Modern Cardiac Surgery is based on, but does not consist completely of, papers submitted at the annual course of cardiac surgery run by the combined Institutes and Post-Graduate Hospitals involved in cardiac surgery in London (1977). The subjects which have been chosen and included fulfil one of two criteria; either they are subjects which were not included in the previous book, The Current Status of Cardiac Surgery, or they cover subjects which needed to be updated. Because this is a teaching course and not a symposium, the emphasis has been on being informative rather than on presenting masses of results. The book has been prepared partly from manuscripts submitted by the authors and partly from annotated tapes of the proceedings of the meeting. Through out the editing and production of this book careful consideration has been given to the requirements of the readership. The book is aimed at all students of cardiac surgery and cardiology at all levels, and as much information as possible has been packed into it. Neverthe less, the editor wishes to thank the authors for the efforts they have made to be concise and clear in their presentation and for their tremendous co-opera tion in alterations which have been incorporated to make it a more readable treatise. This means that this is a book which is of value to nurses interested in cardiology in intensive care, to physiotherapists and students wishing to look up particular topics before their final examinations."

Over 10 years have passed since the first edition of The Mediastinum was published in 1977. I have been very gratified by the response to the first edition and determined to do a second edition as soon as possible. However, good intentions are sometimes difficult to achieve and a decade has passed. This period has been one of enormous growth in the discipline of diagnostic imaging. In the study of the mediastinum, computed tomog raphy, and more recently magnetic resonance, have revolutionized our diagnostic capabilities. This second edition of the mediastinum is in tended to emphasize the importance of these modalities to the evalua tion of mediastinal disease. In addition, an attempt will be made to integrate into the text the many new and important observations relat ing to all aspects of mediastinal imaging which have appeared in the literature since 1977. The overall emphasis, however, will remain the same: that accurate radiologic diagnosis is based upon a thorough understanding of corre lated radiographic anatomy and pathology. No matter what the imag ing modality, this principle remains fundamental to each and every radiographic interpretation. I would like to express once again my deep appreciation to Dr. Stephen A. Kieffer, Chairman of the Department of Radiology at the State University of New York Health Science Center at Syracuse for his continued support and encouragement."

In July 2008, European and Japanese specialists in neurosurgery, neurology, interventional neuroradiology and neurointensive care joined together to discuss the latest developments in the management of cerebrovascular disorders at the 4th European Japanese Joint Conference on Stroke Surgery, held in Helsinki, Finland. This collection of papers from the meeting deal with aneurysm surgery and management of subarachnoid hemorrhage and stroke, arterial dissection, intracranial arteriovenous malformations and fistulas, and microneurosurgical bypass and revascularization techniques.

Few diagnostic methods in Cardiology have heralded such revolutionary developments as the introduction of coronary arteriography. When, in the early 1960's, Dr. F. Mason Sones demonstrated that visualization of the coronary anatomy in living humans was not only feasible but sufficiently safe and reliable to be used as a clinical tool in the evaluation of patients with known or suspected ischemic heart disease, the thus far somewhat neglected area of coronary circulation became the focus of interest. Naturally, for a considerable period of time a great deal of emphasis was placed upon coronary anatomy. Simple relations between narrowing lesions, impediment to flow, and prognosis were assumed to exist. Spectacular results of surgical coronary revascularization seemed to confirm this concept. Gradually it has become evident that the pathophysiology of coronary artery disease is considerably more complex. Diagnostic methods were introduced to assess and quantify exercise-induced myocardial ischemia. At first, these tests were used mainly to achieve a more discriminative selection of candidates for coronary arteriography and the coronary arteriogram remained the gold standard. Currently, these techniques have evolved to the point where they provide valuable functional and metabolic information. They have become powerful independent tools in clinical investigations and evaluation of individual patients.

A pioneering group of authors describes in this book, for the first time, the state of the art of spinal cord stimulation for chronic critical limb ischemia. This method, a progeny of pacemaking in cardiac rhythm disorders, is a promising, innovative procedure; it presents a modern challenge in treatment of endstage peripheral vascular disease or neuropathic pains. Spinal cord stimulation may have a tremendous future if it further develops to become a standard treatment in special indications.

Over the past 15 years, mechanical valves, and in particular, bileaflet mechanical valves, have made considerable strides in durability and hemodynamic per- formance. However, biocompatibility in terms of thrombo- embolism, thrombosis, and hemolysis has remained an area where improvement is needed. "New Development in Bileaflet Mechanical Heart Valve" discusses advances in these important areas of prosthetic valve function and provides clinical experience with a new open pivot, bileaflet mechanical valve.

Posttraumatic stump formation and replantation of the severed limb are both reconstructive plastic operations which may lead to the improvement or destruction of a patient's lifestyle. For the primary attending surgeon, the decision whether to undertake such an operation depends on the patient's clinical condition, the operational circumstances, the psychological and social aspects and, last but not least, on the surgeon's own abilities. This monograph is designed as a synopsis of the great number of patho-physiological parameters and surgical and rehabilitational aspects which must be considered in the analysis of complications in major limb replantation. In addition, basic information about the key role of ischemic myopathy and microangiopathy is supplied to encourage further experimental investigations.

Prior to the virtual atomic explosion of medical knowledge, at a time when communica tion was very much slower, a medical book, to be authoritative and believable, had to be written by a very knowledgable, and, per force, usually quite senior person. The choice of texts was limited and tended to be dominated by a few "classic" (a phrase not quite synonymous with dogma). Following the information explosion, the scenario is quite different. Not only is there a geometric progression in the quantity and speed of devel opment of new medical knowledge, but also this development is occurring at very dif ferent rates in different countries. This is particularly true in medical imaging. The result is that it is now virtually impossible to produce a "single author" book that can cover the field or even a subdivi sion of it. This absolute requirement for multiple authors has in turn created the need for a new type of editor/author who must be multinational in approach, have a uniquely informed appreciation of what is going on in medical imaging research throughout the entire world and possess the depth of personal knowledge and experience to judge cor rectly what work is the most rigorous and likely to have the greatest impact."

Despite a worldwide reduction in its incidence, stroke remains one of the most common diseases generally and the most important cause of premature and persistent disability in the industrialized countries. The most frequent cause of stroke is a localized disturbance of cerebral circulation, i.e., cerebral ischemia. Less common are spon taneous intracerebral and subarachnoid hemorrhages and sinus ve nous thromboses. The introduction of new diagnostic procedures such as cranial computed tomography, magnetic resonance imaging, digi tal subtraction radiologic techniques, and various ultrasound tech niques has led to impressive advances in the diagnosis of stroke. Through the planned application of these techniques, it is even possible to identify the pathogenetic mechanisms underlying focal cerebral ischemia in humans. However, these diagnostic advances have made the gap between diagnostic accuracy and therapeutic implications even greater than before. This fact can be easily explained. In the past, therapeutic studies had to be based on the symptoms and temporal aspects of stroke; it was impossible for early investigations to consider the various pathogeneses of cerebral ischemia. Inevitably, stroke patients were treated as suffering from a uniform disease.

The European School of Oncology came into existence to respond to a need for informa tion, education and training in the field of the diagnosis and treatment of cancer. There are two main reasons why such an initiative was considered necessary. Firstly, the teaching of oncology requires a rigorously multidisciplinary approach which is difficult for the Univer sities to put into practice since their system is mainly disciplinary orientated. Secondly, the rate of technological development that impinges on the diagnosis and treatment of cancer has been so rapid that it is not an easy task for medical faculties to adapt their curricula flexibly. With its residential courses for organ pathologies and the seminars on new techniques (laser, monoclonal antibodies, imaging techniques etc.) or on the principal therapeutic controversies (conservative or mutilating surgery, primary or adjuvant chemotherapy, radiotherapy alone or integrated), it is the ambition of the European School of Oncology to fill a cultural and scientific gap and, thereby, create a bridge between the University and Industry and between these two and daily medical practice. One of the more recent initiatives of ESO has been the institution of permanent study groups, also called task forces, where a limited number of leading experts are invited to meet once a year with the aim of defining the state of the art and possibly reaching a consensus on future developments in specific fields of oncology.

Controlled and predictable interference with hormonal feed- back mechanisms has become a major direction of preclinical and clinical research. There is a steadily increasing number of hormonal pep tides detected and characterized that are re- sponsible for endo-, para-, and autocrine cellular actions. Naturally, these peptides have been studied with regard to their cell growth stimulatory action and, in parallel, the re- spective antagonists are being investigated in terms of their antiproliferative (antineoplastic) function. Among the numerous pep tides of interest in this respect, somatostatin (somatotropin release inhibitory factor) and bombesin antagonizing factors have been the topic of inten- sive research during recent years. No presentation of the role of pep tides in oncology would be complete without a compre- hensive treatise of their physiological, preclinical and clinical functions in the context of their antineoplastic mechanism of action. Somatostatin and its various short- and long-acting analogs have the unique feature of suppressing and inhibiting a wide range of cellular processes including cell proliferation. Recep- tors for these peptides, which belong in a wider sense to the family of neuropeptides or neurotransmitters, are widely dis- tributed, a feature which is not in keeping with the general view of a growth hormone regulatory system. Thus, these substances are found in the gut in a variety of endocrine and exocrine glands including breast, pancreas, and prostate, and in the nervous system.

This book represents the first European effort to provide a collection of test descriptions used in evaluation of the compatibility of biomaterials in contact with tissues and blood. The urge to compile this book arose from the fact that it is the properties of the material which ultimatively seem to determine the functional outcome of a medical device, almost regardless of how ingenious the construction of the very device is. The longer the exposure is, the more important these basic properties become. Unfortunately only a small part of the interactive phenomena is fully elucidated and understood. This challenge reflects itself in an effort to cover numerous aspects of testing, beginning with fundamental analysis of the material, continuing with the mechanical properties, the resistance to degradation and the analysis of surface and chemical properties including adsorption patterns of proteins ending with test on cell cultures, ex vivo and in vivo. A number of the tests which are generally accepted as being important are already described as official requirements (primarily Pharmacopeas). These official requirements are not included in order to limit the size of the book. It is the aim of this book to present the tests like a recipe in a uniform way to ease the reader in finding his/her way through the material and to present it as a kind of "cook-book" in an order to provide an easy access to copy the procedures. This has unfortunately not been possible in all circumstances.

It was the genius of Gordon Murray in Toronto that introduced the use of allografts into cardiac surgery in the 1950s. Soon after this on opposite sides ofthe world, Sir Brian Barratt-Boyes in Auckland, New Zealand, and Mr. Donald Ross in London, undertook to use allografts for the replacement of diseased aortic valves. Since that time the global interest in allografts has been patchy, episodic, and without a con sensus. Nonetheless, for the last 20 years at least three groups in the world have steadfastly pursued the development of new and relevant information concerning the use of allograft valves in humans. These are the centres of Sir Brian Barratt Boyes, Mr. Donald Ross, and Mark O'Brien in Brisbane. More recently, talented investigators, including Drs. Yankah, Yacoub, and others, have been developing information concerning the immunological aspects of the use of allografts, as well as their clinical use. No doubt, at present, cardiac valve allografts of one sort or another are the devices of choice for conduits and have an important place in the surgery of aortic valve replacement. Even so, in the mind of this writer at least, the future usefulness of allografts for the replacement of diseased cardiac valves and conduits between a ventricle and the pulmonary artery, remains problematic, and depends upon improvements in other devices for this purpose and upon improve ments that may be made in preparing and using allografts."

Coronary heart disease is one of the major health problems in indus trialized nations because of its high incidence and severity. Recent innovations in medical and surgical treatment of coronary heart dis ease have increased the importance of accurate diagnostic methods for determining the severity of coronary disease, identifying potential treatment alternatives, and evaluating the results of treatment. Great advances have also been made in basic research on coronary circula tion and its interaction with myocardial contraction and relaxation and neural and humoral control. With respect to these developments, the papers included in the present monograph deal with important topics concerned with the basic mechanism of coronary circulation as well as ones of clinical relevance. It is directed toward physicians (cardiologists, cardiac surgeons, cardiac radiologists, anestheologists, and others) and basic scientists (e.g., physiologists, bioengineers). We would like to em phasize the importance of a multidisciplinary approach in which basic scientists and clinicians work closely together. This volume consists of nine chapters. Chapter 1 contains macro scopic and microscopic descriptions of coronary vascular anatomy, which is closely related to the functions of coronary circulation. In Chap. 2 two methods in current use to evaluate phasic coronary blood velocity waveforms are presented, i.e., the laser Doppler and ultrasound Doppler methods. Chapter 3 describes the mechanical properties of coronary circulation, a knowledge of which is indispens able for an understanding of coronary arterial and venous blood flow velocity waveforms in relation to cardiac contraction and relaxation."

Based on the research and clinical work presented at the Fifth International Symposium, Vascular Surgery 1991, this book gathers forty contributions from renowned clinicians and researchers and outstanding young investigators around the world.

This volume contains the revised texts of the presentations at the 29th International Congress of the European Society of Cardiovascular Surgery, held from July 2-5, 1980, in Dusseldorf under the presidency of Jan Nielobowicz (Warsaw). We express our gratitude to all the authors who have been partici- pating in the Congress, in particular to the invited speakers A. R. Castaneda (Boston), D. B. Effler (Syracuse), F. Fontan (Bordeaux), F. Robicsek (Charlotte), and D. N. Ross (London) for their cooperation. We are grateful to our colleagues of the Surgical Department B at the University of Dusseldorf, J. A. Herzer, G. Irlich, R. Karfer, and A. Krian, for their help during preparation and organisation of the Congress. Finally, we are indebted to Sanol Schwarz GmbH for its support of this publication. Dusseldorf, June 1981 Wolfgang Bircks Jarg Ostermeyer Hagen D. Schulte Contents The Contribution of European Surgeons to the Development of Modern Vascular Surgery. J. Nielubowicz. With 20 Figures *. ****** Session I Cardiac Surgery Valvular Surgery I Chairman: V. O. Bjork, Stockholm; Co-Chairman: A. Carpentier, Paris Special Morphological Structures Along the Closing Zone of the Mitral Valve. H. Heine and M. Laatz. With :5 Figures **. **. . *. *. . ** 25 Conservative Surgery of the Mitral Valve. Annuloplasty on a New Adjustable Ring. M. Puig Massana, J. M. Calbet, and E. Castells With :5 Figures ********. **. *****. **. ****. *****************...*.

Assisted Circulation 3 is an authoritative review of the progress which has been achieved in the last 5 years since the appearance of Assisted Circulation 2 in 1984. The present book highlights the work of well-known experts on - new indications for assisted circulation, - cardiac assist devices as bridges toward transplantation, - temporary mechanical heart support, - results of long term studies into problems of tissue overgrowth, infection, and physiological regulation of cardiac devices, and - new results on cardiac transplantation and the new immunsuppresive regima. Assisted Circulation 3 is the latest product of an ongoing effort by the editors to keep readers abreast of recent advances in the field on a regular basis.

This atlas offers a collection of EEG spectral analyses and their corresponding conventional recordings under anes thesio10gical procedures. The EEGs presented here were re corded on general surgical and gynecological patients during the last few years. Premedication, induction and maintenance of anesthesia, recovery the immediate postoperative period, and intensive care are covered. Techniques for operating the necessary equipment and artefacts relevant to the routine clinical use of EEG are briefly outlined. Typical examples of characteristic EEGs are presented at the beginning of each chapter, followed by illustrations of deviations from the norm showing the great variety of anesthesiologically induced changes of cerebral function. The description of each EEG course is assessed in relation to clinical parameters. Sometimes no satisfactory interpreta tion can be made, because many physiological and patho physiological causes of alterations in cerebral function are unknown. Time and again it proves impossible to estimate wether deviations from the norm have their origin in cerebral changes or are secondary to extracerebra1 disturbances. The atlas comprises a complete survey in itself, but it can also be seen as a supplement to the book The Electroenceph alogram in Anesthesia by I. Pich1mayr, U. Lips, and H. Kunkel (Springer, 1983), in which detailed lists of references are quoted that are omitted here."

Assisted Circulation 4 is an authoritative review of the progress which has been achieved in the last 5 years since the publication of "Assisted Circulation 3" in 1989. The present book highlights the work of well-known experts on indications for assisted circulation, cardiac support devices such as bridges, devices for transplantation, devices for chronic mechanical support, biological energy sources, cardiomyoplasty, extracorporeal membraneoxygenation and an overview of cardiac devices support with a specific emphasis on xenotransplantation. Assisted Circulation 4 is the latest product of an ongoing effort by the editors to keep readers regularly informed of recent developments in the field. Assisted Circulation is a standard technology in cardiac surgery and especially in cardiac transplantation.

In textbooks on anatomy, radiology and stead of the normal one. An "accessory ar- surgery only the "normal" arterial blood tery" is a second artery ip addition to the one normally present, without any specifi- supply is usually described. This "nor- mality", however, is sometimes found in cation of size being made. However, there less than 30% of all cases for some arteries, is no general agreement on whether minute but in over 95% for others. Rarely men- vessels with very small diameters and hard- tioned are deviations in the individual ar- ly any significant blood flow should also be tery's origin, topographical localization and considered. the area it supplies. They can be classified The aims of this book were twofold: first, to into two groups: malformations and vari- extract the frequency of arterial anomalies from the literature (often published in inac- ations. Malformations often have a nega- tive influence on the function of the organ cessible journals) and second, to classity under normal circumstances, e.g. if both these arteries by schematic outlines of the basic types.

Use of the implantable cardioverter/defibrillator is the most significant advance in the management of patients with life- botn threatening cardiac arrhythmias. This device represents an important practical as well as conceptual breakthrough in arrhythmia management. It places on firm footing use of non-pharmacologic tools for clinicians. The text, Implan- table Cardioverter/Defibrillator, represents contributions by the leading clinicians in this field from both sides of the Atlantic and is a welcome addition to the library of clinical electrophysiologists as well as cardiac surgeons. The editors have well collated the critical issues related to current use of device therapy in a meaningful and practical fashion. The text amply reminds us that we are in the early growth phases of a technology that promises to completely change our approach to the cure of patients with actual or potentially life-threatening ventricular dysrhythmias. It also reminds us that Dr. Mirwoski's dream continues to live and remains as a perpetual challenge to clinicians and engineers alike to bet- ter perfect and utilize device therapy for our patients. I com- mend the authors and editors for a superb and timely effort. San Francisco, CA, USA Melvin M. Scheinman, M. D. Preface 1teatment of patients with ventricular tachycardia and pre- vention of sudden arrhythmic death is one of the most challenging tasks of modem cardiology. 'len years ago anti- arrhythmic drug therapy was the medical tool used most fre- quently in the management of patients with life-threatening ventricular tachyarrhythmias.

"Rate Adaptive Cardiac Pacing" provides a comprehensive overview of this most advanced form of stimulating the heart by means of cardiac pacemakers that vary the pacing rate according to the needs of the patients. The heart rate is controlled by one or several sensors that detect various parameters such as respiration, blood temperature, oxygen saturation, intracardiac pressure, QT interval, stroke volume andbody activity. Besides describing the clinical and functional characteristics of these various sensors, the book also gives a clear understanding of hemodynamic aspects and in particular, all clinical issues of importance such as indications for rate adaptive pacing and selection of the appropriate patients for rate adaptive pacemakers, with many ECG samples. The book also covers new concepts in rate adaptive pacing such as single lead atrial synchronous pacing and the combination of various sensors, which are among the most recent developments in the field. With contributions from the most wellknown experts in the field from allover the world, this book is the first publication to cover all the hemodynamic, clinical and technical aspects of rate adaptive cardiac pacing.

Major epidemiologists from the UK, USA and Europe contribute to the first ever, much needed comprehensive review of the epidemiology of peripheral vascular disease in the lower limbs.

If a consecutive series of patients with lung cancer is followed up until the decision is made about therapy, it emerges that the role of surgery is quite small. Only a very limited proportion will ultimate ly qualify for rationally conceived surgical therapy; most patients are inoperable. In a series of 397 patients investigated at our hospi tal, 78% were inoperable on the basis of preoperative evaluation and a further 3% proved nonresectable at thoracotomy; therefore, only 19% were suitable for resection. On the other hand, surgery is still thought to offer the best, if not the only realistic chance of cure. The question "operable or not?" is therefore of vital importance for the individual patient. The answer to this crucial question must be based on valid guidelines for pa tient selection and preoperative evaluation, and it should be clearly defined what extent of resection is necessary in order to realize any curative intention. In 1972 a thorough analysis of the literature revealed that re section of bronchial carcinoma - although 40 years old - was being undertaken with very variable indications. There was hardly any systematic staging, and assessment of results was hampered by the fact that most communications in the literature were based on retrospective analysis.

La pathologie vasculaire a ete tres marquee par les progres biologiques de ces vingt demieres annees. Le systeme arteriel est main tenant considere comme un organe a part entiere. Modelee au cours de l'organogenese par les facteurs hemodynamiques, Ie paroi arterielle maintient une structure hautement organisee et des proprietes mecaniques qui dependent directement des conditions de pression et de debit. La monocouche endotheliale developpe 2 une surface de plusieurs centaines de m a l'interface sang-tissu; elle est a la fois un organe endocrine complexe synthetisant de nombreuses proteines qui participent a l'hemostase, une surface thromboresistante et hemocompatible, une barriere de permeabilite contr6lant les echanges sang-tissus. Les cellules musculaires lisses constituent un tissu multifonctionnel, contractile, assurant la synthese des composants structuraux responsables des proprietes mecaniques de la paroi arterielle, la transmission de la force contractile, et une etonnante activite reparatrice en reponse aux agressions. Tout ceci est soumis a un ensemble complexe de communications cellulaires qui font de l'endothelium un veritable systeme recepteur pour la paroi vasculaire. Parallelement, ou a la suite de ces progres, l'angeiologie s'est progressivement affirmee comme une specialite clinique. Debordant Ie cadre de la chirurgie vasculaire, elle integre les concepts physiopathologiques au diagnostic et au traitement des maladies arterielles. De cet effort d'integration est ne cet ouvrage, cherchant a concilier les connaissances fondamentales es plus recentes et la demarche clinique.