Assessing Chronic Pain offers a unique approach to the evaluation and assessment of treatment for chronic pain patients. Rather than adhering to the criteria of any one discipline's approach to treating chronic pain, whether that of anesthesia, physical therapy, psychiatry or psychology, the editors overview a range of disciplines, and focus on the integration of those approaches to achieve what they term a "handbook," rather than a textbook, for the assessment of chronic pain from a multidisciplinary perspective. Issues confronting clinicians have been compounded by procedural problems and assessment indecision, but in Assessing Chronic Pain, Drs. Camic and Brown create a framework to guide specialists in all fields in approaching the patient suffering from chronic, non-malignant pain.

Our present understanding of the psychosocial aspects of pain in children is reviewed in this monograph by leading scientists and practitioners. The contributions are integrated within a developmental perspective to provide an introduction to the conceptual and methodological tools necessary for comprehension of new work in the field. This volume offers a survey of major new developments in the area of pediatric pain and points out the directions in which clinical work and conceptualization are moving. Children in Pain argues consistently and persuasively that both models of pain assessment, intervention techniques, and research designs must demonstrate a sophisticated appreciation for developmental considerations. Topics explored include assessment of pediatric pain; coping and adaptation in children's pain; developmental issues among infants and toddlers and among preschool and school-age children, as well as among adolescents; recurrent abdominal pain; burn injury and treatment; chronic and recurrent pain in hemophilia, juvenile rheumatoid arthritis and sickle cell disease; developmental aspects of the biobehavioral treatment of migraine in childhood; and helping children cope with painful medical procedures.

The science of neuroanaesthesia and neurointensive care is fascinating, and the amounts of experimental and clinical studies are overwhelming. Surely, everyone can surf Medline and other database systems in order to get information. If you, however, ask for head injury, cerebral ischaemia or barbiturate, you will get hun dreds, may be thousands of titles and even the same number of abstracts. The aims of this book are to review important experimental and clinical data with emphasis on up-dated references. The text within each issue and sub-issue systematically covers experimental and clinical data separately, and details con cerning cerebral blood flow, cerebral metabolism, intracranial pressure etc. are reviewed accordingly. In our survey of the literature we did not use Medline or other database sys tems systematically. Rather, we used available medical journals which covered the topics of anaesthesia, neuroanaesthesia and neurointensive care. In this way we hope that relevant literature is presented. On the other hand, we cannot exclude that some important issues are omitted. The book covers 12 topics. In three chapters methodology of CBF measure ments, regulation of CBF, and intracranial pressure are described. In the next 6 chapters inhalation anaesthetics, hypnotic agents, analgesics, muscular relaxants, drugs used for control of blood pressure, and the sitting position are reviewed. The last three chapters cover head injury, subarachnoid haemorrhage and cere bral ischaemia."

Chronic and persistent pain, which is a problem for the individual who suffers and the society that has to deal with it, has become increasingly appreciated. Over the last three decades, several books and journals have been specifically devoted to the topic of pain, especially chronic and persistent pain. It has been increasingly recognized that chronic and persistent pain, unlike acute pain, involves significant psychosocial factors and requires treatment strategies that deal with these issues. All measurements and factors that affect improvement seem to be in the psychosocial area rather than the medical/ biological/physical areas. Psychosocial conveys the importance of the environmental and interpersonal factors of the patient's functioning. The writing of this book has brought together some of the leading researchers and clinicians in the area of managing the patient with chronic pain. The authors express their opinions based on experience and review of the literature available to date. Each of the chapters focuses on an important element of the assessment and/or treatment intervention utilized for the individual with chronic pain. The concluding chapter summarizes the status of the assessment and treatment strategies for those patients.

This volume represents a review of recent work presented by eminent scientists at the Second International Symposium on 'Applied Physiology in Critical Care with Emphasis on Children' at Aruba, Netherlands Antilles, November 28 - 2 December, 1983. We are grateful to the keynote speakers who accepted our invitation and completed their chapters in time for the press. I must thank the Government of Aruba, the Tourist Office of Aruba, Mr Frank Croes and Mr Betico Croes for their support and generosity for organizing this symposium. My sincere thanks go to Mr Rory Arends, Lucy Arends, Simon Meij and Norma van Toornburg for their untiring efforts and cooperation. Omar Prakash, MD IX List of contributors Bryan, A.Ch., MB, BS, PhD, FRCP (C), The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8 Bryan, H., MD, Department of Pediatrics, Room 1241, Mount Sinai Hospital and The Hospital for Sick Children, University of Toronto, Ontario, Canada M5G 1X5 co-authors: A.L. Campbell, Y. Zarfin, M. Groenveld, P. Duffty Enhorning, G., MD, University of Toronto, Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario, Canada M5T 2S8 Gross, I., MD, Perinatal Medicine, Yale University School of Medicine, P.O.

B. Raymond Fink Sheldon Roth and Keith Miller have asked me to record that the Third Conference on Molecular and Cellular Mechanisms of Anesthesia was held in Calgary last May "in my honor. " Such was my dear friends' gracious way of continuing a series that began at the University of Washington, where I hosted two, four, or five previous ones, 1,3-6 depending 2 on how far back one wishes to count. At that, Seattle took up where Paris left off in 1951. These occasions create their own unforgettable memories. This book captures the fine, invigorating ambience of the University of Calgary and the exciting explorations and com panionship of a gathering in a frontier territory of neuroscience. So, floreant symposia. They have progressively refined the quarry, from pathway to synapse to lipoprotein membrane to receptor and single channel, in heuristic convergences of neuronal physiology, biochemistry, and pharmacology. Nevertheless, the anesthesiologist in me senses a certain disquiet, a certain claustrophobia provoked by the narrow confines of micropipettes. How much more tubular must tunnel vision become before the desired broad view emerges? At present, the advances in molecular neurobiology seem continually to increase the apparent complexity of the total problem and the conceptual distance between the reductionists in the laboratories and the holists in the operating rooms. Happily, what is also growing is the excitement in trying to bridge the gap. Perhaps it would be timely to regard general anesthesia not as a state but as a syndrome."

The first two "Brain Heart Conferences" in Jerusalem in 1978 and 1983 were based upon the common interests of clinically orientated neurologists and cardiologists in the problems of centr'al autonomic control and autonomic disturbances of the cardiovascular system. The relatively slow scientific progress, at least clinically, in this area may be due to the fact that neither cardiologists nor neurologists felt competent in both topics. Furthermore, it has become increasingly difficult to have an overall view of the basic research and its clinical applications in this field. New research methods, based on a comtination of morphological, biochemical, and physiological techniques, have enabled the functional differentiation of various areas of the brain and subsequently also of the autonomic nervous system. The simple dualistic concept of an antagonistic sympathetic-parasympathetic regulation of the circulatory system is no longer valid. It is clear that numerous neurotransmitters, in particular the neuropeptides, are involved in a highly differentiated subdivision of the autonomic system. One of the aims of the IIIrd International Brain Heart Conference was therefore to supply a synopsis of the latest developments in basic research undertaken in this field by exceptionally competent scientists, to clinically orientated neurologists and cardiologists, and thus to provide new impulses for clinical research.

Intensive Care Medicine has been continuously growing and expanding, culturally, technically and geographically. Monitoring and instrumentation are continuously improving and more and more hospitals are getting Intensive Care facilities. The costs have proportionally increased over the years, so that ICUs represent today a major cost for health structures. Since the available resources are limited, a real need is emerging to set the limits and indications of Intensive Care. It is understood that the problem not only involves medical considerations, but also ethical and economical aspects of the utmost importance. For the first time in Europe, this book edited by Reis Miranda and his colleagues tackles systematically the many structural aspects of the European Intensive Care. The organisation and financing of health care in the Old Continent is deeply different from the American one, and the results and consequent proposals obtained in the USA cannot simply be transferred to this side of the Atlantic Ocean. Weare extremely pleased to welcome this first European attempt to discuss the Intensive Care problem. It lays no claims to giving definite replies in a continuously developing field, but it will surely become the basis for future discussions and proposals. I am particularly happy that this work has mainly developed within the European Society of Intensive Care, whose final target is to ensure a common standard of therapy in our old Europe, beyond national differences. We warmly congratulate the authors, and I am sure that their work will find wide diffusion and consent.

On 15 November 1997, the first international symposium "Neural and Chemical Control of Breathing: Pharmacological and Clinical Aspects" was held at Leiden University Medical Center on the occasion of the retirement of one of the members of the Control of Breathing Research Group of the Departments of Physiology and Anesthesiology, Dr. Aad Berkenbosch. Among others, Dr. Berkenbosch, played an important role in this research group, which made a large and significant contribution to scientific research on the regulation of breathing. This book presents the proceedings of that meeting together with papers of several authors who have strong bonds with the Leiden Departments of Physiology and Anesthesiology. All studies represent state of the art work on the subject of respiratory control and cardiovascular medicine, with emphasis on the physiological, pharmacological and anesthesiological aspects of both fields. The book is divided in several sections: Oxygen Physiology. Prof. John Severinghaus presents among other things his ideas on oxygen sensing and high altitude related diseases. Prof. Honda gives results from studies in a unique set of subjects without carotid bodies. The findings of Honda's group support the idea that an intact hypoxic drive from the carotid bodies is necessary for the generation of central hypoxic depression. Dr. Hans van Beek discusses the effects of hypoxia and hypercapnia on cardiac contractility in animal models. Prof. Oeseburg demonstrates the feasibility of Near Infra Red Oximetry for monitoring tissue oxygenation in patients. Central Chemoreception.

During the last decade a multitude of studies concerning the dynamic changes in cerebral blood flow (CBF), cerebral metabolic rate of oxygen (CMRO2), and intracranial pressure (ICP) in the acute phase after head injury have been published. These studies have been supplemented with studies of cerebral autoregulation, CO2 reactivity and barbiturate reactivity. Other investigations include studies of cerebrospinal fluid pH, bicarbonate, lactate and pyruvate. In this book experimental and clinical studies of the dynamic changes in CBF, CMRO2, CO2 reactivity and barbiturate reactivity are reviewed. The author's own clinical studies of the dynamic changes in CBF and cerebral metabolism are summarized and discussed, and the therapeutical implication as regards the use of artificial hyperventilation, sedation with barbiturate and mannitol treatment are discussed.

The Manual of Geriatric Anesthesia is a practical guide for physicians, residents, and students interested in the care of the elderly patient undergoing surgery. Although primarily written for anesthesiologists, other perioperative physicians and nurses will also find the information highly valuable. Highlights of the text include concise and clear discussions of preoperative assessment, anesthetic administration, the immediate postoperative care, as well as the more classic 'geriatric' topics such as the hip fracture patient, cataract surgery, postoperative delirium, dementia, ethics and end of life care. Clinical geriatric principles are woven into the text so that the reader can develop skills in geriatrics and develop a broader understanding of terminology and principles used in geriatric medicine.

Pelvic pain in the female patient is common in gynaecological practice, but the specialties of general surgery, urology and orthopaedics provide a significant number of patients and problems. These patients may suffer a multitude of symptoms, and only careful analysis and investigation of each individual problem by the doctor concerned will lead to correct diagnosis and management. The subject matter of this book lies in the practice of many specialties, and all are combined here in a coherent whole. This emphasises the close collaboration necessary between family practitioners, junior hospital staff and consultants. The authors are consultants who work together in a busy district general hospital, and their experience and collaboration is evident in the approach to the diagnosis and management of pelvic pain in the female. Emphasis is laid on the careful evaluation of history and examination and the correct interpretation of diagnostic investigations. Full details of radiology, ultrasound scanning, endoscopy, peritoneoscopy and bacteriological investigation are given. Full consultation between members of staff who have special experience in these investigative procedures is of paramount importance. Details of treatment for relief of pain are important to all doctors concerned with this aspect of clinical management. and this section will be of particular value. The blending of these specialties allows full consideration of the problems affecting the patients. Careful management leads to better treatment for the patient and better satisfaction for the doctor.

It has been estimated that 60 million Americans suffer from pain. There has been an explosion in pain research, new pharmaceuticals, the recognition of complementary and alternative therapies, interventional techniques and surgery, professional pain societies and providers with expertise in pain management. The most common condition seen in primary care settings and in pain clinics is lower back pain. Several studies indicate that primary care providers feel ill-prepared to deal with pain issues. Back and neck pain, myofascial pain, whiplash and fibromyalgia are particularly challenging and troublesome for this group. There are multiple reasons for this discomfort, including lack of training, absence of guidelines, concerns about addiction risk and many other issues. As part of the Oxford American Pain Library, this practical handbook is designed to serve as a concise yet authoritative resource on diagnosing and treating back and neck pain. Co-authored by two primary care physicians and a nurse practitioner with extensive expertise in pain medicine and management, the book is tailored to the needs of busy health care professionals treating patients in the primary care setting, and focuses on essential clinical information for physicians, nurse practitioners, and physician assistants in family practice, and internal medicine. In addition to covering all aspects of diagnosis, treatment-both pharmacological and non-pharmacological, and ongoing management of back and neck pain, the handbook also features a section dedicated to similar conditions of myofascial pain, whiplash and fibromyalgia. In addition to covering traditional clinical areas such as pathogenesis, co-morbidities, pharmacologic and non-pharmacologic treatments, the book also presents an array of practical tools and features such as screening tools for easy diagnosis, disability assessment tools, tips on best questions to ask, useful checklists and additional patient resource information. The pocket-sized format, concise chapters, multiple charts and graphs and bulleted highlights are ideal for all providers needing a quick, easily accessible, portable reference on back and neck pain.

Migraine is a debilitating disorder, it is essential that it is diagnosed accurately and swiftly in patients. This book covers, in-depth, the key diagnostic criteria and treatments that pediatricians and other primary care providers must be aware of in order to treat pediatric migraine effectively.

Written by an expert on the subject of pediatric migraine/headache
A refresher for GPs and hospital doctors with practical diagnostic and treatment advice
Reviews clinical developments and guidelines, and places them into everyday clinical practice
Stresses the importance of early intervention, therapies and patient education
Concise but comprehensive"

"A Quick Reference Text" Easy to read and practical in design, Neurocritical Care is the book specialists will turn to for quick reference. It concentrates on management problems, from diagnostic procedures to therapeutic strategies. Exact descriptions are given for treatment procedures, and it is easy to find the appropriate treatment for a given patient. "International Expertise" More than 100 authors from North America have contributed to the book. The different strategies used on either side of the Atlantic have been described, the sections on neuroimaging have been reviewed by a neuroradiologist. "Comprehensive in Scope" Both frequent and rare neurological diseases that may require critical care treatment and subjects of more general interest such as monitoring strategies, ethical problems, brain death and neurological disorders in internal medicine have been covered. Pathophysiology is also discussed, insomuch as it is important for understanding the treatment strategies.

Following an introduction to the philosophical and theoreti- cal background of traditional Chinese medicine, the dia- gnostic system is presented: the Chinese system of channels and functional organs, the significance of pointsand point categories, methods of needling and moxibustion. There is a chapter on treatment based on western diagnosis.

Neurological, neurovegetative, and psychic changes following surgery or in tensive care indicate alterations in cerebral function. When these changes are analyzed exactly, they are found to be by no means rare; at the same time, they present a wide spectrum of clinical manifestations. While optimal circulatory monitoring - including continuous EEG recording during anes thesia or intensive care - is today regarded as routine, the problem of objec tive and continuous monitoring of cerebral function under various forms of anesthesia, surgery, and intensive care has not been solved. Considerable improvements in clinical neurophysiology, mainly through visual and spectral analytic evaluations of the EEG, show func tional neurophysiological changes to be equivalent to, or the cause of, clinical, neurological, and psychic changes. The question of current interest, therefore, is whether anesthesiological EEG monitoring is able, both theo retically and practically, to detect and adequately interpret cerebral altera tions following perioperative measures such that these alterations can be treated or avoided accordingly. In the long run, the basic questions are to what extent can anesthesiological measures be guided by the EEG pattern and managed effectively, and can EEG analysis be significant both for the individual patient and in the general interpretation of the effect of anes thesiological procedures? Questions of the relevance and practicability of anesthesiological EEG monitoring are dealt with in this book. This study is based on an analysis of more than 1500 EEGs of patients who underwent anesthesia during surgery."

Before the late 1970s, interest in caffeine among both the general public and the scientific community was at a relatively low level for many years, even though it was recognized that caffeine was an al most universal component of the diet. The National Coffee Associa tion was supporting a continuing program of research, some re search was being conducted by a few of the largest companies selling coffee, and an occasional university researcher became inter ested in caffeine and conducted experiments, often on effects of caf feine in very high concentration in vitro on skeletal muscle fibres or on dividing cells. Since 1978, however, there has been a mighty up surge in both public and scientific interest in caffeine. It is interest ing to note that this was prompted not by discovery of hitherto un known effects or hazards of caffeine, but by the actions of a regulatory agency, the Food & Drug Administration (FDA) of the U. S. Public Health Service. The U. S. Congress passed new laws on foods and drugs in 1958. One of the provisions was for testing of food additives to assess risk to health. As it was clearly impracticable to require immediate test ing of all additives already in use, a list was drawn up of some hun dreds of additives that were generally recognized as safe (GRAS)."

The primary mission of the medical school is to create new doctors. Once the medical student has received his or her doctorate, the medical school's interest in, and acceptance of, responsibility for the continued professional development of the physician ceases almost entirely. Yet, with scientific advances in medicine increasing exponentially and the inevitable erosion of memory with time, teachings from our schools of medicine become increasingly irrelevant, forgotten, or both. To maintain competence, the physician must continuously re-educate him- or herself. CME-Continuing Medical Education-will probably never attain the status of the medical school's degree-granting undergraduate program, but medical schools and their faculties must recognize their responsibility, not creating competent physicians but also for maintaining that com only for petence. is the product of a Continuing Medical Education program This volume initiated by the Department of Anesthesiology at the Albert Einstein Col lege of Medicine/Montefiore Medical Center. Our Department of Anes thesiology has historically been, and continues to be, unusually active in post-doctoral education through regional and national conferences and symposia. We recognized, however, that programs that bring physicians together in one location for a limited menu of lectures, questions, and discussion reach only a fraction of the potential audience of anesthesiolo gists. Such programs, as valuable as they are, by their very structure exclude more anesthesiologists than they include."

The peerless authority you trust...the portability you need! This practical handbook covers all of the most critical, clinically relevant topics from Stoelting's Anesthesia and Coexisting Disease, 5th Edition in a format suitable for a quick-reference guide you can carry in your coat pocket. The new edition presents the results of the latest clinical trials to help you make the most effective clinical decisions, while new illustrations aid in clarifying complex concepts. You'll have convenient access to dependable guidance on a full range of pre-existing conditions that may impact the perioperative management of surgical patients. Find the information you need easily with abundant tables throughout, a quick-reference outline format, and the same organization as Stoelting's Anesthesia and Co-Existing Disease. Confidently meet the needs of special patient populations such as pediatric and geriatric patients. Quickly access new guidelines on hot topics such as management of the morbidly obese patient. Make effective clinical decisions with access to current practice guidelines and results of the latest clinical trials.

Theodore H. Stanley, M. D. Anesthesiology and the Heart contains the Refresher Course manuscripts of the presentations of the 35th Annual Postgraduate Course in Anesthesiology which took place at The Cliff Conference Center in Snowbird, Utah, February 16-20, 1990. The chapters reflect new data and concepts within the general framework of "evaluating myocardial function," "pharmacology and the cardiac patient," "anesthesia for patients with cardiac disease," and "stress, cardiopulmonary bypass, coagulation problems and related issues. " The purposes of the textbook are to 1) act as a reference for the anesthesiologists attending the meeting, and 2) serve as a vehicle to bring many of the latest concepts in anesthesiology to others within a short time of the formal presentation. Each chapter is a brief but sharply focused glimpse of the interests in anesthesia expressed at the conference. This book and its chapters should not be considered complete treatises on the subjects addressed but rather attempts to summarize the most salient points. This textbook is the eighth in a continuing series documenting the proceedings of the Postgraduate Course in Salt Lake City. We hope that this and the past and future volumes reflect the rapid and continuing evolution of anesthesiology in the late twentieth century. vii LIST OF CoNTIUBUTDRS Bailey, P. L. Department of Anesthesiology, The University of Utah School of Medicine, Salt Lake City, UT 84132, U. S. A. Barash, P. Department of Anesthesiology, Yale University School of Medicine, New Haven, CT 06510, U. S. A. Covino, B. G.

Despite the progress that has been made in intensive care medicine, sepsis and septic shock are still accompanied by a high mortality rate. In recent years, new therapeutic approaches have been developed on the basis of a better understanding of this complex condition. This monograph contains contributions by well-known scientists and clinicians in the fields of hygienics, microbiology, infectious diseases, physiology, surgery and intensive care medicine. It provides an up-to-date overview of the etiology, pathophysiology, prevention, and therapy of sepsis and its complications.

Concise, recent data are presented on obstetric problems arising in patients with cardiovascular diseases (not only congenital and acquired valvular heart diseases and hypertension, but also uncommon heart lesions) and on cardiological complications encountered in pregnant women. The goal of the book is to provide obstetricians with necessary cardiological information and cardiologists with essential obstetric information to enable both specialists to make optimal decisions regarding the permissibility of pregnancy, management of pregnancy and labour, or termination of pregnancy, and selection of an adequate form of contraception in women with heart and vascular diseases. Along with recent scientific findings, the book contains practical recommendations for examination diagnosis and treatment that is effective for the mother and safe for the fetus.

The number of studies on chronic and recurrent pain bears no relation to the frequency of these complaints in gynecologic practice, nor to the clinical and scientific problems that still need solving in this area. Several factors stand in the way of progress in this field, such as the strongly subjective nature of the complaints, the frequent lack of correlation between them and objective findings, and the complexity of the psychosomatic interac tions involved. Although progress in our knowledge has been much slower than we would have wished, and although we are well aware of these many gaps, it was considered useful to gather in a book what we think we have learned during 3 decades of active interest in pain patients and pain problems in gynecologic practice and 12 years of supervision of a pain clinic in the Department of Obstetrics and Gynecology of Leuven University. As there are many differences between acute pain - clinical as well as experi mental - on the one hand and chronic pain symptoms on the other, it was felt preferable to limit the scope of this book essentially to chronic and recurrent pain in gynecologic practice. When presented with a complaint of lower abdominal and/or low back pain, the gynecologist should constantly be on the lookout for nongynecologic causes, of which the most frequent will be either gastroenterologic or orthopedic and sometimes urologic. I have been fortunate in obtaining the collaboration of Dr."

This important book fills a need in the developing area of Pain Medicine. It provides physicians with an up-to-date resource that details the current understanding about the basic science underlying the mechanism of action of the various CAM therapies used for pain. It summarizes the clinical evidence both for efficacy and safety, and finishes with practical guidelines about how such treatments could be successfully and safely integrated into a Pain practice.