High Altitude Medicine and Physiology PDF

Preface

New advances in the areas of high altitude medicine and physiology continue to be made at a rapid pace. For example, since the last edition of this book in 2007, there have been dramatic advances in the area of genetics of high altitude. One of the most important discoveries has been the genetic differences between Tibetans and Han Chinese with the expectation that this will go a long way in explaining the remarkable adaptation of Tibetans to their environment. Additional important advances have been made on the functions of hypoxia-inducible factors which we now realize orchestrate many of the body's responses to hypoxia. Added to this has been a better understanding of the phenotypic differences between Andeans and Tibetans which are the two principal populations of the world that have so successfully adapted to high altitude. All this new work has justified a new chapter on genetics at altitude and this is written in a way that should make this somewhat technical topic accessible to those of us who do not have a strong background in the area.

Additional important advances have been made in the management of high altitude diseases. For example, the value of the different medications available for acute mountain sickness is addressed, together with new information on strategies for acclimatization. Advances in our understanding of the mechanism of high altitude pulmonary edema are discussed together with their therapeutic implications. Extensive additions have been made to the chapter on other high altitude related medical conditions. In addition, the chapter on pre-existing medical conditions has been extensively revised.

Another burgeoning area is the challenge presented to people who need to go to high altitude to work. Mines are being developed at increasingly high altitudes, particularly in South America. There are now very large telescopes located as high as 5000 m in north Chile and effective workat those altitudes is only possible using oxygen enrichment of room air. A striking technological advance is the new Chinese train to Lhasa which passes through an altitude over 5000 m. The ingenious solution has been to increase the oxygen concentration in every passenger car on the train. A sadder event is the continuing dispute between India and Pakistan in the region of the Siachen Glacier where troops are operating at over 6000 m with a correspondingly high morbidity.

For this new edition, all sections of the book have been carefully updated, but great pains have been taken to maintain a reasonable length. There are a number of new illustrations. The references have been brought up to date with some of them so recent that they have been completed in the proof stage.

A welcome addition to the group of editors is Andrew Luks MD from the University of Washington in Seattle. He is an avid mountaineer and has a particular interest in the clinical aspects of high altitude diseases. He has been responsible for updating several of the chapters in this area.

Mountains continue to attract increasing numbers of people for skiing, trekking or climbing. In addition, commercial activities at high altitude are increasing at a rapid rate. Happily, there has been a large increase in research on the diseases that affect permanent dwellers at high altitude, an area that has traditionally received less attention than should have been the case. Our hope is that this new edition will continue to improve the health and safety of all people who live, visit or work at high altitude. It is a pleasure to acknowledge the continuing support of Joanna Koster and her colleagues at Hodder Arnold.