00. Cover Harrison Prinsip-Prinsip Ilmu Penyakit Dalam Volume 1

Harrison PRINSIP-PRINSIP ILMU PENYAKIT DALAM (Harrison's Principles of Internal Medicine) Volume 1 Editor: Kurt J. Isselbacher, A.B.,M.D, Mallinckrodt Professor of Medicine, Harvard Medical School; Physician and Director, Cancer Center, Massachusetts General Hospital, Boston Eugene Braunwald, A.B., M.D., M.A. (Hon), M.D. (Hon), ScD. (Hon.) Hersey Professor of the Theory and Practice of Medicine, Harvard Medical School; Chairman, Department of Medicine, Brigham and Women's Hospital, Boston Jean D.Wilson, M.D. Charles Cameron Sprague Distinguished Chair and Professor of Internal Medicine; Chief, Division of Endocrinology and Metabolism, The University of Texas Southwestern Medical Center, Dallas Joseph B. Martin, M.D.., Ph.D., F.R.C.P. (C), M.A. (Hon.) Professor of Neurology and Chancellor, University of California, San Francisco Anthony S. Fauci, M.D. Director, National Institute of Allergy and Infectious Diseases; Chief, Laboratory of Immunoregulation; Director, Office of AIDS Research, National Institutes of Health, Bethesda Dennis L. Kasper, M.D. William Ellery Channing Professor of Medicine, Harvard Medical School; Chief Division of Infectious Diseases, Beth Israel Hospital; Co-Dliector, Channing Laboratory, Brigham and Women's Hospital, Boston Editor Edisi Bahasa Indonesia: Prof. Dr. Ahmad.H. Asdle, Sp.PD-KE Guru Besar Dmu Penyakit Dalam Universitas Gadjah Mada/RSUP Dr. Sardjito - YogyakartaPENERBIT BUKU KEDOKTERAN

HARRISON'S PRINCIPLES O F INTERNAL MEDICINE. 13/EInternational edition. Copyright © 1994 by McGraw-Hill Inc.HARRISON PRINSIP-PRINSIP ILMU PENYAKIT DALAM. VOL. 1. E/13Published by arrangement with McGraw-Hill Book Co., SingaporeEditor edisi bahasa Indonesia: Prof. Dr. A h m a d H . Asdie, Sp.PD-KEHak cipta terjemahan Indonesia© 1995 Penerbit B u k u Kedokteran E G CDesain kulit muka: Samson P. EarnsHak cipta dilindungi Undang-UndangDilarang mengutip, memperbanyak dan menerjemahkan sebagian atauseluruh isi buku ini tanpa izin tertulis dari penerbit.Cetakan I : 1999 \ Perpustakaan Nasional: Katalog Dalam Terbitan (KDT) Harrison p r i n s i p - p r i n s i p i l m u p e n y a k i t d a l a m / e d i t o r e d i s i b a h a s a I n g g r i s , K u r t J. I s s e l b a c h e r ... [ e t a l . ] ; e d i t o r e d i s i bahasa I n d o n e s i a , A h m a d H. A s d i e . - J a k a r t a : E G C , 1 9 9 9 . xxii, 539 hlm.+ (8 him. Lampiran & 39 him. Indeks); 21 X 29,7 cm. J u d u l a s l i : Harrison's principles of internal medicine ISBN 979-448-453-9 (no. vol. lengkap) ISBN 979-448-454-7 (vol. 1) 1. P e n y a k i t d a l a m . I . Isselbacher, K u r t J. I I . A s d i e , A h m a d H. 616Edisi TerjemahanCIna (Edisi 12)-McGraw-Hill Book Company-Singapore © 1994Indonesia ( E d i s i 1 3 ) - P e n e r b i t B u k u K e d o k t e r a n E G C © 1 9 9 5Itali ( E d i s i 1 2 > - M c G r a w - H i l l L i b r i I t a l i a S . r l . © 1 9 9 2Jepang ( E d i s i 1 l > - H i r o k a w a , © 1 9 9 1Jerman<Edisi IO)-Schwabe and Company, Ltd., © 1986Perancis ( E d i s i 1 2 > - F l a m m a r i o n , © 1 9 9 2Portugis ( E d i s i 1 2 ) - E d i t o r a G u a n a b a r a K o o g a n , S . A . , © 1 9 9 2S p a n y o l (Edisi 12)-McGraw-Hill/Interamericana de Espana, © 1992Yunani ( E d i s i 1 2 ) - P a r i s s i a n o s , © 1 9 9 4 (est.)Isi di h j v tanggung jawab percatakan

PERINGATAN Ilmu kedokteran selalu beruba.h. Karena peneiitian baru dan pengalaman klinis memperluas pengetahuan kita, diperlukan perubahan dalam pengobatan dan terapi obat. Para penyunting dan penerbit karya ini telah mengecek pada sumber-sumber yang diyakini dapat diandalkan dalam upaya menyajikan informasi yang lengkap dan secara umum sesuai dengan standar yang diterima pada saat buku ini diterbitkan. Walaupun demikian, karena adanya kemungkinan kesalahan manusiawi atau perubahan ilmu kedokteran, baik penyunting, penerbit, maupun pihak lain yang terlibat dalam persiapan atau penerbitan karya ini tidak dapat menjamin bahwa informasi yang dimuat di dalamnya akurat dan lengkap dalam semua hal. Pembaca diminta mengkonfirmasikan informasi yang terkandung di dalamnya dengan sumber lain. Misalnya dan teristimewa, pembaca dianjurkan. untuk mengecek lembar informasi produk yang disertakan pada bungkus setiap obat yang mereka akan berikan untuk memastikan bahwa informasi yang dimuat di dalam buku ini akurat dan belum pernah ada perubahan dalam hal dosis yang direkomendasikan atau kontraindikasi dalam pemberian obat. Rekomendasi ini terutama penting dalam kaitannya dengan obat yang baru atau jarang digunakan. Pembaca juga harus berkonsultasi dengan laboratorium mereka sendiri untuk mengetahui nilai yang normal.

A SALUTE TO ROBERT G. PETERSDORF By The Editors Of Harrison's.We dedicate this thirteenth edition of H a r r i s o n ' s Principles o f I n t e r n a l M e d i c i n e to Robert G . Petersdorf.Dr. Petersdorf became an editor of Harrison's in 1968 for the preparation of the sixth edition andserved as Editor-in-Chief of the tenth edition. He was a powerful force for seven editions and morethan 20 years in estabUshing the pivotal role of this book in the education of students, residents andpractitioners of medicine.Dr. Petersdorf & a graduate of Brown University and of Yale University Medical School. Hisgraduate training included residencies in medicine at Yale and at the Peter Bent Brigham Hospital anda research fellowship at Johns Hopkins. A s Chair of the Department of Medicine at the University ofWashington he fashioned one of the truly great departments of internal medicine in the nation, withwell-balanced and great strengths in education, clinical care, and research. His interests and contribu-tions broadened steadily and he served suicessively as the first President of the newly merged Brighamand Women's Hospital in Boston, as Vice Chancellor for Health Sciences and Dean of the School ofMedicine, University of California, San Diego, and most recently as President of the Association ofAmerican Medical Colleges.Dr. Petersdorf has, from the beginning of his career, made notable and outstanding contributionsin a number of areas in the field of Infectious Disease. H e carried out a series of classic studies on thepathogenesis of fever, on pneumococcal meningitis and infective endocarditis, and on the chemopro-phylaxis and epidemiology of gram-negative infections, especially of the urinary tract.

DAFTAR ISI RINGKASDAFTAR KONTRIBUTOR - xiKATA PENGANTAR xxl~ ^ BAGIAN SATU ^ PENGANTAR ILMU KEDOKTERAN KLINISSeksi 1 BAGIAN DUASeksi 2 MANIFESTASI UTAMA PENYAKITSeksi 3Seksi 4 NyeriSeksi 5Seksi 6 KPPPPDPPeeeeeeeislrrrrrrafuuuuuuuibbbbbbnnaaaaaaaghhhhhhnsaaaaaai hnnnnnnseifsfpfdsmuuutuaaennnahdlmgaggtuaosmssliiitskousbaugfgubirelairinakutkrsfgkhutresloaimissniiehtedksdastanuinnaarleeldsleapknirtarroseliiptroduksiSeksi 7Seksi 8 BAGIAN TIGASeksi 9 GENETIK DAN PENYAKIT BAGIAN EMPAT FARMAKOLOGI KLINIS BAGIAN LIMA GIZI

DAFTAR ISIDAFTAR KONTRIBUTOR Xi 18 D/ZZ/A/ESS DAN VERTIGO 115KATA PENGANTAR xxl Robert B. Daroff BAGIAN SATU 19 GANGGUAN PADA PENGLIHATAN 118PENGANTAR ILMU KEDOKTERAN KLINIS DAN GERAKAN BOLA MATA1 PRAKTIK ILMU KEDOKTERAN 1 Shirley H. Wray/ Thomas L. Slamovits / Ronald M. Burde Editor 20 GANGGUAN PADA PENCIUMAN,2 KPEEDROSOKATELARNANETKILSINPIASDA Bernard Lo PENGECAPAN, DAN PENDENGARAN 130 James B. Snow, Jr /Joseph B. Martin 7 21 PARALISIS DAN GANGGUAN GERAK 1373 PEJAMU DAN PENYAKIT: JohnH. Growdon/J. Stephen FinkPENGARUH FAKTOR DEMOGRAFIK 11 22 GAKTEAASYKEASIBMIAEBRDAJANANGLAAGNNANDGANGUANEugene Braunwald/ Jean D. Wilson SidGilman 1484 PENGARUH FAKTOR SOSIAL 23 SPASME OTOT, KRAM, DAN 153 KELEMAHAN EPISODIKYANG KUAT TERHADAP PENYAKIT 13Virginia L. Emster Roberto. Griggs5 KESEHATAN PEREMPUAN 18 24 MATI RASA, RASA PEDIH, DAN Anthony L. Komaroff /Beverly Woo . HILANGNYA SENSORIS 1576 KELAINAN MEDIS SELAMA 22 Arthur K. Asbury KEHAMILAN 25 KEADAAN BINGUNG AKUT, Thomas F. Ferris7 MASALAH KESEHATAN REMAJA 29 AMNESIA, DAN DEMENSIA 161Charles E. Invin, Jr /Mary-Ann Shafer Martin M. Brown / Vladimir C. Hachinski8 ILMU KEDOKTERAN GERIATRIK 37 26 KOMA DAN GANGGUAN KESADARAN LAINNYANeil M. Resnick 171 Allan H. Ropper / Joseph B. Martin9 SADAR BIAYA DALAM KEDOKTERAN 47 Lee Goldman 27 SINDROMA YANG DISEBABKAN10 ASPEK KUANTITATIF PENALARAN 53 OLEH LESI SEREBRAL FOKAL 180 KLINIS Raymond D. Adams /Maurice Victor Lee Goldman 28 GANGGUAN BICARA DAN BAHASA 184 BAGIAN DUAMANIFESTASI UTAMA PENYAKIT J. R Mohr 29 GANGGUAN TIDUR DAN IRAMA Seksi 1: Nyeri SIRKADIAN 19011 NYERI: PATOFISIOLOGI DAN Charies A. Czeisler/Gary S. Richardson /Joseph B. SMeakrtisni 4: Perubahan Fungsi Sirkulasi danPENATALAKSANAAN 60Howard Fields / Joseph B. Martin Respirasi12 NYERI DADA DAN PALPITASI 66 30 BATUK DAN HEMOPTISIS \" 199 Lee Goldman /Eugene Braunwald ' 74 Eugene Braunwald13 NYERI ABDOMEN 31 • DISPNEA DAN EDEMA PARU 203William Siren RolandH. Ingram, Jr /Eugene Braunwald14 NYERI KEPALA 77 32 HIPOKSIA, POLISITEMIA, DANNeil H. Raskin SIANOSIS 20815 NYERI PUNGGUNG DAN LEHER 86 Eugene Braunwald Henry J. Mankin /Lawrence F. Borges 33 SEEueDgekEnseMi 5AB:raPunewrauldbahatninaFlungsi Gastrointes- 213 3364 JJJMMSKooAhsYOAAneNpOTNLhSTIA.KIFUEMPEGNSErPSeGNeaKTnrrsDilAApl{oaACSRnADIDROAIODKRIVAAALCSPKAEURNRLEYE ARS TK, )IH,TEDNATNI 218 SSekesk\ si 23:: PDeisrufubnaghsainSSisutehmu TSuabraufh 91078 35 231176 TKDDIEADANMADKASAMEDAR,INKTAEEMNTRGAAMUAHANUPSIIKUNPEKGEJSNADAYNENEGM,BASAMIBNNYKYAOANPG 223 JoesflerepyhA. B. GMealrftain/dJ/ereCmhyarles RAu.sDkiinnarello /Sheldon M. Wolff Robert J. Myerburg/AgustinCastellanos

DAFTAR ISI ix37 DISFAGIA 239 58 PEMBENGKAKAN KELENJAR LIMFE DAN Raj. K. Goyal LIMPA (LIEN) 36938 ANOREKSIA, NAUSEA, VOMITUS, Bamn F. HaynesDAN DISPEPSIA 241 59 KELAINAN FAGOSIT KUANTITATIF 376 DAN KUALITATIFLawrence S. Friedman / Kurt J. Isselbacher 24739 DIARE DAN KONSTIPASI John I. Gallin Lawrence S. Friedman /Kurt J. Isselbacher BAGIAN TIGA GENETIK DAN PENYAKIT40 KENAIKAN DAN PENURUNAN BERATBADAN 257 60 ASPEK GENETIK PADA PENYAKIT 385 259 396 Daniel W. Foster 61 JohnL. Goldstein / Michael S. Brown 414 42341 PERDARAHAN SALURAN MAKANAN ILMU KEDOKTERAN DAN 430 437James M. Richter /Kurt J. Isselbacher42 IKTERUS 443 263 GENETIKA MOLEKULER 456L e e M . Kaplan /Kurt J. Isselbacher 62 Arthur L. Beaudet/Andrea Ballabio 46343 PEMBESARAN ABDOMEN DAN ASPEK SITOGENETIK DARI 477ASITES 269 63 PENYAKIT MANUSIA 483 Robert M.Glickman/Kurt J. Isselbacher James German 488 64 491 Seksi 6: Perubahan Fungsi Berkemih dan GENA DAN NEOPLASIA 497 Elektrolit 505 272 Stanley J. Korsmeyer 50844 PERUBAHAN FUNGSI BERKEMIH 65 KOMPLEKS HISTOKOMPATIBILITAS 518Fredric L. Coe GENA MAYOR45 CAIRAN DAN ELEKTROLIT 280Norman G. Levinsky Charles F. Carpenter46 ASIDOSIS DAN ALKALOSIS 293 TPEERNAYPAIKFIDTAARGNBMEAPANGEKEINOATCNILKEOEGGMAIPHKAALTNINISNorman G. Levinsky David ValleSeksi 7: Perubahan dalam Fungsi Seksual dan Reproduksi47 IMPOTENSI 303 66 PRINSIP-PRINSIP TERAPI OBATJohn D. McConnell / Jean D. Wilson John A. Oates/Grant R. Wilkinson48 GANGGUAN MENSTRUASI DAN 67 EFEK SAMPING OBATFUNGSI SEKSUAL PEREMPUAN 307 AlastairJ. J. WoodBruce R. Carr / Jean D. Wilson 68 FISIOLOGI DAN FARMAKOLOGI49 HIRSUTISME DAN VIRILISASI 309 SISTEM SARAF AUTONOMWilliam J Kovacs /JeanD. Wilson Lewis Landsberg /James B. Young \- , 69 PROTEIN G DAN PENGATURAN Seksi 8: Perubahan pada Kulit SISTEM PERANTARA KEDUA50 PEMERIKSAAN KULIT 312 Michael Freissmuth / Alfrbd G. Gilman Thomas J. Lawley/KimB. Yancey 70 EIKOSANOID DAN PENYAKIT51 EKZEMA, PSORIASIS, INFEKSI KULIT, AKNE, DAN GANGGUAN 316 MANUSIA BAGIAN LIMA KULIT UMUM LAINNYA GIZI R. Paul RobertsonRobert A. Swertick/Thomas J. Lawley52 REAKSI KULIT KARENA OBAT 322 71 ILMU GIZI DAN KEBUTUHAN GIZIBnjce U. Wintroub / Robert S. Stem Irwin H. Rosenberg53 PENYAKIT KULIT IMUNOLOGIK 329 72 MALNUTRISI ENERGI-PROTEIN Kim B. Yancey/Thomas J. Lawley JoelB. Mason/Inn/in H. Rosenberg54 GEJALA KULIT PADA PENYAKIT 73 OBESITASDALAM 334 Jen-old M. OlelskyJean Bolognia / Irwin M. Bra verman 74 ANOREKSIA NERVOSA DAN55 FOTOSENSITIVITAS DAN REAKSI BULIMIALAIN TERHADAP CAHAYA 352 Daniel W. FosterDavid R. Bickers 75 TERAPI DIETSeksi 9: Kelainan Hematologik Johanna T. Dwyer/JodI Roy56 ANEMIA 358 76 TERAPI NUTRISI PARENTERAL DAN ENTERALH. Franklin Bunn57 PERDARAHAN DAN TROMBOSIS Lyn Howard 363Robert L Handirt'

DAFTAR ISI77 DEFISIENSI DAN KELEBIHAN 527 Lampiran: Nilai Laboratorium Klinis L-1 VITAMIN yang Bermakna I-1 Jean D. Wilson Indeks78 GANGGUAN PADA METABOLISME 537 UNSURKELUMIT Kenneth H. Falchuk

DAFTAR KONTRIBUTOR ELIAS ABRUTYN, M.D. ARTHUR L. BEAUDET, M.D. Professor andAssociate Chairman, Medicine,- and Vice-Dean for Veterans Professor, Institute f o r Molecule Genetics and Departments o fPediatrics a n d Affairs, Medical College o f Pennsylvania; Chief, Infectious Diseases, Veterans Cell Biology, Baylor College o fMedicine; Investigator, H o w a r d Hughes Medical Administration Medical Center, Philadelphia Institute, Houston RAYMOND D. ADAMS, B.A., M.A., M.D., M.A. JOHN E. BENNETT, M.D. (Hon.), D.Sc. (Hon.), M.D. (Hon.) Head, Clinical Mycology Section, Laboratory o fClinical Investigation, BuUard Professor o fNeuropathology, Emeritus, Harvard Medical School; National Institute o fAllergy andInfectious Diseases, National Institutes o f Health, Consultant Neurologist, Massachusetts General Hospital; Emeritus Director, Bethesda Eunice K .Shriver Research Center, Boston; Medicin Adjoint L' Hopital, Cantonale de Lausanne, Lausanne ANDREW BERCHUCK, M.D.MICHAEL J. AMINOFF, M.D. Associate Professor, Division o fGynecologic Oncology, Duke University Medi- cal Center Durham Professor o f Neurology; Director, Clinical Neurophysiology Laboratories, Uni- versity o fCalifornia, San Francisco MICHAEL S. BERNSTEIN, M.D.MICHAEL A. APICELLA, M.D. Assistant Professor o f Medicine andAnesthesia, Division of Pulmonary and Criti- cal Care Medicine, University o fCalifornia at S a n Francisco Medical Center, Professor and Head, Department o fMicrobiology, University o fIowa College o f San Francisco Medicine, Iowa City DANIEL G. BICHET, M.D.GORDON L E E ARCHER, M.D. Associate Professor o fMedicine, University o fMontreal; Director, Clinical R e - Professor o f Medicine and Microbiology/Immunology and Chairman, Division search Unit, Hopital d uSacre-Coeur de Montreal, Montreal of Infectious Diseases, Medical College o fVirginia, Virginia Commonwealth University, Richmond DAVID R. BICKERS, M.D.ARTHUR K. ASBURY, M.D. Professor andChairman, Department o fDermatology, Case Western Reserve Uni- versity School o fMedicine; Director. Department o fDermatology, University Ruth Wagner V a nMeter and J. R a y V a nMeter Professor o fNeurology; Vice Hospitals o fCleveland, Cleveland Dean forResearch, University o fPennsylvania School o fMedicine and Hospital of the University o fPennsylvania, Philadelphia EDWIN L. BIERMAN, M.D.K. FRANK AUSTEN, M.D. Professor o fMedicine and Head. Division o fMetabolism, Endocrinology and Nutrition, University o fWashington School o fMedicine, SeattleTheodore Bevier Bayles Professor o fMedicine, Harvard Medical School; Chair-man, Department o fRheumatology a n dImmunology, Brigham and Women's NEIL R. BLACKLOW, M.D.Hospital, Boston Richard M . Haidack Professor o fMedicine and Chairman. Department o f Medi-ROBERT AUSTRIAN, M.D., D.Sci. (Hon.) cine, University o fMassachusetts Medical School, WorcesterJohn Herr Musser Professor and Chairman Emeritus, Department o f Molecular MARTIN J. BLASER, M.D.and Cellular Engineering, University o fPennsylvania School o f Medicine,Philadelphia The Addison B .Scoville Professor o f Medicine; Director, Division o f Infectious Diseases and Professor o fMicrobiology and Immunology, VanderbiltBERNARD BABIOR, M.D., Ph.D. University School o fMedicine; Staff Physician, Veterans Affairs Medical Center, NashvilleHead, Division o fBiochemistry, Department o fMolecular and ExperimentalMedicine and Member, Division o f Hematology and Oncology, Department o f JEAN L. BOLOGNIA, M.D.Medicine, Scripps Clinic and Research Foundation, L a Jolla Associate Professor o f Dermatology, Department o fDermatology, Yale Univer-KAMAL F. BADR, M.D. sity School o fMedicine, N e w HavenProfessor o fMedicine, E m o r y University; C h i e f Division o fNephrology, Atlanta LAWRENCE E BORGES, M.D.Veteran's Medical Center; Attending Physician, E m o r y University Hospital,Atlanta Associate Professor o fSurgery (Neurosurgery), Harvard Medical School; Asso- ciate Visiting Neurosurgeon, Massachusetts General Hospital, BostonDONALD S. BAIM, M.D. RICHARD C. BOUCHER, Jr., M.D.Associate Professor o fMedicine, Harvard Medical School; C h i e f InterventionalCardiology Section, Beth Israel Hospital, Boston Professor o fMedicine a n dDirector, Division o fPulmonary Diseases, Critical Care and Occupational Medicine, University o f North Carolina at Chapel Hill;ANN SULLIVAN BAKER, M.D. University o fNorth Carolina Hospitals, Chapel HillAssociate Professor o fMedicine, Haivaid Medical School; Director, Infectious AUBREY E. BOYD HI, M.D.Diseases Service, Massachusetts E y e a n dEar Infiimary; Physician, InfectiousDisease Service, Massachusetts General Hospital, Boston Professor o fMedicine a n dNeuroscience; C h i e f Division o f Endocrinology, Diabetes, Metabolism and Molecular Medicine, N e w England Medical Center,ANDREA BALLABIO, M.D. BostonAssociate Professor, Institute forMolecular Genetics and H u m a n Genome Cen- WALTER G. BRADLEY, D.M., F.R.C.P.ter, B a y l o r College o f M e d i c i n e , H o u s t o n Professor and Chairman, Department o fNeurology, University o fM i a m i SchoolKENNETH J. BART, M.D., M.PH. of Medicine, MiamiDirector, National Vaccine Program, Office o fthe Assistant Secretary o f Health, HUGH R. BRADY, M.D., Ph.D., F.R.C.RLDepartment o f Health and H u m a n Services, Rockville Assistant Professor o fMedicine, Harvard Medical School; C h i e f Renal Section,ROBERT C. BAST, Jr., M.D. BrocktonAVest Roxbury Veteran's Affairs Medical Center; Associate Physician, Brigham and Women's Hospital, BostonR. W a y n e Rundle Professor o fMedicine and Director, D u k e ComprehensiveCancer Center, Duke University Medical Center, Durham DAVID L. BRAFF, M.D.M. FLINT BEAL, M.D. Professor o f Psychiatry, University o fCalifornia atS a nDiego; Director o f Psy- chiatry, U C S D Medical Center San DiegoAssociate Professor o fNeurology, Harvard Medical School; Assistant Neurolo-gist, Massachusetts General Hospital, Boston

DAFTAR KOtfTRIBUTORKENNETH D. BRANDT, M.D. BRUCE R. CARR, M.D. Professor of Medicine and Head, Rheumatology Division, Indiana Univer- Paul C . MacDonald Professor and Director, Division of Reproductive E n - sity School of Medicine, Indianapolis; Director, Multipurpose Arthritis and docrinology, Department of Obstetrics and Gynecology, The University of Musculoskeletal Diseases Center. Indiana University School of Medicine, Texas Southwestern Medical Center, Dallas Indianapolis AGUSTIN CASTELLANOS, M.D.EUGENE BRAUNWALD, A.B., M.D., M.A. (Hon.),M.D. (Hon.), ScD. (Hon.) Professor of Medicine, University of Miami School of Medicine; Director Clinical Electrophysiology, Jackson Memorial Hospital, Miami Hersey Professor of the Theory and Practice of Medicine, Harvard Medical School; Chairman, Department of Medicine, Brigham and Women's Hospital, VERNE S. CAVINESS, Jr., M.D., Ph.D. Boston Joseph P. and Rose F . Kennedy Professor of C h i l d Neurology and MentalIRWIN M. BRAVERMAN, M.D. Retardation, Harvard Medical School; Chief. Pediatric Neurology Service Massachusetts General Hospital, Boston Professor, Department of Dermatology, Yale University School of Medicine, New Haven JOHN S. CHILD, M.D.JAMES L. BREELING, M.D. Professor of Medicine, School of Medicine, University of Califomia at L o s Angeles; Associate Chief, Division of Cardiology and Director, Adult Car- Associate Chief, Medical Service, West Roxbury V A Medical Center, Boston diac Imaging and Hemodynamics Laboratories, U C L A Medical Center, Los AngelesJOEL G. BREMAN, M.D., D.T.P.H. WALLACE A. CLYDE, Jr., M.D. Deputy Chief, Malaria Branch, Division of Parasitic Diseases, National Cen- ter for Infectious Diseases, Centers for Disease Control and Prevention, Professor of Pediatrics and Microbiology, University of North Caroline Atlanta; Visiting Lecturer, Harvard School of Public Health, Boston Chapel HillBARRY M. BRENNER, M.D., A.M. (Hon.), D.Sc. FREDRIC L. COE, M.D*(Hon.), D.M.SC. (Hon.) Professorof Medicine and Physiology and Chief, Nephrology Program Uni- Samuel A. Levine Professor of Medicine, Harvard Medical School; Senior versity of Chicago Pritzker School of Medicine, Chicago Physician and Director, Renal Division, Brigham and Women's Hospital, Boston ALAN S. COHEN, M.D.KENNETH R. BRIDGES, M.D. Distinguished Professor of Medicine and Rheumatology; Director, Arthritis Center at Boston University School of Medicine, Boston University School Assistant Professor of Medicine, Harvard Medical School; Brigham and of Medicine, BostonWomen's Hospital, Boston WILSON COLUCCI, M.D.KAREN THATCHER BRIXTON, M.D., Ph.D. Associate Professor of Medicine, Harvard Medical School; Physician,Professor of Psychiatry, University of C a l i f o m i a at San Diego, L a Jolla Brigham and Women's HospitalCLAIRE V. BROOME, M.D. PATRICL\ C. COME, M.D.Associate Director for Science, Centers for Disease Control and Prevention, Associate Professor of Medicine, Harvard Medical School; Harvard C o m -Atlanta munity Health Plan, BostonMARTIN M. BROWN, M.A., M.D., M.R.C.P. JOEL D. COOPER, M.D.Senior Lecturer in Neurology, St. George's Hospital Medical School, London Professor of Surgery and Head, Section of General Thoracic Surgery, Washington University School of Medicine; Barnes Hospital, St. LouisMICHAEL S. BROWN, M.D. MAX D. COOPER, M.D.Paul J. Thomas Professor, Department of Molecular Genetics, The Univer-sity of Texas Southwestern Medical Center, Dallas Professor of Medicine, Pediattics and Microbiology and Howard Hughes Medi- cal Institute Investigator, University of Alabama at Birmingham, BirminghamROBERT H. BROWN, Jr., M.D., D.PhU. LAWRENCE COREY, M.D.Associate Professor, Harvard Medical School; Associate Neniologist andDirector, Cecil B . Day Laboratory for Neuromuscular Research, Massachu- Professor of Laboratory Medicine, Microbiology and Medicine, Universitysetts General Hospital, Boston of Washington, SeattleH. FRANKLIN BUNN, M.D. MARK A. CREAGER, M.D.Professor of Medicine, Harvard Medical School; Senior Physician and D i - Associate Professor of Medicine, Harvard Medical School; Director, Vascu-rector, Hematology Research, Brigham and Women's Hospital, Boston lar Diagnostic Laboratory, Brigham and Women's Hospital, BostonRONALD M. BURDE, M.D. RONALD G. CRYSTAL, M.D.Isidor Tachna Professor and Chairman, Department of Ophthalmology; Webster Professor of Medicine, Cornell University Medical College; AttendingOphthalmologist and Neuro-ophthalmologist, Albert Einstein College of Physician, New York Hospital; Chief, Division of Pulmonary and Critical CareMedicine/Montefiore Medical Center, New York Medicine, New York Hospital-Cornell Medical Center, New yorkJOAN R. BUTTERTON, M.D. JOHN J. CUSH, M.D.C l i n i c a l and Research Fellow. Infectious Diseetses Unit, Massachusetts Associate Professor of Internal Medicine, Rheumatic Diseases Division Uni-General Hospital, Boston versity of Texas Southwestern Medical Center at Dallas, DallasALFRED E. BUXTON, M.D. CHARLES A. CZEISLER, Ph.D., M.D.Professor of Medicine and Cardiology, Temple University School of Medicine; Associate Professor of Medicine, Harvard Medical School; Physician andAssociate Chief, Cardiology Section, Temple University Hospital, Philadelphia Director, Laboratory for Circadian and Sleep Disorders Medicine, Brigham and Women's Hospital, BostonSTEPHEN B. CALDERWOOD, M.D. THOMAS M. DANIEL, M.D.Associate Professor of Medicine, Harvard Medical School; Chief, Infec-tious Diseases Unit, Massachusetts General Hospital, Boston Professor of Medicine and International Health, Center for International Health, C W R U School of Medicine, ClevelandCHARLES B. CARPENTER, M.D. GILBERT H. DANIELS, M.D.Professor of Medicine, Harvard Medical School; Director, Laboratory of Immu-nogenetics and Transplantation, Brigham and Woman's Hospital, Boston Associate Professor of Medicine, Harvard Medical School; Physician and Co-Diiector, Thyroid Clinic, Massachusetts General Hospital, Boston

DAFTAR KONTRIBUTOR XUtROBERT B DAROFF, M.D. KENNETH H. FALCHUK, M.D.Gilbert W Humphrey Professor and Chairman, Department of Neurology, Case Associate Professor of Medicine, Harvard Medical School; Physician, Brigham and Women's Hospital, BostonWestem Reserve University School of Medicine; Director, Department of Neu- FERRIC C. FANG, M.D.rology, University Hospitals of Cleveland; Neurology Service Cleveland Veteran's Assistant Professor of Medicine and Patholog)^ University of Colorado HealthAdministration Medical Center, Cleveland , Sciences Center; Director, Clinical Microbiology Laboratory, University Hospi- tal, DenverJOHN R. DAVID, M.D. ANTHONY S. FAUCI, M.D. Richard Pearson Strong Professor and Chaiman, Department of Tropical Public Health, Harvard School of Public Health, Boston Director, National Institute of Allergy and Infectious Diseases; Chief, Laboratory of Immunoregulation; Director, Office of A I D S Research, National Institute ofCHARLES EDWARD DAVIS, M.D. Health, BeUiesda Professor of Pathology and Medicine, School of Medicine, University of MURRAY J . FAVUS, M.D. California, San Diego; Director, Microbiology Laboratory, U C S D Medical Center, San Diego Professor of Medicine, Sections of Endocrinology and Nephrology, Department of Medicine, University of Chicago Pritzker School of Medicine, ChicagoKENNETH DAVIS, M.D., F.A.C.R. THOMAS F FERRIS, M.D. Professor of Radiology, Harvard Medical School; Department of Neuroradiology, Massachusetts General Hospital, Boston Nesbitt Professor and Chairman, Department of Medicine, University of Minne- sota; University of Minnesota Hospital and Clinics, MinneapolisROBERT L. DERESIEWICZ, M.D. BERNARD N. FIELDS, M.D.Instmctor in Medicine, Harvard Medical School; Associate Physician, Brighamand Women's Hospital, Boston Adele Lehman Professor of Microbiology and Molecular Genetics, Professor of Medicine and Chairman, Department of Microbiology and Molecular Genetics,ROBERT J DESNICK, Ph.D., M.D. Harvard Medical School, BostonProfessor and Chairman, Department of Human Genetics, Mount Sinai; School HOWARD L . FIELDS, M.D., Ph.D.of Medicine; Attending Physician, Mount Sinai; Hospital, New Yoric Professor of Neurology and Physiology and Vice Chauman, Department of Neu-MARC A. DICHTER, M.D , Ph.D. rology, University of Califomia, San FranciscoProfessor of Neurology and Pharmacology, University of Pennsylvania School of GREGORY A. FILICE, M.D.Medicine and Graduate Hospital, Philadelphia Associate Professor of Medicine and Chief, Infectious Disease Section, Univer-JULES L . DIENSTAG, M.D. sity of Minnesota VA Medical Center, MinneapolisAssociate Professor of Medicine, Harvard Medical School; Associate Physician ROBERT W. FINBERG, M.D.Massachusetts General Hospital; Boston Associate Professor of Medicine, Harvard Medical School; Chief, Laboratory ofALAN R. DIMICK, M.D. Infectious Disease, Dana-Farber Cancer Institute, BostonProfessor of Surgery, University of Alabama at Birmingham; Director, B u m Center STUART C. FINCH, M.D.University of Alabama Hospital, Birmingham Professor of Medicine, University of Medicine and Dentistry of New Jersey-CHARLES A. DINARELLO, M.D. Robert Wood Johnson Medical School and the Cooper Hospital/ University Medi- cal Center, CamdenProfessor of Medicine, Tufts University School of Medicine; Division of Geo-graphic Medicine and Infectious Diseases, New England Medical Center, Boston J. STEPHEN FINK, M.D.ROBERT G. DLUHY, M.D. Associate Professor, Harvard Medical School; Assistant Neurologist, Massachu- setts, General Hospital, BostonAssociate Professor of Medicine, Harvard Medical School; Associate ProgramDirector of the Clinical Research Center, Brigham and Women's Hospital, Boston DANIEL W. FOSTER, M.D.RAPHAEL DOLIN, M.D. Donald W. Seldin Distinguished Chair in Internal Medicine and Chairman, De- partment of Internal Medicine, The University of Texas Southwestern, MedicalCharles A Dewey Professor of Medicine; Chair, Department of Medicine, Uni- Center, Dallasversity of Rochester School of Medicine and Dentistry, Rochester MICHAEL M. FRANK, M.D.DANIEL B DRACHMAN, M.D. Professor and Chairman, Department of Pediatrics, Duke University MedicalProfessor of Neurology and Neurosciences and Director, Neuromuscular Unit, Center, DurhamThe Johns Hopkins University School of Medicine, Baltimore ARNOLD S. FREEDMAN, M.D.JEFFREY M. DRAZEN, M.D. Associate Professor of Medicine, Harvard Medical School; Division of TumorParker B. Francis Professor of Medicine, Harvard Medical School; Chief, Pul- Immunology, Dana-Farber Cancer Institute, Bostonmonary Division, Brigham and Women's and Beth Israel Hospitals, Boston STANLEY D FREEDMAN, M.D.JOHANNA T. DWYER, D.Sc, R.D. Clinical Professor of Medicine, University of Califomia at San Diego; Head,Professor of Medicine and Community Health, Tufts University School of Medi- Division of Infectious Disease, Scripps Clinic and Research Foundation, L a Jollacine; Professor of Nutrition, Tufts University School of Nutrition; Senior Scien-tist, U S D A Human Nutrition Research Center on Aging, Tufts University; D i - MICHAEL FREISSMUTH, M.D.rector, Frances Stem Nutrition Center, New England Medical Center Hospital,Boston Lecturer, Department of Pharmacology, University of Vienna, ViennaVICTOR J DZAU, M.D. GERALD H. FRIEDLAND, M.D.William G , Irwin Professor of Medicine and Chief, Division of Cardiovascular Director, A I D S Program, Yale University School of Medicine, New HavenMedicine, Stanford University School of Medicine; Stanford University Hospi-tal, Stanford HARVEY MICHAEL FRIEDMAN, M.D.BARRY I EISENSTEIN, M.D. Chief, Infectious Disease Division, Department of Medicine, University of Penn- sylvania School of Medicine, PhiladelphiaProfessor of Medicine, Indiana University School of Medicine; Vice President,Lilly Research Laboratories, IndianapoUs LAWRENCE S. FRIEDMAN, M.D.VIRGINIA L . ERNSTER, Ph.D. Associate Professor of Medicine, Harvard Medical School; Associate Physician, Massachusetts General Hospital, BostonProfessor and Chair, Department of Epidemiology and Biostatistics, Universityof Califomia, San Francisco

xiv DAFTAR KONTRIBUTOR PAUL J FRIEDMAN, M.D. JOSEPH L. GOLDSTEIN, M.D. Professor o fRadiology, University o fCalifornia, San Diego; Paul J Thomas Professor and Chaimian, Department o fMolecular Genetics, T h e University o fTexas Southwestem Medical Center, Dallas WILLIAM E FRIEDMAN, M.D. RAJ K. GOYAL, M.D. J H Nicholson Professor o f Pediatrics (cardiology) and Executive Chairman, Department o fPediatrics, University o fCalifornia, Los Angeles School o f Medi- Rabb Professor o f Medicine, Harvard Medical School; C h i e f Division o f Gas- cine; University o fCalifornia, L o sAngeles Medical Center, L o s Angeles troenterology, Beth Israel Hospital, Boston LAWRENCE A FROHMAN, M.D. JOHN W. GRAEF, M.D. Edmund F Foley Professor and Head, Department o f Medicine, University o f Associate Clinical Professor o f Pediatrics, Harvard Medical School; Director, Illinois at Chicago, Chicago The LeadA'oxicology Clinic, T h eChildren's Hospital, Boston ROBERT K GAGEL, M.D. HARRY K GREENBERG, M.D. Professor o f Medicine and Chief o f Endocrinology Section, T h e University o f Professor o fMedicine and Microbiology and Immunology, Stanford University Texas, M . D . Anderson Cancer Center, Houston Medical Center, StanfordJOHN L GALLIN, M.D. NORTON B GREENBERGER, M.D., M.A.C.P. Director. Division o f Intramural Research, National Institute o fAllergy and In- Peter T. Bohan Professor and Chairman, Department o fMedicine, University o f fectious Disease, National Institute o f Health, Bethesda Kansas Medical Center, Kansas City ROBERT C. GALLO, M.D. JOHN S. GREENSPAN, B.D.S, Ph.D., ER.C.Path. Chief, Laboratory o f T u m o r Cell Biology, National Cancer Institute, National Professor and Chairman, Department o f Stomatology, University o f Dentistry, Institute o f Health, Bethesda San FranciscoMARC B. GARNICK, M.D. JAMES E. GRIFFIN, M.D. Associate Clinical Professor o f Medicine, Dana-Farber Cancer Institute and Professor o f Internal Medicine, T h eUniversity o fTexas Southwestern Medical Harvard Medical School; Vice President forClinical Development, Genetics In- Center, Dallas stitute, Cambridge J. McLEOD GRIFFISS, M.D.JEFFREY A. GELFAND, M.D. Professor o fLab Medicine and Medicine, University o fCalifomia at S a n Fran- Sara Murray Jordan Professor andVice Chairman, Department of Medicine, Tufts cisco V A Medical, Center, S a n Francisco University School o f Medicine; Associate Physician-in-Chief, N e w England Medical Center,Boslon ROBERT C. GRIGGS, M.D.JAMES L. GERMAN IH, M.D. Edward A . and A l m a Vollensen Rykenboer Professor o fNeurophysiology, Pro- fessor o f Neurology and Medicine, and Chairman, Depanment o f Neurology, Professorof Pediatrics, Cornell University Medical College; Director, Labora- University o fRochester School and Dentistry, University o fRochester Medical tory o f H u m a n Genetics, N e wYork Blood Center, N e w York Center, RochesterBRUCE C. GILLILAND, M.D. WILLIAM GROSSMAN, M.D. Professor o fMedicine. Professor o fLaboratory Medicine and Adjunct Professor Dana Professor o f Medicine, Harvard Medical School; Chief, Cardiovascularof Microbiology, andAssociate Dean, Clinical Affairs, University o f Washington Division, Beth Israel Hospital, BostonSchool o fMedicine, Seattle JOHN H. GROWDON, M.D.ALFRED G. GILMAN, M.D., Ph.D. Professor o f N e u r o l o g y , H a r v a r d M e d i c a l S c h o o l ; Neurologist aiftl Director,Raymond Willie Distinguished Chair inMolecular Neuropharmacology; Depart- Memory Disorders Unit, Massachusetts General Hospital, Bostonment o f Pharmacology, T h e University o f Texas Southwestem Medical Center,Dallas SUBHASH C. GULATI, M.D., Ph.D.SID GILMAN, M.D. Associate Professor o fMedicine, Cornell University Medical College; Associate Member and Associate Attending Physician, Memorial Sloan- Kettering CancerProfessor and Chaimian, Department o f Neurology, University o f Michigan, Center, N e w YorkAnn Arbor VLADIMIR HACHINSKI, M.D.RICHARD J. GLASSOCK, M.D. Richard andBeryl Ivey Professor andChairman, Department o fClinical Neurologi-Professor andChairman, Department o fInternal Medicine, University o f Kentucky cal Sciences, University o fWestern Ontario, University Hospital, London, OntarioCollege o fMedicine, Lexington BEVRA HANNAHS HAHN, M.D.ROBERT M. GLICKMAN, M.D. Professor o f Medicine, Department o f Medicine; Chief o f Rheumatology. Uni-Herman Ludwig Blumgart Professorof Medicine, Harvard Medical School; Phy- versity o fCalifomia. L o sAngeles, L o s Angelessician-in-Chief Beth Israel Hospital, Boston ROBERT I . HANDIN, M.D.MARK A. GOLDBERG, M.D. Associate Professor of Medicine, Harvard Medical School; Director, HematologyAssistant Professor o fMedicine, Harvard Medical School; Associate Physician, Oncology Division, Brigham andWomen's Hospital. BostonBrigham and Women's Hosphal, Boston H. HUNTER HANDSFIELD, M.D.ARY GOLDBERGER, M.D. Professor o fMedicine, University o fWashington School o fMedicine; Director,Associate Professor o f Medicine, Harvard Medical School; Physician, Beth Is- S T D Control Program, Seaitle-King County Department o f Public Health, Seattlerael Hospital. Boston STEPHEN L. HAUSER, M.D.DAVID W. GOLDE, M.D. Betty Anker Fife Professor andChairman, Department o fNeurology, UniversityProfessor o f Medicine, Cornell University Medical College; Professor o f M o - of California, San Franciscolecular Pharmacology andTherapeutics, Sloan-Kettering Division o fthe CornellGraduate School o fMedical Sciences; Member, Attending Physician, and Head, BARTON F. HAYNES, M.D.Division o f Hematologic Oncology, Memorial Sloan-Kettering Cancer Center,New York Director, Arthritis Center; C h i e f Division Rheumatology and Immunology; Frederic M Hanes Professor o f Medicine; Director, Basic Research, Center forL E E GOLDMAN, M.D. .\"MDS Reseaich, Duke University School o f Medicine, DurhamProfessor o f Medicine. Harvard Medical School; Vice-Chairman, Department o f STEVEN C. HERBERT, M.D.Medicine and Chief, Division o fClinical Epidemiology, Brigham and Women'sHospital, Boston Associate Professor o f Medicme. Harvard Medical School; Physician, Brigham and Women's Hospital, Boston

DAFTAR KONTRIBUTOR XVI CRAIG HENDERSON, M.D. LEWIS L JUDD, M.D. Professor o fMedicine; Chief o fMedical Oncology; Director, Clinical Oncology Mary Gilman Marston Professor and Chairman, Department o fPhychiatry. Uni- Program, Moffitt-Long Hospitals, San Francisco versity o fCalifornia at S a n Diego, L a JollaCHARLES B HIGGINS, M.D. L E E M. KAPLAN, M.D., Ph.D. Professor o f Radiology and Chief, Magnetic Resonance Imaging, University o f Assistant Professor o f Medicine, Harvard Medical School; Assistant in Medi- Califomia School o fMedicine; San Francisco cine, Gastrointestinal Unit, Massachusetts General Hospital. BostonRAYMOND L HINTZ, M.D. DENNIS L. KASPER, M.D. Professor o fPediatrics and Head, Division o fPediatric Endocrinology, Stanford William Ellery Channing Professor o fMedicine, Harvard Medical School; Chief University School o fMedicine; Stanford Division o f Infectious Diseases, Beth Israel Hospital; Co-Director, Channing Laboratory, Brigham and Women's Hospital, BostonMARTIN S. HIRSCH, M.D. LLOYD H. KASPER, M.D. Professorof Medicine, Harvard Medical School; Massachusetts General Hospital, Boston Professor o fMedicine, Neurology andMicrobiology, Dartmouth Medical School, HanoverFRED HOCHBERG, M.D. SATISH KATHPALIA, M.D., RA.C.RAssociate Professor o fNeurology, Harvard Medical School; Neurologist, Massa-chusetts General Hospital, Boston Associate Professor o fMedicine, University o fIllinois School o fMedicine; At- tending Physician, Renal Division, Department o f Medicine, Michael ReeseGARY S. HOFFMAN, M.D. Hospital and Medical Center, ChicagoChairman, Department o f Rheumatic andImmunologic Diseases, Cleveland Clinic DONALD KAYE, M.D.Foundation, Cleveland Klinghoffer Professor and Chairman, Department o f Medicine, T h e MedicalJOHN H. HOLBROOK, M.D. College o fPennsylvania, PhiladelphiaProfessor o fInternal Medicine, University o fUtah School o fMedicine, Salt Lake GERALD T. KEUSCH, M.D.City Professor o f Medicine and Chief Division o f Geographic Medicine and Infec-MICHAEL F. HOLICK, Ph.D., M.D. tious Diseases, N e wEngland Medical Center Hospital, BostonProfessor o f Medicine, Physiology and Dermatology; Chief o f Endocrinology, MICHAEL B. KIMMEY, M.D.Diabetes and Metabolism, Director o f the General Clinical Research Center,Boston University School o fMedicine, Boston Associate Professor o f Medicine and Director o f G I Endoscopy, University o f Washington School o fMedicine; SeattleKING K. HOLMES, M.D., Ph.D. LOUIS V. KIRCHHOFF, M.D.Professor o fMedicine and Director, Center forA I D S and Sexually TransmittedDiseases, University o fWashington School o fMedicine; Seattle Associate Professor o f Internal Medicine and Staff Physician, Department o f Veterans Affair Medical Center, Iowa CityRANDALL K. HOLMES, M.D., Ph.D. J. PHILLIP KISTLER, M.D.Chairman, Department o f Microbiology and Immunology, Uniformed ServicesUniversity o fthe Health Sciences, Bethesda Associate Professor o f Neurology, Harvard Medical School; Associate Neuro- logist and Director o fStroke Service, Massachusetts General Hospital, BostonTHOMAS H. HOSTETTER, M.D. HARVEY G. KLEIN, M.D.Professor o f Medicine, University o f Minnesota School o f Medicine; Director,Division o fRenal Diseases, University Hospital, Minneapolis Chief Department o fTransfusion Medicine, Clinical Center, National Institutes of Health, BethesdaLYN J. HOWARD, B M., D.Ch., ER.C.R JAMES P. KNOCHEL, M.D.Professor o f Medicine and Associate Professor o f Pediatrics; Head, Division o fClinical Nutrition, Albany Medical College, Albany Professor o fInternal Medicine, T h eUniversity o fTexas Southwestern Medical Center; Chairman, Department o fMedicine, Presbyterian Hospital, DallasHOWARD HU, M.D., M.P.H., ScD. HOWARD K KOH, M.D.Assistant Professor o fMedicine, Harvard Medical School; Associate Physician,Channing Laboratory, Brigham and Women's Hospital, Boston Associate Professor o f Dermatology, Medicine, and Public Health; Co-Director, Skin Oncology Program; Director, Cancer Prevention andControl Center, BostonGARY W. HUNNINGHAKE, M.D. University Schools o fMedicine and Public Health, BostonProfessor o fInternal Medicine and Director, Pulmonary andCritical Care Medi- ANTHONY KOMAROFF, M.D.cine, University o fIowa College o fMedicine, Iowa City Professor o f Medicine, Harvard Medical School; Director, Division o f GeneralEDWARD P. INGENITO, M.D., Ph.D. Medicine, Brigham and Women's Hospital, BostonAssistant Professor o fMedicine, Harvard Medical School; Director, Medical In- STANLEY J. KORSMEYER, M.D.tensive Care Unit, Brigham and Women's Hospital, Boston Professor, Howard Hughes Medical Institute, Washington University School o fROLAND H. INGRAM, Jr, M.D. Medicine; Saint LouisProfessor o f Medicine, E m o r y University School o f Medicine; Chief o f Medi- WILLIAM J KOVACS, M.D.cine, Emory-Crawford L o n g Hospital, Atlanta Associate Professorof Medicine, Division o fEndocrinology, VanderbiU Univer-CHARLES E. IRWIN, Jr, M.D. sity School o fMedicine; NashvilleProfessor o fPediatrics; Director, Division o fAdolescent Medicine, Department STEPHEN M. KRANE, M.D.of Pediatrics School o fMedicine; University o fCalifornia; San Francisco Persis. C y m s . andM a r l o w B Harrison Professor of Medicine, Harvard Medical School;KURT J ISSELBACHER, M.D. Physician andChief Arthritis Unit, Massachusetts General Hospital, BostonMallinckrodt Professor o f Medicine, Harvard Medical School; Physician and DONALD KUFE, M.D.Director, M G H Cancer Center, Massachusetts General Hospital, Boston Professor o f Medicine, Harvard Medical School; and Dana-Farber Cancer Insti-MARK E. JOSEPHSON, M.D. tute, BostonProfessor o f Medicine, Harvard Medical School; Director, Harvard-Thorndike HELENA KUIVANIEMI, M.D., Ph.D.Electrophysiology Institute and Arrhythmia Service, Beth Israel Hospital, Boston Research Assistant Professor, Department o f Biochemistry and Molecular Bio- logy, Jefferson Medical College o fThomas Jefferson University, Philadelphia

xvi DAFTAR KONTRIBUTORJ. THOMAS La MONT, M.D. DANLLONGO,M.D. Chief. Section of Gastroenterology, The University Hospital, Boston Director, Biological Response Modifiers Program, Division of Cancer Treatment, National Cancer Institute, Frederick Cancer Research and Development Center,LEWIS LANDSBERG, M.D. Frederick Irving S. Cutter Professor and Chairman, Department of Medicine, Northwestern FREDERICK H. LOVEJOY, Jr, M.D. University Medical School; Physician-in-Chief, Nordiwestem Memorial Hospi- tal, Chicago William Berenberg Professor of Pediatrics, Harvard Medical School; Associate Physician-in-Chief, The Children's Hospital, BostonH CLIFFORD LANE, M.D. SHEILA A. LUKEHART, Ph.D. Clinical Director, National Institute of Allergy and Infectious Diseases, National Institutes of Healdi; Chief, Clinical Molecular Retrovirology Section, Laboratory Research Associate Professor Department of Medicine, Division of Infectious of Immunoregulation, National Institute of Allergy and Infectious Diseases, NIH, Diseases, University of Washington School of Medicine, Seattle Bethesda LAWRENCE C. MADOFF, M.D.THOMAS J. LAWLEY, M.D. Assistant Professor of Medicine, Harvard Medical School; Channing Laboratory, Professor and Chairman, Department of Dermatology, Iimory University School Brigham and Women's Hospital, Division of Infectious Diseases, Beth Israel of Medicine, Atlanta Hospital, BostonALEXANDER R. LAWTON III, M.D. JAMES HARVEY MAGUIRE, M.D. Edward C Stahlman Professor in Pediatric Physiology and Cell Metabolism; Pro- Associate Professor of Medicine, Harvard Medical School; Physician, Brigham fessor of Pediatrics and Microbiology; Head, Division of Pediatric Immunology and Women's Hospital, Boston and Rheumatology, Vanderbilt University School of Medical, Nashville HENRY J. MANKIN, M.D.J MICHAEL LAZARUS, M.D. Edith M Ashley Professor of Orthopaedic Surgery, Harvard Medical School; Chief,Associate Professor of Medicine, Harvard Medical School; Senior Physician and Orthopaedic Services, Massachusetts General Hospital, BostonDirector of Clinical Services, Nephrology Division, Brigham and Women's Hos-pital, Boston FRANCIS L MARCHLINSKIROBERT SAMUEL LEBOVICS, M.D., F.A.C.S. Clinical Professor of Medicine, University of Pennsylvania School of Medicine; Co-Director, Philadelphia Heart Institute, PhiladelphiaChief Otolaryngology, National Institute on Deafness and Other Communica-tion Disorders, National Institutes of Health, Bethesda JOSEPH B. MARTIN, M.D., Ph.D., F.R.C.P. (C), M.A. (Hon.)RICHARD T. L E E , M.D. Professor of Neurology and Chancellor, University of California, San FranciscoAssistant Professor of Medicine, Harvard Medical School; Director, NoninvasiveCardiac Laboratory, Brigham and Women's Hospital, Boston JOEL B. MASON, M.D.PHILLIP I. LERNER, M.D. Assistant Professor, Divisions of Clinical Nutrition and Gastroenterology; Scien- tist, USDA Humau Nutrition Research Center on Aging, Tufts University, BostonProfessor of Medicine, Case Western Reserve University School of Medicine;Chief Division of Infectious Diseases, The Mount Sinai Medical Center, HENRY MASUR, M.D.Cleveland Chief, Critical Care Medicine Department, National Institutes of Health, BethesdaNORMAN G. LEVINSKY, M.D. ROBERT J MAYER, M.D.Wade Professor and Chairman, Department of Medicine, Boston University Schoolof Medicine; Physician-in-Chief, Boston City Hospital and Boston University Professor of Medicine and CUnical Director, Department of Medicine, Dana-Medical Center Hospital, Boston Farber Cancer Institute, BostonMATTHEW E. LEVISON, M.D. JOHN D McCONNELL, M.D.Professor of Medicine and Chief Division of Infectious Diseases, Medical Col- Associate Professor of Surgery, Division of Urology, The University of Texaslege of Pennsylvania, Philadelphia Southwestem Medical Center, DallasRICHARD W. LIGHT, M.D. E. R. McFADDEN, Jr., M.D.Professor of Medicine, University of Califomia, Irvine, Physician, Veterans Ad- Atgyl J Beams Professor of Medicine and Director, Division of Pulmonary andministration Hospital, Long Beach Critical Care Medicine, Case Westem Reserve University School of Medicine, ClevelandCHRISTOPHER H. LINDEN, M.D., F.A.C.E.P. JAMES E. McGUIGAN, M.D.Associate Professor of Medicine; Associate Director, Toxicology Services andAssociate Clinical Director, Department of Emergency Medicine, University of Chairman, Department of Medicine, University of Florida College of Medicine,Massachusetts Medical Center, Worcester GainesvillePETER E. LIPSKY, M.D. NANCY K. MELLO, Ph.D.Professor of Internal Medicine and Microbiology; Director, Rheumatic Diseases Professor of Psychology, Department of Psychiatry (Neuroscience), HarvardDivision; Director, Harold C Simmons Arthritis Research Center, The Univer- Medical School, Boston; Co-Director, Alcohol and Drug Abuse Research Cen-sity of Texas Southwestem Medical Center at Dallas, Dallas ter, McLean Hospital, BelmontLEO X. LIU, M.D., D.T.M.H. JERRY R. MENDELL, M.D.Assistant Professor of Medicine, Harvard Medical School; Division of Infectious Professor and Chairman, Department of Neurology, The Ohio State UniversityDiseases, Department of Medicine, Beth Israel Hospital, Boston College of Medicine, ColumbusBERNARD LO, M.D. JOHN MENDELSOHN, M.D.Professor of Medicine; Director, Program in Medical Ethics; Co- Director, Rob- Winthrop Rockefeller Chair in Medical Oncology and Chairman, Department ofert Wood Johnson Clinical Scholars Program; Physician, Moffitt- Long Hospi- Medicine, Memorial Sloau-Kettering Cancer Centertals, University of Califomia, San Francisco JACK H. MENDELSON, M.D.RICHARD M. LOCKSLEY, M.D. Professorof Psychiatry (Neuroscience) Harvard Medical School, Boston; Co-Director,Associate Professor of Medicine and Microbiology and Immunology and Chief, Alcohol and Drag Abuse Research Center, McLean Hospital, BelmontDivision of Infectious Diseases, Department of Medicine, University of California,San Francisco RICHARD A. MILLER, M.D. Associate Professor of Medicine, University of Washington School of Medicine; Chief, Infectious Diseases Section, Seattle VA Medical Center, Seattle

DAFTAR KONTRIBUTOR xviiJOHN D. MINNA, M.D. DARWIN L PALMER, M.D.Professor of Medicine and Pharmacology and Director, Simmons Cancer Center, Professor of Medicine and Chief Division of Infectious Diseases, University ofThe University of Texas Southwestem Medical Center, Dallas New Mexico of Medicine, AlbuquerqueJEROME H. MODELL, M.D. JOSEPH E. PARRILLO, M.D.Professor of Anesthesiology, College of Medicine, University of Florida; Senior James B Herrick Professor of Medicine, Rush Medical College; Chief Section ofAssociate Dean for Clinical Affairs; Associate Vice President for University of Cardiology; Chief Section of Critical Care Medicine and Medical Director, RushFlorida Health Science Center Affiliations, Gainesville Heart Institute, Rush-Presbyterian-St Luke's Medical Center, ChicagoJ P. MOHR, M.D. RICHARD C. PASTERNAK, M.D.Sciarra Professor of Clinical Neurology, College of Physicians and Surgeons of Assistant Professor of Medicine, Harvard Medical School; Director of Preven-Columbia University Neurological Institute, New York tive Cardiology and Cardiac Rehabilitation, Massachusetts General Hospital, BostonSTEPHEN MORSE, Ph.D. PETER L. PERINE, M.D.Director, Division of Sexually Transmitted Diseases Laboratory Research, Na-tional Center for Infectious Diseases, Centers for Disease Control and Preven- Professor of Epidemiology, Center for AIDS and STD, University of Washington,tion, Atlanta Seattle; Professor of Tropical Public Health and Medicine Emeritus, Uniformed Services University of the Heahh Sciences, BethesdaKENNETH M. MOSER, M.D. ROBERT G. PETERSDORF, M.D.Professorof Medicine, School of Medicine, University of Califomia at San Diego;Director, Pulmonary/Critical Care Division, UCSD Medical Center, San Diego President, Association of American Medical Colleges, Washington, D C.ARNOLD M. MOSES, M.D. ELIOT A. PHILLIPSON, M.D.Professor of Medicine and Director, Clinical Research, Unit, State University of Sir John and Lady Eaton Professor of Medicine and Chair, Department of Medi-New York Health Science Center, Syracuse cine, University of Toronto; Physician-in-Chief, Mount Sinai; Hospital, TorontoHARALAMPOS M. MOUTSOPOULOS, M.D. GERALD B P<6R, Ph.D.Professor and Head of Medicine, Department of Intemal Medicine, University of Associate Professor of Medicine, Harvard Medical School; Channing Labora-loannina Medical School, loannina, Greece tory, Brigham and Women's Hospital, BostonROBERT F MUNFORD, M.D. DANIEL K. PODOLSKY, M.D.Professor of Intemal Medicine and Microbiology, The University of Texas South- Associate Professor of Medicine, Harvard Medical School; Chief Gastrointestinalwestem Medical Center, Dallas Unit, Massachusetts General Hospital, BostonDANIEL M. MUSHER, M.D. RONALD J POLINSKY, M.D.Chief Infectious Diseases Section, Veterans Affairs Medical Center; Professor Senior Associate Director, Human Pharmacology, Drug Safety Department,of Medicine and Professor of Microbiology and Immunology, Baylor College of Sandoz Research Institute, Sandoz Pharmaceuticals Corporation, East Hanover,Medicine, Houston New JerseyROBERT J. MYERBURG, M.D. RONALD E. POLK, Pharm.D.Professor of Medicine and Physiology and Director, Division of Cardiology, Professor of Pharmacy and Medicine, School of Pharmacy, Medical College ofUniversity of Miami School of Medicine, Miami Virginia, Virginia Commonwealth University, RichmondL E E M. NADLER, M.D. MATTHEW POLLACK. M.D.Professor of Medicine, Harvard Medical School; Division of Tumor Immunol- Professor of Medicine, Uniformed Services University of the Health Sciences, F.ogy, Dana-Farber Cancer Institute, Boston Edward Hebert School of Medicine, BethesdaTHEODORE ELLIOT NASH, M.D. JOHN T. POTTS, Jr., M.D.Senior Scientist, Laboratory of Parasitic Diseases, National Institutes of Health, Jackson Professor of Clinical Medicine, Harvard Medical School; Physician-in-Bethesda Chief Massachusetts General Hospital, BostonLAURENCE NEEDLEMAN, M.D. LAWRIE W. POWELL, M.D.Associate Professor of Radiology and Associate Director, Division of Diagnostic Professor of Medicine, The University of Queensland; Director Queensland; In-Ultrasound, Thomas Jefferson University Hospital, Philadelphia stitute of Medical Center, BrisbaneTHOMAS B. NUTMAN, M.D. DARWIN J. PROCKOP, M.D.Senior Investigator, Laboratory of Parasitic Diseases, National Institute of Al- Professor and Chairman, Department of Biochemistry and Molecular Biology,lergy and Infectious Diseases, National Institutes of Health, Bethesda Jefferson Medical College of Thomas Jefferson University; Director, Jefferson Institute of Molecular Medicine, PhiladelphiaJOHN OATES, M.D. AMY PRUITT, M.D.Professor and Chairman, Department of Medicine, Vanderbilt University Hospi-tal, Nashville Assistant Professor of Neurology, University of Pennsylvania School of Medi- cine and Graduate Hospital. PhiladelphiaJERROLD M. OLEFSKY, M.D. LOUIS J. PTACEK, M.D.Professor of Medicine and Head, Division of Endocrinology and Metabolism,School of Medicine, University of Califorrna at San Diego, La Jolla Department of Neurology, The University of Utah School of Medicine, Salt Lake CityANDREW K ONDERDONK, Ph.D. JOEL M. RAPPEPORT, M.D.Associate Professor of Pathology, Harvard Medical School; Director, ChnicalMicrobiology Laboratory, Brigham and Women's Hospital, Boston Professor of Medicine, Yale University School of Medicine; Director, Bone Mar- row Transplantation Program, Yale New Haven Hospital, New HavenSTUART H. ORKIN, M.D. NEIL H. RASKIN, M.D.Leland Fikes Professor Pediatric of Medicine, Harvard Medical School, Children'sHospital, Boston; Professor of Neurology, University of California, San FransciscoROBERT A O'ROURKE, M.D. C. GEORGE RAY, M.D.Charles Conrad Brown Distinguished Professor of Medicine, The University of Professor and Chairman, Department of Pediatrics, St. Louis University SchoolTexas Health Science Center at San Antonio; Director of Cardiology, The Uni- of Medicine, St. Louisversity of Texas Health Science Center Teaching Hospitals, San Antonio

xviii DAFTAR KONTRIBUTOR SHARON L E E REED, M.D. MATTHEW SAMORE, M.D. Associate Professor o f Pathology andMedicine andAssociate Director, Microbi- Instructor i nMedicine, Harvard Medical School; N e w England Deaconess Hos- ology Laboratory, Division o f Infectious Diseases, U C S D Medical Center, S a n pital, Boston Diego JAY P SANFORD, M.D. ANTONIO B REGINATO, M.D. Professor of Internal Medicine, University of Texas Southwestern Medical School; Head, Division o fRheumatology; Professor o fMedicine, Cooper Hospital/ Uni- Dean Emeritus, Uniformed Services University o fthe Health Sciences, Dallas versity Medical Center, University o f Medicine and Dentistry o f N e w Jersey/ Robert W o o d Johnson Medical School at Camden, C a m d e n DAVID A. SCHEINBERG, M.D., Ph.D. RICHARD C. REICHMAN, M.D. C h i e f Leukemia Service, Memorial Sloan-Kettering Cancer Center, N e w York Professor of Medicine andHead, Infectious Disease Unit, University o f Rochester I HERBERT SCHEINBERG, M.D School o fMedicine and Dentistry, Rochester Senior Lecturer i n Medicine College o f Physicians and Surgeons, ColumbiaNEIL M. RESNICK, M.D. University; Senior Research Associate, StLuke's/Roosevelt Hospital, N e w York Assistant Professor o f Medicine, Harvard Medical School; C h i e f Division o f W. MICHAEL SCHELD, M.D. Gerontology, Brigham andWomen's Hospital, Geriatric Research Education and Clinical Center, Brockton-West Roxbury Veterans Administration Medical Professor o f Internal Medicine and Neurosurgery and Associate Chair for Center, Boston Residency Programs, University o fVirginia School o fMedicine, CharlottesvilleHERBERT Y. REYNOLDS, M.D. ALAN L . SCHILLER, M.D. Chairman, Department o f Medicine and J. Lloyd H u c k Professor o f Medicine, Irene Heinz Given and John LaPorte Given Professor andChairman of Pathology, The Pennsulvania State University; University Hospital, T h e Milton S. Hershey Mount Sinai; School o f Medicine; Chairman o f Pathology, T h e Mount Sinai Medical Center, Hershey Hospital, N e w YorkSTUART RICH, M.D. ROBERT T SCHOOLEY, M.D. Professorof Medicine andC h i e f Section o f Cardiology, University o fIllinois at Professor o f Medicine and Head, Infectious Disease Division, University o f Chicago College o fMedicine, Chicago Colorado Health Sciences Center; DenverGARY S RICHARDSON, M.D. JOHN SPEER SCHROEDER, M.D. Instructor in Medicine, Harvard Medical School; Associate Physician, Brigham Professor o f Medicine (Cardiology), Stanford University School o f Medicine; and Women's Hospital, Boston Stanford Hospital, StanfordHAL B. RICHERSON, M.D. ANNE SCHUCHAT, M.D. Professor o fInternal Medicine, University o fIowa College o f Medicine; Univer- Medical Epidemiologist, Meningitis and Special Pathogens Branch, Division o f sity o fI o w a Hospitals and Clinics, I o w a City Bacterial andMycotic Diseases, National Center for Infectious Diseases, Centers of Disease Control andPrevention, AtlantaJAMES M. RICHTER, M.D. MARC A SCHUCKIT, M.D.Assistant Professor o fMedicine, Harvard Medical School; C h i e f Gastrointesti-nal Clinic, Massachusetts General Hospital, Boston Professor o f Psychiatry, School o f Medicine; University o f California atSan Diego; Director, Alcohol Research Center SanDiego Veteran's Administration MedicalR. PAUL ROBERTSON, M.D. Center, L a JollaProfessor of Medicine andCell Biology; Director, Division o f Diabetes, Endocri- PETER H. SCHUR, M.D.nology and Metabolism. University o fMinnesota, Minneapolis Professor o fMedicine, Harvard Medical School; Department o f Rheumatology,ALLAN H. ROPPER, M.D. Brigham andWomen's Hospital, BostonProfessor o fNeurology, Tufts University School o fMedicine; C h i e f Division o f DAVID S SEGAL, Ph.D.Neurology, St.Elizabeth's Medical Center, Boston Professor o fPsychiatry, University o fC a l i f o m i a at S a nDiego; L a JollaIRWIN H. ROSENBERG, M.D. JULIAN I SEIFTER, M.D.Professor o fMedicine. Nutrition andPhysiology; Director, U S D A H u m a n Nutri-tion Research Center o n Aging, Tufts University, Boston Associate Professor o fMedicine, Harvard Medical School; Physician, Brigham and Women's Hospital, BostonLEON L ROSENBERG, M.D. ANDREW P SELWYN, M.D.President, Bristol Myers Squibb Pharmaceutical Research Institute, Princeton Associate Professor o f Medicine, Harvard Medical School; Director o f CardiacWENDELL F ROSSE, M.D. Catheterization, Brigham and Women's Hospital, BostonFlorence Reynaud McAlister Professor o f Medicine andMedical Research, Duke PETER A. SELWYN, M.D., M.RH.University Medical Center, Durham Associate Professor o fInternal Medicine, Epidemiology andPublic Health, andDANIEL ROTROSEN, M.D. Associate Director, A I D S Program, Yale University School o f Medicine; N e w HavenMedical Office, Laboratory o fHost Defenses, National Institute o fAllergy andInfectious Diseases, National Institute o f Health, Bethesda MARY-ANN SHAFER, M.D.JODI ROY, M.S., R.D. Professor o f Pediatrics; Associate Director, Division o f Adolescent Medicine, Department o f Pediatrics; School o f Medicine; University o f California, SanFrances Stem Nutrition Center, N e w England Medical Center Hospital, Boston FranciscoARTHUR H. RUBENSTEIN, M.D. GORDON C. SHARP, M.D.Lowell T Coggeshall Professor; Chairman Department o fMedicine, University Curators' Professor and Michael Einbender Distinguished Professor of Medicine;of Chicago Pritzker School o fMedicine, Chicago Director of Immunology and Rheumatology; Director, Arthritis Center; Director, Missouri Arthritis Rehabilitation Research and Traning Center; AssociateJEREMY N. RUSKIN, M.D. Chairman for Research, Department o f Intemal Medicine, University of Missouri- Columbia School o f Medicine; Director, Antinuclear Antibody Laboratory o fAssociate Professor o f Medicine, Harvard Medical School; Director, Cardiac Missouri Hospital & Clinics, ColumbiaArrhythmia Service, Massachusetts General Hospital, BostonARTHUR L . SAGALOWSKY, M.D.Professor o f Urology and Surgical Director o fRenal Transplantation, T h e Uni-versity o fTexas Southwestern Medical Center, Dallas

DAFTAR KONTRIBUTOR xix ELIZABETH M. SHORT, M.D. RUP TANDAN, M.D., M.R.C.R Associate Chief Medical Director for Academic Affairs, Department o f Veteran's Associate Professor o f Neurology, University o f Vermont College o f Medicine; Affairs, Washington, D C Attending Neurologist, Medical Center Hospital o fVermont, Burlington GEORGE R. SIBER, M.D. JOEL D TAUROG, M.D. Associate Professor o f Medicine, Harvard Medical School; Director, Associate Professor, Department o f Intemal Medicine and Investigator Harold Massachusetts Public Health Biologic Laboratories, Jamaica Plain C. Simmons Arthritis Research Center, T h e University o f Texas Southwestern Medical Center; Attending Physician, Parkland Memorial Hospital, Sale LipshyWILLIAM SILEN, M.D. University Hospital, Veterans Administration Medical Center, Dallas Johnson and Johnson Professor o f Surgery, Harvard Medical School; Surgeon- BAYU TEKLU, M.D. in-Chief; Beth Israel Hospital, Boston Professor and Chairman, Department o fIntemal Medicine, College o f Medicine;FRED E. SILVERSTEIN, M.D. King Saud University, Abha Branch; Consultant Physician, Asir Central Hospital, Saudi Arabia Professor o f Medicine and Dhector, Gastrointestinal Endoscopy Fellowship Training, University o fWashington School o fMedicine, Seattle STEPHEN F TEMPLETON, M.D.KARL L. SKORECKI, M.D., ER.C.R(C) Assistant Professor o fDermatology and Pathology, E m o r y University School o f Medicine, Atlanta Director, Division o fNephrology, Department o fMedicine and Pediatrics; Uni- versity o fToronto, Toronto E. DONNALL THOMAS, M.D.THOMAS L SLAMOVIT^, M.D. Professor o f Medicine Emeritus, University o f Washington; Member, Fred Hutchinson Cancer Research Center, Seattle Professor and Vice Chairman, Department o f Ophthalmology and Professor o f Neurology and Neurosurgery, Albert Einstein College o f Medicine/Montefiore LUCY STUART TOMPKINS, M.D. Medical Center, N e w York Associate Professor o fMedicine (Infectious Diseases andGeographic Medicine)CHRISTOPHER A. SLAPAK, M.D. and Microbiology and Immunology, Stanford University School o f Medicine; Director, Clinical Microbiology Laboratory, Stanford University Medical Center,Assistant Professorof Medicine, Harvard Medical School andDana-Farber Cancer Stanford Institute, Boston PHILLIP R TOSKES, M.D.JAMES B. SNOW, JR., M.D. Professor o f Medicine and Chief, Division o f Gastroenterology, University o fDirector, National Institute o n Deafness and Other Communication Disorders, Florida, GainesvilleNational Institutes o f Health, Bethesda GERARD TROMP, M.DARTHUR J. SOBER, M.D. Research Assistant Professor, Department o f Biochemistry andMolecular Biology,Associate Professor o f Dermatology, Harvard Medical School; Associate Chief Jefferson Medical College o fThomas Jefferson University, Philadelphiaof Dermatology, Massachusetts General Hospital, Boston E.R TRULOCK, M.D.FRANK E. SPEIZER, M.D. Associate Professor o f Medicine, Washington University School o f Medicine;Edwad H Kass Professor o f Medicine, Harvard Medical School; Co-Director, Barnes Hospital, St LouisChanning Laboratory, Brigham and Women's Hospital, Boston KENNETH L TYLER, M.D.ANDREW SPIELMAN, SD Professor o fNeurology, Medicine, Microbiology, University o fColorado HealthProfessor o fTropical Public Health, Harvard Medical School o f Public Health, Sciences Center; C h i e f Neurology Service, V A Medical Center DenverBoston DAVID VALLE, M.D.WALTER E STAMM, M.D. Professor o fPediatrics and Molecular Biology and Genetic, Johns Hopkins Uni-Professorof Medicine, University o fWashington School o fMedicine; Head, In- versity School o f Medicine; Investigator, Howard Hughes Medical Institute,fectious Diseases, Harborview Medical Center, Seattle BaltimoreALLEN C. STEERE, M.D. MAURICE VICTOR, M.D.Professor o f Medicine and C h i e f Rheumatology/Immunology, N e w England Professor o f Medicine (Neurology), Dartmouth Medical School, Hanover; Dis-Medical Center andTufts University School o fMedicine, Boston tinguished Physician o fthe Veterans Administration, White River JunctionROBERT S STERN, M.D. JAMES F WALLACE, M.D.Professor, Department o f Dermatology, Beth Israel Hospital, Boston Professor o f Medicine, University o f Washington School o f Medicine, Associate Physician-in-chief University o f Washington Medical Center,DENNIS L. STEVENS, M.D., Ph.D. SeattleProfessor o f Medicine, University o f Washington School o f Medicine, SeatUe; RICHARD J. WALLACE, Jr., M.D.C h i e f Infectious Diseases, V A Medical Center, Boise Chairman, Department o f Microbiology, University o f Texas Health Center,GENE H. STOLLERMAN, M.D. TylerProfessorof Medicine andPublic Health, Boston University; University Hospital, PETER D. WALZER, M.D.Boston Professor o fMedicine, University o fCincinnati College o fMedicine; Chief, In-RICHARD M. STONE, M.D. fectious Diseases Section, V A Medical Center, CincinnatiAssistant Professor of Medicine, Harvard Medical School andDana-Farber Cancer LEONARD WARTOFSKY, M.D.Institute, Boston Professor o f Medicine and Physiology, Uniformed Services University o ftheSTEPHEN E. STRAUS, M.D. Health Sciences; Chairman, Department of Medicine, Washington Hospital Center, Washington, D CC h i e f Laboratory o fClinical Investigation, National Institute o fAllergy and In-fectious Diseases, National Institutes o f Health, Bethesda CARL V WASHINGTON, Jr. M.D.DAVID H.R STREETEN, M.D. Assistant Professor o f Dermatology, E m o r y University School o f Medicine, AtlantaProfessor o fMedicine and Head, Section o f Endocrinology, State University o fN e w York Health Science Center, SyracuseROBERT A. SWERLICK, M.D.Associate Professor, Department o f Dermatology, E m o r y University School o fMedicine, Atlanta

DAFTAR KONTRIBUTORSTEVEN E. WEINBERGER, M.D. SHELDON M. WOLFF, M.D. Associate Professor of Medicine, Harvard Medical School; Associate Chairman Endicott Professor and Chairman, Department of Medicine, Tufts University for Education, Department of Medicine, and Clinical Director, Pulmonary and School of Medicine; Physician-in-Chief, New England Medical Center, Boston Critical Care Division, Beth Israel Hospital, Boston BEVERLY w o o , M.D.LOUIS WEINSTEIN, M.D., Ph.D. Assistant Professor of Medicine, Harvard Medical School; Physician, Brigham Senior Physician (Emeritus), Department of Medicine, Brigham and Women's and Women's Hospital, Boston Hospital, Boston ALASTAIR J. J. WOOD, M.B.Ch.B., FRCP (Edin)ROBERT A. WEINSTEIN, M.D., F.A.C.R Professor of Medicine and Professor of Pharmacology, Vanderbilt UniversityProfessor of Medicine and Program Director, Joint University of Illinois/Univer- School of Medicine; Attending Physician, Vanderbilt University Hospital,sity of Chicago Infectious Disease Fellowship Training Program, Department of NashvilleMedicine, Michael Reese Hospital and Medical Center, Chicago THEODORE E. WOODWARD, M.D., M.A.C.RPETER F WELLER, M.D. Professor of Medicine Emeritus, University of Maryland School of Medicine andAssociate Professor of Medicine, Harvard Medical School; Division of Infec- Hospital, Baltimoretious Disease, Department of Medicine, Beth Israel Hospital, Boston ROBERT L WORTMANN, M.D,MICHAEL R. WESSELS, M.D. Professor and Chairman, Department of Medicine, East Carolina University SchoolAssociate Professor of Medicine, Harvard Medical School; Associate Physician, of Medicine; Chief Medical Service, Pitt County Memorial Hospital, UniversityBeth Israel Hospital; Division of Infectious Diseases, Channing Laboratory, Medical Center of Eastern Carolina-Pitt County, GreenvilleBrigham and Women's Hospital, Boston SHIRLEY H. WRAY, M.D., Ph.D., F.R.C.RNICHOLAS J. WHITE, M.B., B.S., B.Sc, M.R.C.P. Associate Professor of Neurology, Harvard Medical School; Director, Unit forWellcome Mahidol University, Oxford Tropical Medicine Research Programme, Neurovisual Disorders, Department of Neurology, Massachusetts General Hos-Faculty of Tropical Medicine, Mahidol University, Bangkok pital, BostonRICHARD J. WHITLEY, M.D. PAUL W. WRIGHT, M.D.Loeb Eminent Scholar in Pediatrics and Professor of Pediatrics, Medicine and Professor of Family Practice, University of Texas Health Center, TylerMicrobiology, University of Alabama at Birmingham, Birmingham JOSHUA WYNNE, M.D.GRANT R. WILKINSON, Ph.D. Professor of Intemal Medicine and Chief Division of Cardiology, Wayne StateProfessor of Pharmacology, Vanderbilt University School of Medicine, Nashville University School of Medicine; Chief Section of Cardiology. Harper Hospital, DetroitGORDON H. WILLIAMS, M.D. KIM B. YANCEY, M.D.Professor of Medicine. Harvard Medical School; Chief, Endocrine-HypertensionDivision, Brigham and Women's Hospital, Boston Senior Investigator, Dermatology Branch, National Cancer Institute, National Institutes of Health, BethesdaJEAN D. WILSON, M.D. JAMES B. YOUNG, M.D.Charles Cameron Sprague Distinguished Chair and Professor of Internal Medi-cine; Chief Division of Endocrinology and Metabolism, The University of Texas Professor of Medicine, Northwestern University Medical School; Attending Phy-Southwestern Medical Center, Dallas sician, Northwestern Memorial Hospital, ChicagoBRUCE U. WINTROUB, M.D. D O R I E ZALEZNIK, M.D.Professor and Chairman, Department o f Dermatology, Universityo f Califomia at Assistant Professor of Medicine, Harvard Medical School; Hospital Epidemio-San Francisco; Associate Dean UCSP/Mt. Zion Medical Center, San Francisco logist, Beth Israel Hospital, Boston

KATA PENGANTAR S e j a k e d i s i p e r t a m a Prinsip-Prinsip Ilmu Penyakit Dalam Harrison Tinjauan yang tenitama berorientasi etiologi dalam Bab Enam, diterbitkan iiampir 50 taiiun yang lalu, setiap edisi berikutnya telah \"Penyakit Infeksi,\" telah direvisi secara luas dan diperbarui di bawah menjadi andalan dasar klinis yang kokoh dan kemajuan ilmu pengawasan editor baru kami, Dennis L. Kasper. D i sini pembaca p e n g e t a h u a n u n t u k s e m e n t a r a . P a d a Harrison e d i s i k e - 1 3 i n i , p a d a akan menemukan pendekatan terhadap diagnosis, pencegahan, dan editor telah rnerevisi teks secara luas untuk menunjukkan kemajuan terapi dari infeksi bakteri, virus, dan jamur yang terakhir. Bab-bab yang penting dalam pengertian kami mengenai biologi dan baru meliputi \"Infeksi (Kecuali A I D S ) pada Pengguna Obat Sunlik,\" patofisiologi penyakit dan dalam pada itu untuk membangun \"Infeksi pada Pejamu dengan Daya Tanggap Imun yang Lemah,\" hubungan yang tepat antara kemajuan yang luar biasa pada ilmu dan \"Infeksi Kulit, Otot, dan Jaringan Lunak.\" Terdapat juga revisi pengetahuan dasar dengan kedokteran klinis, dan untuk menegaskan bab-bab utama yang meliputi interaksi pejamu-organisme, diagno- ketnajuan ini sementara tetap mempertahankan kebenaran yang ada sis laboratorium penyakit infeksi, septikemia dan syok septik, infeksi yang, walaupun tidak baru, tetap berguna dan penting secara klinis. nosokomial, serta mekanisme molekuler dari patogenesis bakteri. Setiap babdalam edisi ke-13 ini telah banyak sekali direvisi atau Terdapat sebuah bab yang penting dan terbaru mengenai retrovirus ditulis kembali, dan telah ditambahkan bab-bab baru. Dalam kata manusia. pengantar ini, kami tidak dapat menggambarkan semua bagian yang telah direvisi.Namun, kami ingin meminta perhatian pembaca pada KaiTii p e r c a y a b a h w a b a b m e n g e n a i p e n y a k i t H I V d a n A I D S o l e h beberapa bagian yang paling penting: Anthony S. Fauci dan H . Clifford Lane merupakan salah satu dari s e b a g i a n b e s a r risalah y a n g k o m p r e h e n s i f d a n t e r b a r u m e n g e n a i Bagian Satu, \"Pengantar Ilmu Kedokteran Klinis,\" terdiri dari A I D S . H a l i n i m e l i p u t i b i d a n g riwayat a l a m i a h d a n e p i d e m i o l o g ibab-bab baru mengenai etis medis dan pengaruh faktor sosial terhadap m e n g e n a i risalah i l m i a h t e n t a n g m e k a n i s m e i m u n o p a t o g e n i k p e n y a k i t penyakit, meliputi pengaruh usia, jenis kelamin, latar belakang HIV. D i samping itu,bab tersebut berisi suatu sistem organ melalui genetik, geografi, dan asal etnik. Faktor-faktor ini sangat pendekatan sistem organ serta timbulnya infeksi dari komplikasi mempengaruhi insidensi danekspresi klinis penyakit manusia. penyakit H I V yang utama.Contoh dari persoalan kesehatan perempuan pada Bab 5 meliputiskrining penyakit jantung iskemik dan pembahasan mengenai osteo- I n t i d a r i Harrison, p e n y a k i t s i s t e m o r g a n , m e l i p u t i B a b T u j u hporosis dan penyakit yang diperantarai secara imunologis. Penyakit sampai Empatbelas, dan mencakup catatan ringkas mengenaimedis yang penting selama kehamilan terdapat pada Bab 6 yang baru. patofisiologi penyakit manusia yang utama, dengan perhatian padaBab 8 yang baru, \"Ilmu Kedokteran Geriatrik,\" menjelaskan manifestasi penyakit, prosedur diagnostik, diagnosis banding, dan.perubahan yang berhubungan dengan usia pada setiap sistem organ strategi terapi. Tinjauan penyakit sistem organ yang komprehensifdan akibat klinisnya. Terdapat juga pembahasan yang terperinci meliputi bab baru mengenai elektrokardiografi, dengan ilustrasi barumengenai penatalaksanaan keadaaan yang sering pada manusia lanjut yang unggul mengenai pengenalan elektrokardiografik dari infarkusia, yang meliputi gangguan intelektual, mobilitas, inkontinensia, miokard akut. Terdapat bab yang diperbarui mengenai fibrosis kistik,dan reaksi obat iatrogenik, D u a bab yang tepat pada waktunya pencangkokan paru, glomerulopati yang berhubungan dengan(9 dan 10) terfokus pada kesadaran akan biaya dan aspek kuantitatif penyakit multisistem, penyakit peptik-asam (dengan fokus khususdari obat. p a d a H. pylori), h e p a t i t i s a k u t d a n k r o n i k , d a n p e n c a n g k o k a n h a t i . Bagian Dua, \"Manifestasi Penyakit Jantung,\" tetap memper- S e k s i m e n g e n a i h e m a t o l o g i d a n o n k o l o g i m e l i p u t i bab-babtahankan aliran utama edisi ini, dan berfungsi sebagai pengantar tentang onkogen dan gen supresor tumor, gen supresor tumor, palingkedokteran klinis yang komprehensif. Gejala pasien yang utama sering hilang atau mengalami mutasi pada kanker manusia. Terdapatditinjau kembali melalui sistem organ danberhubungan dengan bab baru yang penting mengenai terapi kanker, dengan menekankankeadaan penyakit yang spesifik—dasar diagnosis banding. Edisi pada imunoterapi dan peranan terapi gen yang potensial. Terdapatke-13 juga berisi babmengenai nyeri kepala, nyeri punggung dan juga bab baru mengenai penyakit yang mempengaruhi sisteinl e h e r , d e m a m , m e l i p u t i d e m a m y a n g t i d a k d i k e t a h u i s e b a b n y a (fever e n d o k r i n m u l t i p e l , p o r f i r i a , d a n p i r a i {gout). B a b m e n g e n a i d i a b e t e sof unknown origin), d a n g a n g g u a n p e n c i u m a n , c i t a r a s a , d a n meliputi pembahasan pengaruh kendali yang ketat mengenaipendengaran. Terdapat bab yang baru sama sekali dan bab yang ditulis komplikasi diabetes.kembali secara luas mengenai diare-dan konstipasi, serta bab yangbenar-benar baru mengenai ikterus. Pada Bab Eippatbelas, \"Penyakit Neurologis,\" terdapat bab baru mengenai pengaruh neurobiologi terhadap neurologi maupun Bagian Tiga, \"Genetik dan Penyakit,\" telah diperbarui secara luas, psikiatri. Terdapat juga tabulasi yang terperinci mengenai penemuanmeliputi sebuah bab baru mengenai gen dan neoplasia. g e n e t i k m o l e k u l e r y a n g m u t a k h i r d a l a m n e u r o l o g i . T e r d a p a t bab b a r u mengenai elektrofisiologi klinis, penyakit demielinasi mirip sklerosis Bagian Empat, \"Farmakologi Klinis\" danBagian Lima, \"Gizi multipel, meningitis bakteri dan abses otak, penyakit virus pada sistemKlinis,\" telah disusun kembali dandiperbarui. B a b mengenai saraf pusat, danpenyakit sistem saraf autonom. Untuk pertamafarmakologi klinis meliputi prinsip-prinsip terapi obat dan sebuah kalinya terdapat bab mengenai sistem kelelahan kronik,suatu wujudbab baru mengenai reaksi buruk terhadap obat. Cakupan fisiologi y a n g t e l a h m e n c i p t a k a n m i n a t yang besar k a r e n a h u b u n g a n n y adan farmakologi yang terbaru dari sistem saraf autonom menyelidiki dengan kedokteran psikosomatik.peran kuncinya pada banyak penyakit danberbagai cara yang didalamnya obat berinteraksi dengan sistem ini. Termasuk juga di sini Akhirnya, Bab Limabelas, \"Risiko Lingkungan dan Pekerjaan,\"sebuah bab yang diperbarui mengenai protein G dan pengaturan telah diperiuas dan disusun kembali.p e r a n t a r a k e d u a {second messenger) V&da Harrison e d i s i k e - 1 2 , e d i t o r m e m u t u s k a n u n t u k m e n g e n a l i Cakupan gizi dalam kedokteran klinis meliputi kebutuhan gizi, data laboratorium dengan menggunakan unit Sistem Internasionalpenilaian status gizi, gangguan makan yang penting seperti anoreksia [International System {SI)] u n t u k n i l a i l a b o r a t o r i u m k l i n i s , d i t a m b a hnervosa dan bulimia, serta obesitas. Pembahasan yang baru terdapat dengan sistem konvensional nomenklatur laboratorium yangpada terapi diet, meliputi nutrisi enteral dan parenteral. digunakan pada sebagian besar rumah sakit di Amerika Serikat. Kami merasa hal iniadalah penting, karena unit Sistem Internasional sering

xxii KATA PENGANTARdigunakan pada banyak negaia lain selain Amerika Serikat. Pada Women's Hospital. B e l i a u j u g a a d a l a h Professor of Medicine p a d aedisi ke-12 dan pada edisi ke-13 ini, kami telah mendaftar unit Harvard Medical School. K a m i m e n y a m b u t k e d a t a n g a n . D r . K a s p e rSistem Internasional yang pertama dan unit konvensional dalam sebagai editor baru dan kolega yang istimewa.tanda kurung untuk seinua ukuran kecuali tekanan darah, yanghanya diberikan dalam milimeter air raksa, dan untuk ukuran- Kami juga ingin untuk mengekspresikan penghargaan kepadaukuran dengan j u m l a h yang sama untuk kedua sistem tersebut. banyak rekan dan kolega, yang sebagai ahli dalam bidangnya, yangS e b a g a i p e m b a c a l i t e r a t u r m e d i s m u n g k i n s a d a r , d a l a m New membantu kami dengan kritik yang membangun dan saran yangpM^land Journal of Medicine 1992, y a n g m e n g e s a h k a n u n i t S i s t e m bermanfaat. Robert Alpem, Jon Astor, JudyAnn Bigby, TroyenInternasional sebelumnya, memutuskan untuk \"mundur\" ke Brennan, Neil A. Breslau, Bruce Bristian, Charles Carpenter, R i -p e n g g u n a a n h a n y a u n i t k o n v e n s i o n a l . N a m u n , e d i t o r Harrison chard Davey, W i l l i a m Dec, W i l l i a m R Dillon, Robert Dluhy, Jef-telah menyimpulkan bahwa, paling sedikit untuk edisi ke-13, kami frey Drazen, Stuart J. Eisendrath, Judy Falloon, Christopher Fanta,sebaiknya terus inenggunakan unit Sistem Internasional, dengan Robert A. Fishman, David W . Foster, Patricia Eraser, Jonas Galper,unit konvensional dalam tanda kurung. Pada sebagian besar Alan M . Gelb, Donald Goldmann, Stephen Goldring, Linniekeadaan, interkonversi antara Sistem Internasional dan unit Golightly, Christine Grady, James E. Griffin, Rachel Haft, Robertkonvensional adalah jelas. Namun, adalah penting sekali bahwa Handin, Seigo Izumo, Joseph H . Keffer, Arthur Kleinman, A n -pembaca mengkonsultasikan laboratoriumnya sendiri untuk nilai thony K o m a r o f f , H . Clifford Lane, Russell K . Laros, Jr., Richardnormal. M u n g k i n bahaya potensial terbesar yang melekat pada M . Locksley, Joseph Loscalzo, Carlos Luciano, James Maguire,keberadaan kedua sistem tersebut adalah interpretasi glukosa Robert Mayer, Walter O'Donnell, Tristram G .Parslow, Doloresplasma dankadar kalsium plasma, tetapi perhatian sebaiknya M. Peterson, Lynn Peterson, Michael Polis, Kenneth Ryan, Frankdiamati dalam interpretasi semua nilai laboratoriuin. Sacks, Jay P. Sanford, Paul Sax, Michael Seiden, Egilius Spierings, Chirstopher Stowell, Daniel Vlock, Robert Walker, Steven Dalam tinjauan kebutuhan untuk meneruskan pendidikan bagi Weinberger, Michael Wessels, Alison Wichman dan Edward Yeh.izin praktik dan izin praktik ulang, dan juga perhatian terhadaps e r t i f t k a s i d a n s e r t i f i k a s i u l a n g , r e v i s i Swa-Penilaian dan Tinjauan Buku ini tidak dapat diedit tanpa bantuan pengabdian temanPra-Uji akan d i t e r b i t k a n b e r s a m a d e n g a n e d i s i i n i . H a l i n i t e r d i r i sekerja kami pada kantor editorial dari masing-masing editor. Kamid a r i b e b e r a p a r a t u s p e r t a n y a a n y a n g b e r d a s a r k a n Harrison, b e r s a m a secara khusus berhutang budi kepada: Dorothy Binford, Mariedengan jawaban dan penjelasan untuk jawaban. D i samping itu, Bullock, Martha Cassin, Hilda Gardner, Christy K . Gonzales,Companion Handbook y a n g d i p e l o p o r i s e b a g a i s u p l e m e n u n t u k Bienda H. Hennis, Leslie LaPiana, Julie McCoy, Jaylyn Olivo,Harrison e d i s i k e - 1 1 y a n g d i p e r b a r u i d a n a k a n s e g e r a t e r b i l . Lucy Renzi, Kathryn A. Saxon, dan Elin Woodger S a l a h s a t u k e k u a t a n Harrison a d a l a h h u b u n g a n y a n g e r a t a n t a r a Akhirnya, kami terus akan berhutang budi kepada dua anggotaeditor. Dalam konteks tersebut, kami gembira sekali untuk yang terkemuka dari organisasi McGraw-Hill: J. Dereck Jeffers,menyambut editor baru yaitu Dr. Dennis L . Kasper, yang memiliki Editor-in-Chief, d a n S t u a r t B o y n t o n , Development Editor. M e r e k akeahlian yang sangat mendalam pada semua aspek penyakit infeksi. adalah tim yang efektif yang memberi semangat yang konstan danD r . D e n n i s L . K a s p e r d a r i Infectious Diseases Division p a d a Beth saran yang bijaksana kepada editor, dan sangat membantu terbitnyaIsrael Hospital d i B o s t o n d a n m e n j a b a t s e b a g a i Co-Director of edisi ini dengan hasil yang baik dan tepat waktu.the Channing Laboratory, y a n g b e r h u b u n g a n d e n g a n Brigham and EDITOR