"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.

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.

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.

Spinal Cord Stimulation II (SCS) contains the state of the art of this innovative method in the treatment of peripheral vascular disease.
The volume presents such topics as: Spinal Cord Stimulation for Chronic Pain.- Management of Critical Limb Ischemia.- Spinal Cord Stimulation for Angina Pectoris.- Buerger's Disease.- Miscellaneous.

D. B. LONGMORE The concept ofthe meeting on which this book is based is unique. There has never be fore been a multi-disciplinary meeting based entirely on the concept of making a major branch of surgery safer. Hopefully, this meeting will be archetypal and will set a precedent for similar attempts in other disciplines as well as future efforts to make cardiac surgery safer. Cardiac surgery is still a rapidly growing discipline even after a quarter of a century of experience. Like any new area of science, or medicine, initially there is an exponential growth ofwork, publications, meetings, options of available equipment and all the ancillary and peripheral disciplines associated with it. The ideas of the handful of original surgical pioneers, some of whom have contributed to this book, formed the basis of a still rapidly growing young branch of surgery with a whole new medical discipline of total extracorporeal circulation involving biochemical and haemodynamic control of a patient.

Circulation through the deep femoral artery and its branches is critical to patients with aortoiliac and infrainguinal arteriosclerosis. It is, accordingly, essential that all physicians who are seriously interested in treating patients with lower extremity ischemia have a good working knowledge of this crucial artery's anatomy and func tion. It is equally essential that they be aware of arteriosclerotic disease patterns that involve this important artery, how these patterns can be Clccurately defined, and, most importantly, what therapeutic options are available and when they should be used. All this important information relating to the deep femoral artery and its surgical significance is included in Dr. Merlini's fine volume. Eighteen authors have contributed 11 well-edited and nicely illustrated chapters that provide all the facts that the com mitted vascular surgeon would ever want to know about the deep femoral artery and how it should be managed in patients with lower limb ischemia. Although some of the chapters overlap in some areas, this adds to the value of the book since the different authors are' all acknowledged experts and their varying perspectives. are beneficial to a reader seeking to formulate his own unbiased views.

Reconstructive microvascular surgery is now in its teens. At first many thought this new child was a whim and would fail to thrive. Some were un certain, others with vision either supported or became actively involved in this new area of surgical endeavour. Although initial interest was focused on the replantation of amputated parts, it has been the one stage free trans fer of living tissue to a distant site which has launched microsurgery into the surgical spotlight. From its humble beginnings we have witnessed a revolution in this branch of plastic surgery; many of the long established methods of recon struction have, like barricades, fallen before the advances made in this field. In its infancy there were relatively few procedures available. There was a tendency to make the patient's problem fit the operation, rather than the reverse, and this frequently led to an inferior result. The then known flaps, such as the groin flap and the deltopectoral flap, were employed. Unfortunately they were sites which posed many technical problems; namely those of vascular anomaly, a short pedicle and vessels of small cal ibre. Long operations were the norm, and vascular thrombosis was not un common. Hospital routine often was disrupted and there was a danger that these new techniques would fall into disrepute. Over the last decade this state of affairs has changed dramatically.

The history of electric cardiac stimulation is long and fascinating. The grow- ing clinical importance has been recognized and renewed as Zoll in 1952 described a successful resusciation in cardiac standstill by external stimula- tion. Meanwhile, patients with disorders of cardiac rhythm have been treated all over the world for about 15 years. Recently the technical refinements of intracardiac stimulation in combination with a subtile analysis of endocavi- tary electrocardiograms improv~d the understanding of human intracardiac conduction. These new procedures include the possibility to study the initia- tion and termination of tachycardias. - The pertinent interest in these devel- opments and the intention to learn more about the basic fundamentals of excitability and conduction under both normal and pathological circum- stances were reasons to organize an international symposium on that topic. - The papers contained in this book were presented at this meeting on diagnos- tic and therapeutical tools of cardiac pacing, held at Munich on November 7 and 8, 1975, sponsored by the first Medical Clinic of the University of Munich and generously supported by Medtronic. Especially focused are the investigations on sinus node function, disturbances of av-conduction and electrophysiology of supraventricular and ventricular tachycardias. The content of the book that is emerging from the symposium were created by the authors. I wish to thank them for teaching us about the recent advances in cardiac tissue stimulation by electricity. Much credit is due Priv. Doz. Dr. B. Uideritz, who organized the symposium and published these proceedings.

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.

The motivation for this book was the recognition by two of us (RL and TL) that, despite our training as cardiologists, we had a limited understand ing of many aspects of the surgical management of our patients. Conversa tions with other cardiologists at our own institution and at other medical centers around the country convinced us that many of our colleagues shared our uncertainty about the details of surgical procedures and the factors that determine decisions in the perioperative period. As surgical techniques continue to evolve, this knowledge gap can become only more severe. We therefore compiled information about cardiac surgery that might be useful for cardiologists and other nonsurgeons. We asked cardiologists what questions they would like to ask their surgical colleagues and provided these questions to the authors of the chapters. Thus, the goal of these chapters is to help nonsurgeons answer their own questions about common cardiac procedures, and to help prepare these physicians to address the questions raised by their patients. In addition, we hope that insight into these issues will improve communication between surgeons and their col leagues-and, ultimately, lead to better patient care. Contents Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi 1 Chapter 1. Anesthesia for Cardiac Surgery JONATHAN B. MARK Chapter 2. Cardiopulmonary Bypass . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 DANIEL FITZGERALD Chapter 3. Myocardial Protection in Cardiac Surgery . . . . . . . . . . . . . . . . . . 23 JEFFREY SELL Chapter 4. Coronary Artery Bypass Grafting . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 HENDRICK B. BARNER Chapter 5. Surgery for Left Ventricular Outflow Obstruction: Aortic Valve Replacement and Myomectomy . . . . . . . . . . . . . ."

Amaurosis fugax, or "fleeting blindness," has been known as a clinical entity for hundreds of years (1). Since 1859, we also have understood that the phenomenon frequently is related to atheroembolic disease and that it is considered a classic manifestation of ocular transient ischemic attacks and a potential precursor to stroke. However, many questions about this syndrome have remained unanswered until quite recently, when a great deal of new information and thought has been directed to the subject. Transient monocular blindness (TMB) is only one manifestation of a complicated syndrome of ocular, systemic, and cerebral diseases that may include some degree of monocular blindness. The duration of blindness varies from very brief (seconds) to complete and permanent. The per manent type is referred to as ocular infarction or ocular stroke. Retinal infarction is the most severe degree of monocular blindness and usually is due to embolic occlusion of the central retinal artery or one of its branches. Varying types of arterial emboli have been described, including thrombus, cholesterol, platelets, and fibrin.

Here, two of the foremost cardiothoracic surgeons have brought together many of the top cardiologists and haematologists to produce the most current reference source on all aspects of blood conservation, from an overall clinical approach to the use of erythropoietin and the benefits of post-operative blood salvage. The subject matter covers numerous areas involved in the preoperative considerations in cardiac surgery, the intraoperative decision-making in cardiac surgery, postoperative bleeding and management and a section on the algorithm for bloodless surgery used at the New York Hospital-Cornell Medical Center.

Interventional cardiology means the cardiological practice of the future. This book provides the physician with practical guidelines to interventions. All procedures involving modern technology and drugs are described with emphasis on the "how to" aspects. The indications, techniques, results and merits of each procedure are given. These include: coronary angioplasty and angioscopy, valvuloplasty, lasers and cardiac transplantation as well as basic procedures such as cardiac catheterization, electrophysiologic studies and automatic implantable defibrillators. Readers of the book will find the way to new dimensions in cardiologic practice.

Originally published in 1980-1981 as a two-volume set, the Manual of Cardiac Surgery has been completely revised and now includes new full-color illustrations in a single convenient volume. This new edition maintains the high standards established in the first edition: insightful descriptions of various cardiac surgical procedures illuminated by clear, brilliant illustrations.

In November 1986, I was invited to attend a symposium held in Barcelona on Diseases of the Pericardium. The course was directed by Dr. J. Soler-Soler, director of Cardiology at Hospital General Vall d'Hebron in Barcelona. During my brief but delightful visit to this institution, my appreciation of the depth and breadth of study into pericardial diseases, carried out by Dr. Soler and his group, grew into the conviction that these clinical investigators have accumulated a wealth of information concerning pericardial diseases, and that investigators and clinicians practicing in English speaking countries would greatly profit from ready access to the results of the clinical investiga tions into pericardial disease carried out in Barcelona. The proceedings of the Barcelona conference were published in a beauti fully executed volume in the Spanish language edited by Dr. Soler and pro duced by Ediciones Doyma. Because I believe that this work should be brought to the attention of the English speaking scientific and clinical com munities, I encouraged Dr. Soler to have the book translated into English. I knew that this task could be accomplished and that the book would be trans lated into good English without change of its content. My confidence was based upon a translation of my own book, The Pericardium, into Spanish undertaken by Dr. Permanyer, who is a contributor and co-editor of the pre sent volume."

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

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.

Based on the research and clinical work presented at the Sixth International Symposium, Vascular Surgery 1992, this book gathers contributors from renowned clinicians and researchers and outstanding young investigators from around the world.

Among the greatest challenges in cardiovascular surgery today remain operations on aortic arch pathology, supraaortic vessels, and the protection of the brain from hypoxic or ischemic injury during these delicate operations. Since DeBakey's first successful repair of an aortic arch aneurysm in 1957, understanding of the aortic arch pathology, neuroprotective strategies, neuromonitoring and surgical technique have markedly improved. Although the specific surgical procedures have reached an advanced standard and general acceptance, many questions remain unanswered and have contributed to ongoing controversy.
Cerebral Protection in Cerebrovascular and Aortic Surgery presents the current knowledge of understanding causes and pathogenesis of cerebral damage during surgery on the aortic arch and supraaortic vessels and prevention of brain damage by specific surgical therapy.

In this book, the latest results in coronary artery surgery are discussed and the factors decisive for long-term prognosis are elucidated. The indications for re-operation are considered and redefined, and the surgical technique with regard to multiple bypass is described. The aim of the book is to depict clearly long-term prognoses and to determinate the future needs of coronary artery surgery in the next decade. This far-sighted approach also makes the book a valuable reference for the planning and extension of cardiology centers in Europe. 1

Advances in heart surgical treatment have been impressive in the last 15 years. In end-stage heart disease, procedures are now performed routinely which were only experimental one or two decades ago. Heart transplantation has become a well-established procedure. According to the Gen eral Registry of the International Society of Heart and Lung Transplantation. 40,738 heart transplantations had been performed through the end of 1997 with survival rates of 78 % at one year, 65 % at five years, and 42 % at ten years. The progress in this field has been due to intense efforts in understanding and modulating immune responses to the trans planted heart, to elaborate therapeutic strategies to constrain infections, and to improved out-patient care. Accordingly, heart transplantation is integrated into the facilities of the health care systems, the routine of physicians, and the awareness of patients. The resulting increase in potential organ recipients has not been met, however, by an equivalent increase of available donor organs. This increasing discrepancy has forced the technical improvement and clinical evalua tion of mechanical circulatory support systems as an option for treatment of critically ill patients with a failing heart. Initially, these assist devices were only used to maintain sufficient circulation in post-cardiotomy heart failure until myocardial function had recov ered. Since the late 1980s, their primary use has been that of bridging patients with heart failure until a suitable organ is available so that heart transplantation can be performed."

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.

Over the past 15 years, a multitude of new transluminal techniques have been developed, all designed to broaden the range of indications and improve the results of angioplasty. Among these, the implantation of intravascular stents has emerged as the technique with the greatest promise. It has become clear that stenting not only successfully deals with the problem of abrupt closure after angioplasty, but also reduces the incidence of restenosis, the Achilles heel of angioplasty. The reason why restenosis is reduced may be because the immediate gain of luminal diameter is greater with stenting than with any other technique. Even if the late loss of diameter is similar among most currently used transluminal techniques, the end result will stilI be better after stenting because of the nearly ideal primary effect. The aims of this book are twofold: first it presents a state-of-the-art summary of the progress made in stenting so far, and secondly it details some of the prospects for future improvement. The concept of stenting has proved to be a correct one, and therefore alI future efforts wilI be directed towards new, safe, and biologicalIy "friendly" stents.

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.

Nach den femorokruralen und aortoiliakalen VerschluBprozessen fruherer Bande wurde fur diesen Band der Oberschenkel-VerschluBtyp gewahlt. Schon morpholo- gisch weist diese Etage eine Besonderheit auf, denn sie besitzt mit der tiefen Ober- schenkelarterie eine Arterie, die Linton schon 1964 als besten korpereigenen Bypass bezeichnete. Urs Brunner nannte die Profunda gar die Konigin der Beinarterien. Dies beruht auf ihrer besonderen Kollateralisierungsbefahigung. Dem ist es zuzu- schreiben, daB das therapeutische Spektrum auf dieser Etage wesentlich breiter ist als in den beiden anderen VerschluBetagen. Andererseits ist dieser VerschluBtyp am haufigsten mit anderen VerschluBlokalisationen kombiniert, so daB eine ausschlieB- lich auf den Oberschenkel-ArterienverschluB gerichtete Betrachtung nicht moglich und naturlich auch nicht sinnvoll ist. Wie es in dieser Reihe ublich ist, wurde versucht, das Gebiet umfassend darzustel- len. Das erforderte eine umfangreiche interdisziplinare Bearbeitung, wozu auch namhafte Experten aller Bereiche gewonnen werden konnten. Diagnostik, physik ali- sche Therapie, konservative Behandlung, operative Verfahren und kombinierte MaBnahmen konnten so in einem Band zusammengefaBt werden. Zu betonen ist, daB die dargestellten Behandlungsverfahren nicht als konkurrierende Therapieprin- zipien sondern als sich sinnvoll erganzendes therapeutisches Spektrum in Abhangig- keit yom Stadium der DurchblutungsstOrung anzusehen und einzusetzen sind. Den Referenten ist es zu danken, daB dieser Band trotz vieler Schwierigkeiten doch noch relativ zeitgerecht erscheinen wird. Auch Frau Sabine Muller und ihrem Team yom Dr. D. Steinkopff-Verlag, mit der mich nun schon eine mehrjahrige ver- trauensvolle Kooperation verbindet, mochte ich fur ihre wertvollen Anregungen und ihre Unterstutzung danken.