As the number of people aged 65 years and above rises, physicians are increasingly confronted by elderly patients with impaired renal function, altered drug metabolism and multiple comorbidities. This book examines in detail the nature of renal injury in the elderly and its optimal management. A wide range of key topics are covered, including end-stage renal disease, diabetic nephropathy, acute kidney injury, drug metabolism and renal toxicity, dialysis and its complications and the use of renal transplantation. In addition, the assessment of glomerular filtration rate in the elderly and the role of novel renal biomarkers are carefully examined. Quality of life issues, the significance of other age-related medical problems and end of life care are also discussed. This book will be of value not only to nephrologists but also to general practitioners, medical students, intensivists, cardiologists, pharmacologists and those working in related specialties. "

Management of Musculoskeletal Injuries in the Trauma Patient summarizes the most current concepts and clinical practices for the management of the patient with musculoskeletal traumatic injuries. The text covers optimal time frames for stabilization of orthopedic injuries and strategies to mitigate systemic injury while minimizing damage due to pelvic, spine and long bone trauma. The volume covers the gamut of traumatic axial and extremity injuries, including cervico-lumbar-thoracic spine injuries, spinal cord injuries, long bone fractures with special emphasis on the femoral shaft, pelvic and acetabular injuries, open fractures, mangled extremities, upper extremity injuries, combination and severe soft tissues injuries and periarticular fractures. These are discussed in the context of isolated injury and combined with orthopedic injuries of the brain, abdomen, chest and other musculoskeletal injuries. Written by internationally recognized experts, Management of Musculoskeletal Injuries in the Trauma Patient is a valuable resource for orthopedic surgeons.

The close correlations between anatomo-functional data and clinical aspects are substantiated by the study and interpretation of the data of respiratory mechan ics. This field has developed to such an extent that, today, it is hard to single out one researcher who is an expert of the whole sector, whereas super experts can be found among scholars who, thanks to their studies and continuous comparisons, have contributed to the widening of knowledge and the development of that part of research which correlates some basic disciplines with clinical medicine. This notion is of paramount importance. Indeed, it has to be regarded as a starting point requiring a more precise definition. The analysis of data concern ing ventilation parameters is based on the use of mathematical models that are necessary to simplify the complexity of the various clinical situations. For a cor rect application and interpretation of data, the most recent technological acquisi tions in terms of ventilatory support require to be used as a function of simple mathematical models for the study, control and evolution of the lung diseases that concern the ICU. Thus, the need has arisen to compare the experience acquired in the field of applied physiology and in the clinical sector."

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.

Ventilator-associated pneumonia (VAP) continues to be one of the greatest challenges to critical care practitioners and one of the greatest threats to the survival of our patients. The choice of this topic for an issue of the PERSPECTIVES IN CRITICAL CARE INFECTIOUS DISEASES Series is therefore quite appropriate. Despite its importance, many areas of the management of ventilator-associated pneumonia remain controversial. We therefore are pleased to include contributions from experts and investigators offering different perspectives on some of these controversial areas.

During the last decade, the effects of anaesthetics on cerebral blood flow, cerebral metabolic rate of oxygen and intracranial pressure have been studied experimentally and clinically. In this review studies of CBF and CMRO2 during craniotomy have been performed with the classical technique described by Kety and Schmidt. In chapter 1 general considerations concerning the effects of anaesthetics on cerebral blood flow and metabolism are reviewed. In chapters 2 and 3 the effects of inhalation agents and hypnotics on flow and metabolism are considered. Chapters 4 and 5 cover the effects of central analgetics, and neuromuscular blocking agents. In chapter 6 the effects of other drugs in common use in neuroanaesthetic practice are summarized. Chapter 7 considers the effects of drugs used for controlled hypotension. In chapter 8 the application of Kety's method in studies of CBF and metabolism is reviewed, the studies of cerebral circulation and metabolism during nine different techniques of anaesthesia for craniotomy are presented, and other studies of cerebral circulation during neuroanaesthesia are reviewed. In chapter 9 considerations concerning central and cerebral hemodynamics during anaesthesia in the sitting position are considered. This review is primarily addressed to anaesthetists, but it will also be of interest to those working within neurosurgery, neuroradiology and clinical neurophysiology.

This eighth edition of Dr Reichel's formative text remains the go-to guide for practicing physicians and allied health staff confronted with the unique problems of an increasing elderly population. Fully updated and revised, it provides a practical guide for all health specialists, emphasizing the clinical management of the elderly patient with simple to complex problems. Featuring four new chapters and the incorporation of geriatric emergency medicine into chapters. The book begins with a general approach to the management of older adults, followed by a review of common geriatric syndromes, and proceeding to an organ-based review of care. The final section addresses principles of care, including care in special situations, psychosocial aspects of our aging society, and organization of care. Particular emphasis is placed on cost-effective, patient-centered care, including a discussion of the Choosing Wisely campaign. A must-read for all practitioners seeking practical and relevant information in a comprehensive format.

A cutting-edge review of the fundamental biological principles underlying the more common inflammatory disorders of the nervous system. The authors provide extensive updates on the latest findings concerning the mechanisms of inflammation and introduce such new concepts and methodologies as "endothelial and leukocyte microparticles" and "gene microarray technology" to help explain important links between the central nervous system (CNS) and general inflammatory processes. Among the diseases examined from an inflammatory perspective are multiple sclerosis, acute disseminated encephalomyelitis, optic neuritis, transverse myelitis, CNS vasculitis, neuropsychiatric systemic lupus erythematosis, Alzheimer's disease, and Parkinson's disease. The role of the immune system in neuroinflammation is also explored in such disorders as neurosarcoidois, HIV-Associated dementia, and HTLV-associated neurological disorders.

A comprehensive, state-of-the-art contribution to a field that is rapidly developing, "The Behavioral Consequences of Stroke" provides a broad overview of the cognitive and neurobehavioral effects of stroke. As attention to paralysis and the more obvious physical disabilities stroke patients incur expands, greater attention is being paid today to the cognitive and neurobehavioral complications that impact stroke morbidity and even functional neurological recovery in patients. Written by an international panel of experts and edited by a neurosurgeon and by a cognitive neuroscientist, this unique title addresses the full range of issues relevant to the field, including epidemiology, general treatment, sensorimotor control after stroke, post-stroke aphasia, memory loss after stroke, post-stroke depression, the role of imaging after a stroke, and an update on some stroke clinical trials, to name just some of the areas covered.

Illuminative and an influential addition to the literature, "The Behavioral Consequences of Stroke" will serve as an invaluable resource for neurologsits, neurosurgeons, physiatrists and other physicians, as well as physical, speech and occupational therapists, nurses, psychologists, and other professionals. "

Cardiopulmonary Physical Therapy: Management and Case Studies, Second Edition is a unique and succinct textbook for the classroom that blends clinical notes on assessment and management together with case-based instructional approaches to cardiopulmonary care for acute and ambulatory care patients. This one-of-a-kind text describes current approaches that cover traditional physical therapist management strategies and includes evidence-based chapters on early mobilisation and exercise training on a wide range of cardiopulmonary patient groups. The updated Second Edition presents twenty-four cases that were designed to complement each chapter topic and represent the most common pulmonary, cardiac, and neurological conditions that are typically managed in cardiopulmonary care. These cases have been carefully selected and developed over several years to illustrate a spectrum of clinical issues essential for the preparation of the entry-level therapist. The very interactive nature of the case history approach is engaging and provides the opportunity to work through many of the steps of the clinical decision-making process. Cardiopulmonary Physical Therapy: Management and Case Studies, Second Edition also includes answer guides for the questions posed in the assessment and management chapters, as well as for the twenty-four cases. New in the Second Edition: Twenty-four carefully selected evidence-based cases designed to go "hand-in-hand" with chapter topics An international perspective that is relevant to physical therapy practice in several countriesDetailed chapter on non-invasive ventilation and mechanical ventilationSeveral chapters describe early mobilisation and exercise training for a range of cardiopulmonary patient groups including those admitted to an intensive care unitFaculty will benefit from the "Talk Me Through" PowerPoint slides, which provide a great opportunity for independent learning and complement classroom teaching The two-fold evidence and case-based learning approach used by Dr. W. Darlene Reid, Frank Chung, and Dr. Kylie Hill allows for a more engaging experience. The inclusion of interactive materials will allow students to learn and develop skills to prepare themselves for their professional transition while clinicians can use the text as a reference tool.

This volume contains selected works from the 25th Anniversary of the International Conference on Intracranial Pressure (ICP) held in Williamsburg, Virginia. The theme of the meeting was Intracranial Pressure and Neuromonitoring and focused on all the current state of the art brain monitoring methodologies and their application to brain injury. The brain monitoring techniques covered a wide spectrum from neurochemical monitoring of the injured brain to specialized techniques for assessing shunt function in normal pressure hydrocephalus. It also includes the most recent advances in monitoring of the brain oxygen levels using electrodes or the less invasive Near Infrared Sprectroscopy devices. Controversial issues regarding the management of ICP and CPP or both are also addressed and there are several works dealing with this topic. Of particular interest is the group of papers describing diagnosis and outcome in normal pressure hydrocephalus. It is the first compilation of papers which covers all the latest brain monitoring studies in both ischemia, trauma and hydrocephalus. The manuscripts in this volume have been selected from over 300 abstracts submitted to this international symposium. The abstracts are also published in order to provide the most comprehensive view of the progress made in brain injury research.

Ake Nygren Karolinska Institute, Sweden would like to welcome you on behalf of Karolinska Institute, I one of the organizers and initiators of this series of confer- ences on traffic safety. The conference we are opening today is the fourth in the series. Karolinska Institute is the largest medical university in Sweden. It is dedicated to improving health through research, educa- tion and dissemination of information and ideas. The series on traffic safety is one of the ways in which we are disseminating information and ideas on an international front. Karolinska Institute is 190 years old. The Medico Chirurgiska Institute was originally established in 1811 by royal decree after wars and cholera epidemics. In 1822, it became known by the name "Carolinska" . Amongst many other international endeavors, Karolinska Institute is perhaps best known for the nomination and appointments of Nobel Prize winners in medicine and physiology. Under the terms of Alfred Nobel's will, the prize winners are nominated and chosen by the Nobel Assembly of Karolinska Institute. During the hundred years that the prize has been in existence, several researchers from Karolinska Institute have become laureates. These are Hugo Theorell in 1955; Ragnar Granit in 1967; Ulf von Euler in 1970; and Sune Bergstrom and Bengt Samuelsson in 1982. In 1987, the medicine prize was awarded to Tonegawa from v Japan and in 1994 the literature prize was awarded to Oe Kenzaburo.

Infectious Complications in Transplant Patients has been uniquely designed and formatted to address issues and trends pertaining to pathogens deemed important in critically ill transplant patients. The chapters have been carefully selected so as to direct the focus of the book towards current approaches to controversial, emerging or topical problems in these patients. Each chapter has been authored by a North American and a European specialist. This format serves to impart an added dimension reflective of the diversity of opinions and practices pertaining to unresolved or controversial issues. The authors are recognized experts in their respective fields.

Individualized dosing regimens specific to the patient, infection, bacteria, and antibiotic can optimize outcome. Integration of pharmacokinetic and pharmacodynamic data, called dual individualization, can be accomplished through the use of AUIe. AUIC dosing has been shown to predict bacteriological outcomes, hasten clinical outcomes, reduce the emergence of resistance, and be cost-effective. MPC dosing has been shown to predict the emergence of resistant submutants. AUIC and MPC information can provide guidance as to when low doses can be used, and when higher concentrations are required. This strategy can ensure efficacy, minimize toxicity, reduce the opportunity for resistance to occur, and save money. REFERENCES I. Paladino JA. Streamlining antibiotic therapy: clinical application of pharmacokinetic and pharmacodynamic principles. J Osteopath Med 1991; 5: 16-25. 2. Liss RH, Batchelor FR. Economic evaluations of antibiotic use and resistance - a perspective: report of task force 6. Rev Infect Dis 1987; 9 (suppI3): S297-312. 3. Holmberg SO, Solomon SL, Blake PA. Health and economic impacts of antimicrobial resistance. Rev Infect Dis 1987; 9: 1065-78. 4. Sanders cc. Mechanisms responsible for cross-resistance and dichotomous resistance among the quinolones. Clin Infect Dis 2001; 32(Suppl I ):S 1-8. 5. Ballow CH, Schentag 11. Trends in antibiotic utilization and bacterial resistance: report of the NNRSG. Diagn Microbiol Infect Dis. 1992; 15(suppl):37S-42S. 6. Rice LB, Eckstein EC, DeVente J, Shlaes OM. Ceftazidime-resistant Klebsiella pneumoniae isolates recovered at the Cleveland Department of Veterans Affairs Medical Center. Clin Infect Dis 1996; 23: 118-24.

Autoimmune (IgG4-related) Pancreatitis and Cholangitis reviews the breadth of clinical, imaging, histological, laboratory, and imaging features associated with IgG4-associated systemic disease, especially AIP and IAC. Written by experts in their fields, each chapter includes an overview of existing data as well as the most up-to-date scientific information and emerging data. The book also addresses areas of uncertainty and controversy, briefly highlighting clinical and research needs relative to the respective topic. Comprehensive and easy to use, Autoimmune (IgG4-related) Pancreatitis and Cholangitis is a valuable resource for physicians who deal with or are interested in these complex disease processes, including gastroenterologists, hepatologists, and surgeons.

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.

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.

Drug dosage in renal insufficiency has become an toxication. In 1975, his Poison Index was pub important facet of nephrology, a subspeciality of lished, first in German, and two years later in internal medicine which is only 30 years young but English, with supplements in 1979 and 1983. This constantly growing in scope and importance. Two volume has become an obligatory reference in more thirds of all drugs are partially, mainly, or exclu than 2500 dialysis units. sively excreted by the kidneys. In the presence of Based on GOnter Seyffart's experience and renal insufficiency, dose adjustments are therefore knowledge in this field, the plans for this book obligatory. In patients on dialysis, drug elimination matured in 1984, a logical step in view of his by this route must also be considered. untiring effort and diligence. In order to deal with As the reader of this book will discover, 20 more than 1200 different drugs and almost 4000 percent of currently used drugs are contraindicated references, 21 contributors were sollicited, while it where there is any degree of renal insufficiency, took six years to complete the work. The major and for at least another 60 percent a dose reduc share of the effort was thus left to the main author tion is required. It is obvious, therefore, that the and editor and he has produced a concise work of detailed knowledge required can never be com impressive clarity.

Information is provided from the basic and clinical sciences on the mechanisms damaging the brain from trauma or ischemia. New aspects involve the endoplasmic reticulum, mitochondrial failure, pathobiology of axonal injury, molecular signals activating glial elements, or the emerging therapeutical role of neurotrophins. Experimental issues involve a better analysis of the ischemic penumbra, the salvagable tissue. Therapeutic contributions reach from the environmental influence to gene expression, including neuroprotection, such as hibernation - mother nature's experiment - or hypothermia which is reported to induce cell swelling. Treatment issues deal also with thrombolysis and combination therapies, or with the clearance of adverse blood components - LDL/fibrinogen - by a novel procedure using heparin. Other highlights are discussing the specificities of pediatric vs. adult brain trauma, or the evolving role of the Apolipoprotein-E e4 gene in severe head injury. An update is also provided on an online assessment of the patient management during the pre- and early hospital phase in Southern Bavaria. The empirical observation of neuroworsening is analyzed in further details, whether this is a specificity autonomously driving the posttraumatic course. Finally, the unsolved question why drug trials in severe head injury have failed so far in view of the promising evidence from the laboratory is subjected to an expert analysis.

Much research over the past 30 to 40 years has shown that the inflammatory response, while critical for host defense during microbial infection, may itself play a central role in the pathogenesis of sepsis. Although key mediators responsible for this injury have been identified, efforts clinically to augment our conventional antimicrobial and supportive therapies during sepsis with agents modulating the inflammatory response have been unsuccessful. As a result, the mortality associated with this lethal syndrome, especially when complicated by shock, has remained persistently high. Unfortunately, during this same period of time, the incidence of sepsis has accelerated as other fields of medicine have relied increasingly on therapies that predispose to infection. While frustrating, overall this experience in the field of sepsis has not been without value. Most importantly, it has helped define on several different levels the complexity of the septic patient. Recognizing and addressing this complexity as discussed by each of the contributors to Evolving Concepts in Sepsis and Septic Shock may now provide new inroads into the treatment of sepsis.

The international interdisciplinary gathering of top of secondary brain damage in brain trauma, as ac- level clinical and laboratory scientists in Mauls, Italy knowledged from the beginning of these workshops in has developed from its beginning in 1984into a fruitful Mauls, the significance of inflammation is all but clear. tradition where worldwide experts active and knowl- Although inflammatory phenomena are seen in trauma edgeable in cerebral ischemia and trauma convene for and ischemia ofthe brain, as activation ofwhite blood update and exchanges of their most recent clinical and cells with emigration into the tissue presumably en- experimental findings and concepts. These meetings hancing damage, inflammatory cells may have benefi- have, of course, experienced shifts in emphasis from cial properties as well. Thechapter on the Janus-faceof the past until now, corresponding to the most actual inflammation isanalyzing this ambiguity. developments, which were fascinating clinicians and The exploration of novel cell-biological mechanisms laboratory scientists alike. The current Supplement of on a molecular or more systemic basis causing apop- Acta Neurochirurgica is an example in case. Its virtue totic cell death, inflammation, or regeneration, provide as before is that authors contribute articles in a review- useful objectives for therapeutical interventions ex- like manner on their own field of research, according pected to be more specific than the present treatment to the platform presentations at the meeting as indis- modalities.

The small neck of the aneurysm afforded an easy surgical attack. An ordinary flat silver clip was placed over the sac and tightly compressed obliterated it completely. The clip was flush with the wall of the carotid artery. The sac, lateral to the silver clip, was then picked up with the forceps and thrombosed by the electocautery. Walter Dandy reporting his successful operation of a posterior communicating aneurysm on March 23, 1937. Walter Dandy's patient left the hospital in good health 2 weeks later, and from his report one may gain the impression that the operation was an easy task. Despite continuous developments during the following decades, it was not until the introduction of the operating microscope and microsurgical techniques that surgical treatment was generally accepted. During the microsurgical era surgical results have continued to improve due to diagnostical, neuroanaesthesi ological, and microsurgical refinements, and improved neurointensive care. Endovascular obliteration has become an important treatment alternative but this has not been included in this particular volume. The purpose of the present supplement of the ACTA NEUROCHIRURGICA is to review some of the elements in the neurosurgical management of patients with aneurysmal subarachnoid haemorrhage that are important for a successful outcome. Professor Helge Nornes has been a major force in the development of new techniques and research strategies in this area for a number of years and has recently retired from the National Hospital in Oslo."

Transmediastinal gunshot injuries present the risk of immediately life threatening injuries. Stable patients have been evaluated by a combination of esophageal swallow and endoscopy, aortography and bronchoscopy. There is an increasing trend favoring CT scan. Unstable patients require immediate exploration, being prepared to enter both hemi-thoraces. Selected References: * Bergsland J, Karamanoukian HL, Soltoski PR, Salerno TA. Single suture forcircumflex exposure in coronary artery bypass grafting. Ann Thorac Surg.1999;68: 1428-1430. * Fedalen PA, Bard MR, Piacentino V, et al. Intraluminal shunt placement and off- pump coronary revascularization for coronary artery stab wound. J Trauma 200 1;50: 133-135 * Hanpeter DE, Demetriades D, Asensio JA, Berne TV, Velmahos G, Murraygunshot wounds. J Trauma 2000;49(4):689-695. * MacPherson D. Bullet Penetration: Modeling the dynamics and the incapacitation resulting from wound trauma. Ballistics Publications, EI Segundo, CA, 1994 * Wall MJ, Soltero E. Damage control for thoracic injuries, Surg Clin North AmI997;77(4):863-878. * Rozycki GS, Feliciano DV, Oschner MG, Knudson MM, Hoyt DB, Davis F, Hammerman D, Figueredo V, Harviel JD, Han DC, Schmidt JA. The role ofUltrasound in patients with possible penetrating cardiac wounds: aProspective multicenter study. J Trauma 1999; 46(4):543-552. * Roussseau H, Soula P, Bui B, D'Othee BJ, Massabuau P, Meites G, Concina P,Mazzerolles M, Joffre F, Otal P. Delayed treatment of traumatic ruptureof the thoracic aorta with endoluminal covered stent. Circulation 1999 Feb2; 99(4): 498-504.

At the Sixth Wiggers Bernard Conference, a group of scientists from various disciplines discussed new findings relating to nitric oxide synthase inhibitor in shock, sepsis, and organ failure. Dedicated to the presentation and discussion of both positive and negative findings related to the use of NOS inhibitors, the meeting served as a forum for issues relating to specific and non-specific inhibitors, as well as the role of nitric oxide-oxygen radical interactions. Both experimental and clinical data were presented in the trauma and sepsis field.

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.