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.

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.

This book is based on the proceedings of a conference held in Tubingen, West Germany, in 1981, at which anesthesiologists, neuro surgeons, pathologists and neurophysiologists met to consider the place of controlled hypotension in neurosurgery. In the first part of the book alternative methods of inducing hypotension are considered, and it is important to emphasize that the techniques which are suitable for neurosurgery may not be so for other types of surgery, and vice versa. In neurosurgery, and par ticularly in aneurysm surgery, the emphasis is on lowering intra luminal pressure and not mainly on reducing blood flow or limiting tissue oozing. Another special consideration in neurosurgery is the influence of drugs used to induce hypotension on intracranial pressure, with nitroprusside (NTP), and especially nitroglycerine, increasing ICP in the closed skull and increasing brain "bulk" when the skull is open. These and other points are extensively covered. The use of a non-essential technique like controlled hypotension demands that the procedure should carry minimal risk to the patient. Contributions in part IV consider the neuropathology associated with too severe a lowering of oxygen supply through hypotension. In the clinical avoidance of such ischemic changes in individual patients, monitoring of the brain electrical function is much the most import ant and practical approach and is discussed in part III. The Editors hope that the publication of these contributions to the Tubingen Symposium will help in the effective and safe appli cation of the technique of controlled hypotension in neurosurgery."

Pain is a symptom of many clinical disorders, afflicts a large proportion of the population and is largely treated by pharmacological means. However, the two main classes of drugs used are the opioids and the non-steroidal anti inflammatory drugs, drugs that have a long history. The last decade has seen remarkable advances in our understanding of some of the pharmacological bases of pain and analgesia and this book aims to reflect these rapid changes in our understanding of pain mechanisms. One impetus to these scientific advances has been dialogue and interactions between scientists and clinicians; as a result we now has a number of animal models of clinical pain states, to mimic certain aspects of clinical pathophysiological pain states. Molecular aspects of receptors and the synthesis of tools for probing receptor function have also been rapid growth areas. A number of controlled clinical studies using novel licensed drugs have also resulted from recent research, offering hope to certain patients with severe intractable pain. However, we desperately need the pharmaceutical industry to develop new drugs based on these novel targets for analgesic therapy. This book attempts to provide an overview of the important areas of the pharmacology of pain. This book, although providing an account of the pharmacology of pain transmission and its control based on the underlying anatomical organization and physiological responses, does not attempt to cover these latter two areas."

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.

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.

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.

Contrary to common belief, infectious diseases are not as well under control as we would like. We are now at a crossroads regarding the impact of the environment on infectious diseases. Renewed interest in biological weapons and the emergence of new pathogens, coupled with a better understanding of the impact of infectious agents on other conventional diseases, has led us to realise that we can no longer remain complacent about the impact of infectious agents on human, animal and crop health. The present book first discusses current and emerging military and civilian policies on the environment. In addition, the impact of environmental biology on the future of space exploration is discussed, especially in reference to the Mars mission. There follows a discussion of the state of bacteria in the environment, with a presentation of current and emerging techniques of microbial investigation. Finally, two case studies are presented on the impact of these techniques on both political and environmental problems.

Patients with pain disorders pose many clinical challenges for the attending physician. Even experienced clinicians occasionally arrive at the point where diagnostic, work-up, treatment, or prognostic thinking becomes blocked.
Pain teaches the reader to recognize and appropriately treat a variety of pain disorders using a case study format. Divided into three section, chronic pain conditions, chronic pain and related disorders, and treatment overview, and derived from consultation requests from providers in medical practice, the cases are written in a format that encourages the reader to formulate a differential diagnosis and treatment plan for a variety of pain problems. Succinct in its presentation and logical in its layout, Pain is the perfect resource for the busy practitioner on the go.

Your awareness of uncommon diseases and possible complications is vital to successful anesthetic patient management. Anesthesia and Uncommon Diseases, 6th Edition, brings you up to date with new information on less commonly seen diseases and conditions, including the latest evidence and management guidelines. This unique medical reference book is essential for a complete understanding of today's best options and potential difficulties in anesthesia. Improve your ability to successfully manage every patient, including those with rare diseases or conditions. Avoid complications with unique coverage of an important aspect of anesthetic management. Access the complete contents and illustrations online at www.expertconsult.com - fully searchable! Stay current with all-new chapters on adult congenital heart disease, rheumatic diseases, and the cancer patient, plus many more revisions throughout. Get outstanding visual guidance with hundreds of illustrations, now in full color. Understand uncommon diseases to avoid anesthetic complications!

Georg Rodewald University of Hamburg Hamburg, Federal Republic of Germany Allen E. Willner Hillside Hospital Glen Oaks, NY In contrast to the initial years of cardiac surgery (37 years ago), there is now increasing interest in cerebral protection. Rodewald [1] in 1978 was among the first to point out the surgeon's concern with "psychopathological problems" and Taylor [2] in 1989 stressed that" *** the awareness of the cerebral consequences of open heart surgery has risen considerably in recent years * * * " This book reviews the evidence for neurological, psychological, and neuropsycho logical reactions to cardiac surgery. In previous studies one problem is that small samples of patients were studied with different measuring instruments so that it was difficult to ma~e sense of inconsistent findings. Considerable controversy resulted with little ability to sort out discrepant findings. It appeared that a large multi center study using uniform measures might help clarify the picture.

Essentials of Pain Management is a concise, evidence-based guide that stresses a multidisciplinary approach to pain and provides a thorough review of clinical principles and procedures. Edited by faculty from Yale and Harvard Medical Schools, Essentials provides a practical approach to pain management for every type of pain management practitioner. Features: * Extensive case vignettes illustrating specific pain management challenges and solutions * Multiple-choice questions with detailed answers useful for exam preparation * In-depth discussions of palliative medicine, end-of- life care, physical therapy and acupuncture, behavioral therapy, and pediatric and elderly pain * A formulary of commonly used drugs for an easy go-to reference for every office * Special considerations for nurses and dentists From career choices in pain management to the specific drugs, procedures, and therapies that can alleviate pain, Essentials of Pain Management is a valuable resource for all pain management practitioners.

The Objective Structured Clinical Examination (OSCE) is a highly reliable and valid tool for the evaluation of trainees in anaesthesia. It enables examiners and trainers to assess a number of competencies in an organised way. Performance in the OSCE is considered to be a fair reflection of the level of knowledge and skill attained during anaesthesia training. Apart from having a wide and deep knowledge on the subject, trainees are expected to have the capacity to demonstrate their competency in a short period of time allotted for each station. The authors of this book have a rich experience in successfully conducting OSCE courses in the United Kingdom. The sample OSCE sets in the book closely simulate the style and content of the Royal College of Anaesthetists' examination format. The book contains 100 OSCE stations with answers based on key practical procedures, clinical skills, communication skills, data interpretation, anaesthetic equipment and the management of critical incidents on a simulator. The answers are presented thoroughly and clearly. The tutorial on the relevant topic and additional key points at the end of each station, together with more than 100 illustrations throughout the book will complement the reader's overall understanding. The marking system signifies the relevance of each question, enabling objective assessment of knowledge and practical skills. This book will also help candidates all over the world to pass highly competitive postgraduate examinations in anaesthesia. It is an invaluable educational resource for all anaesthetists.

Dr. G. M. Woerlee is well known in my department both as a clinician and teacher. Years ofexperience have taught him that the problems discussed here have as yet not been treated in this way in any single work. In my opinion there is a real need for such abook, not only for resident and specialist anaesthetists, but also among surgeons and internists, specialist and trainee. Management of a patient in the operating room is a matter of teamwork, and knowledge of the problems encountered is the basis of any mutual understanding The information which has been assembled and clearly presented in this book should prove to be of great assistance in guiding our patients though an important phase of their lives. Professor Dr. Joh. Spierdijk, Department of Anaesthesia, University Hospital of Leyden, The Netherlands. vii PREFACE Much of the literature being published in the field of anesthesiology today concerns a narrow, in-depth scrutiny of a specific area or anesthetic technique that does not provide the novice with an overview ofthe perioperativeperiod and the commoneveryday problems faced by the anesthetist. Dr G. M. Woerlee of the University of Leiden with his book, "Com mon Perioperative Problems and the Anaesthetist," has filled a void in the current anes thetic literature. Dr Woerlee reviews in a straightforward, no-frills manner problems routinely encountered during the perioperative period. Other anesthesia textbooks do not cover the material in quite the same logical, step-by-step fashion."

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.

Thoracic anaesthesia is regarded as a post fellowship sub-speciality within anaesthesia, and can be daunting. This handbook provides an easily accessible, informative, and palatable guide to this often complex subject. The text is sub-divided into basic sciences, pre-operative assessment, diagnostic procedures, and an anaesthetist's walk-through of key thoracic surgical procedures. It concludes with an emergency section covering thoracic anaesthesia emergencies, critical care, and the thoracic surgical patient, and ends with essential guidance on the relevant practical procedures necessary to manage cases. The text provides an essential reference for the core curriculum of the Fellowship of the Royal College of Anaesthetists and for the day-to-day practice of post fellowship anaesthetists alike. The discussions of the surgical procedures are simple, highlighting the poignant stages that can affect the anaesthetic management of the patient. The authors use the very latest evidence in order to keep the reader up to speed with developments in the field. Whether on-call, running day-to-day lists or working within critical care, this indispensable guidebook will optimise the preparedness of all staff in dealing with any case, whether simple or complex.

From the time questions about the impact of wireless technology on public health were first raised in 1993 through the present, Wireless Technology Research, LLC (WTR) has been the largest independent surveillance and research program trying to identify and solve human health problems associated with wireless phones. In 1995 at the University "La Sapienza" of Rome, WTR sponsored the first comprehensive forum for the discussion of these issues. Papers from the 1995 State of the Science Colloquium were collected andpublished in Volume I ofthis series, Wireless Phones andHealth: Scientific Progress. This second volume assembles papers presented at WTR's Second State of the Science Colloquium in Long Beach, CA, in June 1999; it contains the most comprehensive research on the public health impact of wireless phones to date. The operating words for the proper understanding of these data are science and public health. Science is a tool for making public health decisions, but the framework in which we are operating is truly that of public health. We are looking for problems that have to do with wireless technology. We are trying to decide how this technology impacts on the public for one purpose and one purpose alone, and that purpose is to solve problems that are identified. I would like to challenge you, the reader, to suspend your parochial orientation as you consider these latest findings.

close circle of anaesthetic scientists but, with the help of computer technology, has greatly influenced the practice of the modern clinical anaesthesiologist. The efforts of anaesthesiologists, pharmaceutical companies, and the development of the internet has lead to a situation that now almost every anaesthesiologist can be in close contact to anaesthetic pharmacology computer simulation pro grams and target controlled infusion devices. These two tools allow us to in crease our understanding and improve the controllability of anaesthetic drug administration, on site, in the operating theatre. In Europe the growing enthusi asm regarding the study and practice of intravenous anaesthesia has lead to an increased output of manuscripts on this subject, the initiation of workshops on the pharmacology of anaesthetic agents and the formation of a society that embodies this spirit; the European Society for Intravenous Anaesthesia, the EuroSIVA. EuroSIVA The concept of EuroSIVA has been to provide a forum to co-ordinate, facilitate and promote high quality presentations in the area of intravenous drug admini stration. The first two meetings held in 1988 in Barcelona and 1999 in Amster dam achieved these aims. During the Barcelona and Amsterdam meetings pre senters of over 10 countries shared their knowledge with 250 and 400 partici pants, respectively. In addition to the EuroSIVA meetings the international board aims to promote education for those involved with intravenous anaes thesia."

The 14th volume in the series will focus on cutting edge research at the interface of hypoxia and exercise. The work will cover the range from molecular mechanisms of muscle fatigue and muscle wasting to whole body exercise on the world 's highest mountains. State of the art papers on training at high altitude for low altitude athletic performance will also be featured.

Advances of cardiovascular engineering prompt one to consider innovative device technology - that is, the development of new replacement heart valves or engineering of a totally implantable energy source for an artificial heart. However, these kinds of advances have often proved unable to achieve a long-lasting benefit as the cardiovascular field has matured so fast. Cardiovascular engineering has matured to the point where a major innovation must not only function, but must continuously function better than existing devices. This is difficult to accomplish in the complex cardiovasculature system, in which energy source, biocompatibility, compliance, and functionality all must be considered. The maturation of the field is evident from the fact that many engineered prosthetic systems perform well - for example, heart valves function for long periods of time, large-vessel vascular grafts are quite adequate, extracorporeal membrane oxygenation has significantly prolonged the feasible length of heart bypass and other surgical operations, and total artificial hearts can be used as a bridge to transplant without serious complications, yet none of these systems is as good as the natural ones it replaces. The reasons for this are many and incompletely understood. The next stage of progress must be better to alterations understandings of the various components of vasculature and their response by our devices, be they at the micro- or macro-circulatory levels, in the blood, or associated with the vascular wall.

Monitoring of Cerebral and Spinal Haemodynamics During Neurosurgery is a comprehensive description of subdural monitoring of intracranial pressure (ICP) during neurosurgery. It offers thorough analysis of a comprehensive database consisting of measurements of ICP, cerebral perfusion pressure and other relevant physiological data from more than 1,800 patients subjected to intracranial surgery at Aarhus University Hospital. Features of anaesthesia, both inhalation and total intravenous, are discussed, and measures to reduce ICP are described. A majority of the patients had supratentorial tumours, but the database also includes patients with infratentorial tumours and patients with no intracranial space-occupying lesions. A chapter is reserved for discussion of the special features of children with cerebral tumours.

Leading investigators critically evaluate the latest information on how anesthetics work at the molecular, cellular, organ, and whole animal level. These distinguished experts review anesthetic effects on memory, consciousness, and movement and spell out in detail both the anatomic structures and physiological processes that are their likely targets, as well as the cellular and molecular mechanisms by which they operate. Comprehensive and authoritative, Neural Mechanisms of Anesthesia draws together and critically reviews all the recent research on anesthetic mechanisms, highlighting the precise routes along which these substances operate, and how this deeper understanding will lead to the design of effective drugs free ofundesirable side effects.

This is the second part in a two-volume work on neuromodulation. It describes the techniques and procedures applied by direct contact with the central nervous system or cranial nerves (in order to modulate the function of neural networks) or in deeply located structures inside the nervous system (in order to alter the function on specific networks).

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.

Pain is a common symptom, yet it is frequently underevaluated and undertreated. It is difficult to define, describe-and sometimes to prove. It's pain, and suspicions of exaggerations often add further insult to a patients' injuries. Biobehavioral Approaches to Pain translates this highly subjective experience-and its physical, psychological, social, and cultural dimensions-into practical insights key to transforming the field of pain management.

This pathbreaking volume synthesizes a rich knowledge base from across disciplines, including neurobiologic, genetic, biobehavioral, clinical, narrative, substance abuse, health services, ethical and policy perspectives, for a deeper understanding of the impact of pain on individual lives and the larger society. Its international panel of contributors highlights special issues and review best practice guidelines, from placebo effects to cancer, Whiplash Associated Disorders to pain imaging to complementary medicine, phantom limb pain to gene therapies to AIDS. Among the topics covered:

• The distinction between acute and chronic pain: is it clinically useful?
• Improving clinical assessment of patients with pain.
• Age and sex differences in pain.
• The what, how and why of the placebo and nocebo effect
• Psychosocial and partner-assisted biopsychosocial interventions for disease-related pain
• Substance abuse issues in pain treatment.
• The personal, social and economic costs of chronic pain.

Biobehavioral Approaches to Pain offers clinical and health professionals, psychologists, as well as specialists in pain management or palliative care, new directions in their ongoing dialogue with patients. Given the prevalence of pain in the general population, it should also interest researchers and students in the field of public health.