Cardiovascular disease is the major cause of morbidity and mortality worldwide. While the past 40 years have brought major progress in cardiac valve repair and replacement, there remain large patient populations that do not receive such therapies. This, in turn, implies a great need for future basic, applied, and clinical research and, ultimately, therapeutic developments. Heart Valves is a state-of-the-art handbook dedicated to: 1) cardiac valve anatomy, 2) models for testing and research methods; 3) clinical trials; and 4) clinical needs and applications.

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.

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.

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.

In the last decade tremendous progress has been made in the diagnosis and treatment of tumours of the mediastinum. The use of immunohistochemistry, molecular biology, electron microscopy, CT and MRI, and a better knowledge of tumour markers, has made for better diagnosis, often without the need for biopsy, in many cases. This in turn has clarified the classification and thus the epidemiology of tumours of the mediastinum, and modern radiotherapy, chemotherapy and surgery has led to improved survival of patients at risk. With over 300 illustrations, mostly in full colour, and a well-referenced text, this atlas is an invaluable bench reference for the practising diagnostic pathologist and a study aid for the trainee, as well as a comprehensive source of reference for oncologists and surgeons.

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.

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.

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.

In recent years much enthusiasm and energy has been directed toward the development of human gene therapies, especially for inherited conditions and cancers. However, current gene transfer technology is limited in its transduction efficiency and ability to permanently and safely correct genomic defects. Thus the promise of gene therapy for these conditions is as yet unrealized. The progression of gene transfer technology will eventually surmount these limitations. Gene Therapy for Acute and Acquired Diseases includes selected examples of ongoing studies in molecular genetics that have the potential to evolve into human therapies for acute illnesses. These chapters are intended to highlight lesser known applications of gene therapy for acquired disorders. It is expected that human gene therapy trials for these conditions will be forthcoming in the near future, leading to previously unimaginable therapies. Thus, this first-ever book about gene therapy for acute and acquired diseases is intended to serve as a glimpse into the future.

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 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.

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.

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...

New Techniques for Thoracic Outlet Syndromes presents in a comprehensive format an up-to-date, state of the art reference that physicians can use in consultation to properly treat patients using the resources that modern medicine offers. This book offers the newer surgical approaches that have been developed during the past 30 years. Some of these techniques are modification of operations that were proposed previously but were not fully affective and left many patients suffering with permanent disability. This textbook is a compendium of the proper management of these patients that cannot be found in isolated reports of literature. The neurogenic-arterial thoracic outlet syndrome section covers how to diagnosis the illness using the proper tests, therefore eliminating the use of expensive, uncomfortable and inconvenient tests. The text is organized in three basic sections that cover all the aspects of the thoracic outlet syndromes. The first section addresses the neurogenic-arterial type, with the pertinent subsections: symptoms, diagnosis. A list of the useful tests is provided to make a correct diagnosis of this syndrome. This is followed by the sections on treatment, using the surgical approaches with historical aspects and evolution of the operations proposed. The second section involves the venous thoracic outlet syndrome divided into the corresponding subsections comprising: symptoms and physical findings, etiology, diagnosis. This section also includes a list of the usual tests to make the proper diagnosis. The last section of this text is dedicated to the presence of cervical ribs and their classification of the different types that occur, and also the proper surgical treatment when fusion of the upper ribs is present. New Techniques for Thoracic Outlet Syndromes offers the current, acceptable and most effective methods to handle thoracic outlet syndromes. It will be of great value to thoracic surgeons, vascular surgeons, interventional radiologists as well as fellows and residents in training for cardiothoracic and vascular surgery.

The book will be written by the experts in the disease including imaging, interventional cardiology and surgical valve expertise. The book has five main sections: Aortic Valve Disease Mitral Valve Disease Tricuspid Valve Disease Pulmonic Valve Disease Multimodality Imaging The main objectives of the book are: 1- to provide the main guidelines to clinicians on how to identify and diagnose valvular heart disease 2- to provide an overview of what the near future will bring in the diagnosis, prevention and risk stratification of patients to catheter versus surgical approaches 3- to outline the possible implications for medical therapies in slowing progression of calcific aortic valve disease and myxomatous mitral valve disease

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.

Therapeutic hypothermia has emerged as a very important treatment option for patients with cardiac arrest as it provides significant protection from developing neurologic injury once the patient has been successfully resuscitated. Studies have demonstrated over 15% absolute risk reduction in death and neurologic injury using this therapy. Although hospitals and medical centers have become familiar with this important intervention it still remains greatly under utilized due to an experience and lack of resources to safely and effectively deploy such a program. The objective of this book is to educate and familiarize both providers and institutions as to how to develop and deploy and provide therapeutic hypothermia to their patients. The current knowledge for this is provided by speakers and national experts and also by literature review. There are several courses being provided on this as well throughout the US. These are good venues for people to come and see and get hands on experience, but there still needs to be a concrete book with references on how to go about getting this program started.

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.

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.

This book is the first of its kind - a comprehensive reference for anesthesia and perioperative clinicians involved in aortic surgery. With a primary focus on anesthesia for various aortic surgical procedures, including endovascular aortic surgery, the title also provides expanded coverage of CNS monitoring and protection, intraoperative transesophageal echocardiography, renal and spinal cord protection during surgery, management of aortic trauma, and postoperative care. Written by top cardiac anesthesiologists, surgeons, and intensivists, this indispensable reference provides everything you need to know about the burgeoning field of aortic surgery in one handy volume.

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)

Tetralogy of Fallot is the most common form of cyanotic congenital heart disease, and one of the first to be successfully repaired by congenital heart surgeons. Although "fixed", patients born with tetralogy of Fallot cannot be considered "cured". Improving survival and quality of life for this ever-increasing adult population will continue to challenge the current and future generations of cardiologists. Adult patients with tetralogy of Fallot should be seen by a cardiologist specializing in the care of adults with congenital heart disease, to be monitored for late complications. They need to be checked regularly for any subsequent complications or disturbances of heart rhythm. This monograph is intended as both an introduction to the subject and a timely, comprehensive review, and will be welcomed by adult cardiologists, pediatric cardiologists, internists, surgeons, obstetricians, and intensivists who wish to learn about the most recent discoveries and advances concerning tetralogy of Fallot in adults. It will also be of interest to advanced undergraduates wanting to learn more about the subject.

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.

This book consists of an edited report of the proceedings of the Fifth Cardiac Surgical Course run by the Royal Post-Graduate Medical School, The Institute of Cardiology, The Institute of Diseases of the Chest, The Institute of Child Health, The National Heart Hospital, The Brompton Hospital, The Hammersmith Hospital and Great Ormond Street Children's Hospital. These organisations encompass most of the major London hospitals associated with cardiac surgery. The course has been run annually, its aim being to help young men and women who are training in the specialised field of cardiac surgery. Thus this book consists of the proceedings of a teaching course rather than of a symposium, the 60 authors having been charged with the task of teaching rather than displaying their results or discussing their latest ideas and the proceedings reflect an interesting appraisal of the current status of cardiac surgery. The speakers were chosen from all over the world, because they were leaders in their field or because they have access to up to date and reliable information, and I am grateful to all the lecturers for their cooperation in the production of this volume. Ten thousand surgical cases are reported. These figures are drawn from experience in the United Kingdom, France, Germany, Switzerland, the United States of America, Australia and New Zealand. The reader may be surprised to find that only a handful of experiments are described.