CRC HIGH ALT MED PHYSIO PDF

Preface

This new edition of High Altitude Medicine and Physiology incorporates some major changes. First, Michael Ward has retired after spearheading the first three editions. Indeed it was his previous book, Mountain Medicine,which provided the initial impetus for this text which has enjoyed considerable success as a standard work in the area. With Michael's departure, Robert ‘Brownie' Schoene has joined us thus adding new young blood. The three of us previously worked extensively together at high altitude during the 1981 American Medical Research Expedition to Everest and this makes a nice comparison with the three original editors who were together on the 1960–61 Silver Hut Expedition.

Brownie Schoene is well known to physicians and physiologists interested in high altitude. He has studied the control of ventilation at high altitude, particularly the importance of the hypoxic ventilatory response for tolerating extreme altitude. In addition, with Peter Hackett, he carried out some remarkable investigations high on Denali where climbers with high altitude pulmonary edema consented to bronchoalveolar lavage. These bold studies showed that the alveolar fluid had a very high protein concentration and contained numerous cells thus proving that it was a high permeability type of edema caused by damage to the pulmonary capillaries. His expertise in high altitude medicine and physiology complements that of the other two editors very well.

In addition to this change in editors, there have been major changes in the scientific content of the book with updates in many areas. Since the last edition, the area of genetics has assumed great importance along with other advances in molecular biology and medicine. There are now numerous allusions to these topics throughout the text, particularly in the areas of mechanisms of oxygen sensing, regulation of the pulmonary circulation particularly hypoxic pulmonary vasoconstriction, adaptation of permanent residents of high altitude, and tolerance to extreme altitude. It was thought preferable to deal with genetic and molecular mechanisms throughout the text rather than have a specific chapter devoted to them. Other areas where extensive updating has occurred include sections on women and children at high altitude, the role of vascular endothelial growth factor, neurological disorders at high altitude, athletic training using high altitude, recent work on high altitude pulmonary edema, and the problems of patients with existing diseases who plan to go to high altitude.

All this new information could substantially increase the size of the book but we have tried to avoid this by prudent pruning. For example, we have reduced the length of the sections on cold injury. Although this topic can be important at high altitude, injuries caused by cold are certainly not limited to this environment. Cold injury was one of the primary interests of Michael Ward, and in this new edition we have attempted to include sufficient information to inform people who go to high altitude about prevention and treatment without going into as much detail as in the previous editions.

In addition to these substantial changes in scientific content, a number of formatting changes have been made to make the book easier to read.We have kept the summaries at the beginning of each chapter but these have been highlighted to make them clearer. Additional tables have also been incorporated; for example, dealing with the features and the treatment of some of the most important high altitude diseases including acute mountain sickness, high altitude pulmonary edema, and high altitude cerebral edema.

Finally, the rapid pace of advances in the area of high altitude medicine and physiology clearly justifies a new edition. In the six years since the last edition appeared there have been several international meetings of the International Society for Mountain Medicine, various international Hypoxia meetings, and a welter of new material appearing in journals. The journal High Altitude Medicine and Biology which had just begun publication when the last edition appeared has now become established as the international journal in the field.

Increasingly, lowlanders go to high altitude to trek, ski or climb, and there is also a large increase in the number of people who now work at high altitude, for example in mines or with telescopes. Even more important perhaps is the large population of permanent residents of high altitude who have generally received short shrift in the past partly because many are in poorly developed countries. However, there is presently a great increase in interest in diseases such as chronic mountain sickness and high altitude heart diseases of residents. Our hope, as was the case for previous editions of this book, is that it will continue to improve the health and safety of all people who visit, live or work at high altitude.