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.

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."

On the occasion of the inauguration of the Department of Heart Surgery at the Rehabilitation Center in Bad Krozingen, we held under the aus pices of the European Society of Cardiology an International Symposium on March 17 to 18, 1978 with the topic: . "Coronary Heart Surgery - a Rehabilitation Measure" This book contains the papers given at that time. The editors of this book, together with the other members of the sci entific committee - H. Denolin from Brussels, Ch. Hahn from Geneva, and F. Loogen from DUsseldorf - aimed at selecting controversial top ics as well as speakers representing different viewpoints. Thus avoid ing portrayal of an image of a world of coronary bypass surgery in which all problems have found a solution. In keeping with the topic of the meeting, special emphasis was drawn to the long-term functional results of aortocoronary bypass surgery; symptomatic imprQvement be ing, in most patients, significant enough and lasting for at least some years, thus allowing the patients to return to work. However, a combination of social, economic, and psychological factors may hamper optimal rehabilitation, as can be seen from some of the following papers. The incorporation of heart surgery into a rehabilitation center - being the motif of this symposium - may hopefully stimulate a global approach to cardiac rehabilitation which includes surgical, medical, psychological, vocational, and social rehabilitation mea sures. Bad Krozingen, January 1979 H. Roskamm M. Schmuziger Table of Contents 1."

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.

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.

After decades of laboratory investigations mechanical circulatory support for the failing heart has entered the clinical arena. Today, a growing number of patients with progressive myocardial failure awaiting cardiac transplantation is successfully bridged to transplantation with ventricular assist devices. The proceedings of the "Mechanical Circulatory Support"-meeting, held in Berlin, October 21-22, 1995, present new aspects of mechanical circulatory support, recent experience with MCS in newborns and children using specially developed small devices, and the results of long-term mechanical assistance. The ability of the myocardium to recover under pressure de-loading and reduced workload is discussed. All these topics open up new perspectives for the use of mechanical circulatory support, not only as a bridge to transplantation, but also as a definitive approach for treating patients with end-stage heart failure. Some of these concepts may even provide real alternatives to heart transplantation, these being sorely needed in light of the severe donor organ shortage. Regulatory as well as ethical aspects of the extended use of mechanical circulatory support systems and new technical developments in the field are discussed by internationally distinguished experts.

Cardiovascular Biomaterials presents current research mate- rial developed by contributors from universities und profes- sional laboratories in the UK, USA, Canada, and Germany, each recognised for their abilities in this field.The book begins with an introduction to the work of developing a new artificial artery, and proceeds through the topics of the problems and developments in heart valve replacements, car- diac assist devices, mechanical properties of arteries and arterial grafts, biostability of vascular prostheses, blood compatibility in cardiopulmonary bypass, collagenin cardio- vascular tissues and the pacemaker system. Researchers, practitioners, graduate students, and libraries will find the book of interest.

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."

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.

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."

Cardiovascular disease, the leading cause of With increased experience using the inter- death in industrialized societies, not only nal mammary artery, these groups of sur- strikes down a significant fraction of the geons eventually applied the procedure to a population without warning, but also causes larger population of patients. Eventually, prolonged suffering and disability in even the mammary artery was used in sequential larger number. Until the development of fashion to bypass more than one artery, and, heart surgery and the introduction of diag- in some patients, both mammary arteries nostic techniques including cineangiogra- were used. Using these new techniques, sur- phy, stress electrocardiography, echocardio- geons could bypass almost every area of the graphy, and myocardial scanning, the diseased coronary system except the distal treatment of arteriosclerotic heart disease circumflex branches and distal right branch- was confined to medical measures that were es. Then, in 1983 and in 1985, Campeau and usually only partially effective. Lytle published the results of their long-term After the introduction of selective coro- studies of mammary artery bypass. These nary angiography by Sones, surgeons, led by important reports showed significantly dif- Favaloro and Johnson, began to apply the ferent results in favor of the internal mam- principle of bypass to coronary arterial dis- mary artery over the saphenous vein graft. ease.

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 ********. **. *****. **. ****. *****************...*.

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.

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.

It is essential to know all of the intricate lymph pathways when performing surgery for esophageal cancer in order to determine the extent of lymph node metastasis. Professor Sato has undertaken, at the request of the TNM Research Committee of the International Society for Diseases of the Esophagus, to map out and classify the lymph nodes of the mediastinum and neck. The beautiful artwork in the Color Atlas of Surgical Anatomy for Esophageal Cancer edited by Professor Sato gives an excellent understanding of the lymph node pathways and their importance in surgical treatment. Minute dissections which represent real life situations, not just the superficial pathways, show the precise location and topographical arrangement of the lymphatics. Full-color schematics are given with the actual dissection illustrations and photographs. The atlas clearly presents the classification of four significant pathways and their communication, the relationship of these pathways en route to the venous angles and the definition and assessment of the most critical nodes. Thoracic surgeons especially will benefit from the excellent illustrations of surgical techniques and the methods for recording the dissected lymph nodes which are presented by Professor Kakegawa. Leading experts fighting esophageal cancer with surgical treatment can use the classification in this outstanding atlas for many years to come as a standard for international comparison. The careful dissection of the lymph nodes may be the best way to improve survival rates after surgery for cancer of the thoracic esophagus.

Restenosis, the proliferation of smooth muscle cells (SMC) that line blood vessels, often follows angioplasty. Despite advances in cardiology, restenosis continues to affect up to 40% of the over 500,000 patients who undergo angioplasty each year. Applications of Antisense Therapies to Restenosis is the first volume to address the potential of using antisense therapies to inhibit the restenosis that occurs after percutaneous transluminal angioplasty and coronary stenting. The work critically examines the application of various antisense therapies for inhibiting restenosis.

A workshop was organised in order to achieve multi-discipli- nary review of the pathogenesis and management of acute failure, particularly as it occurs and is managed in intensive therapy units. The book deals with the realities and practicalities of this important area of acute medicine. Each chapter is followed by a discussion, so that a concen- sus view is obtained from an international body of experts.