The Aetiology of Deep Venous Thrombosis

A Critical, Historical and Epistemological Survey
(318 Seiten)
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P. Colm Malone
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"What we now call 'deep venous thrombosis' (DVT) has been elucidated by a diversity of investigative approaches during the past four centuries. The authors of this book survey the history of the field and ask: why has one of these perspectives - the haematological/biochemical - come to dominate research into the causation of DVT during the past 50 years and to exclude alternatives? In answering this question, they show that the current consensus model is conceptually flawed. Building on the work of William Harvey, John Hunter, Rudolf Virchow, Ludwig Aschoff and a number of pathologists in the mid-20th century, they offer a revised account of the aetiology of this condition. In the process they retrace and review the 160-year-old philosophical and methodological schism in biomedical research and, using DVT as an example, propose how this schism might be bridged to the benefit of both research and clinical practice. TOC:Preface.- Acknowledgments.- Synopsis.- Introduction to the study of deep venous thrombosis.-The coagulation cascade and the consensus model of DVT.- Hypercoagulability.- Historical roots.- Coagulation and its disorders: a history of haematological research.- Virchow and the pathophysiological tradition in the 19th century.- The pathophysiological tradition after Virchow.- Interrupted circulation: the 'stasis' hypothesis and the significance of venous valves.- Underperfusion of valve pockets and the initiation of VVP.- The role of endothelial hypoxia in DVT.-The valve cusp hypoxia hypothesis.- Molecular changes in the hypoxic endothelium.- Cadaver blood or agonal thrombi?- Appendix: science, medicine and philosophy."
to the Study of Deep Venous Thrombosis.- The Coagulation Cascade and the Consensus Model of DVT.- Hypercoagulability.- Historical Roots.- Coagulation and its Disorders: A History of Haematological Research.- Virchow and the Pathophysiological Tradition in the 19th Century.- The Pathophysiological Tradition after Virchow.- Interrupted Circulation: The 'Stasis' Hypothesis and the Significance of Venous Valves.- Underperfusion of Valve Pockets and the Initiation of DVT.- The Role of Endothelial Hypoxia in DVT.- The Valve Cusp Hypoxia Hypothesis.- Molecular Changes in the Hypoxic Endothelium.- Cadaver Clots or Agonal Thrombi?.
What we now call ‘deep venous thrombosis’ (DVT) has been studied in diverse ways during the last 200–300 years. Each of these approaches contributes to a full modern understanding of aetiology. Therefore, much of this book is a historical survey of the field. However, our remit is broader than the title might suggest: the evolution of ideas about DVT is typical in many ways of medical biology as a whole. Thus, although the aetiology of DVT may seem a narrow topic for a monograph – it implicitly excludes arterial thrombosis and marginalises prophylaxis, therapy, and even such clinically significant sequelae as pulmonary embolism – we hope to engage the reader in a much more general inquiry. Our historical investigation reveals a 160-year-old schism between two contrasting philosophies of medical and biological research, a schism that is particularly – but by no means uniquely – relevant to the study of DVT. In principle, these philosophies should be complementary rather than competing. So while we wish to elucidate the aetiology of DVT per se, we are also concerned with a more abstract and wide-ranging issue: the future accommodation or rapprochement between two conceptual and methodological traditions.

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