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The majority of the offending toxicants to be reviewed in this volume were devel­ oped to help mankind, and it is only with prolonged or widespread application that their adverse effects have been recognized. Conversely, in the case of pre scrip­ tion drugs, there has been an attempt to identify the adverse effects in advance and incorporate these risks into the decision of approval for human consumption. Unfortunately, for those drugs in which recognized injury occurs only after prolonged use, such appraisals are made in retrospect. Despite this, most renal injury induced by drugs or toxicants can be either prevented by excluding drugs with unacceptable side effects or interrupted by eliminating the offending agent once damage is manifested. The fact that prevention, reversibility, or arrest of renal injury is possible provided a major impetus for this publication. Since no international registry for nephrotoxic injury exists, estimates of incidence must rely on less than ideal sources. Recently I, together with Dr. William Bennett, summarized a survey of the frequency of various categories of nephrologic disease (Porter and Bennett, 1981). Based on this survey, we projected that in nearly one of ten patients seeking nephrologic consultation a nephrotoxic etiology may be involved. Of cases of end-stage renal disease, between 3 and 4% are due to drug nephrotoxicity, according to recent published results(European Dialysis and Transplant Association, 1979). For acute renal failure, antibiotics and contrast agents persist as major offending agents, while for chronic renal failure, analgesics remain a worldwide problem.

The advances in science and medicine we are now experiencing are unprec­ edented and exciting. Life expectancy is prolonged, and quality of life is much improved. We learn of fabulous new discoveries made at the bench or the bedside every week. Many diseases have been totally eliminated, others can be significantly improved by new therapeutic formulations. Much of the success can be attributed to a better understanding of disease processes and the specific targeting of new and more effective medications. As is the case in many areas of successful human endeavour, there can be a downside. In the case of drugs and chemicals it is their adverse effects which are of concern. Of course, every effort is made to devise medications that are safe, and the need to elucidate and understand mechanisms are crucial, yet adverse effects remain a problem. They can be unpredictable and diverse. Drugs have been shown to induce virtually the whole gamut of human liver pathology from acute fulminant hepatitis to chronic active hepatitis to cirrho­ sis and even malignancy. Hence the possibility of adverse drug effects must be considered in the differential diagnosis of many patients with liver disease. This is well recognized and is very important; indeed, removal of the offending agent can often lead to reversal of the adverse effect. This is an area of hepatology where we can really make a difference.

Increasing survival figures and the use of more intense combined treatment regimens in modern oncology have raised the problem of late therapeutic sequelae in long-term survivors after cancer. Recent scientific approaches to late sequelae concentrate on the evaluation of subclinical changes with sophisticated functional measurements and experimental investigation of the underlying pathophysiological mechanisms.The objective of the book is to bring together these recent clinical and experimental data from different medical disciplines to give an overview of the most relevant problems of late sequelae. In clinical practice the book may help regarding estimation of risks, selection of diagnostic methods, and estimation of the prognosis of late sequelae.

In the world at large and in the Western World in particular, the average age of the population is increasing. This is related to an increase in lifespan resulting from remarkable advances in preventive medicine and the clinical sciences. There has also been a concomitant rise of the modern pharmaceutical and chemical industries which support modern treatment methods and influence the pattern of human disease. The science of nutrition has also made major advances in recent years and is poised for even more encouraging contributions as the tools of molecular biology are applied to mechanisms of nutrient effects at the molecular level. Instruction in nutritional science can no longer be restricted to a description of the chemistry of major dietary constituents, diseases associated with a deficiency, and the amounts of nutrients required to prevent them. Modern nutritionists must now address the pervasive interrelationships of long-term nutritional habits and chronic diseases of the cardiovascular system, of cancer, and of osteoporosis, among others. There is also the role of nutrition as a tool in the treatment of post­ operative and other patients in the clinical setting. It is at these interfaces that drugs and nutrients interact in significant ways.

Drugs are often associated with adverse effects, and the digestive tract is the most frequent target. This volume collects a number of updated overviews from experts in this area to offer to the reader a single, complete source of information and reference on that subject.

When Critical Issues in Psychiatry was conceived, there were several sub­ jects I considered to be of crucial importance in a series devoted to residents and clinicians in psychiatry, as well as to other mental health professionals. Of prominence was the pressing need for an in-depth and scholarly exam­ ination of the interface between medicine and psychiatry. I had been amazed to find that not a single book, to my mind, adequately addressed the psy­ chological symptoms and manifestations of both common and rare medical illness. It seemed to me that there was a need for a work which would achieve the following goals: First, it would assist in the differential diagnosis of functional psychiatric symptoms versus symptoms secondary to recog­ nized or unrecognized medical illness; second, it would elucidate the psy­ chological symptoms resulting from pharmacologic and other therapeutic interventions in medical illness; and third, it would examine the use of psychopharmacological agents in the presence of medical illness and the drugs used to treat that illness. Dr. Jefferson is Board Certified in both internal medicine and psychiatry, and both Drs. Jefferson and Marshall have extensive clinical experience from their many years of consultation/liaison work in psychiatry. Their experience and expertise have resulted in what I believe to be a monumental contri­ bution to the literature.