MANUALUL MERCK TRADUS IN LIMBA ROMANA

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MANUALUL MERCK. EDITIA A XVIII-A MANUALUL MERCK EDIIA a XVIII-a Ediia I 1899 Ediia a II-a 1901 Ediia a III-a 1905 Ediia a IV-a 1911 Ediia a V-a 1923 Ediia a VI-a 1934 Ediia a VII-a 1940 Ediia a VIII-a 1950 Ediia a IX-a 1956 Ediia a X-a 1961 Ediia a XI-a 1966 Ediia a XII-a 1972 Ediia a XIII-a 1977 Ediia a XIV-a 1982 Ediia a XV-a 1987 Ediia a XVI-a 1992 Ediia a XVII-a 1999 Ediia a XVIII-a 2006 MANUALUL MERCK. EDITIA A XVIII-A MANUALUL MERCK. EDITIA A XVIII-A EDITII N ALTE LIMBI ale Manualului Merck Arab Larike Publications Services, Cyprus Ceh Egem, Prague Chinez People's Medical Publishing House, Beijing Coreean Hanwoori Publishing Co., Seoul Croat Placebo, Split Francez Editions d'Aprs, Paris German Elsevier, Ltd., Munich Greac Medical & Scientific Publishing, Athens Italian Springer-Verlag Italia Srl (Medicom), Milan Japonez Nikkei Business Publications, Tokyo Polonez Elsevier, Ltd, Wroclaw Portughez Editora Roca Ltda., So Paulo Rus MIR Publishers, Moscow Spaniol Elsevier Espaa, S.A., Madrid Turc Yce, Istanbul Ungar Melania, Budapest ALTE CRI MERCK THE MERCK INDEX Ediia I, 1889 THE MERCK VETERINARY MANUAL Ediia I, 1955 THE MERCK MANUAL OF GERIATRICS Ediia I, 1990 THE MERCK MANUAL OF MEDICAL INFORMATION-HOME EDITION Ediia I, 1997 THE MERCK MANUAL OF HEALTH & AGING MANUALUL MERCK. EDITIA A XVIII-A Ediia I, 2004 Crile Merck sunt publicate fr a obine profit, ca un serviciu adus comunitii tiinifice i publicului. MANUALUL MERCK. EDITIA A XVIII-A EDIIA A XVIII-A MANUALUL MERCK DE DIAGNOSTIC I TRATAMENT MARK H. BEERS, MD, Edittor ef ROBERT S. PORTER, MD, Edittor THOMAS V. JONES, MD, MPH, Edittor asociat JUSTIN L. KAPLAN, MD, Edittor asistent MICHAEL BERKWITS, MD, MSCE, Edittor asistent Comittett edittorial Richard K. Albert, MD Marjorie A. Bowman, MD, MPA Sidney Cohen, MD Jan Fawcett, MD Eugene P. Frenkel, MD Susan L. Hendrix, DO Michael Jacewicz, MD Gerald L. Mandell, MD, MACP John E. Morley, MB, BCh H. Ralph Schumacher, Jr., MD David A. Spain, MD Peter G. Szilagyi, MD, MPH MANUALUL MERCK. EDITIA A XVIII-A Paul H. Tanser, MD, FRCP(C), FRCP (Glasgow) Publicatt de MERCK RESEARCH LABORATORIES Divizia MERCK & CO., INC. Whittehouse Sttattion, N.J. 2006 MANUALUL MERCK. EDITIA A XVIII-A THE MERCK MANUAL OF DIAGNOSIS AND THERAPY Mark H. Beers, Robert S. Porter Copyright 2006 Merck & Co., Inc., Whitehouse Station, N.J., USA, All Rights Reserved. Publicat n original n limba englez cu titlul The Merck Manual of Diagnosis & Therapy, 18th Edition. Copyright 2006 by Merck&Co., Inc. MANUALUL MERCK DE DIAGNOSTIC I TRATAMENT Mark H. Beers, Robert S. Porter Toate drepturile rezervate Editurii ALL. Nicio parte din acest volum nu poate fi copiat fr permisiunea scris a Editurii ALL. Drepturile de distribuie n strintate aparin n exclusivitate editurii. All rights reserved. The distribution of this book outside Romania, without the written permission of ALL, is strictly prohibited. Copyright 2009, 2012, 2014 by ALL. Editura ALL: Bd. Constructorilor nr. 20A, et. 3, sector 6, cod 060512 Bucureti Tel.: 021 402 26 00 Fax: 021 402 26 10 Departamentul distribuie: Tel.: 021 402 26 30; 021 402 26 33 Comenzi la: comenzi@all.ro www.all.ro Redactor: Dr. Bianca Vasilescu Coperta: Alexandru Novac 61 MANUALUL MERCK. EDITIA A XVIII-A Traductori: Adriana Muat Graiela Niu Ioana Popescu Oana Trifnescu Andrei-Vlad Vasilescu Tiparul executat la G. Canale & C. S. A. Romnia MANUALUL MERCK. EDITIA A XVIII-A CUVNT NAINTE Ediia precedent a Manualului Merck a celebrat cea de a 100-a aniversare i o istorie strlucit n oferirea informaiilor pentru cei implicai n sistemul de sntate din toat lumea. Cu aceast nou ediie, implementm schimbrile necesare pentru a fi siguri c Manualul Merck satisface nevoile dumneavoastr de informare n noul secol. Nevoile dumneavoastr s-au schimbat, aa c Manualul Merck trebuie s se schimbe la rndul su. n ziua de azi, cititorii doresc s gseasc rapid ceea ce caut pentru a se putea concentra asupra subiectelor specifice. Cu toate acestea, cititorii doresc o resurs bogat n toate informaiile de care au nevoie, acum sau mai trziu. Pentru c n medicin informaiile noi apar foarte rapid, o carte de medicin devine la rndul ei foarte rapid depit. Manualul Merck nu mai poate atepta nc cinci ani pn s apar cu noi informaii. Revoluia a venit i, odat cu ea, Manualul Merck ncepe un nou capitol n istoria sa. n anul 1899, Merck a publicat o lucrare de 192 de pagini intitulat Merck's Manual of the Materia Medica, care mai trziu a devenit cunoscut ca The Merck Manual of Diagnosis and Therapy (Manualul Merck de Diagnostic i Tratament). Acea carte a fost printat i legat, ditribuit i, n final, rescris i publicat ca a doua ediie civa ani mai trziu. Dup aceea, au urmat mai multe ediii, la intervale cuprinse ntre 2 i 12 ani. Dac ar fi fost ca durata dintre ediii s fie proporional cu viteza cu care se moderniza ngrijirea medical, atunci ediiile ar fi aprut din ce n ce mai rapid, cu apariii intermitente de ediii atunci cnd s-au descoperit antibioticele, atunci cnd a fost perfecionat chirurgia pe cord deschis, sau cnd studiile de imagistic asistat de computer s-au dezvoltat. n zilele noastre, progresele importante n ngrijirea medical sunt continue, informaiile nvechite sunt potenial periculoase, iar ntrzierea n oferirea informaiilor corecte este inacceptabil. Aceast carte trebuie s se schimbe sau s dispar. Aceast ediie a Manualului Merck a fost astfel organizat i structurat pentru a v ajuta s gsii ceea ce dorii mult mai uor. Indexul este complet i detaliat. Informaiile au fost separate chiar mai clar acum n entiti care descriu fiziopatologia, etiologia, simtomele i semnele, diagnosticul, prognosticul, tratamentul i profilaxia. Un sumar al punctelor cheie se gsete n introducerea fiecre pri importante. Cu toate c putei n aceast ediie nou s rsfoii i s citii subiecte aa cum dorii, acum este mult mai uor i rapid s cutai ceva precis de care avei nevoie. Manualul pe care l avei acum n fa este att de nou n prospeimea informaiei MANUALUL MERCK. EDITIA A XVIII-A pe ct poate fi o carte tiprit. Este ediia a XVIII-a i, chiar mai important, este ediia anului 2006. A fost revizuit i finalizat chiar nainte s fie dat la tiprit. Cu toate acestea, n doar cteva luni dup apariia pe pia, ea va deveni depit. Bineneles, marea majoritate a informaiei pe care o conine va fi corect i relevant pentru cei din sistemul de sntate, timp de ani buni de acum ncolo. ns, n unele domenii ale medicinei, noi informaii vor deveni disponibile dup aceasta. Pe ct de repede posibil, noi vom remprospta aceste informaii pe site-ul nostru de internet www.merckmanuals.com, care poate fi accesat gratuit. v MANUALUL MERCK. EDITIA A XVIII-A vi / CUVNT NAINTE Varianta electronic a Manualul Merck de Diagnostic i Tratament va fi mult mai la curent cu ultimele informaii medicale dect aceast form tiprit. Publicaiile electronice fac acest lucru s fie posibil, chiar dac rpesc o parte din farmecul acestei cri. Site-ul este, ns, o surs electronic, el neavnd niciun pic din farmecul i confortul unui volum tiprit. Mai mult ca sigur, astfel de "acuzaii" au fost ndreptate i ctre Guttenberg din partea scribilor care afirmau c toate crile ar fi trebuit s fie obiecte de art i nu obiecte utilitare, produse n mas. Cartea s-a schimbat i noi suntem recunosctori c aceast modificare a avut loc. La un moment dat n viitorul apropiat, vom tipri o nou ediie a Manualul Merck de Diagnostic i Tratament. Va fi versiunea printat a coninutului adus la zi de pe site- ul Web. Vom face acest lucru pentru aceia care se bucur de senzaia de a ine o carte n mn, rsfoindu-i paginile, ndoindu-i colurile i fcnd notaii pe marginea paginilor. Sperm c aceia care se ncadreaz n aceast categorie s rmn ct mai numeroi pentru muli ani de acum ncolo. De asemenea, sperm ca aceast ediie a Manualul Merck s v fie de ajutor dumneavoastr, cititorilor notri, s fie compatibil cu nevoile dumneavoastr i demn de a fi consultat frecvent. Mulumim celor cteva sute de persoane care au contribuit la realizarea ei. Sugestii pentru mbuntirea crii vor fi primite cu bucurie i analizate atent. MARK H. BEERS, MD, i ROBERT S. PORTER, MD MANUALUL MERCK. EDITIA A XVIII-A Dedicat oferirii informaiilor medicale: Merck i Manualele Merck ' n anul 1899, productorul american de medicamente Merck & Co. a publicat pentru prima oar o carte intitulat Merck s Manual of the Materia Medica. Aceast carte avea ca scop s fie un ajutor pentru medici i farmaciti, amintind doctorilor c memoria poate s joace feste". Compact ca dimensiuni, uor de folosit i cuprinztor, Manualul Merck (cum a ajuns s fie cunoscut cartea mai trziu) a devenit o favorit printre cei implicai n industria medical, dar i printre cei care cutau informaii medicale. Chiar i Albert Schweitzer a avut aceast carte n Africa n anul 1913, iar amiralul Byrd a luat cu el Manualul n cltoria sa ctre Polul Sud n anul 1929. n anii 1980, cartea devenise deja cel mai vndut text medical i era tradus n peste 12 limbi. Cu toate c numele companiei mam s-a schimbat ntr-o anumit msur peste ani, numele crii a rmas neschimbat, cunoscut oficial ca Manualul Merck de Diagnostic i Tratament" dar pomenit ca Manualul Merck", sau mai simplu, Merck"-ul. n anul 1990, editorii au introdus pe pia The Merck Manual of Geriatrics, care a devenit rapid cea mai bine vndut carte cu aceast tem, oferind informaii specifice i cuprinztoare n legtur cu ngrijirea persoanelor n vrst. Cea de a treia ediie a fost publicat n cinci limbi. Crearea acestei cri reflect dedicarea Merck-ului fa de populaia acestei lumi i dorina companiei de a mbunti ngrijirea geriatric n toat lumea. n anul 1997, a fost publicat The Merck Manual of Medical Information Home Edition. n aceast carte revoluionar, editorii au tradus limbajul medical complex din Manualul Merck ntr-un limbaj accesibil, crend astfel o carte care putea fi citit i de cei care nu aveau o pregtire medical. Cartea a primit aprecieri excepionale i a fost vndut n peste dou milioane de exemplare. Cea de a doua ediie a fost publicat n anul 2003 i a continuat angajamentul companiei de a oferi informaii medicale cuprinztoare, uor de neles, pentru publicul larg. The Merck Manual of Health and Aging, publicat n anul 2004, a continuat MANUALUL MERCK. EDITIA A XVIII-A angajamentul societii Merck pentru educaie i mbtrnire sntoas, oferind informaii n legtur cu mbtrnirea i ngrijirea persoanelor n vrst, ntr-un limbaj pe nelesul tuturor. Ca parte a dorinei ca orice persoan care are nevoie i dorete informaii medicale s le poat obine, Merck ofer coninutul acestor cri pe site-ul su, fr a percepe nicio tax (vizitai www.merckmanuals.com). Nu este necesar nregistrarea pe site i accesul este nelimitat. Publicaiile on-line sunt n permanen actualizate, astfel nct informaiile s fie ct mai recente. Merck susine, de asemenea, i comunitatea chimitilor i a altor persoane care au nevoie s cunoasc informaii n legtur cu compuii chimici, oferindu-le acestora vii MANUALUL MERCK. EDITIA A XVIII-A viii / DEDICAT OFERIRII INFORMAIILOR MEDICALE Merck Index. Publicat pentru prima oar n anul 1889, este de fapt mai vechi dect Manualul Merck, fiind n acelai timp i cel mai larg folosit text din categoria sa. The Merck Veterinary Manual a fost publicat pentru prima oar n anul 1955, oferind informaii n legtur cu ngrijirea animalelor; este cea mai important lucrare n acest domeniu. Merck & Co, Inc. este una dintre cele mai mari companii farmaceutice din lume. Compania este dedicat oferirii de informaii medicale de excepie i, ca parte a acestui efort, continu s ofere toate manualele sale ca un serviciu pentru comunitate. MANUALUL MERCK. EDITIA A XVIII-A CUPRINS NR. SECIUNE PAG. GHID PENTRU CITITORI ......................................... x ABREVIERI ............................................................. xi COMITET EDITORIAL ......................................... xiii CONSULTANI ...................................................... xv COLABORATORI.................................................... xvii NUT 1 BOLILE DE NUTRIIE ............................................. 1 DIG 2 BOLILE APARATULUI DIGESTIV .......................... 62 HEP 3 BOLILE FICATULUI I CILOR BILIARE ............................................................... 184 MUS 4 BOLILE OSTEOMUSCULARE I ALE ESUTULUI CONJUNCTIV ................................. 249 RES 5 BOLILE APARATULUI RESPIRATOR .................. 351 URG 6 MEDICINA DE URGEN .................................... 512 CVS 7 BOLILE CARDIOVASCULARE ............................. 570 ORL 8 AFECIUNI OTORINOLARINGOLOGICE I DENTARE ........................................................ 773 OFT 9 BOLILE OFTALMOLOGICE ................................. 867 DER 10 AFECIUNI DERMATOLOGICE .......................... 929 HEM 11 HEMATOLOGIE I ONCOLOGIE ..................... 1028 END 12 BOLILE ENDOCRINE I METABOLICE .............. 1172 IMU 13 IMUNOLOGIA; BOLILE ALERGICE ................... 1319 INF 14 BOLILE INFECIOASE ...................................... 1381 PSI 15 AFECIUNI PSIHIATRICE .................................. 1665 NEU 16 AFECIUNI NEUROLOGICE ............................. 1745 GU 17 BOLILE GENITO-URINARE ............................... 1926 GIN 18 GINECOLOGIE I OBSTETRIC ....................... 2059 PED 19 PEDIATRIE ......................................................... 2213 FAR 20 FARMACOLOGIE CLINIC ............................... 2513 TRA 21 TRAUMATISME; INTOXICAII ......................... 2545 MANUALUL MERCK. EDITIA A XVIII-A SSP 22 SUBIECTE SPECIALE .......................................... 2696 APE APENDICE Ghid de referin ............................................ 2773 Denumirile comerciale ale unor medicamente frecvent utilizate ................... 2776 IND INDEX ................................................................. 2787 ix MANUALUL MERCK. EDITIA A XVIII-A GHID PENTRU CITITORI Cuprinsul (pag. IX) conine paginile la care cititorii vor gsi lista membrilor comitetului editorial, consilierilor, consultanilor suplimentari i autorilor, precum i abrevierile i simbolurile, titlurile seciunilor, apendicele i indicele. Fiecare seciune ncepe cu propria tabl de materii, enumernd capitolele i subcapitolele din acea seciune. Capitolele sunt numerotate progresiv, de la nceputul pn la sfritul crii. Indicele conine intrri multiple, ncruciate; numrul paginilor cu caractere bold semnific prezentarea principal a temei. n plus, cititorii vor gsi multe referine ncruciate la alte seciuni i capitole din text. Colontitlurile indic pe pagina din stnga numrul i titlul seciunii, iar pe pagina din dreapta numrul i titlul capitolului. Abrevierile i simbolurile utilizate n text pentru economia de spaiu sunt enume- rate n paginile XI i XII. Alte abrevieri din text sunt exprimate la prima menionare n capitolul sau subcapitolul respectiv. Tabelele i figurile sunt trecute la indice, dar nu sunt enumerate ntr-o tabl de materii. Seciunea 22, Subiecte speciale, trateaz, printre altele, medicina complementar i alternativ, suplimente dietetice, elemente de genetic, oprirea fumatului, recuperarea, medicina geriatric, ngrijirea pacientului chirurgical, ngrijirea pacientului muribund i luarea de decizii clinice. Valorile de laborator din carte sunt date n uniti convenionale. ns, n majoritatea cazurilor, sunt trecute n parantez i unitile din sistemul internaional. Medicamentele sunt desemnate n text prin denumirile generice (comerciale). n Apendicele II, multe dintre medicamentele menionate n lucrare sunt listate alfabetic, cu denumirea generic urmat de una sau mai multe denumiri comerciale. Important: autorii, consultanii i editorii acestei lucrri au depus mari eforturi pentru a se asigura c tratamentele, medicamentele i schemele de dozaj sunt corecte i conforme cu standardele acceptate n momentul publicrii. Cu toate acestea, schimbrile constante informaionale care rezult din continua cercetare i experien clinic, diferenele acceptate de opinie dintre specialitii de marc, aspectele unice ale cazurilor clinice individuale i posibilitatea de eroare uman n pregtirea unui text de asemenea amploare impun ca fiecare cititor s-i exercite propriul raionament atunci cnd ia o decizie clinic i, dac este necesar, s consulte i s compare informaii provenite din alte surse. ndeosebi, cititorul este sftuit s verifice informaiile legate de produs, oferite de productor, nainte de a prescrie sau a administra medicamentul, n special dac acesta nu i este familiar sau este utilizat rar. MANUALUL MERCK. EDITIA A XVIII-A Not: cititorii pot gsi informaii actualizate, tabele i figuri suplimentare, precum i date multimedia la adresa de web www.merckmanuals.com. Vizitai frecvent site-ul pentru a vedea ultimele date i informaii medicale. x MANUALUL MERCK. EDITIA A XVIII-A ABREVIERI Urmtoarele abrevieri sunt utilizate n text; alte abrevieri sunt explicate la prima menionare n capitolul sau subcapitolul respectiv. ACTH hormon adrenocorticotrop ADH hormon antidiuretic ADN acid dezoxiribonucleic AINS medicamente anti-inflamatorii nesteroidiene ALT alanin aminotransferaz (fost GPT) AMPc adenozin monofosfat ciclic ARN acid ribonucleic AST aspartat aminotransferaz (fost GOT) ATP adenozin trifosfat BCG bacilul Calmette-Gurin BPOC boal pulmonar obstructiv cronic C Celsius; centigrad; complement Ca calciu CHEM concentraia eritrocitar medie de hemoglobin cGy centigray Ci curie CIM concentraie inhibitorie minim CK creatinkinaz Cl clor cm centimetru CO2 dioxid de carbon CPER colangiopancreatografie endoscopic retrograd CPK creatinfosfokinaz CT tomografie computerizat cu cubic D/A sau D dextroz n ap dL decilitru (=100 mL) DTP diftero-tetano-pertussis (anatoxin/vaccin) EBS endocardit bacterian subacut ECA enzima de conversie a angiotensinei ECG electrocardiogram MANUALUL MERCK. EDITIA A XVIII-A EEG electroencefalogram F Fahrenheit (grad) FDA U.S. Food and Drug Administration (S.U.A.) FEN febr de etiologie necunoscut g gram G6PD glucozo-6-fosfat dehidrogenaz GI gastro-intestinal GU genito-urinar Gy gray h or Hb hemoglobin HCl acid clorhidric HCO3 bicarbonat Hg mercur HIV virusul imunodeficienei umane HLA antigen leucocitar uman HMG- CoA hidroximetil glutaril coenzima A Ht hematocrit Hz hertz (cicli/secund) i.m. intramuscular i.v. intravenos ICRS infecie de ci respiratorii superioare IgA etc. imunoglobulina A etc. IL interleukin IM infarct miocardic INR raport normalizat internaiona l IQ coeficient de inteligen ITU infecie de tract urinar K potasiu kcal kilocalorie (calorie alimentar) kg kilogram L litru lb livr (pound) LCR lichid cefalorahidian LDH lactic dehidrogenaz LEC lichid extracelular x i MANUALUL MERCK. EDITIA A XVIII-A xii / ABREVIERI LES lupus eritematos sistemic LIC lichid intracelular m metru M molar m2 metru ptrat mCi milicurie mEq milliechivalent Mg magneziu mg miligram min minut mL mililitru mm milimetru mmol milimol mOsm miliosmol mUI mili-unitate internaional N azot; normal (puterea unei soluii) Na sodiu NaCl clorur de sodiu ng nanogram (=milimicrogram) nm nanometru (=milimicron) nmol nanomol NPT nutriie parenteral total O2 oxigen OMS Organizaia Mondial a Sntii ORL otorinolaringologie OTC fr prescripie medical (medicament) P fosfor; presiune p.o. per os (oral) PACO2 presiune parial a dioxidului de carbon alveolar PO2 presiune parial a oxigenului (sau tensiune) PPD derivat proteic purificat (tuberculin) ppm pri per milion PR poliartrita reumatoid PTI purpur trombocitopenic idiopatic RCR resuscitare cardiorespiratorie RFG rat de filtrare glomerular RMB rat metabolic bazal RMN rezonan magnetic nuclear s.c. subcutanat SaO2 satura ie arterial n oxigen SCT suprafa corporal total SHU sindrom hemolitic uremic SI Sistem Internaional de Uniti SIDA sindrom de imunodeficien dobndit SIDS sindromul morii subite la sugar SNC sistem nervos central sol soluie sp specie (singular) spp specii (plural) TA tensiune arterial TB tuberculoz TP timpul de protrombin TPT timp parial de tromboplastin UI uniti internaionale PaCO2 presiune parial a dioxidului de carbon arterial UI UTI urografie intravenoas PAO2 presiune parial a oxigenului alveolar (ATI) VEM unitate de terapie intensiv volum eritrocitar mediu PaO2 presiune parial a oxigenului arterial VD VS ventricul drept ventricul stng PCO2 presiune parial a dioxidului de carbon (sau tensiune) VSH viteza de sedimentare a hematiilor MANUALUL MERCK. EDITIA A XVIII-A PCR reacie de polimerizare n lan micro-; micron PET tomografie cu emisie de Ci microcurie pozitron g microgram pg picogram (=micromicrogram) L microlitru pH logaritmul cu semn schimbat m micrometru (=micron) al concentraiei ionilor de mol micromol hidrogen Osm micro-osmol PMN polimorfonucleare (leucocite) m milimicron (=nanometru) MANUALUL MERCK. EDITIA A XVIII-A EDITORI I COMITETUL EDITORIAL EDITORI Editor ef MARK H. BEERS, MD Executive Director of Geriatrics and Clinical Literature, Merck & Co., Inc. and Clinical Professor of Medicine, Drexel University College of Medicine Editor ROBERT S. PORTER, MD Merck & Co., Inc. and Clinical Assistant Professor, Department of Emergency Medicine, Jefferson Medical College Editor asociat THOMAS V. JONES, MD, MPH Merck & Co., Inc. and Adjunct Clinical Associate Professor of Medicine, Temple Univer- sity School of Medicine Editor asistent JUSTIN L. KAPLAN, MD Merck & Co., Inc. and Clinical Associate Professor, Department of Emergency Medicine, Jefferson Medical College Editor asistent MICHAEL BERKWITS, MD, MSCE Merck & Co., Inc. and Adjunct Assistant Professor of Medicine, University of Pennsylvania School of Medicine COMITETUL EDITORIAL RICHARD K. ALBERT, MD Professor, Department of Medicine, Uni- versity of Colorado Health Sciences Center; Chief of Medicine, Denver Health Medical Center MARJORIE A. BOWMAN, MD, MPA Professor and Chair of Family Practice and Community Medicine, University of Penn- MANUALUL MERCK. EDITIA A XVIII-A sylvania School of Medicine SIDNEY COHEN, MD Professor of Medicine and Director, Research Programs, Thomas Jefferson University JAN FAWCETT, MD Professor of Psychiatry, University of New Mexico School of Medicine EUGENE P. FRENKEL, MD Professor of Internal Medicine and Radio- logy, Patsy R. and Raymond D. Nasher Dis- tinguished Chair in Cancer Research; Elaine Dewey Sammons Distinguished Chair in Cancer Research in honor of Eugene P. Frenkel, MD; and A. Kenneth Pye Professorship in Cancer Research, Harold C. Simmons Comprehensive Cancer Center, The Univer- sity of Texas Southwestern Medical Center at Dallas xiii MANUALUL MERCK. EDITIA A XVIII-A xiv / EDITORI I COMITETUL EDITORIAL SUSAN L. HENDRIX, DO Professor, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Hutzel Women's Hospital MICHAEL JACEWICZ, MD Professor of Neurology, University of Tennessee Health Science Center and Vete- rans Administration Medical Center, Memphis GERALD L. MANDELL, MD, MACP Professor of Medicine, Owen R. Cheatham Professor of the Sciences, University of Virginia Health Center JOHN E. MORLEY, MB, BCh Dammert Professor of Gerontology, Saint Louis University Health Sciences Center; Director, Geriatric Research, Education and Clinical Center, St. Louis VA Medical Center H. RALPH SCHUMACHER, JR., MD Professor of Medicine, University of Pennsyl- vania School of Medicine; Chief of Rheuma- tology, Department of Veterans Affairs Medical Center, Philadelphia DAVID A. SPAIN, MD Professor of Surgery and Chief of Trauma/ Surgical Critical Care, Stanford University PETER G. SZILAGYI, MD, MPH Professor of Pediatrics and Chief, Division of General Pediatrics, University of Roches- ter School of Medicine and Dentistry PAUL H. TANSER, MD, FRCP(C), FRCP (Glasgow) Professor of Medicine (Emeritus), McMaster University; Medical Head of Cardiology, Palmerston North Hospital, New Zealand MANUALUL MERCK. EDITIA A XVIII-A CONSULTANI INA CALLIGARO, PharmD Assistant Dean for Education and Associ- ate Professor of Clinical Pharmacy, Temple University School of Pharmacy Formule farmaceutice pediatrice i dozri ROBERT B. COHEN, DMD Associate Professor of Dentistry and Prac- tice Coordinator, Tufts University School of Dental Medicine Afeciuni dentare RALPH E. CUTLER, MD Professor of Medicine (Emeritus), Loma Linda University School of Medicine; Con- sultant in Nephrology, Loma Linda VAMC Afeciuni genitourinare DAVID P. HUSTON, MD Cullen Professor of Immunology, Depart- ments of Medicine and Immunology, Baylor College of Medicine Imunologie SIDNEY N. KLAUS, MD Professor of Medicine, Section of Derma- tology, Dartmouth Medical School Afeciuni dermatologice JOANNE LYNN, MD, MA, MS Senior Researcher, RAND Health, Arlington Subiecte speciale NAYAHMKA MCGRIFF-LEE, PharmD Senior Regional Medical Scientist, Glaxo- SmithKline Formule farmaceutice i dozri MELVIN I. ROAT, MD Assistant Surgeon, Wills Eye Hospital, Philadelphia Afeciuni oftalmologice JAMES R. ROBERTS, MD, FACEP, FAAEM, FACMT Professor and Vice Chair, Department of Emergency Medicine and Director, Division of Medical Toxicology, The Drexel Univer- sity College of Medicine; Chair, Department of Emergency Medicine and Director, Divi- sion of Medical Toxicology, Mercy Catholic Medical Center Intoxicaii i traumatisme ROBERT J. RUBEN, MD, FACS, FAAP Distinguished University Professor, Albert Einstein College of Medicine, Department of Otolaryngology, Montefiore Medical Center Afeciuni otorinolaringologice MANUALUL MERCK. EDITIA A XVIII-A x v MANUALUL MERCK. EDITIA A XVIII-A xvi Revizia capitolelor Steven Berney, MD Gail P. Jarvik, MD, PhD William C. Black, MD Peter Laibson, MD Jerrold T. Bushberg, PhD, DABMP Allen S. Levine, PhD John J. Caronna, MD Colonel David F. Murchison, DDS, MMS Patricia Coyle, MD John S. Oghalai, MD Dwight L. Evans, MD Ann Ouyang, MB, BS Margery Gass, MD Stewart Shankel, MD Laura C. Hanson, MD, MPH David R. Thomas, MD Mary L. Hardy, MD Elise W. van der Jagt, MD, MPH Jerome M. Hershman, MD James Wayne Warnica, MD, FRCP(C) Helen Hoenig, MD Eric C. Westman, MD, MHS Randall Hughes, MD Mulumiri Mulumim pentru asistena editorial acordat lui: Rosalyn Carson-Dewitt, MD, J. Ricker Polsdorfer, MD, Susan Spitz, MD, MSJ, i Oren Traub, MD, PhD. De asemenea, adresm mulumiri lui Andrew J. Fletcher, MB, BChir, Sandra J. Masse, Debra G. Share, i Jonathan S. Simmons, care ne-au ajutat la prima editare a acestei cri, i lui Maureen Howard, Mary Evangelisto Miller, J. Donna LeBlanc, Beth A. Mescolotto, Nicole L. Paul, i Regina A. Stamatis, care ne-au ajutat la corectur. MANUALUL MERCK. EDITIA A XVIII-A COLABORATORI MOIRA L. AITKEN, MD Professor of Medicine, University of Washington Broniectaziile ROY D. ALTMAN, MD Professor of Medicine, Division of Rheu- matology and Immunology, David Geffen School of Medicine at University of Califor- nia, Los Angeles Afeciuni articulare; Boala Paget a osului BRADLEY D. ANAWALT, MD Associate Professor of Medicine, Univer- sity of Washington; Assistant Chief of Medi- cine, VA Puget Sound Endocrinologia sistemului reproductor masculin KENNETH C. ANDERSON, MD Kraft Family Professor of Medicine, Harvard Medical School; Chief, Division of Hematologic Neoplasia, Dana-Farber Cancer Institute Afeciunile celulelor plasmatice GERALD L. ANDRIOLE, MD Professor and Chief of Urologic Surgery, Washington University School of Medicine; Urologist-in-Chief, Barnes-Jewish Hospi- tal, St. Louis Afeciunile prostatei BRIAN R. APATOFF, MD, PhD Director, Multiple Sclerosis Clinical Care and Research Center, Department of Neu- rology and Neuroscience, New York Pres- byterian Hospital; Weill Medical College of Cornell University Boli demielinizante NOEL A. ARMENAKAS, MD Clinical Associate Professor of Urology, Cornell Weill Medical School; Attending Surgeon, Lenox Hill Hospital and New York Presbyterian Hospital Traumatismele tractului genitourinar MANUALUL MERCK. EDITIA A XVIII-A J. MALCOLM O. ARNOLD, BSc, MD, FRCP, FACC Professor of Medicine, Physiology and Phar- macology, University of Western Ontario; Program Leader, Circulation Group, Lawson Health Research Institute; Re- search Director, Division of Cardiology, London Health Sciences Center Insuficiena cardiac i cardiomiopatiile JOHN A. ASTIN, PhD California Pacific Medical Center, San Francisco Medicin complementar i alternativ GEORGE L. BAKRIS, MD Professor of Preventive Medicine and Internal Medicine and Director, Hyperten- sion/Clinical Research Center, Rush Medi- cal Center Hipertensiunea arterial DAVID H. BARAD, MD, MS Associate Clinical Professor, Albert Einstein College of Medicine, Bronx Abordarea pacientei cu afeciuni ginecologice JOHN G. BARTLETT, MD Professor of Medicine and Chief, Division of Infectious Diseases, Johns Hopkins Uni- versity School of Medicine Bronitia acut; Pneumonia; Abcesul pulmonar ROSEMARY BASSON, MD, FRCP (UK) Clinical Professor, Department of Psychia- try, University of British Columbia Disfunciile sexuale la femei BYRON E. BATTEIGER, MD Professor of Medicine and Microbiology and Immunology, Division of Infectious Diseases, Indiana University School of Medicine Infeciile cu Chlamydia i Mycoplasma J. BRAD BELLOTTE, MD Department of Neurosurgery, Allegheny General Hospital, Pittsburgh Traumatismele coloanei vertebrale xvii MANUALUL MERCK. EDITIA A XVIII-A xviii / COLABORATORI CHESTON M. BERLIN, JR., MD University Professor of Pediatrics, Penn State Children's Hospital, M. S. Hershey Medical Center, Hershey Principiile tratamentului medicamentos la copii BRIAN M. BERMAN, MD Professor of Family Medicine; Director, Center for Integrative Medicine, Univer- sity of Maryland School of Medicine Medicin complementar i alternativ RICHARD W. BESDINE, MD Professor of Medicine, Greer Professor of Geriatric Medicine, and Director, Division of Geratrics (Medicine) and Director of Center for Gerontology and Healthcare Research, Brown Medical School Medicin geriatric ALBERT BIGLAN, MD Adjunct Associate Professor of Ophthalmol- ogy, University of Pittsburgh School of Medicine; Staff Physician, Children's Hos- pital of Pittsburgh Afeciuni i malformaii oculare JOSEPH J. BIUNDO, MD Medical Director of Rehabilitation, Kenner Regional Medical Center Bursitele, Tendinitele, i Fibromialgia SEAN BLACKWELL, MD Assistant Professor, Department of Obste- trics and Gynecology, Wayne State Univer- sity School of Medicine, Hutzel Women's Hospital Sarcina i patologia asociat ANN S. BOTASH, MD Professor of Pediatrics, State University of New York, Upstate Medical University Abuzarea copilului ALFRED A. BOVE, MD, PhD Chief of Cardiology, Cardiology Section, Temple University School of Medicine Boli provocate de scufundare sau de lucrul n condiii de presiune ridicat KAREN BOWEN, MD Assistant Clinical Professor of Medicine, The George Washington University; Asso- ciate Medical Director, Community Hos- pices of The Washington Home ngrijirea pacientului muribund MANUALUL MERCK. EDITIA A XVIII-A THOMAS G. BOYCE, MD, MPH Assistant Professor of Pediatrics, Mayo Clinic College of Medicine; Consultant in Pediatric Infectious Diseases, Mayo Clinic Gastroenteritele PETER C. BRAZY, MD Professor of Medicine, University of Wisconsin-Madison Anomalii n transportul renal CHRISTIAN M. BRIERY, MD Fellow, Maternal-Fetal Medicine, Univer- sity of Mississippi Medical Center Sarcina cu risc crescut GEORGE R. BROWN, MD Professor and Associate Chairman, Depart- ment of Psychiatry, East Tennessee State University; Chief of Psychiatry, Mountain Home VAMC Sexualitatea i tulburrile sexuale HAYWOOD L. BROWN, MD Professor and Chair, Department of Ob- stetrics and Gynecology, Duke University Medical Center Sarcina normal, Traaliul; Naterea ROBERT G. BRZYSKI, MD, PhD Associate Professor of Obstetrics and Gynecology, The University of Texas Health Science Center at San Antonio Endocrinologia sistemului reproductor feminin REBECCA H. BUCKLEY, MD J. Buren Sidbury Professor of Pediatrics and Professor of Immunology, Duke Uni- versity Medical Center Afeciuni imunodeficitare ANGELA CAFIERO, PharmD, CGP Assistant Professor of Clinical Pharmacy, University of the Sciences in Philadelphia, Philadelphia College of Pharmacy; Clinical Pharmacy Specialist- Geriatrics, Philadel- phia VA Medical Center Farmacodinamica CHARLES LEE CAPERTON II, MD Assistant Professor of Obstetrics and Gyne- cology, The University of Texas Health Science Center at San Antonio Endocrinologia sistemului reproductor feminin MANUALUL MERCK. EDITIA A XVIII-A JOHN J. CARONNA, MD Professor of Clinical Neurology and Vice Chairman, Department of Neurology and Neuroscience, Weill Medical College of Cornell University Starea de incontien i coma MARY T. CASERTA, MD Associate Professor of Pediatrics, Univer- sity of Rochester School of Medicine and Dentistry; Attending Physician, Golisano Children's Hospital at Strong Enteroviroze; Alte viroze; Infeciile nou-nscutului BRUCE A. CHABNER, MD Professor of Medicine and Clinical Direc- tor, Massachusetts General Hospital Can- cer Center and Harvard Medical School Principiile tratamentului n cancer IAN M. CHAPMAN, MBBS, PhD Associate Professor of Endocrinology, Uni- versity of Adelaide; Department of Medi- cine, Royal Adelaide Hospital Afeciunile glandei hipofize RACHEL L. CHAPMAN, MD Assistant Professor, Department of Pedi- atrics, Yale University School of Medicine Fiziologia perinatal; Abordarea ngrijirii sugarului i copilului; ngrijirea copilului bolna i a familiei LAN X. CHEN, MD, PhD Clinical Assistant Professor and Attending Rheumatologist, University of Pennsylva- nia Medical Center-Presbyterian and VAMC Infeciile articulaiilor i ale oaselor WILLIAM D. CHEY, MD, FACG, FACP Associate Professor, Director of Gastro- intestinal Physiology Laboratory, Univer- sity of Michigan Bezoarele i corpurile strine JILL M. CHOLETTE, MD Critical Care Pediatrics Fellow, University of Rochester School of Medicine and Dentistry Afeciuni hematologice perinatale WILLIAM J. COCHRAN, MD Vice Chairman, Department of Pediatrics, Geisinger Clinic, Danville, PA Malformaii congenitale gastrointestinale; Afeciuni gastrointestinale la nou-nscut i sugar MANUALUL MERCK. EDITIA A XVIII-A COLABORATORI / xix ALAN S. COHEN, MD Distinguished Professor of Medicine (Emeritus), Boston University School of Medicine; Editor-in-Chief, Amyloid: The Journal of Protein Folding Disorders Amiloidoza ROBERT B. COHEN, DMD Associate Professor of Dentistry and Prac- tice Coordinator, Tufts University School of Dental Medicine Abordarea pacientului stomatologic; Urgene dentare; Afeciuni dentare comune; Abordarea pacientului cu simptome nazale, bucale i faringiene; Traumatismele faciale SIDNEY COHEN, MD Professor of Medicine and Director, Research Programs, Thomas Jefferson University Gastrite i Ulcerul peptic; Afeciuni esofagiene i Tulburri de nghiire NANANDA F. COL, MD, MPP, MPH, FACP Associate Professor of Medicine, Brown University Medical School Luarea deciziilor medicale KATHRYN COLBY, MD, PhD Assistant Professor of Ophthalmology, Harvard Medical School; Attending Sur- geon, Cornea Service and Director of the Joint Clinical Research Center, Massachu- setts Eye and Ear Infirmary Abordarea pacientului oftalmologic DANIEL W. COLLISON, MD Associate Professor of Medicine and Sur- gery, Section of Dermatology, Dartmouth Medical School Psoriazisul i alte boli nrudite; Tulburri de pigmentare; Tulburri ale transpiraiei; Tumori benigne; Ulcere de presiune EVE R. COLSON, MD Associate Professor of Pediatrics, Yale Uni- versity School of Medicine; Director, Well Newborn Nursery, Yale-New Haven Hospital Fiziologie perinatal; Abordarea ngrijirii nou- nscutului i sugarului; ngrijirea copilului bolnav i a familiei sale MARY ANN COOPER, MD Professor, Department of Emergency Medi- cine, University of Illinois at Chicago Leziuni produse de curentul electric MANUALUL MERCK. EDITIA A XVIII-A xx / COLABORATORI BRYAN D. COWAN, MD Professor and Chairman, Department of Obstetrics and Gynecology; University of Mississippi Medical Center Fibroamele uterine JILL P. CRANDALL, MD Assistant Professor, Division of Endocrinol- ogy, Diabetes Research and Training Cen- ter, Albert Einstein College of Medicine Diabetul zaharat i Afeciunile metabolismului carbohidrailor RICARDO CRUCIANI, MD, PhD Clinical Assistant and Professor, Depart- ment of Neurology and Anesthesiology, Albert Einstein College of Medicine; Direc- tor, Research Division, Department of Pain Medicine and Palliative Care, Beth Israel Medical Center Neurotransmisia BURKE A. CUNHA, MD Professor of Medicine, State University of New York School of Medicine; Chief, In- fectious Disease Division, Winthrop-Uni- versity Hospital, Mineola Spirochetele; Bacilii Gram-Negativi EMMETT T. CUNNINGHAM, JR., MD, PhD, MPH Professor of Ophthalmology and Director, The Uveitis Service, New York University School of Medicine; Senior Vice President, Medical Strategy, Eyetech Pharmaceuticals Uveitele DREW C. CUTLER, MD Associate Professor of Pediatrics, Loma Linda University School of Medicine Boala chistic renal RALPH E. CUTLER, MD Professor of Medicine (Emeritus), Loma Linda University School of Medicine; Con- sultant in Nephrology, Loma Linda VAMC Abordarea pacientului genitourinar; Terapia de nlocuire renal; Afeciunile tubulointerstiiale; Infeciile de tract urinar PATRICIA A. DALY, MD Assistant Professor of Clinical Medicine, University of Virginia; Clinical Endocrinolo- gist, Front Royal, VA Sindromul de neoplazie endocrin multipl JOHANNA P. DAILY, MD Associate Physician, Brigham and Women's Hospital; Instructor, Harvard Medical School Virozele MANUALUL MERCK. EDITIA A XVIII-A DANIEL F. DANZL, MD Professor and Chair of Emergency Medicine, University of Louisville School of Medicine Leziuni produse de frig NORMAN L. DEAN, MD, FCCP Pulmonologist, Internal Medicine, Geriatrics, North Carolina Department of Corrections; Director of Airway Clinics, North Carolina Correctional Institution for Women necul ALAN H. DeCHERNEY, MD Professor of Obstetrics and Gynecology, Division of Reproductive Endocrinology, David Geffen School of Medicine at Uni- versity of California, Los Angeles Endometriozele RONALD DEE, MD Associate Clinical Professor of Surgery, Albert Einstein College of Medicine, Bronx Afeciunile sistemului venos periferic i a sistemului limfatic PETER J. DELVES, PhD Reader in Immunology, Department of Immunology and Molecular Pathology, Division of Infection and Immunity, Uni- versity College London Biologia sistemului imun CRAIG S. DERKAY, MD Professor, Otolaryngology and Pediatrics, Eastern Virginia Medical School; Director, Pediatric Otolaryngology, Children's Hos- pital of the King's Daughters, Norfolk Afeciuni orofaringiene ARA DerMARDEROSIAN, PhD Professor of Pharmacognosy and Medici- nal Chemistry, Roth Chair of Natural Pro- ducts, Scientific Director, Complementary and Alternative Medicine Institute, Univer- sity of the Sciences in Philadelphia, Phila- delphia College of Pharmacy Suplimente dietetice DEEPINDER KAUR K. DHALIWAL, MD Associate Professor, University of Pitts- burgh School of Medicine; Director of Cornea/ External Disease and Director of Refractive Surgery, University of Pittsburgh Medical Center Eye Center; Medical Direc- tor, University of Pittsburgh Medical Center Laser Center Erori de refracie

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