th It is a great pleasure for me to open the jubilee 25 International Symposium on Blood Transfusion here in Groningen. This symposium is co-sponsored by the World Health Organization and is being held under the auspices of the ISBT and the Secretary General of the Council of Europe, Mr Walter Schwimmer. The patronage was granted with great pleasure for several reasons. First of all, Dutch experts are very active in our Committees and have largely contributed in developing the Council of Europe principles in the blood area. Secondly, the Council of Europe is active today in the area of blood transfusion due to a tragic event, which occurred in 1953 in the Netherlands; following a flooding many of the blood products given for assistance' could not be used due to incompatibilities and differences in labelling. Some words to present the Council of Europe since the organisation is sometimes confused with institutions ofthe European Union: The organisation has been founded in 1949 to establish the principles of democracy and rule of law all over Europe. Since 1989, the year of the fall of the Berlin wall and the opening up of the iron curtain, these principles could be extended to the countries of Central and Eastern Europe. Today this makes the Council of Europe the only pan-European organisation with 41 Member States thus representing more than 750 million people.

Infection Control in the ICU Environment provides the details of the most common infection control problems facing intensive care units. Authors include noted scientists, intensivists and epidemiologists from the United States and Europe as well as infection control experts from the Centers for Disease Control and Prevention. Acinetobacter, methicillin resistant staphylococcus aureus and vancomycin resistant enterococci are examined in detail. This volume also includes cutting edge information regarding the potential for prophylactic and pre-emptive therapy of fungal infections in intensive care units. Innovations in vascular catheter care and prevention of bloodstream infections are discussed in this volume as well as the newest information in mathematical modeling to understand the epidemiology and control of infections in intensive care units.

With the introduction of new post-graduate Medical training in the UK, virtually all doctors will be exposed to some form of surgical training prior to specialization. Many of these doctors will have little exposure to surgical emergencies in medical school. Thus, they may unnecessarily refer to a senior doctor when not needed, or catastrophically neglect a patient needing urgent surgical opinion. Surgical Emergencies in Clinical Practice is a compact resource which allows any clinician, without previous surgical knowledge, to be able to make an accurate diagnosis and have a treatment plan for the whole spectrum of surgical emergencies. The essential steps of initial management of all surgical emergencies is outlined in a manner that can be used on a day-to-day basis for clinical management. Written by experts in the field, Surgical Emergencies in Clinical Practice is a valuable tool for all junior doctors and medical students in the UK, Europe, Asia and North America. It will also be of interest to nurse practitioners, general practitioners and allied health professionals managing these patients.

Rodney E. Slater Secretary of Transportation, U. S. Department of Transportation know many of you have traveled great distances to be here. I To me, that shows not only your dedication to the cause, but demonstrates how very important transportation safety is becoming throughout the world. So I am very thankful to the main organizers of this third annual conference -- all of whom are from Sweden: Dr. Hans von Holst of the Royal Institute of Technology; Dr. Ake Nygren of the Karolinska Institute; Dr. Ake E. Andersson of the Institute for Futures Studies; and finally, Dr. Arne Witt16v and Lars Anell from AB Volvo. And let me give a special welcome to our friends from Africa. I will be visiting a number of African nations in January. And while my main mission is to promote trade and investment with the United States, we will be talking about safety, too. Airline safety, for example, is a big concern, as Africa grows and prospers and the demand for air travel expands. We discussed it during recent meetings of the International Civil Aviation Organization in Montreal several weeks ago. And we will do so again during my trip. plan to talk about how my department can help the Also, we many nations of Africa improve highway safety. Africa relies heavily on road transportation. But highway fatalities are very high. And the economic costs are very steep, especially for Africa's fragile, emerging v market economies.

This book has been written to provide general practitioners with an easy to read, easy to consult guide, to aid in the management of the large majority of practice emer gencies. Each presenting problem is approached logically with telephone assessment and advice followed by the assessment and management necessary when the patient is seen. The emphasis is on practical primary care with discussion of differential diagnosis only taken as far as is needed for deciding the best immediate course of action. Words are kept to a minimum though tables are liberally used to summarise useful information. For each situation the final management advice is highlighted by being presented within a heavily lined box. Our guiding principles for emergency care, which this book naturally reflects, are: (1) Visit first - argue or educate later. (2) If in doubt - see the patient. To use this book for ready reference by the telephone, in the car, or at the bedside: (i) If the patient is a child, look at the contents list at the beginning of chapter 4 and then turn to the relevant pages. (ii) If the patient is an adult, first decide the system involved then look at the contents list at the beginning of the appropriate chapter before turning to the relevant pages."

The ability to read a paper, judge its quality, the importance of its result, and make a decision about whether to change practice based on the information given is a core skill for all doctors. To be able to do this quickly and efficiently is without doubt a skill needed by all time-pressured emergency physicians and one which is tested in the Fellowship of the College of Emergency Medicine (FCEM) examination.
This book is the essential revision source for all those wanting to pass the critical appraisal section of the FCEM and will be a useful tool for all emergency physicians who want a refresher on critical appraisal, as well as those who wish to excel in their MCEM examination.

• Become truly competent in critical appraisal
• Go to the next level and excel with more advanced information provided in Spods' Corner
• Invaluable help for all those writing their Critical Topic Review
• Text and practice your knowledge using the two fictitious practice papers
• Help is at hand via the glossary which explains terms that regularly come up in scientific papers but are often not explained

With its relaxed conversational style yet crammed with essential information, key tips, and advice, this book is an essential purchase for all those wanting to pass and achieve examination success in their FCEM and MCEM examinations.

This book is the first of four books on the core principles of acute neurology. This book is a primer - and a great deal more - on how to clinically recognize acute brain injury and to treat its consequences. Acute brain injury often changes the dynamics of cerebral blood flow, cerebrospinal fluid mechanics and eventually intracranial pressure. And furthermore, acute brain and spine injury impacts on heart function, blood pressure control, breathing regulation and even gastric and bladder function. It is necessary to not only understand these fundamentals but also how certain measures could influence or correct these manifestations. Major concepts are illustrated to facilitate understanding. Each chapter concludes with a section that explains its relevance to clinical practice.The book truly combines basic neuroscience with practical know- how in an easy to read prose useful for both the novice and expert.

In any acute neurologic condition situations come up which generate questions about management. In a deteriorating patient there is a strain in decision making and many acute problems are hard calls. Handling Difficult Situations includes solutions for these reoccurring dilemmas. Each topic is carefully chosen and reflects clinical practice. The book addresses how to recognize treatable coma, how to judge the severity of traumatic brain and spine injury, and discusses how to recognize neurosurgical emergencies. Handling Difficult Situations also includes recognition and management of acute respiratory neuromuscular failure. A separate chapter discusses errors in CT scan evaluation of acute neurologic conditions.

Brain resuscitation is the therapeutic intervention for critically ill patients with severe brain damage, particularly the types caused by ischemia and hypoxia. The The objective of the International Symposium on Brain Resuscitation held in Ube, Yamaguchi Japan October 31 to November 2 1988, and sponsored by Yamaguchi University and the Japanese Ministry of Education, was to review our recent progress in brain resuscitation and to discuss controversies both basic and clinical. To my knowledge, this symposium was the first held in Japan. Our understanding of neuronal dysfunction due to ischemic/hypoxic insults at organ, cellular, and molecular levels has advanced significantly in the last two decades. We had therefore intended that this international symposium should broadly cover the topics which are of interest to both basic researchers and clinicians. Three hundred and twenty-five attendants, including twenty scientists from eight different countries, actively participated in discussion and exchange of new ideas and thoughts concerning brain resuscitation. This book comprises the re ports presented during the symposium which consisted of two main parts: basic and clinical. Although one single meeting can never be expected to solve any problems, meetings often highlight areas of ignorance and problems which are ripe for solving. It has been hard to review all the papers because of the multi plicity of the discussed topics, but the overview on brain resuscitation by Profes sor Bo K. Siesjo and the summary by Professor J."

This aim of this book is to focus on a very common situation seen in medical practice, the acute catabolic state. This pathophysiological sit uation is rarely discussed as a separate entity, possibly because it is seen in all specialties of medicine and results from a great diversity of agents, insults, and diseases. It thus seemed to be high time to gather the most important and up-to-date knowledge on this entity, and the primary aim of the book is to offer a collection of updated information on the acute catabolic state. Another objective of the book is to make clear that, apart from the general response of the whole organism during the acute catabolic state, a series of organ-specific responses will also take place, which must also be considered during treatment. It has become very clear of these organ-spe from working on this book that current knowledge cific responses is very sparse and in some areas almost nonexistent; this book thus also focuses on the responses and changes which take place in different organs during the acute catabolic state and the inter action between these organs and their responses.

In spite of today's increasing body of knowledge in regard to central nervous func tion and/or the mode of action of centrally active compounds, little is done to monitor those patients which are at risk of cerebral lesions either in the OR or in the ICU. Due to the inconsistency of reports regarding the application and the benefits computerized EEG and/or evoked potential monitoring will bring to the clinician, physicians still are reluctant to get involved with a technique, which they think, will have little or no effect on the outcome of a patients well being. However, due to the development in computer technology, data acquisition and comprehension, it now is possible to monitor such a viable organ as the Central Nervous System (CNS) on a routine base without being a specialist in neurology or electroencephalography. Thus, the book is intended to guide the clinician to use BEG and evoked potential monitoring in a day to day situation, without going too deep into technical details. As an improvement of cerebral care is needed, various representative cases underline the interpretation of EEG power spectra and evoked potential changes in regard to the underlying clinical situation. It is hoped that this book will serve as a guide to anyone who considers cerebral monitoring a necessity in today's patient care. This may be the anesthesiologist, the intensive care therapist, the nurse anesthetist as well as the medical personnel in the lCU setting."

From the unique position of a decade in government service, I was given the opportunity to observe the changes in the provision of emer gency medical care across the country. In 1970, Emergency Medical Service (EMS) systems were a new and much needed development in the national health care delivery system. A systems approach to field casualty care has been progressively improved during each successive military conflict since the Civil War. These improvements were ini tiated after the rnedil: al care and evacuation disaster experienced by the Union Army of the Potomac at Bull Run on July 21, 1861. During the Civil War, major changes in administration, professional personnel, transportation, hospitals, sanitation, and medical records established patterns that have been continually refined and improved. Stimulated by the pressing demands of war surgery and coupled with parallel advances in medical care over the last century, an almost unbelievable level of performance was realized in Vietnam. Advances in field resuscitation, efficiency of aeromedical transportation, and energetic treatment of military casualties have proved to be major fac tors in the decrease in death rates of battle casualties reaching facilities: from 8% in World War I to 4. 5% in World War II to 2. 5% in Korea and to less than 2% in Vietnam."

In recent years much enthusiasm and energy has been directed toward the development of human gene therapies, especially for inherited conditions and cancers. However, current gene transfer technology is limited in its transduction efficiency and ability to permanently and safely correct genomic defects. Thus the promise of gene therapy for these conditions is as yet unrealized. The progression of gene transfer technology will eventually surmount these limitations. Gene Therapy for Acute and Acquired Diseases includes selected examples of ongoing studies in molecular genetics that have the potential to evolve into human therapies for acute illnesses. These chapters are intended to highlight lesser known applications of gene therapy for acquired disorders. It is expected that human gene therapy trials for these conditions will be forthcoming in the near future, leading to previously unimaginable therapies. Thus, this first-ever book about gene therapy for acute and acquired diseases is intended to serve as a glimpse into the future.

A large number of cardiovascular diseases are accompanied by inflammation. This volume on the molecular basis of microcirculatory disorders gives a comprehensive summary of key steps in the inflammatory cascade. Leading investigators present a state-of-the-art analysis of the molecular determinants of leukocyte-endothelial cell adhesion, mechanotransduction in endothelial and inflammatory cells, mechanisms of cell activation, microvascular apoptosis with applications to ischemia-reperfusion in the brain, the heart and in venous disease, diabetes and hypertension. The book provides the latest thinking in these important cardiovascular problems, with the most contemporary literature and a look at the increasingly complex events during inflammation. Molecular biology tools, microvascular and modern bioengineering analysis are seamlessly integrated into the analysis of clinical problems. The book helps not only newcomers to gain entry into the interesting problems associated with microvascular disorders, but lays the foundation for the design of new therapeutic interventions.

Contrary to popular belief, death is not a moment in time, such as when the heart stops beating, respiration ceases, or the brain stops functioning. Death, rather, is a process--a process that can be interrupted well after it has begun. Innovative techniques, such as drastically reducing the patient's body temperature, have proven to be effective in revitalizing both the body and mind, but studies show they are only employed in approximately half of the hospitals throughout the United States and Europe.

In Erasing Death, Dr. Sam Parnia presents cutting-edge research from the front line of critical care and resuscitation medicine that has enabled modern doctors to routinely reverse death, while also shedding light on the ultimate mystery: what happens to human consciousness during and after death. Parnia reveals how medical discoveries focused on saving lives have also inadvertently raised the possibility that some form of "afterlife" may be uniquely ours, as evidenced by the continuation of the human mind and psyche in the first few hours after death. Questions about the "self" and the "soul" that were once relegated to theology, philosophy, or even science fiction are now being examined afresh according to rigorous scientific research.

With physicians such as Parnia at the forefront, we are on the verge of discovering a new universal science of consciousness that reveals the nature of the mind and a future where death is not the final defeat, but is in fact reversible.

Until recently, monitoring of cerebral blood flow and metabolism was an unattained goal. Determination of cerebral blood flow was limited to intermittent measurements and particularly difficult to perform in critically ill patients. Meanwhile there are techniques available, however, to monitor cerebral blood flow and cerebral oxygenation, both globally and regionally. Therefore we thought it worthwhile to discuss these new continuous techniques and to compare them with well-known techniques which discontinuously measure CBF. For that purpose, an international workshop with some leading experts in the field was held in October 1992 in Berlin. The workshop consisted of about 20 lectures, either reviews on a special topic, or latest results. These contributions were given by invitation and were extensively discussed. Unfortunately it is impossible to reproduce the discussions. On the other hand, all speakers delivered a manuscript promptly after the meeting so that we were able to edit them within a short time. Since monitoring of cerebral blood flow in intensive care is a rapidly growing and changing topic, the written contributions should be quickly available. Authors, editors and publishers have tried to come close to this ideal. As editors we would like to thank the authors and the publishers who enabled us to come out with this volume of the proceedings as early as possible.

In recent years much progress has been made in the field of neurochemical monitoring for the acutelly injured brain. The development of safe continuous microdialysis techniques coupled with microanalytical methodology can generate semi-continuous time profiles of the changes in numerous brain analytes such as lactate, glucose, pyruvate, excitatory amino acids, structural amino acids, indicators of free radical generation, cytokines, adenosine, and neuroprotective drugs. Descriptive studies have shown profound, prolonged, and severe abnormalities in many of the analytes measured and the next phase is to determine the effects of therapeutic interventions upon these parameters. This field of research has contributed tremendously to our understanding of pathomechanisms in acute human brain damage.

This volume contains contributions by well-known scientists and clinicians in the fields of microbiology, infectious diseases, physiology, internal medicine, surgery, anaesthesiology, and intensive care medicine. It provides an up-to-date overview of the mediators and pathophysology of sepsis and septic shock as well as the latest therapeutic approaches.

During the past twelve years, a course on critical care medicine has been sponsored by the Post Graduate Division of the University of Southern California School of Medicine in association with its Center for the Criti cally Ill. The content of each of the symposia has paralleled the evolution of critical care medicine as a recognized service specialty. The annual program was planned as a teaching session for physicians and allied medical personnel who sought to advance their involvement in this rapidly advancing field. A panel of highly regarded authorities on sub jects bearing on critical care medicine, faculty members of the USC School of Medicine, and staff members of our own Center for the Critically 111 at the Hollywood Presbyterian Medical Center serve as faculty of these symposia. Although the primary commitment of the organizers to maintain this as a teaching and demonstration session was not abandoned, the number of annual registrants progressively increased from fewer than 100 to more than 1200, gradually outstripping local hotel facilities in central Los Angeles. The symposium for the past two years has been held in the large and at tractive Anaheim Convention Center adjacent to Disneyland."

A multidisciplinary overview of techniques for monitoring acute head trauma patients is given in this book. It includes neuroimaging procedures (TCD, MRI, SPECT) and multiple neurophysiological approaches: EEG, videomonitoring and integrated computer systems with clinical applications. Results that have been obtained by using new drugs to protect the brain as well as progress made in recovering techniques are emphasized. The long-term consequences of acute lesions are also discussed. The relationship between acute and long-term seizures is studied in posttraumatic epilepsy cases, and the relationship between neurophysiological and long-term clinical patterns, especially in posttraumatic epilepsy, is discussed. The socio-economic costs of traffic accidents are analysed - based on data from epidemiological studies - and then compared with reported data.

Trauma surgery has increasingly become a specialized field inspired by different principles and philosophy. A good trauma surgeon is a surgeon who knows how to perform abdominal, vascular, thoracic, urologic, gynecologic, and orthopaedic procedures and is able to repair multiple traumatic injuries in the best sequence possible. In this second volume the focus is exclusively on thoracic and abdominal trauma, with coverage of injuries to all regions. The surgical techniques employed in managing such trauma are carefully described with the aid of high-quality illustrations. Exploratory surgery (via either laparotomy or laparoscopy), damage control surgery, and definitive surgery are all fully covered, and attention is drawn to important technical tips and tricks. The volume will be a handy pocket guide for trainee surgeons who are beginning to deal with severe multiple trauma patients, as well as for all general or specialty surgeons and professionals (including scrub nurses and theatre staff) who are involved in trauma care and wish to keep abreast of developments in this complex field. Also available: Trauma Surgery Vol. 1: Trauma Management, Trauma Critical Care, Orthopaedic Trauma and Neuro-Trauma

Great progress has been made in the understanding and prevention of secondary brain damage from acute cerebral disorders, such as trauma and ischemia. Advances may be concerned in particular with better organization and logistics of preclinical emergency care, including rapid arrival of well-trained medical staff on the scene of an accident and of transportation to a competent hospital. Nevertheless, it is a safe assumption that development of secondary brain damage from both intra- and extracranial causes still represents a major factor for the final outcome in severe head injury. Thus, exchanges of experiences and information between various disciplines involved with this important clinical problem - trauma still assumes the number one position as a cause of morbidity and mortality up to an age of 45 years - may provide a basis for in-depth analysis of remaining problems as well as of methods of their solution. This exactly is the purpose of the present publication on concepts and findings pertinent for the general subject of secondary brain damage from various experimental as well as clinical viewpoints. An internationally high-ranking group of experts has been contributing to this collection of reviews on cerebral trauma and ischemia and its adverse sequelae, including cerebral exploration by most modern technologies, such as NMR spectroscopy or PET scanning, among others.

Despite a worldwide reduction in its incidence, stroke remains one of the most common diseases generally and the most important cause of premature and persistent disability in the industrialized countries. The most frequent cause of stroke is a localized disturbance of cerebral circulation, i.e., cerebral ischemia. Less common are spon taneous intracerebral and subarachnoid hemorrhages and sinus ve nous thromboses. The introduction of new diagnostic procedures such as cranial computed tomography, magnetic resonance imaging, digi tal subtraction radiologic techniques, and various ultrasound tech niques has led to impressive advances in the diagnosis of stroke. Through the planned application of these techniques, it is even possible to identify the pathogenetic mechanisms underlying focal cerebral ischemia in humans. However, these diagnostic advances have made the gap between diagnostic accuracy and therapeutic implications even greater than before. This fact can be easily explained. In the past, therapeutic studies had to be based on the symptoms and temporal aspects of stroke; it was impossible for early investigations to consider the various pathogeneses of cerebral ischemia. Inevitably, stroke patients were treated as suffering from a uniform disease.

Over the last 10 years the syndrome of severe acute renal failure has progressively changed in its epidemiology. It is now most frequently seen in critically ill patients, typically in the context of sepsis and multiorgan failure. This epidemiologic change has meant that intensive care physicians and nephrologists must now work in close cooperation at all times and must take many com plex issues of prevention, pathogenesis, and management into account that they did not previously have to tackle. Simultaneously, the last 10 years have seen the development of major technical and conceptual changes in the field of renal replacement therapy. There are now previously unavailable therapeutic options that provide physicians with a flexible and rapidly evolving armamentarium. The nutrition of these patients, previously limited by the par tial efficacy of renal replacement therapies, has also become more aggressive and more in tune with the needs of critically ill patients. Increased understanding of the pathogenesis of the multi organ failure syndrome has focused on the role of many soluble "mediators of injury" (cytokines, leukotrienes, prostanoids etc.). These molecules are likely to participate in the pathogenesis of acute renal failure. Their generation and disposal is also affected by different techniques of artificial renal support."

This book reviews the most recent developments in the patho- physiology and therapy of ventilatory failure. It contains contributions by twenty-five internationally recognized aut- horities on respiratory muscle function and investigators actively contributing to our knowledge of the cause, diagno- sis and therapy of ventilatory failure. Of particular inter- estare the descriptions of new modalities of partial and complete ventilatory assistance as well as new knowledge re- garding ventilatory control and fatigue during stressful breathing. The reader will find here a state-of-the-art re- view of the latest research and practical applications in this most critical area of intensive care medicine.