How to face 'the faces' of cardiac pacing represents an editor's compiled selection of lectures on cardiac pacing and electrophysiology. Electrical stimulation of the heart is an ever-changing and, at times, explosive field. The number of implanting centres is growing tremendously and pacing is not exclusively confined to arrhythmologists. Therefore, the editors attempted to organize a course being both practical in daily clinical management and instructive in understanding technical concepts. The glossary of terms have to be clearly understood before one is able to interpret the complex electrocardiograms of DDD and especially DDDR pacemakers. Those electrocardiograms have to be approached in a system atic way, using a step-by-step analysis. The main clinical symptom requiring pacemaker implantation is syncope. It cannot be over-emphasized that syncope is a clinical diagnosis merely based on history and physical examination. The organization of a pacemaker follow-up clinic depends on local facilities and needs. The effectiveness of pacing controls markedly increases when using a systematic approach. Repeated optimal adjustment of pro grammable functions is part of the control. Antiarrhythmic drugs are loosing popularity in the treatment of tachy arrhythmias. Nonpharmacologic treatment (antitachypacing, implantable defi brillators and antiarrhythmic surgery) at the present time have definite indications, probably expanding in the future. When complexity in electronic devices increases, repercussions on ex penses, either by the government or social and private insurances, needs consideration."

Liposuction began as a contouring procedure but has evolved into the treatment of obese patients, gynecomastia, ptosis, macromastia, and even patients who have complications from heart disease or diabetes. Other disorders such as axillary sweat hypersecretion, lipomas, and angiomas are also potential disorders that may be treated with liposuction.

Physicians performing liposuction must be adequately trained and experienced in the potential and actual complications before attempting to perform liposuction. Patient safety is the most important aspect of all surgeries, but especially of cosmetic surgery, which is an elective procedure.

New technology helps improve results but experience, care, and skill of the cosmetic surgeon is necessary to obtain optimal results that satisfy the patient.

The contributors to this book have spent time and effort presenting the cosmetic and plastic surgeon as much information as possible on the techniques and uses of liposuction for cosmetic and non-cosmetic surgery purposes.

primary goal of all forms of therapy is not just prolonging life, but improving the quality of life, has forced analysis of what constitutes quality of life, a concept whose structure pervades all walks of life and eludes definition. Global well being, happiness, morale, vitality, fullness of social life, and satisfaction must be integrated and assessed for the effects of the disease and the therapy, in the context of specific personality traits, attitudes to life, family situation, and socio-economic and political freedom. A growing inter est in research on this subject has led to a clearer understanding of the components which come to determine quality of a patient's life, and how they can be measured in a reproducible manner so that valid comparisons can be made. Keeping these recommendations of analysing quality of life within the context of patients who have undergone open heart surgery, it seemed appro priate to me to separate the influence of various forms of open heart surgery into five aspects of life which can comprehensively reflect the quality of life outcome of the operation. These five 'components' are (1) Physiological state, which summarises the traditionally reported incidence of operative mortality and morbidity, objectively and subjectively measured physical ca pacity, and the residual symptoms, treatment and long-term survival. (2) Intellectual functioning relates to the psychoneurolgocial deficit in memory, reasoning or judgement because of cerebral microembolism and hypo perfusion during cardiopulmonary bypass.

In a condition of such complexity as bronchial carcinoma and at a time when the scientist's understanding of malignant disease is still incomplete, it is inevitable that views within the medical profession will proliferate. This book is an attempt to assemble these views in the light of 33 years of surgical experience and is intended for those specialists who will be concerned with the diagnosis and treatment of lung cancer in the foreseeable future. The wide clinical experience of the contributing authors has ena bled every aspect of this disease to be considered, with emphasis being placed on diagnostic techniques such as CT scanning and fine needle transpleural biopsy, as well as on the latest method of treatment by lasers. Bronchial carcinoma remains the major cause of cancer death in the United Kingdom, accounting for 60Jo of all deaths. While the incidence has decreased slightly in the male population, there has been an equivalent increase in the female population.

Subjects of the book are Heart Failure and Atrial Fibrillation, two emerging pathologies in the field of cardiology, to which many investigators are now addressing their research. Their diffusion in the sick population represents a major public health problem at the beginning of the third millennium. The volume aims to present the latest approaches to the management of heart failure and atrial fibrillation, emphasising in particular the intrinsic relation existing between them, the results after 10 years of biventricular pacing, the innovative pacing techniques now available, and the use of new drugs, devices or ablation procedures for the prevention and treatment of atrial fibrillation recurrences.

The second volume of Operative Manual of Endoscopic Surgery covers some of the operative endoscopic procedures which have been introduced into clinical practice since the publication of VoI. 1. In the general section, we have included an updated chapter on instrumentation and new chapters on anaesthetic manage ment of patients undergoing endoscopic surgery and on video image and record ing. Both topics are of importance to the practice of endoscopic surgery and have not been adequately covered in the reported literature. Volume 2 deals with endoscopic procedures)nthechest and abdomen. There have been significant advances in thoracoscopic surgery duririg the past 2 years; particular reference rs made to anatomical pulmonary resections and oesophageal resections. As far as the gastrointestinal trad is concerned, we have included gastric and allied operations but have not covered the colorectal region as we believe that more evaluation is needed before definitive accounts can be written on endoscopic colorectal resections, especially for cancer. For this reason, we have decided to defer this important topic to VoI. 3, which is in preparation. The same applies to laparoscopic repair of abdominal hernias. The same layout has been adopted as in VoI. 1 of the series, with heavy em phasis on illustrative representation of the operative steps and techniques. In the diagrams on sites of trocar/cannulae, we have indicated not only the site and size but also the functional role of each port.

Leading heart surgeons (including the President of the Royal College of Surgeons) bridge the ever-widening gap between the "student" (both pre- and post-graduate) and an increas- ingly remote group of medical and surgical specialists in this , the only book devoted entirely to the established principles of cardiac diagnosis.

In open heart surgery, protection of the myocardium against injury by ischemia-reperfusion is an issue of utmost clinical interest. The knowledge on the causal mechanisms of myocardial injury in ischemia-reperfusion has greatly progressed in recent years, both to clinical and experimental research. This book provides a critical and comprehensive overview on the current discussion of myocardial protection in cardiac experimental research and surgery. Leading groups from Europe, the U.S. and Japan have contributed reviews of their special fields. On the basic science side, major topics discussed are the mechanisms of stunning and lethal reperfusion injury, the role of the endothelium and leukocyte activation in postischemic myocardial dysfunction, and the differences between the adult and neonatal myocardium. On the clinical side, the major concepts and procedures for cardioplegic myocardial protection, their rationales, application and respective merits are discussed. In a third part of the book, possible approaches for the monitoring of myocardial injury during ischemia and reperfusion are evaluated, with particular attention to their intraoperative use. This book brings together the scientific discussions on ischemia-reperfusion in experimental cardiology and cardiac surgery, a task needed for a long time. It is of general interest for clinicians as well as research workers and students in the cardiac field.

The last five years have witnessed an increasing interest in the subject of transmyocardial revascularization (TMR). The ideas and concepts associated with this particular method of myocardial revascularization have changed dramatically over a short period of time. The original premise of 'de-evolving' mammalian hearts to recreate a reptilian-like myocardial circulation by multiple channels through the myocardium has been almost completely dismissed. Now, the most popular notion is that there is an angiogenic response to myocardial channel making. It is this development of new blood vessels that is thought to be responsible for the apparent improvements in symptoms and blood flow. Along the way, the idea that a channel could stay open and allow blood to flow directly from the ventricular chamber has found little support. Rather than directly explore all of these issues and merely duplicate previously published articles, our aim was to take a novel approach: that is, to step back from these arguments and provide perspective from the vantage point of distance.In the case of transmyocardial revascularization, distance comes both in terms of history and in terms of methodology and knowledge from other fields of research. The purpose of Direct Myocardial Revascularization: History, Methodology, Technology is to provide the necessary perspective to stimulate investigators (both clinicians and basic scientists) to ask the appropriate questions in their own experiments and, in time, determine whether direct myocardial revascularization has a place in the treatment of coronary artery disease.

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.

Cardiac Pacement has undergone a rapid development in technique and application in the last years. Methods of cardiac pacement have become more successful but also more complicated. This book is written for internists in their practice and also for the specialists in cardiology to improve their therapeutic measures being informed about specific problems in cardiac pacement. Apart from the basics of cardiac pacement also indications, selection of pacers, implantation methods and complications are described. A special focus is on postoperative monitoring of the patient. A vast amount of illustrations is combined with very instructive text. This book is for daily practice and desk reference for practicioners and clinicians.

The definite treatment ofaortic disorders goes back to the resection ofisthmic coarctation by Clarence Crafoord in 1944. It took another third of a century until all portionsofthe aortabecameaccessible to highly standardized surgery. This progress, delayed as it was in relation to most other cardiovascular in- terventions, depended on the availability of safe protective methods for the heart and central nervous system, of reliable vascular grafts and atraumatic instruments, novel suture material and tissue adhesives. The development ofadvanced surgical techniques went hand in hand with, and depended upon, the emergence of proper diagnostic tools, starting with aortography andultimately culminating inCT-scanning, transesophageal echo- cardiography and magnetic resonance imaging. These tools now allow for the rational planning and conductofany aortic intervention which may be surgical or, more recently, catheter-guided. Nienaber's and Fattori's new book aptly is addressing both the diagnos- tic procedure as well as the treatment of aortic disease. The authors are well known experts in the fields of advanced diagnostics of aortic pathology, both spearheading a remarkably innovative group of aortic interventionalists as well. On account of their expertise, their chapters are able to answer any question rising in conjunction with these subjects.

I am extremely honored and pleased to have the opportunity to write a few introductory words for this timely volume on Na + /It exchange. This is a field of investigation that I entered into by challenge and necessity, embraced with passion and fmally left in my quest for new discoveries in growth control. Ten years, one third of my scientific life, has been devoted to uncovering the mysteries of intracellular pH (PH;) regulation with respect to growth factor action. I got started on this new topic in 1980, when I heard a rather provocative hypothesis presented by Enrique Rozengurt at an ICN-UCLA Keystone meeting on "Cell Surface and Malignancy." He showed that all mitogens induced amiloride-sensitive Na + entry into resting cells and proposed that, if a compound stimulates Na + influx, it could be a mitogen. In support of his proposal Enrique reported that the amphipathic polypeptide, mellitin, which induced Na+ influx, was indeed mitogenic for 3T3 cells. This was only correlation at this stage. However, I was fascinated by this talk. I immediately approached Enrique to inform him of my skepticism about this beautiful story, and to indicate that I would only be convinced when I succeeded in isolating mutant fibroblasts lacking the amiloride-sensitive Na+ transporter. ''Good luck " was his response.

Coronary artery bypass surgery in the elderly: Too often or too seldom? It is a testimony to scientific advances that raising a simple inquiry today, such as whether coronary artery bypass surgery is done too often or too seldom in elderlypatients, requiresanexplorationofwhatviewsonemightholdonseveral medical as well as non-medical issues. Unlike earlier years when doctors were clinically free to decide what should be done with a patient, health has become an expensive human right, decisions about which also involve the patient, the epidemiologist, the health policy administrator, politicians, the exchequer, and the philosopher. In its broadest definition health has come to mean the core of well-being and, therefore, the goal ofany socio-economic system. Until only a decade ago, medical opinion regarding how often coronary artery bypass surgery (CABG) was indicated or useful was unclear. Becauseof multi-organ senescence, the elderly were expected to have a higher rate operative morbidity and mortality and, having crossed an advanced life span, might not live very long after the operation. Decision making on medical grounds first depends on knowing if a patient can survive an operation compared to how long they would survive without it, i. e.

Apart from the articles on history and nursing, the con- ditions discussed include Mediastinal Masses in childhood seen from a Pathologist's point of view, Intrapulmonary se- questration, lymphangiomata involving the neck as well as thorax, unusual forms of Diaphragmatic Hernia and Congenital Heart Disease. Such a volume would hardly be complete with- out some references to Oesophageal Atresia and one article discusses The Influence Of Anatomy And Physiology On The Ma- nagement Of Oesophageal Atresia.

Thisisthefirstvolumeinthe CerelJral Cortexseriesdevotedtomathematicalmodels ofthecortex. Itwasmotivatedbytherealizationthatcomputationalmodelsof individualneuronsandensemblesofneuronsareincreasinglyusedinresearchon corticalorganizationandfunction. Thisis,inpart,becauseofthenowubiquitous presenceofpowerfulandaffordablecomputers. Suitablemachineswereformerly rareinresearchlaboratoriesandrequiredsubstantialprogrammingexpertisetobe usedinconstructingandusingneuronalmodels. However,computersarenow routinelyusedinallareasofneurobiologyandanumberofsoftwarepackagesallow scientistswithminimalcomputerscienceandmathematicalbackgroundstocon- structseriousneuronalmodels. Asecondfactorleadingtotheproliferationof modelingstudiesisthedevelopmentoftechnologiesthatallowthekindsofdata collectionneededtodeveloprealisticmodelsofcorticalneurons. Characterization ofthekineticsofvoltage-andligand-gatedchannelsandreceptorshadbeenlim- itedtorelativelylargeneurons. However,therapiddevelopmentofsliceprepara- tions,patch-clampmethods,andimagingmethodsbasedonvoltage-sensitivedyes andintracellularcalciumindicatorshasresultedinasignificantdatabaseonthe biophysicalfeaturesofcorticalneurons. Thescopeofmodelingapproachestocorticalneuronsandfunctionsiswide anditseemednecessarytolimitthepurviewofthevolume. Thefocusisonattempts tounderstandthepropertiesofindividualcorticalneuronsandneuronalcircuitry throughmodelsthatincorporatesignificantfeaturesofcellularmorphologyand physiology. Noattemptwasmadetoincludemodelingapproachestounderstanding corticaldevelopmentandplasticity. Thus,workdealingwiththedevelopmentof oculardominancecolumnsandtheorientationselectivityofneuronsinvisualcortex isnotconsidered. Similarly,modelsdealingwiththecellularmechanismsunderlying long-termplasticityandwithapproachestolearningandmemorybasedonmodifica- tionofHebbiansynapsesarenotconsidered. Relativelyabstractattemptstounder- standhigherlevelandcognitiveprocessesbasedonneuralnetsrepresentasecond, majorareaofworkthatisnottreated. Modelsofcognitiveprocessesbasedon dynamicalsystemsmethodsinwhichnoattemptismadetoincludethebiophysical featuresofindividualneuronsarealsonotconsidered. vii viii Thetenmajorchaptersfallintothreegroups. Thefirstgroupdealswith compartmentalmodelsofindividualcorticalneurons. LyleBorg-Grahamprovides PREFACE anintroductiontothemethodsinvolvedinconstructingcompartmentalmodels andthenreviewstheexistingmodelsofhippocampalpyramidalcells. Becauseof theeffectivenessofhippocampalslicepreparations,theseneuronshavewell-ehar- acterizedbiophysicalproperties. Thischapterillustrateshowcompartmentalmod- elscanbeusedtosynthesizeexperimentaldataandprovideanintegrativeviewof thepropertiesofindividualneurons. PaulRhodescontinuesthethemebyfocusing ontheroleofvoltage-gatedchannelslocatedonthedendritesofcorticalneurons. Thisisanareainwhichtechnologicaladvancesinthevisualizationofneuronsin slicepreparationsbasedoninfraredmicroscopyhavegreatlyexpandedtheinfor- mationavailableondendriticfunctioninjustafewyears. Thechapterbothreviews theexperimentaldataonactivedendriticconductancesandemphasizestheirpo- tentialfunctionalroles. Thesecondgroupofchaptersdealwiththegenerationofreceptivefield propertiesofneuronswithinvisualcortex. Theyaddressissuesstemmingfromthe originalattempttounderstandhowthereceptivefieldpropertiesofneuronsincat andmonkeyprimaryvisualcortexaregeneratedbyinteractionsbetweengenicu- lateafferentsandcorticalneurons. ThechapterbyFlorentinWorgotterevaluates modelsthathavebeenusedtoanalyzethegenerationofreceptivefieldproperties. RodneyDouglasandhiscolleaguesaddressaspecificsetofissuesdealingwiththe roleofintracorticalexcitationmediatedbypyramidalcellcollaterals. Animportant featureofthischapterisitsrelationtoattempttoconstructfabricatedcircuitsthat duplicatethefunctionsofcorticalcircuits. ThechapterbyPhilipUlinskifocuseson thegenerationofmotion-selectivepropertiesincorticalneurons. Itseekstoidenti- tycellularmechanismsusedbyneuronsthatrespondpreferentiallytovisualstimuli movingwithparticularspeedsordirections. MatteoCarandiniandhiscolleagues discussthefeatureofcorticalneurons,knownasgaincontrol,thatallowsneurons torespondeffectivelytovisualstimulibypoolinginformationacrosspopulationsof corticalneurons. ThechapterbyHughWilsondealswiththereceptivefieldproper- tiesofextrastriateareasandintroducesnewworkanalyzingface-selectiveneurons. Thefinalsetofchaptersconsidermodelsofensemblesofthalamicandcortical neurons. ThechapterbyWilliamLyttonandElizabethThomasusesthetheoryof dynamicalsystemstoanalyzethetemporalrelationshipsbetweenthalamicand corticalneurons. Animportantfeatureoftheinteractionbetweenthalamusand cortexisthepresenceofoscillationsthatdependinpartuponthevoltage-gated conductancespresentonindividualneuronsandinpartonthestructureofthe overallnetwork. PaulBushcontinuesthisemphasisonoscillationsbydiscussinga modelthatdealswiththegenerationofsynchronizedoscillationsinvisualcortex. Oscillationsofthiskindhaveattractedsubstantialattentioninrecentyearsbecause oftheirpotentialroleincognitiveprocesses. Thelastchapter,byMichaelHasselmo andChristianeLinster,reviewstheirworkonmodelingpiriformcortex,emphasiz- ingtheroleofcholinergicmechanismsinmodulatingtheactivityofcorticalneu- rons. Anattempthasbeenmadethroughouttomakethevolumeaccessibleto readerswithminimalmathematicalbackgrounds. Thevolumethusbeginswitha shorthistoryofmodelsofcorticalneuronsandcircuitrythatintroducestheprinci- palmodelingstyles. ThechaptersbyWorgotterandUlinskicontainmoreextensive ix introductionstosomeofthemodelingmethodsthathavebeenusedtostudyvisual cortex,andthemathematicallychallengedreaderwillfindthatthechapterby PREFACE LyttonandThomascontainsareadableintroductiontotheuseofdynamical systemstheoryinneurobiology. PhilipS. Ulinski EdwardG. Jones Chicago and Davis Contents Chapter 1 ModelingCorticalCircuitry:AHistoryandProspectus PhilipS. Ulinski 1. Introduction "...1 2. LorentedeNothroughDynamicalSystemsModels...2 2. 1. LorentedeNo...2 2. 2. CellAssembliesandNeuralNets...3 2. 3. DynamicSystemsModels...8 3. HodgkinandHuxleythroughNetworkModels...11 3. 1. HodgkinandHuxley...11 3. 2. WilfridRall...11 3. 3. SoftwarePackages...13 3. 4. RealisticModelsofCorticalNetworks...14 4. Prospectus...14 5. References...15 Chapter 2 InterpretationsofDataandMechanismsforHippocampalPyramidal CellModels LyleJ Borg-Graham 1. Introduction...19 1. 1. NeuronModelEvolution-followingElectrophysiology...19 1. 2. NeuronModelEvaluation-followingtheParameters...21 1. 3. WhyHippocampus? 21 1. 4. OrganizationofThisChapter...22 xi xii 2. TheDatabaseforSingle-NeuronModels...23 2. 1. VoltageClampversusCurrentClamp...23 CONTENTS 2. 2. Single-ChannelversusMacroscopicCurrents...24 2. 3. TypeofPreparation...24 2. 4. KineticandPharmacologicalDissection...25 2. 5. TemperatureDependence...26 2. 6. AgeDependence...27 2. 7. HippocampalSubfieldDependence...27 2. 8. DifferencesinFiringPropertiesbetweenSharpversusPatch Recordings...28 2. 9. TheMeasuredVoltage...

This book discusses contemporary features of ject, creating, therefore, a lacuna the could be diagnosis of endocrine diseases using the filled by this project. radiologic technique of percutaneous venous This book is intended to be a practical guide blood sampling for hormone assay. A compre- for vascular and interventional radiologists, in- hensive survey of the field is provided by the ternists, surgeons, endocrinologists, and other contributing authors, who have considerable physicians who care for patients with endocrine expertise in the subject. Some have published diseases. The intention is to provide a practical several articles in the literature; others have text covering anatomical data, clinical prob- extensive clinical experience. lems related to the diagnosis of the endocrine The approach to many of the endocrine dis- diseases, patient preparation for the sampling, eases has been markedly improved ~uring the blood sampling techniques, sample manipula- last two decades because of selective venous tion and storage, laboratory data, and clinical blood sampling, not only in the diagnosis of the significance of the hormone sampling and condition but especially in the precise localiza- assay. tion of the hormone-producing lesion and its clinical significance. Scattered informationbn venous blood sam- pling is available in the literature, but there is Renan Uftacker no comprehensive text dealing with the sub- Reingard Sorensen Contents Preface v Contributors xi 1 Selective Venous Sampling for the Differential Diagnosis of Female Hyperandrogenemia 1 Lathar Moltz and Reingard Sorensen Introduction ...1 Diagnostic Procedures ...2 Indications ...4 Anatomy and Anatomical Variations...

The papers presented at the Fifth International Symposium on Heart Valves and published in this volume discuss clinical experience with heart valve replacement in pediatric patients, in adults (age 65 and younger), and in the elderly (age 66 and older). Special considerations in heart valve replacement, such as valve selection, reoperation, results of double valve implantation, quality of life, and the use of valved conduits are also included. Finally, long term clinical follow-up with the ST. JUDE MEDICAL (R) heart valve, giving 7- and 8-year data is discussed. HEART VALVE REPLACEMENT IN PEDIATRIC PATIENTS Anticoagulation Anticoagulation in children is a difficult and interesting problem. Three princi pal considerations in the use of anticoagulants are patient education, timing, and anticoagulating substance. Additional considerations are patient tolerance and compliance. Generally, the findings indicate, if pediatric patients receive anticoagulation following mechanical valve replacement, it is well accepted and results in few complications. If children are not anticoagulated, complications arise. Conflicting results regarding the efficacy of PERSANTINE (R) and the use of aspirin vs. COUMADIN (R) were reported. Doctor Sade's data address some of these questions. * After a 5-year study in * See J Thorac Cardiovasc Surgery 1988; 95:533-561.

Clinical lung transplantation has seen an early start within the history of solid organ trans plantation, marked by the 1963 first lung transplant by James D. Hardy. This was prompted by the seemingly easy way of joining the transplanted organ to the recipient by me ans of a few well-defined anastomoses, i.e. bronchus, pulmonary artery and pulmonary vein carry ing left atrial cuff. The following decade thus witnessed a number of such mostly unilateral lung transplants in several centres, in Germany represented by the two only lung transplants performed by E. S. Bucherl, then at the Neukolln City Hospital in Berlin in 1969. As with most other such attempts these two patients suffered early and lethai graft failure. There was only one single lung transplant patient who lived up to ten months after the transplant at Gent, Belgium, having been operated on by Derom in 1969. The alm ost universal failure during this initial phase was attributed to bronchial anasto motic insufficiency, pulmonary infection of either the transplanted lung or the left-in-place contralateral lung and a far-reaching lack of knowledge how to cope with transplant rejec tion. In the early 1970s it had become gene rally accepted that lung transplantation could not be performed successfully."

Cardiac surgery has developed dramatically since the first open-he art operations were performed in the mid 1950s. Although the improvement of surgical technique, extracorporeal circulation, and postoperative management has contributed to a marked reduction of morbidity and mortality, the development of cardiac surgery to its present state would not have been possible without blood substitution by homologous donor blood. Only 20 years ago, open-heart operations required an average of 8 units of blood preserves. The excessive need of donor blood in those early days was mainly due to premature surgical technique, insecure control of anticoagulation, severe blood trauma by extracorporeal circulation, and the lack of retransfusion technologies that would have allowed the reuse of shed mediastinal blood. The introduction of new technologies, such as normovolemic hemodilution, in traoperative autotransfusion, postoperative return of shed mediastinal blood, and predonation of autologous blood has greatly reduced donor blood requirements. At present the majority of routine coronary artery surgical procedures can be performed without any blood transfusion. Blood loss, however, may be considerable in patients undergoing complex valve surgery or reoperations, as they often require several units of transfused blood. Blood conservation has now become an area of major interest for the cardiac surgeon. This increased concern is caused by infectious complications of blood transfusion, in particular hepatitis and, more recently, AIDS."

The International Symposium on Ischemic Mitral Incompetence was held December2-4,1988 at the Intercontinental Hotel, Berlin . It wasorganized bythe German Heart Center Berlin with the primary aim to bring together experts interested in the subject of ischemic mitral regurgitation. Our intention was to face the problems associated with diagnosis and treatment of mitral incompetence resulting from coronary artery disease. A "work-up" of the whole topic from its basic, diagnostic, and surgical aspects wasinitiated. In the first section weconcentrate on the basic anatomical and pathophysiological knowledge, as well as on experimental work. In the second section cardiologists report on inci- dence of ischemic mitral incompetence, diagnostic methods that include esophageal echocardiography, follow-up studies of medical- and surgical-treated patients. This section considers interventional therapy in acute myocardial infarc- tion, as well. The third section includes contributions by cardiac surgeons with many years' experience in operative treatment of ischemic mitral incompetence including the decision-making criteria for non-mitral valve surgery, and for valve reconstruction or replacement.

This book will systematically cover all the main topics involved in the current practice of a cardiac surgeon. It will incorporate current guidelines for practice (such as from the American Heart Association and European Society of Cardiology) and up-to-date information based on current literature. All the chapters have been written by cardiac surgeons who have recently undertaken their Cardiothoracic Board / Specialty Exit examinations and reviewed by a cardiothoracic examiner of the Royal College of Surgeons of England. Each chapter will be structured to include aetiology, pathophysiology, clinical features, indications for surgery, peri-operative management, surgical options and postoperative care. Possible complications will be discussed and the results of current practice presented. Importantly there will be a section on basic sciences related to the practising cardiac surgeon and a further section on cardiac investigations with many images illustrating the variety of pathologies. Each chapter will also contain important references for further reading and greater depth of knowledge. The data and body of knowledge presented in this book is strictly evidence-based and is relevant to all cardiac surgical trainees, at any stage of their training programme. It will provide interns, residents and specialist registrars the necessary information to carry out their daily duties. Adult cardiologists and cardiothoracic intensive care unit specialists will also find the book useful in terms of the indications and surgical management of these patients, as they are integral to the cardiac surgical process. Another important group is the nursing staff, physiotherapists and other professions allied to medicine, both surgical and cardiological, working with patients with adult cardiac disease either pre-operatively or postoperatively, as it will help to give a detailed understanding of the principles surrounding adult cardiac surgical disease. Most importantly, the book is ideal as a revision aid for residents/registrars undertaking their Cardiothoracic Surgery Board examinations around the world. Although these examinations vary in format in different countries, this book is applicable to all cardiothoracic surgical trainees. Its concise, yet complete coverage of the important topics, make it the ideal guide to answer the key questions in cardiac surgery that are asked within the confines of an examination.

The incidence of concomitant disease in patients referred for cardiac surgery has increased substantially throughout the years. Years ago a significant proportion of patients due for cardiac surgery would not have been operated on, as the risk of concomitant disease were estimated as being too high. Over the years techniques in cardiac surgery, anaesthesiology and intensive care treatment have improved, thus, enabling us to operate on and to treat more severely ill patients and those with extraneous complications. Cardiac Surgery and Concomitant Disease presents the current knowledge in dealing with high risk patients scheduled for cardiac surgery.

All diseases involving the lung are presented in alphabetical order. Each is discussed in the same way under the subheadings of definition, epidemiology, pathophysio- logy, clinical prognosis, radiology, gross and micro patho- logy, histomorphological descriptors, special stains, hall- mark of diagnosis and differential diagnosis.
"An encyclopedic collection of terms dealing with diseases and/or pathological conditions of the respiratory organs with the aim to give the reader rapid information about the essential aspects. This encyclopedic source can be recommended not only to pathologists but also to clinicians and practitioners faced with pulmonary diseases." (Experimental and Toxicologic Pathology)

With the growing age of the general population, the proportion of elderly patients with diffuse coronary artery disease and severe comorbidities is increasing. When medical therapy cannot relieve the symptoms in these patients, their characteristics render them unsuitable for currently rec- ognized invasive procedures, namely coronary artery bypass grafting and percutaneous transluminal angioplasty. There is an urgent need for new treatment modalities which can alleviate their symptoms and increase blood flow to the ischemic myocardium while being less inva- sive for their fragile condition. The idea for this book was to relate my personal experience in the research and clinical fields and the current state of knowledge as reported in the literature. An additional aim was to provide anatomical and physiological background as well as a complete review of the new methods of revascularization currently being developed. To this purpose, I have analyzed many studies on the microvascula- ture of the heart, the historical forerunners of the new procedures, and the new treatment modalities themselves: transmyocardiallaser revascu- larization, therapeutic angiogenesis, and neurostimulation. I wish to thank my teachers in surgery, cardiology, and medicine: B. Faidutti (Geneva), J.-P. Berger (Vevey), 1. Kappenberger (Lausanne), F. Harder (Basel), T. Amery (Frimley), K. Arnold (Brig), and especially 1.K.