Dieser Band gibt die Referate des 4. Internationalen An{sthesie-Symposiums, 15.-17. Juni 1989 wieder. Amerikanische und europ{ische Spezialisten der unter- schiedlichsten Fachgebiete diskutieren neueste Entwicklungen der Labor- und klinischen Forschung.

Perinatal medicine, which is concerned with the problems of the fetus and newborn, has rapidly developed in the last two decades as an important and challenging specialty. Rapid advances in the field, coupled with tech nological advances, now are making survival of infants with weights as low as 500 grams possible. Ventilator care for severe respiratory problems is on the verge of being replaced by surfactant replacement therapy; on the other hand, development of such technologies as extracorporeal mem brane oxygenation and jet ventilation has revolutionized the care of these sick infants. The advances taking place today in the field of perinatal medicine make periodic updates, like the one provided by this volume, a virtual necessity for clinicians and paramedical personnel alike. A distinguished group of specialists in various aspects of perinatal medicine has contributed to this book. Their wide-ranging experience and points of view should make this book a valuable reference for all physicians and allied health personnel involved in the care of the high-risk fetus and newborn. MANOHAR RATHI, M.D. Acknowledgements. I am grateful to the contributors for their cooperation in preparing the manuscripts, to my associates for their help and support, and to the publishers for their continued interest in this work. Above all, I thank Ms. Rose Aiello-Lech and Ms. MaryAnn Cichowski for their hard work in making this publication possible."

Nutritional support of critically ill patients is a major treatment modality which will enhance recovery and shorten convalescence. New knowledge has emphasized that much of the organ dysfunction associated with sepsis and altered blood flow is related to oxidative injury. Specific nutrients are highly effective in counteracting these effects and their early administration may attenuate cellular damage and multi-organ failure. Patient outcome may also be enhanced by the route of feeding, administration of newer nutrient combinations, utilization of evolving methods of monitoring and the use of growth factors. This new knowledge has evolved to a new area of metabolic support which is addressed for the first time by a group of international experts. The topics presented and general conclusions are of major importance to the practitioners in this field, for they show, for the first time, a departure from the more traditional approaches of nutritional support in patients with life-threatening diseases.

This volume is a compilation of papers presented at the Tenth International Symposium on Brain Edema held on October 20-23, 1996, in San Diego, California. This follows the sequence of meetings that was initiated 31 years ago in the First International Symposium held in Vienna. Subsequent symposiums were held in Mainz, Montreal, Berlin, Groningen, Tokyo, Baltimore, Bern, and Tokyo CY okohama). A considerable number of papers was chosen from over 100 papers that were received. The organizers wish to thank the Advisory Committee for the excellent work done in selection of the papers. We also wish to thank all the persons who contributed to the success of the Tenth International Symposium, especially the staff who worked behind the scenes. These papers were reviewed, edited, approved or disapproved by the Editorial Board. Those manuscripts that were felt not pertinent to this publication were not accepted by the Editorial Board. Therefore, the excellent quality of those that are in the book are a reflection of the authors' dedication and work and that of those of the Editorial Board in their review process. For the reader's convenience, the papers are structured according to the various disease processes which are associated with the primary topic: hypertension, hydrocephalus, infection, ischemia, tumor, etc. We do hope that the reader will enjoy the articles and that they will provide an impetus and insight for future work.

In January 1980, the First Symposium on the Measurement of Tis sue Oxygen Pressure in Patients was held in Frankfurt. After a 4-year "rest period," the organizers of the 1984 symposium, Profes sor R. Huch of Zurich and Dr. J. Hauss of Munster, together with myself, extended another invitation to come to Frankfurt to find out what had gone on in the field of oxygen pressure measurement and its application in clinical medicine. As the following presentations will show, the application of oxygen pressure measurements has been broadened considerably. Furthermore, technological advances have been made, particularly with the increased use of computers. For various reasons, including technical ones, these methods have not been adapted as widely as one would want. Although con gresses on tissue oxygen pressure have been held in the last few years, the clinical aspect of tissue P0 measurement has not been 2 dealt with in such a concentrated and comprehensive way since 1980. It therefore seemed necessary to hold such a symposium, not only for scientific reasons, but also to enable a larger group of clini cians to gain insight into the importance of the possibilities these methods offer."

Synthesizing insights from psychiatry, social psychology, and anthropology, this important work sets out a framework for therapy that is as culturally informed as it is productive. An international panel of 23 therapists offers contextual knowledge on PTSD, coping skills, and other sequelae experienced by the survivors of traumatic events. Case studies from Egypt to Chechnya demonstrate various therapeutic approaches. Authors explore the balance of inter- and intrapersonal factors in reactions to trauma and dispel misconceptions that hinder progress in treatment.

To be asked to prepare a second edition of a book is heartening for any author or editor. Apart from the opportunity to make the corrections and amendments which are inevitable in a practical manual there is also the possibility to make additions which enhance its usefulness. Above all a further edition usually means that the book has been found to be accept able to a large number of readers and has fulfilled a need. This is indeed the case with Offshore Medicine, which in its description of the medical aspects of offshore work has provided a unique guide to the occupational health of a new industry. The rapid development of offshore exploration for gas and oil which began in the 1960s created a whole new range of related industries. Most attention was focused on the problems of deep diving in the North Sea because of the great expansion of the diving industry, its technological advances and the high mortality of divers in the early years. Diving, however, is only a fraction of the total endeavour concerned with the offshore industry. The much larger population of workers offshore who man the rigs and barges, the toolpushers, helicop ter pilots, crane drivers, scaffolders and roustabouts, geologists and so on, so sympathetically described by A. Alvarez in his recent book Off shore, A North Sea Journey, and the harsh and difficult conditions in which they often have to work are sometimes forgotten."

Albumin is the most abundant serum protein produced by the liver. In clinical practice the serum level of albumin continues to be used as an important marker of the presence, progress or ofthe improvement of many diseases, even though it is the complex end result of synthesis, degradation a. nd distribution between intra- and extravascular space. The clinical history of albumin began as early as in 1837, when Ancell first recognized "albumen" and noted that this protein is needed for trans port functions, for maintaining fluidity of the vascular system and for the prevention of edema. However, the important physiological properties of serum proteins and their role in the regulation ofthe oncotic pressure were demonstrated later by the physiologist E. H. Starling in 1895. In 1917 the clinician A. A. Epstein first described the edema in patients with the nephro tic syndrome as being a result of a very low level of serum albumin. Al though the determination of serum albumin concentration became more popular after Howe in 1921 introduced the technique of separation of serum globulins from albumin by sodium sulfate, the first preparations of human serum albumin were made available for clinical use in only 1941 by the development of plasma fractionation by Cohn and his coworkers at Harvard Medical School."

Are you looking for the essentials you need to learn the basics of echography for anesthesiology, intensive care and emergency medicine? This is what this book offers you! These few pages condense the essential knowledge to make getting started with echography in emergency situations easier. Ultrasounds are presented in great detail in order to facilitate and optimize the medical diagnosis process. As a doctor, you will first be placed in front of the machine in order to take the pictures that will serve to answer the questions asked. Just as the author did, you will realize that, when facing the patient with the machine, the best echographic examination is worth nothing without a good clinical examination. As a "beginner's guide", this book also offers self-training procedure that lays the foundations of the "FAST" learning method. This FAST Program of Echography allows you to learn the process by watching, feeling and talking. This training course is based on an ancient methodology that centers on the learning of a manual gesture: 'practice makes perfect'. This book will show you that you can quickly master this Program of Echography, and will in turn increase your self-confidence when taking care of your patients. Have a nice trip through the fascinating world of ultrasounds!

Provision of efficient resuscitation is mandatory to the success ful functioning of all hospital wards and departments. Failure to provide such a service increases morbidity and mortality. Resuscita tion falls largely into the domain of the anaesthetist. However, an anaesthetist is not always instantly available and resuscitation has to be initiated by those in other specialities who have had little or no for mal training in resuscitation techniques. The purpose of this book is to guide those involved in resuscitation in the indications and methods of resuscitation. Its creation and con tents were stimulated by noting the difficulties encountered in both teaching centres and provincial hospitals. 'Basic' is included in the title to emphasize that, with the exception of 'the acid-base laboratory', the apparatus is simple and available in all hospitals. Furthermore, 'basic' indicates the authors' intention to limit their discussion on resuscitation to that involved in the first hour following the start of treatment. Successful treatment during these 60 minutes, and very often the first few minutes, is often vital in the sav ing of life. Further management can then be decided by the ap propriate specialist.

The fifth edition of this popular textbook continues to provide a solid foundation of pharmacological knowledge for all those working in anaesthesia and intensive care. The content has been thoroughly revised to include expanded chapters with clearer figures, ensuring readers are kept abreast of the ever-changing landscape of clinical pharmacology. Conveniently divided into four sections covering the basic principles of pharmacology, core drugs in anaesthetic practice, cardiovascular drugs, and other important drugs and complemented by new diagrams, tables and chemical formulae to facilitate learning. All four chapters on core drugs in anaesthetic practice have been updated along with others exploring applied pharmacokinetic models, antimicrobials, and drugs used in diabetes. An ideal aid to study and practice for junior and trainee anaesthetists and intensive care specialists preparing for exams. Also an invaluable resource for theatre practitioners, ICU nurses and physicians working in areas that demand a solid knowledge of pharmacology.

This volume is published with a triple aim: to take a look back over the advances during the ten years of the Mediterranean Burns Club and mark its anniversary; to follow up and strengthen the successful twin ning of burns as a clinical, individual illness problem and fires as a societal, disaster management problem; and to look ahead at the per spectives of burn care and fire prevention in the fast-approaching new century. The occasion also marks the tenth annual presentation of the prestigious G. Whitaker International Burns Prize, to which the Mediterranean Burns Club acts as the scientific fulcrum. The award is now established as the most distinguished recognition in burns science worldwide, and it is gratifying that the contributions of many of the renowned recipients will be found in this book. This is a sequel to The Management of Mass Burn Casualties and Fire Disasters, which contained the Proceedings of the First International Conference on Burns and Fire Disasters. The book and the conference have fully justified the authors' initial concept that burn specialists, con stantly combatting burn disease and promoting rehabilitation of the victims, especially in mass casualty situations, had for too long remained separate from that other essential sector, the fire-fighting authorities and fire prevention systems, whose aim is also the protection of the individual and the promotion of safety. This long overdue synergism has now become reality, and the present volume strengthens this desirable trend."

Key Features: * Covers all aspects of acute trauma, including orthopedics, vascular surgery, plastic surgery, neurosurgery, burns, radiology, etc. * Elaborates on damage control resuscitation and management of initial and life-threatening injuries, useful for professionals dealing with trauma patients in the emergency area. * Guides in initial fluid therapy and pain control along with initial patient resuscitation.

by E.K. ZSIGMOND, M.D. Department of Anesthesiology University of Illinois Chicago U.S.A. It is, indeed, a distinct honor and privilege to be invited by the authors to write a preface to this monumental monograph, Regional Opioid Analgesia. Regional Opioid Analgesia is a colossal undertaking by Drs. De Castro, Meynadier and Zenz shortly after the introduction of this revolutionary approach to pain relief which opened a new epoch in analgesiology. This is, indeed, the first authentic and comprehensive textbook encompassing the current knowl edge on this novel approach to pain relief. We are indebted to the authors for introducing the new opioids to regional analgesia with the scientists, who de veloped the potent short and ultrashort acting opioids with high therapeutic indices, which many researchers dreamt about but never before materialized. The side effect liabilities of these new opioids are minute as compared to morphine and meperidine. Regional Opioid Analgesia could not have been more authentically written than by Drs. De Castro, Zenz and Meynadier, who have conducted daily clinical investigations on all known opioids for regional analgesia as well as for neurolept analgesia. Therein lies the great value of this monograph: it is the most authentic work on this topic."

This book describes the underlying mechanisms and pathophysiological processes that relate to various childhood injuries, and brings together experimental and empirical data that determine the rational management of injury in childhood. It also deals with the wider issues of service organization and rehabilitation. The book describes the most common causes and types of injury encountered in the young, including trauma, head injury, near drowning and burns. It also deals with essential aspects of effective hospital management of injury, including trauma scoring, life support and nutritional support. It is intended for trainees and consultants in pediatrics, pediatric surgery, accident and emergency medicine, anesthesia, and intensive care, and it will also serve as a source book for medical and nonmedical researchers.

O ObivoV brac ?vV, eJ de teJcnh makrhv Life is short, the] art long -Hippocrates Pediatric Interviewing: A Practical, Relationship Based Approach by James Binder is filled with a unique blend of wisdom, experience, and evidence, which will serve as a guide and as a reminder that what comes first in the care of the patient is the language and the silences that are shared between patient and physician. The medical interview quickly establishes the type of caring relati- ship the two will share. In this age of electronic medical records, pay-forperformance, and evidence-based medicine it is easy to lose sight that medicine is fundamentally about one person who has knowledge and experience providing care for another individual who is asking for help. How the physician organizes his or her interactions has an important impact on the experience and o- comes for both the physician and for the patient. Dr. Binder presents a conceptual framework with which to approach interviewing and illustrates this framework with pr- tical examples from years of teaching and practice. Physicia- intraining will find this book filled with wisdom and much needed recommendations about how to approach the medical interview. For those of us who have been in practice a number of years, Dr. Binder's book can serve as a refreshing opportunity to reflect in detail about something many of us take for granted - the c- plexity of the medical interview."

Welcome to the City of Groningen, the center of the North of the Netherlands. Groningen is proud of the long lasting tradition of scientific symposia organised by the Sanquin Blood Bank. These Sanquin International Symposia on Blood Transfusion have become a true traditional event in Groningen, marking the early academic year and have contributed to the specific reputation of Groningen and its University in the scientific field of Transfusion Medicine. The growing tradition has also contributed to initiatives of both University, Province and the City of Groningen to bring science and industry together - BioMedCity Groningen. Such repu- tion does not just happen, but is the result of creative and scientific leadership, of vision and an open mind, to explore in a team spirit horizons. Groningen is particularly proud of this reputation thanks to its leadership, the Sanquin Blood Bank North-East. This year in particular the theme chosen some two years ago is extremely timely as it illustrates the activities and scientific interest of an integrated team which includes our regional Sanquin Blood Bank North-East and fits in the City initiatives within the concept of BioMedCity, Groningen.

This publication focuses on the medical management of individuals involved in radiation emergencies, especially those who have been exposed to high doses of ionizing radiation. Its primary objective is to provide practical information, to be used for treatment decisions by medical personnel during a radiation emergency. It also addresses general and specific measures for the medical management of individuals who have been internally contaminated with radionuclides. This publication is complementary to other publications developed by the IAEA in the medical area of radiation emergencies.

lnflammatory reactions are generated in response to extemal and intemal stimuli, such as infection, trauma, clinical insult or dysregulation of the umnune system. The int1ammatory responses may bc antigen-specific or non-specific, local or systemic, chronic or rapid and severe, characterized by a massive release of mediators, often lethal. The aim of this book is to review selectcd aspects associated with the mechanism of the pathology of int1ammatory processes of ditlerent origin and to evaluate therapeutic strategies aimed at combating various inflamma- tory diseases. The introductory article describcs the inmlllnological status of patients with severe sepsis, with particular attention paid to the roJe of circulating neutrophils. Intcgrin activation and chemokine receptor expression and the roles of IL-15, prostaglandins and leukotriens in inflmmnation and immunity are the subjects of next articles. Subsequent reviews are focused on allergic diseases involving mast cells and Th2 type cytokines, in particular the mech- anisms of atopic dennatitis and signaling hy IL-13. The intlmmnatory responscs elicited by Mycobacterium tuberculosis and Mvcobacferium nviwn are also analyzed with special interest paid to the mechanisms which allow the bacteria to escape the host' s immune reactions. The thcrapeutic potential of IL- I 0 in infection and inflammation and thc possible factors contributing to the devclopment of idiopathic pulmonary fibrosis are rcvicwed in the next articles. The final report demonstrates the advantages of bacteriophage ther- apy in thc context of the aggravating problem of hactcrial resistance to antibi- otics.

Until recently, endocrinology and critical care medicine were two specialties in medicine that were rather uncomfortable with each other and hence quite i- lated. Fortunately, these two 'alien' disciplines have joined forces in successful attempts to perform high quality research in order to clarify the unknown. By integrating endocrinology in critical care medicine, or vice-versa depending on the specialty of the observer, new experimental and clinical data on the complex endocrine and metabolic derangements accompanying non-endocrine severe i- nesses came available which generated important novel insights with relevant clinical implications. In addition, the state of the art diagnosis and management of primary endocrine diseases that represent life-threatening situations leading to ICU admission has been updated. This issue of Contemporary Endocrinology aims at compiling the new ?ndings. The book indeed covers both areas of 'Acute Endocrinology' that are often taking care of at very distant sites within hospitals. The ?rst part deals with the classical life-threatening illnesses caused by primary endocrine diseases such as thyrotoxicosis, hypothyroidism, acute adrenal crisis, acute calcium disorders, pheochromocytoma, severe hyper- and hypoglycemia . The second part looks at endocrinology from the ICU side, starting with a g- eral overview of the dynamic neuroendocrine and metabolic stress responses in the condition of intensive care-dependent, non-endocrine critical illness.

Sepsis is an important public health problem around the world. Severe sepsis carries significant morbidity, mortality and high costs. The incidence of sepsis is increasing because of the aging population, the growing number of immunocompromised hosts, the increasing use of invasive procedures, and, to a lesser extent, antibiotic resistance among pathogens. Despite recent advances in the pathogenesis, diagnosis, and therapeutic approaches the mortality rate associated with this condition remains high. Therefore, the goal of Sepsis: New Strategies is to review novel targets to be considered in patients with severe sepsis and to assess new developments for patients with sepsis originating in the respiratory tract.

Sepsis is a very important public health problem. It is widely acknowledged that the severe inflammatory response syndrome/severe sepsis paradigm fails to stratify sepsis patients adequately. This book reviews in detail how sepsis should be managed on the basis of a novel approach to staging. The PIRO (predisposing factors, infection, response, organ dysfunction) model was first proposed at the start of the decade on a theoretical basis and has now been translated into a practical approach for use at the bedside. It is loosely based on the TNM staging system for cancers, with points being allocated to each of the four aforementioned key characteristics of the septic process. The proposed PIRO framework facilitates evaluation of factors that are important in the pathogenesis of severe sepsis and in the development of treatment strategies. This book clearly explains the advantages of the PIRO approach in different settings and will be of value to all practitioners concerned with the management of sepsis.

All Hazards Disaster Response (AHDR) is a groundbreaking program from the National Association of Emergency Medical Technicians (NAEMT) that uses realistic scenarios to prepare first responders to respond swiftly and effectively when disaster strikes. It is the first EMS education program that fully addresses how to best manage patients during disasters. AHDR trains EMS practitioners for a team- and systems-based approach to disaster preparedness and response. Training with AHDR leads to the acquisition of critical knowledge and enables EMS practitioners to explore potentially dangerous situations in an interactive and safe learning environment. Key Features The AHDR Course Manual is designed to be used by participants before, during, and after the course. Before the course, participants can prepare with the evidence-based content and engaging features within each lesson. Check Your Knowledge questions and lesson summaries reinforce key concepts and tie information together, helping participants retain what they have learned. During the course, participants will utilize the course manual as a vital resource during critical-thinking skill stations. After the course, participants can consult the course manual as a trusted reference.

Mental health professionals who don't specialize in trauma practice are discovering more and more frequently that trauma survivors represent a high percentage of their client population. "Trauma 101" is a concise, current, balanced, and accessible overview of one of the most pervasive, yet controversial psychological issues faced today. It is grounded in the most up-to-date research and theories on trauma and its effects, and covers not only the concepts of what trauma is and the ways in which different kinds of traumas affects people, but also considers how it is diagnosed in the wake of the DSM-V and is treated with both evidence-based and alternative methods.

Written by a leading researcher and clinician in the field, the book is an entry-level text for students. It is illustrated with first-person accounts from trauma survivors and encompasses theories, diagnosis, and treatment as well as how trauma affects family members and caregivers. The text also addresses the potential health consequences of trauma and illuminates controversies in the field and such emerging topics as post-traumatic growth, multiple trauma, and how traumatic events affect communities.

Key Features: Provides a comprehensive yet concise overview of trauma for entry-level students Considers theoretical frameworks for understanding trauma and its impact on physical and mental health Addresses diagnosis, treatment and controversial and emerging topics Covers post-traumatic growth, multiple trauma, evidence-based treatments and alternative treatments Includes plentiful firsthand accounts of trauma survivors

Substantialfundamental workhas been undertaken inthe different aspects of impact biomechanics over the past three decades. Much of this has been motivated and undertaken bythe automotive industry intheirefforts to improve transport safety. More recently, however, it has become app- ent that themultidisciplinary synergies which are realisedby interactions between engineers, scientists and clinical practitioners will ultimately lead to a greater understanding of the complex interacting phenomena withinthe human bodyafter it has sustained an impact. In turn, this greater depth of knowledge will provide more fundamentalinsights into the analysis, d- gnosis, treatment and prevention ofimpact injuries across a broader sp- trum of accident environments. Thescienti?c focus of this IUTAM symposium istoaddress those t- ics that are centrally important to the biomechanics ofimpact. These can be groupedinto those that are concerned with the different causes of - cidents (e. g. , transport, occupational and sports injuries), themechanics - volvedinaccident analysis (e. g. , accident investigation, computational m- elling techniques), the different types of resulting traumatic injuries (incl- ing musculoskeletal, organ, spinal and head injuries), methods of asse- ing the extent of injury (e. g. , injury assessment, injury criteria, constitutive laws for human tissue), and providing protection during an impact (e. g. , injury prevention, energy absorption materials, and safety devices).