Differential Diagnosis in Internal Medicine
Preface
The present book, Differential Diagnosis in Internal Medicine, first appeared as a German edition in 1952 and since then has been translated into 10 other languages. Over the past 50 years 19 Ger- man editions have been published, and now the 19th edition of the work, which has become the classic differential diagnosis textbook, is available in English for the first time.
This book encompasses differential diagnosis across the spectrum of internal medicine, cover-ing dermatology, neurology, and rheumatology, and provides the very latest knowledge including pathophysiological aspects. In contrast to ency-clopedically structured textbooks, this book traces the path from symptom to diagnosis, just as the
physician encounters the situation in the hospital and in the office.
With this pragmatic approach—starting from the symptom(s)—the physician will usually suc-ceed in substantiating the suspected diagnosis.
Using this method, Siegenthaler’s Differential Di-agnosis in Internal Medicine guides the reader through the differential diagnostic challenges in the entire field of internal medicine, including dermatology, neurology, and rheumatology. The book incorporates many relevant and instructive illustrations, tables, graphics, and algorithms, all
contributing to the process of narrowing down a definitive diagnosis.
The book is intended for medical students, phy- sicians in clinical practice, generalists, and special- ists in internal medicine, dermatology, neurology, and rheumatology, and also for all those concerned with the fundamental subjects of medicine, who wish to gain a competent knowledge of internal medicine.
My thanks are due to all of the colleagues who worked with me on the book, and also to Thieme Publishing Group, in particular Thieme Publishers Stuttgart. I hope that, with the launch of the English edition, this classic textbook of differential diagnosis in internal medicine will now also find its place in the English-speaking world.
Walter Siegenthaler, MD Professor Emeritus of Internal Medicine University of Zürich Zürich, Switzerland
Foreword
I first met Professor Walter Siegenthaler in the 1970s while he was at the University of Zürich, where both he and his late wife, the superb clinician Doctor Gertrud Siegenthaler-Zuber, were ad-mired for their many accomplishments and dedication to the advancement of medicine. At that time, Professor Siegenthaler helped me establish aprogram to bring cardiologists from the Baylor College of Medicine and the Methodist Hospital in Houston, Texas, to Switzerland to study the pioneering balloon angioplasty work of Andreas Gruentzig.
Subsequently, he honored us by serving as a Visiting Professor at Baylor, exemplifying
the best of Swiss medicine. Now, 30 years later,Professor Siegenthaler remains at the leading edge of medicine, as this expertly realized book in your hands attests.
Differential diagnosis is the fundamental methodology of modern clinical medicine: we note the patient’s symptoms; we develop hypotheses for the affliction and propose treatment; and we adjust treatment based on the patient’s response.
Thus, differential diagnosis requires the physician to be observant, knowledgeable, thoughtful, thorough, and organized, qualities that could alsobe used to describe the conceptualization and execution of the following pages. In the last few decades, we have seen stunning advances in the level of clinical care and diagnostic procedures
available across the spectrum of human diseases.
The sophistication of contemporary nosology is truly impressive.
On the other hand, the rapid turnover of medical information can prove daunting to many clinicians, and the application of the latest evidence to our daily interactions with patients may seem unclear or too complex. Siegenthaler’s Differential Diagnosis in Internal Medicine reminds us to approach diagnostic problems in a practical, system-atic, and critical manner, remembering that each patient’s circumstance is unique and that it is every doctor’s responsibility to exercise his or her best educated judgment to present rational choices about the most probable diagnoses and optimal treatment courses. Occam’s Razor, which advises us that the simplest explanation is usually the correct one, all things being equal, is an important precept in diagnostic medicine, yet doctors must also be flexible and adaptable to the eccentricities of every case.
Thus, physicians should not expect to see a zebra when confronted with a horse, but they should be able to recognize the zebra on the rare occasion that it makes an appearance.
I believe that the scholarship, clinical skill, and practical wisdom that Professor Siegenthaler and his colleagues share with us in this text are indis-
pensable resources for the medical community.
The wealth of illustrative photographs, informative tables, and up-to-date discussion of issues in internal medicine will prove very useful in daily clinical practice.
Antonio M. Gotto, Jr., MD, DPhil The Stephen and Suzanne Weiss Dean Professor of Medicine Weill Cornell Medical College Provost for Medical Affairs Cornell UniversityNew York, USA
Preface
This book encompasses differential diagnosis across the spectrum of internal medicine, cover-ing dermatology, neurology, and rheumatology, and provides the very latest knowledge including pathophysiological aspects. In contrast to ency-clopedically structured textbooks, this book traces the path from symptom to diagnosis, just as the
physician encounters the situation in the hospital and in the office.
With this pragmatic approach—starting from the symptom(s)—the physician will usually suc-ceed in substantiating the suspected diagnosis.
Using this method, Siegenthaler’s Differential Di-agnosis in Internal Medicine guides the reader through the differential diagnostic challenges in the entire field of internal medicine, including dermatology, neurology, and rheumatology. The book incorporates many relevant and instructive illustrations, tables, graphics, and algorithms, all
contributing to the process of narrowing down a definitive diagnosis.
The book is intended for medical students, phy- sicians in clinical practice, generalists, and special- ists in internal medicine, dermatology, neurology, and rheumatology, and also for all those concerned with the fundamental subjects of medicine, who wish to gain a competent knowledge of internal medicine.
My thanks are due to all of the colleagues who worked with me on the book, and also to Thieme Publishing Group, in particular Thieme Publishers Stuttgart.
Walter Siegenthaler, MD Professor Emeritus of Internal Medicine University of Zürich Zürich, Switzerland
Foreword
I first met Professor Walter Siegenthaler in the 1970s while he was at the University of Zürich, where both he and his late wife, the superb clinician Doctor Gertrud Siegenthaler-Zuber, were ad-mired for their many accomplishments and dedication to the advancement of medicine. At that time, Professor Siegenthaler helped me establish aprogram to bring cardiologists from the Baylor College of Medicine and the Methodist Hospital in Houston, Texas, to Switzerland to study the pioneering balloon angioplasty work of Andreas Gruentzig.
Subsequently, he honored us by serving as a Visiting Professor at Baylor, exemplifying
the best of Swiss medicine. Now, 30 years later,Professor Siegenthaler remains at the leading edge of medicine, as this expertly realized book in your hands attests.
Differential diagnosis is the fundamental methodology of modern clinical medicine: we note the patient’s symptoms; we develop hypotheses for the affliction and propose treatment; and we adjust treatment based on the patient’s response.
Thus, differential diagnosis requires the physician to be observant, knowledgeable, thoughtful, thorough, and organized, qualities that could alsobe used to describe the conceptualization and execution of the following pages. In the last few decades, we have seen stunning advances in the level of clinical care and diagnostic procedures
available across the spectrum of human diseases.
The sophistication of contemporary nosology is truly impressive.
On the other hand, the rapid turnover of medical information can prove daunting to many clinicians, and the application of the latest evidence to our daily interactions with patients may seem unclear or too complex. Siegenthaler’s Differential Diagnosis in Internal Medicine reminds us to approach diagnostic problems in a practical, system-atic, and critical manner, remembering that each patient’s circumstance is unique and that it is every doctor’s responsibility to exercise his or her best educated judgment to present rational choices about the most probable diagnoses and optimal treatment courses. Occam’s Razor, which advises us that the simplest explanation is usually the correct one, all things being equal, is an important precept in diagnostic medicine, yet doctors must also be flexible and adaptable to the eccentricities of every case.
Thus, physicians should not expect to see a zebra when confronted with a horse, but they should be able to recognize the zebra on the rare occasion that it makes an appearance.
I believe that the scholarship, clinical skill, and practical wisdom that Professor Siegenthaler and his colleagues share with us in this text are indis-
pensable resources for the medical community.
The wealth of illustrative photographs, informative tables, and up-to-date discussion of issues in internal medicine will prove very useful in daily clinical practice.
Antonio M. Gotto, Jr., MD, DPhil The Stephen and Suzanne Weiss Dean Professor of Medicine Weill Cornell Medical College Provost for Medical Affairs Cornell UniversityNew York, USA