Essence of Anesthesia Practice - 4th Edition - ISBN: 9780323394970, 9780323395427

Essence of Anesthesia Practice

4th Edition

Authors: Lee Fleisher Michael Roizen Jeffrey Roizen
eBook ISBN: 9780323395427
eBook ISBN: 9780323395410
Paperback ISBN: 9780323394970
Imprint: Elsevier
Published Date: 30th May 2017
Page Count: 600
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Description

Highly regarded by anesthesiologists, residents, and nurse anesthetists, Essence of Anesthesia Practice, 4th Edition by Drs. Lee A. Fleisher, Michael F. Roizen, and Jeffrey Roizen, is a trusted resource for point-of-care anesthesia management. Concise, easy-to-find summaries cover a single clinical topic for both common and rare conditions. A renewed focus on diseases and drugs makes this edition even more useful when formulating anesthesia plans and mastering the core knowledge of anesthesia practice.

Key Features

  • Features a unique, easy-to-follow, consistent format that covers a single clinical topic on each page, with a review of its problems, causes, comorbidities, and anesthesia implications.
  • Helps you understand the interactions of common drugs and alternative medicine so that you can develop effective anesthesia plans.

Table of Contents

1 Abruptio Placentae

2 Achondroplasia, Dwarfism

3 Acidosis, Lactic/Metabolic

4 Acidosis, Renal Tubular

5 Acquired Immunodeficiency Syndrome

6 Acromegaly

7 Acute Intermittent Porphyria

8 Acute Respiratory Distress Syndrome

9 Addison Disease

10 Adrenal Insufficiency, Acute or Secondary

11 Alagille Syndrome

12 Alcohol Abuse

13 Allergy

14 Alpha1-Antitrypsin Deficiency

15 Amniotic Fluid Embolism

16 Amyloidosis

17 Amyotrophic Lateral Sclerosis

18 Anaphylaxis

19 Anemia, Aplastic

20 Anemia, Chronic Disease/Inflammation

21 Anemia, Hemolytic

22 Anemia, Megaloblastic

23 Angina, Chronic Stable

24 Anhidrosis (Congenital Anhidrotic Ectodermal

Dysplasia)

25 Ankylosing Spondylitis

26 Anomalous Pulmonary Venous Drainage

27 Anorexia Nervosa

28 Anticoagulation, Preoperative

29 Antithrombin III Deficiency

30 Anxiety Disorders

31 Aortic Regurgitation

32 Aortic Stenosis

33 Apert Syndrome (Acrocephalosyndactyly Type

1 and 2 )

34 Apnea of the Newborn

35 Appendicitis, Acute

36 Arnold-Chiari Malformation (Chiari

Malformation Type II)

37 Aspiration, Perioperative

38 Asthma, Acute

39 Atherosclerotic Disease

40 Atrial Fibrillation

41 Atrial Flutter 41

42 Atrial Septal Defect, Ostium Primum 42

43 Atrial Septal Defect, Ostium Secundum 43

44 Atrioventricular and Bifascicular Heart

Block 43

45 Autoimmune Diseases, Cold 45

46 Autonomic Dysreflexia 45

47 Becker Disease 46

48 Beckwith-Wiedemann Syndrome 47

49 Behçet’s Disease 48

50 Bernard-Soulier Syndrome 50

51 Bilirubinemia of the Newborn 50

52 Bipolar Disorder 51

53 Blebs and Bullae 52

54 Bleomycin Sulfate Toxicity 53

55 Blindness 54

56 Botulism 55

57 Brain Death 57

58 Brain Injury, Traumatic 58

59 Bronchiectasis 59

60 Bronchiolitis Obliterans Syndrome 60

61 Bronchitis, Chronic 61

62 Bronchopulmonary Dysplasia 62

63 Buerger Disease (Thromboangiitis

Obliterans) 63

64 Bulimia Nervosa 64

65 Burn Injury, Chemical 65

66 Burn Injury, Electrical 66

67 Burn Injury, Flame 67

68 Calcium Deficiency/Hypocalcemia 68

69 Cancer, Bladder 69

70 Cancer, Breast 70

71 Cancer, Esophageal 71

72 Cancer, Lung Parenchyma 72

73 Candidiasis 73

74 Carbon Monoxide Poisoning 74

75 Carcinoid Syndrome 75

76 Cardiac Tamponade 76

77 Cardiomyopathy, Alcoholic 77

78 Cardiomyopathy, Dilated 77

79 Cardiomyopathy, Hypertrophic 79

80 Cardiomyopathy, Ischemic 81

81 Cardiomyopathy, Peripartum 82

82 Cardiomyopathy, Restrictive 83

83 Carnitine Deficiency 84

84 Carotid Sinus Syndrome 85

85 Carpenter Syndrome

(Acrocephalopolysyndactyly Type II) 85

86 Central Neurogenic Hyperventilation 86

87 Cephalopelvic Disproportion 87

88 Cerebral Arteriovenous Malformations 88

89 Cerebral Palsy 89

90 Cerebrovascular Transient Ischemic

Attack 90

91 Cervical Disk Disease (Cervical Spine

Disease) 91

92 Chagas Disease 91

93 Charcot-Marie-Tooth Disease 92

94 CHARGE Association 94

95 Cherubism 95

96 Chiari Malformations 95

97 Churg-Strauss Syndrome 97

98 Cigarette Smoking 98

99 Cigarette Smoking Cessation 99

100 Cleft Palate 99

101 Coagulopathy, Factor IX Deficiency 100

102 Coarctation of the Aorta 101

103 Cogan Syndrome 102

104 Complement Deficiency 103

105 Congenital Methemoglobinemia 104

106 Congenital Pulmonary Cystic Lesions/Lobar

Emphysema 105

107 Congestive Heart Failure 106

108 Constipation 107

109 Conversion Disorder (Functional Neurologic

Symptom Disorder) 108

101 Cor Pulmonale 109

111 Coronary Artery Disease (Left Main and Non–

Left Main Disease) 110

112 Coronary Artery Spasm 111

113 Craniofacial Clefts 111

114 Craniosynostosis 112

115 CREST Syndrome 114

116 Creutzfeldt-Jakob Disease 115

117 Cri Du Chat Syndrome (5p− Syndrome) 116

118 Crohn Disease 116

119 Croup (Laryngotracheobronchitis) 117

120 Crouzon Syndrome 118

121 Cryptococcus Infection 119

122 Cushing Syndrome 120

123 Cyanide Poisoning 122

124 Cystic Fibrosis 122

125 Cytomegalovirus Infection 124

126 Dandy-Walker Syndrome 124

127 De Morsier Syndrome 125

128 Deep Vein Thrombosis 126

129 Degenerative Disk Disease 127

130 Delirium (Postanesthetic) and Dementia 128

131 Depression, Unipolar 129

132 Dermatomyositis 130

133 Dextrocardia 131

134 Diabetes Type I (Insulin-Dependent) 132

135 Diabetes, Type II (Noninsulin

Dependent) 133

136 Diabetes, Type III (Gestational Diabetes

Mellitus) 134

137 Diabetes Insipidus 135

138 Diabetic Ketoacidosis 136

139 Diaphragmatic Hernia (Congenital) 137

140 Diarrhea, Acute and Chronic 138

141 DiGeorge Syndrome 138

142 Dilated Cardiomyopathy 139

143 Diphtheria 140

144 Disseminated Intravascular Coagulation 142

145 Diverticulosis 143

146 Do Not Resuscitate Orders 144

147 Double Aortic Arch 145

148 Down Syndrome 146

149 Drug Abuse, Lysergic Acid Diethylamide 147

150 Drug Overdose, Rat Poison (Warfarin

Toxicity) 148

151 Duchenne Muscular Dystrophy

(Pseudohypertrophic Muscular

Dystrophy) 149

152 Duodenal Atresia 149

153 Ebstein Anomaly 151

154 Echinococcosis 152

155 Eclampsia 153

156 Ehlers-Danlos Syndrome 154

157 Eisenmenger Syndrome 155

158 Emphysema 156

159 Encephalitis 157

160 Encephalopathy, Hypertensive 158

161 Encephalopathy, Metabolic 160

162 Encephalopathy, Postanoxic 161

163 Endocardial Cushion Defect (Atrioventricular

Canal) 161

164 Endocarditis 162

165 Epidermolysis Bullosa 163

166 Epiglottitis 164

167 Fabry Disease 165

168 Factor V Leiden Mutation 166

169 Familial Dysautonomia (Riley-Day

Syndrome) 167

170 Familial Periodic Paralysis 168

171 Fanconi Syndrome 169

172 Fat Embolism 170

173 Foreign Body Aspiration 171

174 Friedreich Ataxia 172

175 Galactosemia 173

176 Gastrinoma 174

177 Gastroesophageal Reflux in Children 174

178 Gaucher Disease 175

179 Glaucoma, Closed-Angle 177

180 Glaucoma, Open-Angle 178

181 Glomus Jugulare Tumors 179

182 Glossopharyngeal Neuralgia 180

183 Glucose-6-Phosphate Dehydrogenase

Deficiency 180

184 Glycogen Storage Diseases 181

185 Goldenhar Syndrome 182

186 Gonorrhea 183

187 Goodpasture Syndrome 184

188 Gout 186

189 Graves Disease 187

190 Guillain-Barré Syndrome 188

191 Hashimoto Thyroiditis 189

192 Headache, Migraine 190

193 Heart Disease, Congenital 191

194 HELLP Syndrome 193

195 Hemochromatosis 193

196 Hemophilia 194

197 Hemosiderosis, Pulmonary 195

198 Henoch-Schönlein Purpura 196

199 Hepatic Encephalopathy 198

200 Hepatitis, Alcoholic 198

201 Hepatitis, Halothane 200

202 Hepatitis, Viral 201

203 Hepatopulmonary Syndrome 202

204 Hereditary Hemorrhagic Telangiectasia (Osler-

Weber-Rendu Disease) 203

205 Herniated Nucleus Pulposus 204

206 Herpes, Type I 205

207 Herpes, Type II 206

208 Hirschsprung Disease 207

209 Histiocytosis 208

210 Huntington Disease 209

211 Hydrocephalus 210

212 Hyperaldosteronism, Primary 211

213 Hyperaldosteronism, Secondary 212

214 Hypercalcemia 213

215 Hypercholesterolemia 215

216 Hyperglycemia 216

217 Hyperglycemic Hyperosmolar State 216

218 Hyperkalemia 217

219 Hypermagnesemia 218

220 Hypernatremia 219

221 Hyperparathyroidism 220

222 Hypertension 221

223 Hypertension, Uncontrolled With

Cardiomyopathy 222

224 Hyperthyroidism 223

225 Hypertriglyceridemia 224

226 Hypokalemia 225

227 Hypomagnesemia 226

228 Hyponatremia 227

229 Hypoparathyroidism 229

230 Hypophosphatemia 230

231 Hypopituitarism 230

232 Hypoplastic Left Heart Syndrome 231

233 Hypothermia, Mild 233

234 Hypothyroidism 233

235 Hypoxemia 234

236 IgA Deficiency 235

237 Immune Suppression 236

238 Implantable Cardioverter-Defibrillators 237

239 Infratentorial Tumors 239

240 Insulinoma 240

241 Intracranial Hypertension 241

242 Intraoperative Recall 242

243 Jaundice 242

244 Jehovah’s Witness Patient 243

245 Jeune Syndrome (Asphyxiating Thoracic

Dystrophy) 244

246 Juvenile Gaucher Disease (Type III/Subacute

Neuronopathic) 245

247 Kartagener Syndrome 247

248 Kawasaki Disease 248

249 Klippel-Feil Syndrome 249

250 Lambert-Eaton Myasthenic Syndrome 250

251 Landouzy-Dejerine Dystrophy

(Facioscapulohumeral Muscular

Dystrophy) 250

252 Latex Allergy 252

253 Lesch-Nyhan Syndrome 252

254 Leukemia 253

255 Liddle Syndrome 254

256 Lipidemias 255

257 Long QT Syndrome 256

258 Ludwig Angina 257

259 Lyme Disease 257

260 Lymphomas 258

261 Lysosomal Storage Disorders 259

262 Malignant Hyperthermia and Other

Anesthetic-Induced Myodystrophies 260

263 Malnutrition 262

264 Marfan Syndrome 263

265 Mastocytosis 264

266 Mediastinal Masses 265

267 Mesothelioma 266

268 Methemoglobinemia 266

269 Mitochondrial Disorders 267

270 Mitochondrial Myopathy 268

271 Mitral Regurgitation 269

272 Mitral Stenosis 270

273 Mitral Valve Prolapse 271

274 Mobitz I (Second-Degree Atrioventricular

Block) 272

275 Mobitz II (Second-Degree Atrioventricular

Block) 273

276 Morbid Obesity 274

277 Moyamoya 274

278 Mucopolysaccharidoses 275

279 Multiple Endocrine Neoplasia Type 1

and 2 276

280 Multiple Myeloma 277

281 Multiple Organ Dysfunction Syndrome 278

282 Multiple Sclerosis 280

283 Multisystem Organ Failure, Lung

Dysfunction in 280

284 Myasthenia Gravis 281

285 Mycoplasma pneumoniae Infection 282

286 Myelomeningocele 283

287 Myocardial Contusion (Blunt Cardiac

Injury) 285

288 Myocardial Ischemia 286

289 Myocarditis 287

290 Myoclonic Epilepsy With Ragged Red

Fibers 288

291 Myotonia Dystrophica (Myotonic Dystrophy,

Steinert Disease) 289

292 Myxoma 290

293 Narcolepsy 291

294 Necrotizing Enterocolitis 292

295 Necrotizing Fasciitis 293

296 Nelson Syndrome 294

297 Neurofibromatosis 294

298 Neuroleptic Malignant Syndrome 295

299 Niemann-Pick Disease 296

300 Noonan Syndrome 298

301 Obsessive-Compulsive Disorder 299

302 Occipital Encephalocele 300

303 Occlusive Cerebrovascular Disease 301

304 Opitz-Frias Syndrome (The G

Syndrome) 302

305 Osteoarthritis 303

306 Osteogenesis Imperfecta 303

307 Osteoporosis 304

308 Otitis Media 305

309 Pacemakers 306

310 Paget Disease 308

311 Pancreatitis 309

312 Papillomatosis 310

313 Parkinson Disease (Paralysis Agitans) 311

314 Paroxysmal Atrial Tachycardia 312

315 Patent Ductus Arteriosus 313

316 Patent Foramen Ovale 314

317 Pemphigus 315

318 Pericardial Effusion 316

319 Pericarditis, Constrictive 316

320 Peripheral Vascular Disease 317

321 Pertussis (Whooping Cough) 318

322 Pheochromocytoma 320

323 Physiologic Anemia and the Anemia of

Prematurity 321

324 Pickwickian Syndrome 321

325 Pierre Robin Sequence 322

326 Pituitary Tumors 323

327 Placenta Previa 324

328 Plagiocephaly 325

329 Pneumocystis jirovecii Pneumonia 326

330 Pneumonia, Community-Acquired 327

331 Pneumonia, Ventilator-Associated 328

332 Poliomyelitis 329

333 Polycythemia Vera 330

334 Polymyositis 330

335 Pompe Disease 331

336 Portal Hypertension 333

337 Postoperative Encephalopathy, Metabolic 334

338 Posttransplant Lymphoproliferative

Disorder 335

339 Prader-Willi Syndrome 336

340 Preeclampsia 337

341 Pregnancy, Ectopic 339

342 Pregnancy, Intra-Abdominal 340

343 Pregnancy, Maternal Physiology 340

344 Pregnancy-Induced Hypertension 342

345 Preterm Infant 343

346 Protein C Deficiency 344

347 Pulmonary Atresia 345

348 Pulmonary Embolism 346

349 Pulmonary Fibrosis, Idiopathic 347

350 Pulmonary Hypertension 348

351 Purpura, Immune Thrombocytopenic 350

352 Purpura, Thrombotic Thrombocytopenic 350

353 Pyloric Stenosis 351

354 Q Fever 352

355 Raynaud Phenomenon 353

356 Reflex Sympathetic Dystrophy (Complex

Regional Pain Syndrome) 354

357 Renal Failure, Acute 355

358 Renal Failure, Chronic 356

359 Rett Syndrome 357

360 Reye Syndrome 357

361 Rheumatic Fever (Acute) and Rheumatic Heart

Disease 358

362 Rheumatoid Arthritis 359

363 Riley-Day Syndrome (Familial Dysautonomia;

Hereditary and Sensory Autonomic

Neuropathy Type III) 360

364 Rocky Mountain Spotted Fever 362

365 Rubella and Congenital Rubella

Syndrome 363

366 Saethre-Chotzen Syndrome 365

367 Sarcoidosis 366

368 Sarcoma 366

369 Scheie Syndrome (Mucopolysaccharidosis Type

IS) 367

370 Schizophrenia 368

371 Scimitar Syndrome 369

372 Scleroderma 370

373 Scoliosis and Kyphosis 371

374 Seizures, Absence (Petit Mal) 373

375 Seizures, Epileptic 373

376 Seizures, Intractable 375

377 Seizures, Tonic-Clonic (Grand Mal) 375

378 Sepsis, Severe Sepsis, and Septic Shock 376

379 Shy-Drager Disease 378

380 Sick Sinus Syndrome 379

381 Sickle Cell Disease 380

382 Sickle Cell Trait 381

383 Silicosis 381

384 Single (Including Common) Ventricle 382

385 Sleep Apnea, Central and Mixed 383

386 Sleep Apnea, Obstructive 384

387 Smallpox 386

388 Spasmodic Torticollis 386

389 Spinal Cord Injury 387

390 Spinal Muscular Atrophy 388

391 Stevens-Johnson Syndrome 389

392 Sturge-Weber Syndrome 390

393 Subclavian Steal Syndrome 391

394 Subphrenic Abscess 392

395 Substance Abuse Disorder

(Perioperative) 393

396 Supratentorial Brain Tumors 394

397 Supraventricular Tachycardia

(Tachyarrhythmias) 396

398 Swallowing Disorders 397

399 Syndrome of Inappropriate Antidiuretic

Hormone Secretion 398

400 Syndrome X 399

401 Systemic Lupus Erythematosus 400

402 Takayasu Disease 401

403 Tetanus 401

404 Tetralogy of Fallot 402

405 Thalassemia 403

406 Thrombocytopenia 405

407 Thyroid Neoplasms 406

408 Tracheoesophageal Fistula (Congenital) 407

409 Transfusion-Related Acute Lung Injury 408

410 Transposition of the Great Arteries 409

411 Transverse Myelitis 410

412 Treacher Collins Syndrome 411

413 Tricuspid Atresia 412

414 Trigeminal Neuralgia (Tic Doloureux)

416 Tuberculosis 415

417 Ulcerative Colitis, Chronic 415

418 Upper Respiratory Infections 416

419 Urinary Lithiasis 417

420 Urticaria, Cold 418

421 Uterine Rupture 419

422 Varicella-Zoster Virus 420

423 Ventricular Fibrillation 421

424 Ventricular Preexcitation Syndrome 422

425 Ventricular Septal Defect (Congenital) 423

426 Ventricular Septal Rupture (Defect),

Postmyocardial Infarction 424

427 Ventricular Tachyarrhythmias 424

428 Ventricular Tachycardia 425

429 Vitamin B12/Folate Deficiency 426

430 Vitamin D Deficiency 428

431 Vitamin K Deficiency 429

432 Von Hippel-Lindau Disease 430

433 Von Willebrand Disease 431

434 Waldenström Macroglobulinemia 431

435 Wegener Granulomatosis (Granulomatosis

with Polyangiitis) 432

436 Wilms Tumor 433

437 Wilson Disease 434

438 Wolff-Parkinson-White Syndrome

439 ACE Inhibitors 438

440 Acetaminophen 438

441 Alkylating Agents 439

442 Alpha1 Antagonists 440

443 Alpha2 Adrenergic Agonists 441

444 Amphetamines 442

445 Angiotensin II Receptor Blocking Drugs 443

446 Antianxiety Medications 444

447 Antipsychotics 445

448 Aspirin (Acetylsalicylic Acid) 446

449 Benzodiazepines 446

450 Beta-Adrenergic Receptor Antagonists

(Blockers) 447

451 Bisphosphonates 448

452 Bleomycin 449

453 Buprenorphine 450

454 Calcium-Channel Blockers 451

455 Capsaicin 452

456 Carbamazepine–Oxcarbazepine 452

457 Chemotherapeutic Agents 454

458 Cilostazol459 Cocaine 457

460 Colchicine 458

461 Cromolyn Sodium 459

462 Dabigatran 460

463 Digitalis (Digoxin) 461

464 Dipyridamole 462

465 Diuretics 463

466 Epsilon-Aminocaproic Acid (Amicar) 463

467 Fluoxetine (Prozac) 464

468 Folic Acid 465

469 Glucocorticoids 466

470 Gold (Auranofin, Aurothioglucose,

Aurothiomalate) 467

471 Hormone Replacement Therapy 468

472 Inhaled Bronchodilators 469

473 Insulin 470

474 Leukotriene Antagonists 472

475 Lithium Carbonate (Lithobid) 472

476 Magnesium Sulfate 473

477 Marijuana 474

478 Metformin (Glucophage) 475

479 Monoamine Oxidase Inhibitors; Reversible

Inhibitors of Monoamine Oxidase 476

480 Naltrexone 477

481 Nicotine Replacement Therapies 478

482 Nitric Oxide, Inhaled 479

483 Nitroglycerin 480

484 Nonstatin Hypolipidemic Agents 480

485 Nonsteroidal Anti-Inflammatory Drugs 482

486 Nutritional Support 483

487 Oral Contraceptives 484

488 Oral Hypoglycemic Agents 484

489 P2Y12 Receptor Blockers 485

490 Penicillins 486

491 Phencyclidine 487

492 Phenothiazines 488

493 Phenoxybenzamine 489

494 Phenylephrine (Neo-Synephrine) 490

495 Phenytoin 490

496 Physostigmine, Eserine 491

497 Procainamide (Procan, Procanbid,

Pronestyl) 492

498 Propylthiouracil—Antithyroid Drugs 493

499 Proton Pump Inhibitors 494

500 Pseudoephedrine 495

501 Pyridostigmine Bromide 496

502 Rifampin 496

503 Selective Estrogen Receptor Modulators 497

504 Serotonin: Agonists, Antagonists, and

Reuptake Inhibitors 498

505 Sildenafil Citrate 499

506 Statins 500

507 Tacrolimus (FK-506 ) 501

508 Tetracyclines 502

509 Thiazolidinediones 503

510 Thyroid Supplements 504

511 Tissue Plasminogen Activator 504

512 Tranexamic Acid 505

513 Trimethaphan 506

514 Valproate 507

515 Vitamin B12 (Cyanocobalamin) 508

516 Warfarin (Coumadin) 509

517 Androstenedione 512

518 β-Sitosterol 512

519 Blue Cohosh (Caulophyllum thalictroides) 513

520 Carnitine 514

521 Chitosan 515

522 Chondroitin Sulfate 515

523 Chromium 516

524 Cranberry 516

525 Creatine 517

526 Dandelion 518

527 Dehydroepiandrosterone 518

528 Echinacea (American Coneflower, Purple

Coneflower, E. Angustifolia, E. Purpurea,

E. Pallida) 519

529 Ephedra (Ma-Huang) 520

530 Evening Primrose 520

531 Fish Oil 521

532 Garlic (Allium sativum) 522

533 Ginger (Zingiber officinale) 523

534 Ginkgo biloba 524

535 Ginseng 525

536 Glucosamine Sulfate 526

537 Glycine 526

538 Kava 528

539 Licorice (Glycyrrhiza glabra) 528

540 Melatonin (N-Acetyl-5-Methoxytryptamine,

Bevitamel, Vitamist, Melatonex) 529

541 Nutraceuticals 530

542 Phytosterols 531

543 Red Yeast Rice (Cholestin) 531

544 S-Adenosyl-l-Methionine 532

545 Saw Palmetto 533

546 St. John’s Wort (Hypericum perforatum) 533

547 Valerian (Valeriana officinalis) 534

Details

No. of pages:
600
Language:
English
Copyright:
© Elsevier 2018
Published:
Imprint:
Elsevier
eBook ISBN:
9780323395427
eBook ISBN:
9780323395410
Paperback ISBN:
9780323394970

About the Author

Lee Fleisher

Affiliations and Expertise

Robert Dunning Dripps Professor and Chair of Anesthesiology and Critical Care Medicine, Professor of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania

Michael Roizen

Affiliations and Expertise

Roizen Family Chair, Wellness Institute, Professor of Anesthesiology, Chief Wellness Officer, The Cleveland Clinic, Cleveland, Ohio

Jeffrey Roizen

Affiliations and Expertise

Assistant Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Division of Endocrinology and Diabetes, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania