that an attempt is made to meet the social needs of patients in order to promote good physical and mental health. R. H. Corney 8 Series Foreword This series of books is designed to help general practitioners. So are other books. What is unusual in this instance is their collect­ ive authorship; they are written by specialists working at district general hospitals. The writers derive their own experi­ ence from a range of cases less highly selected than those on which textbooks are traditionally based. They are also in a good position to pick out topics which they see creating difficulties for the practitioners of their district, whose personal capacities are familiar to them; and to concentrate on contexts where mistakes are most likely to occur.

This series of books is designed to help general practitioners. So are other books. What is unusual in this instance is their collec­ tive authorship; they are written by specialists working at district general hospitals. The writers derive their own experi­ ence from a range of cases less highly selected than those on which textbooks are traditionally based. They are also in a good position to pick out topics which they see creating difficulties for the practitioners of their district, whose personal capacities are familiar to them; and to concentrate on contexts where mistakes are most likely to occur. They are all well-accustomed to working in consultation. All the authors write from hospital experience and from the viewpoint of their specialty. There are, therefore, matters important to family practice which should be sought not within this series, but elsewhere. Within the series much practical and useful advice is to be found with which the general practitioner can compare his existing performance and build in new ideas and improved techniques. These books are attractively produced and I recommend them.

There is ample opportunity and scope for gynaecology in prim­ ary care in general practice. Many conditions and problems can be managed successfully in this context without referral to hos­ pital and specialist care. The first aim of this book is to deal with common problems that are referred for consultant opinion and specialist management to the average District General Hospital by analysing problems of presentation and diagnosis on a symptom-orientated basis. Selection for primary care management as opposed to hospital referral is then considered, following which the wide range of available treatment is evaluated with particular emphasis on the maximum use of up-to-date but proven regimes. The full use of the expertise of the practitioner is highlighted throughout. The second aim is to encourage the practice of primary care gynaecology and to help those doctors who have a special in­ terest in the subject, while hopefully stimulating others to de­ velop a similar one. With this in mind, the approach to the problems is realistic and often dogmatic while opportunities for individual management and for practical procedures are kept to the forefront.

In writing this short monograph on 'Problems in Peripheral Vascular Disease', I have tried to steer a course between a simplistic dogmatic approach more appropriate to an under­ graduate text, and a detailed specialist treatise of interest only to vascular surgeons. Although arterial surgery has been performed for centuries, the main indications in the past were to deal with the effects of trauma and aneurysm formation. The development of arterio­ graphy and the ability to see arterial blocks and stenoses allowed surgeons to carry out increasingly sophistidated operations for an enlarging range of pathological conditions. Even today, arterial surgery continues to develop, and although we are often dealing with the 'surgery of ruins', a successful outcome is just as rewarding for surgeon and patient alike. In this book I have also included a discussion on venous problems including a note about recent developments in direct surgery of the deep veins of the lower limb which could be a re­ warding field of endeavour for the vascular surgeon. The original descriptions by Buerger and Raynaud are taken from 'Classic Descriptions of Disease' by Ralph H. Major. While reviewing my own surgical practice, I have had the pleasure of reading once again the publications of H.H.G. Eastcott (arterial surgery), J.T. Hobbs (varicose veins), G.L. Hill (Buerger's disease), Adrian Marston (intestinal ischaemia), Martin Bimstingl (vasospastic disorders) and C.H. Hawkes (lumbar canal stenosis).

The aim of this book is to give a short and practical account of the problems related to the ear, nose and throat. The presenta­ tion is orientated towards arriving at a diagnosis based on the presenting symptoms and signs and aid the management of the case. While it is specifically intended for those who have not had the opportunity of devoting much time to the subject, I hope that it may be of some service to the more experienced practitioner. Padman Ratnesar Farn boro ugh, 1984 7 Series Foreword This series of books is designed to help general practitioners. So are other books. What is unusual in this instance is their collective authorship; they are written by specialists working at district general hospitals. The writers derive their own experience from a range of cases less highly selected than those on which textbooks are traditionally based. They are also in a good position to pick out topics which they see creating diffi­ culties for the practitioners of their district, whose personal capacities are familiar to them; and to concentrate on contexts where mistakes are most likely to occur. They are all well­ accustomed to working in consultation.

Part one of the book presents the gastrointestinal problems that commonly face the general practitioner. Emphasis is placed on analysis of clinical data and how this may provoke the most profitable lines of investigation. Many of the investigation and treatment protocols are within the scope of general practice, but hospital management is also included. It was possible to deal with common oesophageal diseases under the heading of oeso­ phageal problems in Part 1. In contrast, it proved impossible to discuss adequately all of the common diseases affecting other organs of the digestive system under the problem headings. For this reason, a fuller ac count of many common alimentary diseases is provided in Part two. M. L.-5. K. G. D. W. 9 Series Foreword This series of books is designed to help general practitioners. So are other books. What is unusual in this instance is their collec­ tive authorship; they are written by specialists working at district general hospitals. The writers derive their own experi­ ence from a range of cases less highly selected than those on which textbooks are traditionally based. They are also in a good position to pick out topics which they see creating difficulties for the practitioners of their district, whose personal capacities are familiar to them; and to concentrate on contexts where mistakes are most likely to occur. They are all well-accustomed to working in consultation.

Over several years working in a district general hospital as a physician with a cardiological interest, the common problems in this field are clearer. This knowledge has come through normal out-patient clinic referrals, care of in-patients, and by working in a domiciliary consultative capacity. The problems that concern family physicians nowadays are somewhat different from the problems of two or three decades ago. The accent now is very much on the implications of hypertensive and ischaemic heart disease. Rheumatic fever is rarely seen, though its sequelae may still be discovered. Hence the approach of this book is to the common problems of today in family practice, and the book is not intended to be a reference text book of cardiology. It does not include references because it has been written from personal experience gained from the treatment and management of patients with common cardiac problems. It is hoped that it will be of value primarily to family physicians because it has been written in an attempt to fill a need as measured by the problems that are referred to specialists in the cardiological field. It may prove of value to those medical students and nurses who wish to consider medical problems in a practical way, that is from the ways that cardiac problems present in practice.

The topics chosen for discussion represent the most common problems referred by family doctors to chest clinics. It was taken for granted that the reader will be familiar with the symptoms, signs, and natural history of respiratory diseases, so that the stress is on differential diagnosis and treatment. Tuberculosis once occupied nearly all the time of chest physicians. At present weeks go by without a single case presenting itself. There has been no comparable improvement in cancer of the lung, which remains one of the most intract­ able problems. Asthma was seldom referred to out-patient clinics when the disease was regarded as more unpleasant than dangerous. The hazards of severe attacks and the advan­ tages of liaison with a hospital department are now widely recognized. A similar change of attitude to the management of chronic bronchitis brought many new patients to the chest clinics in place of the vanishing tuberculous population. Some uncommon pulmonary diseases are included: allergic alveolitis, because of the importance of early diagnosis, and sarcoidosis in order to discourage unnecessary treatment. The book is intended to be a practical guide and is not a critical review. This might serve as an excuse for its didactic style and the exclusion of controversial subjects. Some statements are repeated at more than one place in order to help readers who wish to consult individual chapters bearing on some current problem. Source references are omitted and are replaced by a short list of books recommended for further reading.

The fact that there are special problems in the care of the elderly in the community is ample justification for writing a separate volume on the subject. The knowledge that there are increasing numbers of older people in virtually every country in the world makes it all the more important that the family physician should have sympathy with and understanding of the problems of them, since they are lilcely to make up a significant part of his worlcload and, increasingly, will take up more of his time and energy. There is a progressive amount of disability with advancing years, and this is particularly true of those aged 75 years and over. Increasing age is associated with serious impairment of hearing and vision, senses which younger people take for granted. Old age sees the arrival of major diseases of middle age with much greater frequency, such as ischaemic heart and cerebrovascular disease, diabetes mellitus and osteoarthritis. There are other disorders that are virtually confined to the elderly, such as fractures of the femoral neck, Paget's disease and myeloma. We now know that the disintegration of the con­ ducting tissue of the heart is largely an age-related phenomenon. Ageing processes affect every major organ system in the body and the impairment of physiological perfor­ mance resulting from these affects the elderly individual's response to infections, disease and environmental changes in complex ways that are not seen in younger people.