Die Endoskopie vermochte bisher Gewebsformationen zu dehnen, zu durchtrennen, abzutragen und zu zerstoren. Gewebedefekte auszufullen, miteinander zu vereinigen und zu heilen, war bislang endoskopisch nicht moglich. Die Einfuhrung von Fibrinklebern eroffnete neue Anwendungsbereiche. Der Kleber kann, in seine Komponenten getrennt, uber doppellumige Sonden uber beliebig weite Strecken an den vorgesehenen Einsatzort unter Sicht des Endoskopes transportiert werden. Die Klebung von Fisteln, Rupturen oder Leckagen an Bronchusstumpfen, im Lungenparenchym oder an gastrointestinalen Anastomosen kann heute komplizierte Heilungsverlaufe und riskante operative Re-Interventionen ersetzen. Die spezielle Technik der endoskopischen Fistelklebung wird in diesem Buch erstmals zusammenfassend und interdisziplinar erortert. Daneben werden neue Moglichkeiten zur Stillung gastrointestinaler Blutungen mit Fibrin durch intramurale Injektion oder oberflachlichem Spray besprochen. Grundlegende Untersuchungen zeigen, dass im Vergleich zu anderen Substanzen, die Fibrinapplikation in das Gewebe zu deutlich geringerer Traumatisation und zu geringeren entzundlichen Reaktionen bei gleichem Hamostaseeffekt fuhrt. Ziel des vorliegenden Buches ist, verstreute Einzelbeobachtung zu sammeln, zu ordnen und zu vergleichen, um dem interessierten Leser die neue Technologie der Verklebung von Defekten und der Hamostase mit biologischen Substanzen zu vermitteln.

The joint workshop between the European Society of Cardiology and the European Society ofCardiovascular Surgery, held October 14-15, 1983 in Innsbruck, Austria, was a unique event. The idea originated in Atlanta, 1982, with C. Hahn and was supported by V. Bjork and N. Browse. H. Denolin and F. Loogen brought added impact from the European Society of Cardiology. The joint workshop specifically emphasized new trends and controversies in coronary artery surgery. The contri- butions appearing in this edition were selected by a scientific committee: H. Deno- lin, H. Kraft-Kinz, F. Unger, F. Loop, L. Cohn, F. Loogen, P. Lichtlen, T. Killip, and F.Kaindl. The specific aim was to evaluate controversial review points in coronary artery surgery. These were covered in six discussions and in nine forums with slide presen- tations. The topics were: 1. Indications for coronary artery surgery 2. Graft patency and long-term results 3. New operative techniques 4. Myocardial preservation and anesthetic management 5. Combined procedures 6. Long-term follow-up Coronary artery surgery is a model for comprehensive cardiology, whereby sur- gery serves as a link between diagnosis and rehabilitation. Because coronary artery surgery has become a routine procedure with standardized techniques, the demand is increasing dramatically as reflected by enormous waiting lists. Hospital mortality can be kept under 1 %, so that the value of this operation can also be discussed with regard to its social and economic aspects. In the majority of cases, patients improve and finally retum to work, finding life most enjoyable again.

In recent years, major social forces such as: ageing populations, social trends, migration patterns, and the globalization of economies, have reshaped social welfare policies and practices across the globe. Multinational corporations, NGOs, and other international organizations have begun to influence social policy at a national and local level. Among the many ramifications of these changes is that globalizing influences may hinder the ability of individual nation-states to effect policies that are beneficial to them on a local level. With contributions from thirteen countries worldwide, this collected work represents the first major comparative analysis on the effect of globalization on the international welfare state.

The Welfare State in Post-Industrial Society is divided into two major sections: the first draws from a number of leading social welfare researchers from diverse countries who point to the nation-state as case studies; highlighting how it goes about establishing and revising social welfare provisions. The second portion of the volume then moves to a more global perspective in its analysis and questioning of the impact of globalisation on citizenship, ageing and marketization.

With its integrative analyses of policy and practice in countries struggling to provide social welfare support for their needy populations, The Welfare State in Post-Industrial Society will become an important voice in the debate on social welfare.

Since the last meeting "Myocardial Biopsy - Diagnostic Signifi cance" was held under the auspices of the International Society and Federation of Cardiology (ISFC) in Munich, many new data and new aspects have been developed in the field of myocardial dis eases. Most importantly, the classification of cardiomyopathies and specific heart muscle diseases, as described in the report of the WHO-ISFC task force (see reference 1 in the Introduction), is now widely accepted as a basis for clinical practice and scientific work. Investigators from all over the world have again assembled un der the auspices of the ISFC at an international workshop on viral heart disease and its implications with regard to congestive cardio myopathy, which was held in Munich January 1983. This book con tains the significant results of the workshop. For practical use, the authors have incorporated important points made in the discussions into their contributions and a subject index has been provided. First of all I should like to thank Professor Riecker, Director of the Medizinische Klinik, Klinikum Grol3hadern, University of Mu nich, West Germany. Without his friendly support in many aspects, this meeting would not have been possible. I should like to thank Professor Goodwin and Dr. Olsen from the ISFC for their active participation and advice in organizing the meeting. Last but not least, I am particularely grateful to all the contributors, whose co operation has made this book possible."

Mankind in the second half of the twentieth century has encountered a number of social and economic problems, which, as never before, determine its future. Among the main problems facing medicine, meriting distinction is organization of the struggle against the increase of cardiovascular and oncological diseases which, with the birthrate, are the main demographic indices of our planet. According to the World Health-Organization, the deathrate from diseases of the cardiovascular system has risen by 60% in recent years, and there has been a sharp increase of myocardial infarctions and cases of sudden death in young people aged 25-30. The "geography" of heart and blood vessel diseases has changed: a dramatic increase of morbidity has been recorded in rural regions, and in districts where 10-20 years ago the native population was practically unaffected by atherosclerosis. Diseases of the cardiovascular system have become widespread among women as well as men. Cardiovascular diseases tax the national economy: they are responsible for over half the mortality among people at the prime of their productive life. More than 50% of temporary disability is also accounted for by ischemic heart disease, hypertension, stroke, etc.

Microcirculation is a rather new field which has been of predominant interest to basic scientists, linking togeth~r technical, hemodynamic, and biochemical aspects. The fmdings elaborated, however, are not only of theoretical interest, but bear in addition great clinical implications. In clinical cardiology this became quite evident by the use of tracers in order to study myocardial perfuSion and by the deSCription of certain clinical entities - such as angina with normal coro nary arteries - which are best explained by "disturbed microcirculation". With respect to this new developing theoretical and clinical field of cardiac microcirculation it was the aim of the Microcirculation Working Group of the European Society of Cardiology to have a symposium on which all different but clinically relevant aspects of cardiac microcirculation will be covered. This symposium, held in Heidelberg in January 1980, was planned not only for the exchange of concepts and ideas, but was expected to be in addition partially a teaching session; the basic scientists should be directed toward a better under standing of the clinical problems, and the clinicians should learn more about the basic mechanisms regulating substrate and ion exchange in such an impor tant organ as the heart, and furthermore the theoretical limitations of some of the diagnostic and therapeutical procedures should be taught. Without a lot of help we would never have succeeded in organizing the sym posium and editing its results.

The International Congresses of Angiology have had a 25-year tradition. Let us remember the 10 previous International Congresses, the first of which took place in Paris in 1952. On this occasion a stimulus for the foundation of the International Union, "Union Internationale d Angeiologie" came into existence. The period of 25 years is lon.qenough to evaluate the scientific progress which has been made in diagnosis, therapy and prevention of vascular diseases. Proceedings of the previous International Congresses of Angiology became attractive resources for scientific information in libraries all over the world. They represent really historic documents of remarkable development of angiology and wittness successful international cooperation in the settlement of serious medical problems of the twentieth century. The Proceedings of the XI. International Congress of Angiology held in Prague 1978 under the stimulating title "Adaptability of Vascular Wall" contains 284 original papers dealing with scientific and clinical research in arterial, venous and lymphatic circulation. The papers are incorporated into 12 chapters according to the main topics. In the first sections the questions of atherogenesis and thrombogenesis are discussed with regard to the adaptability of vascular wall in various metabolic, immunobiologic, and hemodynamic disorders. In the further sections attention is paid to new procedures in investigation, treatment, and prevention of arterial, venous, and lymphatic diseases. Peri pheral microangiopathies, renovascular hypertension, and coronary circulation represent another part."

The first cardiovascular operation in Duesseldorf, a ligation of an open ductus arteriosus (Botallo), was performed in 1938 by E. K. Frey. During the Second World War and the subsequent years many difficulties hindered cardiovascular surgery in Duesseldorf. However, it was resumed on 3 May 1949 by Prof. Ernst Derra, again by ligating an open ductus arteriosus. This was the starting pOint of the successful cooperation between the cardiological and surgical working groups - the "birthday" of the Duesseldorf Heart Centre. Further highlights in cardiac surgery were the introduction of open heart surgery by means of surface-cool- ing hypothermia (9 February 1955) and extracorporeal circulation (21 February 1959) . In addition to cardiac catheterization and surgery in patients with acquired and congenital heart disease, the diagnosis and treatment of arrhythmias was one of the focal points of the centre. On 3 October 1961 the first pacemaker was implanted in a patient with a third-degree AV-block after he had been treated using an external device for about 1 year. In recent years interest has increasingly turned to the tachy- arrhythmias. Close cooperation between the medical and surgical teams made possible the application of new pacing techniques for the treat- ment of tachycardia. In patients with intractable arrhythmias, surgical interventions were made to eliminate the "focus" of the arrhythmia. In the past 2 years intraoperative electrophysiologic studies (endo-cardi- al and epicardial mapping) were applied to enhance the success of the surgical procedures.

Diagnostik und Therapie sind die Pfeiler, auf denen die Medizin ruht. Beide wurden in der letzten Zeit wesentlich erweitert und vertieft - teils zum Nutzen der Patienten, teils aber auch zu deren Nachteil. Betroffen sind alle Fachgebiete der nicht-operativen Medizin inklusive der Pneumologie. Im Bereich der Pharmakotherapie von Lungenerkrankungen fehlte bisher ein Nachschlagewerk im deutschen Sprachraum. Meistens wird das Thema lediglich kursorisch in Lehrbuchern der Inneren Medizin und Pneumologie abgehandelt: Wenig vertieft bzw. kritisch abgehandelt mit Therapieempfehlungen ohne wissenschaftliche Evidenz. Erstmalig im deutschen Sprachraum liegt nun dieses fachbezogene Lehrbuch mit neuesten Erkenntnissen der Pharmakotherapie vor. Es wendet sich vor allem an Internisten und Pneumologen, ist aber auch fur Padiater, Thoraxchirurgen und Allgemeinarzte von grossem Interesse.

Summary A comprehensive review is given of the literature, and the advantages and disadvantages of the bypass operation are discussed in detail. Of all surgical interventions aiming at revascularisation of the myocardium the aorto coronary bypass operation is the one which indoubtedly has earned its place in cardiac surgery. The most suitable candidates for this operation are those with a normal left ventricular angiogram and a good peripheral vascular pattern. Even in these people the question still remains whether the vein can stay patent for many years; moreover what happens to the proximal coronary arteries is as yet uncertain. In the case of poorly contracting ventricles little good is to be expected from the by pass operation. Possible, anastomosis of the internal mammary artery with a stenotic coronary artery merits preference over a venous bypass. To demonstrate the ultimate influence of this type of surgical intervention on life expectance and on a secondary pre vention of angina pectoris and myocardial infarction, Chalmers (1972) and Spodick (1971) favour follow-up studies of patients who are divided at random into a surgical and a non-surgical group. 1.1. OBJECT The object of this investigation is to establish on basis of the results and complications of saphenous vein bypass grafting (briefly termed bypass surgery): - reliable indications for this operation; - to provide the surgeon with a guide to the choice of surgical technique.

The second edition of this critical text features heavily revised chapters detailing how to approach the anesthetic and perioperative management of adult and pediatric patients with congenital heart disease. Initially, a broad overview of relevant concepts in pediatric cardiovascular embryology, physiology, and pharmacology is provided. Subsequently, relevant diagnostic approaches including the use of three-dimensional modeling in surgical planning and preoperative considerations are described. The intraoperative management of a wide range of specific lesions is discussed, with full descriptions of anesthesia plans and the appropriate diagnostic methods and surgical interventions. New topics detailed include the use of hybrid techniques and applications of electrophysiology in patients with congenital heart disease. Postoperative care and potential future approaches are also addressed. Congenital Heart Disease in Pediatric and Adult Patients: Anesthetic and Perioperative Management provide a comprehensive, up-to-date overview of the care of the pediatric patient undergoing cardiac surgery and anesthesia. It is therefore of interest to all practicing and trainee medical professionals who encounter these patients in their day-to-day practice.

This book provides a comprehensive introduction to artificial hearts, summarizing the latest advances in basic technologies, design, evaluation, and management. Featuring 11 chapters, it discusses the origins of the artificial heart, the mechanisms of heart failure, and the principles of artificial heart technologies. Further, it offers an overview of rotary pumps and volume-displacement pumps, and addresses total artificial hearts. Lastly, the book covers evaluation, selection, therapy management, challenges, and the latest innovations. Given its scope, it is a valuable resource for researchers and technicians in the area of biomedical engineering, as well as surgeons.

In Thoracic Surgery: 50 Challenging Cases, editor Wickii T. Vigneswaran has selected 50 challenging cases presented by leading thoracic surgeons. Each case highlights a unique situation from which other surgeons can learn. The selection of Cases includes patients with diagnostic challenges, unconventional and innovative solutions, unexpected findings, and new techniques to treat old problems. The discussions after each case provide a useful starting point for further inquiry. Amply illustrated, this book reflects the wisdom and experience of world leaders in thoracic surgery and teaches junior surgeons how to approach the key thoracic surgical procedures, and how to manage in unexpected and difficult situations. This is a Masterclass in thoracic surgery. Editor Bio Wickii T. Vigneswaran is the Professor and Chief of Thoracic Surgery for the Department of Thoracic and Cardiovascular Surgery at Loyola University Health System.

Trotz der so genannten a ždirekten" und a žbildgebenden" diagnostischen Verfahren, die dazu beigetragen haben, die diagnostische Genauigkeit bei Herzkrankheiten betrAchtlich zu verbessern, ist das EKG weltweit die am hAufigsten verwendete nicht invasive diagnostische Methode geblieben.

Das EKG ist rasch registriert, billig und nicht invasiv und liefert wichtige und unentbehrliche Informationen A1/4ber unsere Patienten, Informationen, die oft mit anderen Methoden nicht zu beschaffen sind.

Neben einer Einleitung in das Thema werden sowohl die klinisch relevanten EKGs, als auch viele interessante, selten auftretende FAlle des normalen und des Belastungs-EKGs dargestellt. Der Text wird durch zahlreiche EKGs und 2-farbige Abbildungen illustriert und anhand von A1/4ber 50 Fallberichten erlAutert.

Zugang zu den Informationen fA1/4r alle wird gewAhrleistet durch die Unterteilung der Kapitel in Abschnitte fA1/4r Leser, die kurze Informationen nachschlagen wollen und fA1/4r Leser, die sich in der Materie weiter vertiefen wollen.

A comprehensive text from the leading transplant centres on the medical management of thoracic organ transplantation, covering the assessment of patients for possible transplantation, through to managing patients after transplantation including any possible complications and shared care aspects of long term management

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

Heart failure is epidemic throughout the world. A growing incidence and prevalence has resulted in a large population of individuals transitioning to advanced stages of the syndrome and requiring uniquely specialised therapies and cardiac transplantation. Oxford Textbook of Advanced Heart Failure and Cardiac Transplantation is a focused and comprehensive work covering this new and rapidly growing cardiovascular subspecialty. Authored by eminent international experts, it is the authoritative text on advanced heart failure and a central resource for clinicians caring for patients with this conditition. By covering a range of characteristics, therapeutic challenges and practical aspects of managing patients this book provides an in-depth source for cardiologists and other related clinicians. A strong focus on the difficult decision making needed to handle advanced heart failure cases, along with specific knowledge of epidemiology, biology and pathophysiology, creates a key tool for optimally managing these complex patients.

This is the only guide you need to pass the MRCS Part B OSCE examination. This unique two-volume set includes comprehensive revision notes on all the areas covered in the exam; numerous practice scenarios with model answers in the format they would be encountered in the exam; and essential exam technique tips. Written by a team of editors and authors with extensive experience of the exam and all the recent changes, it broaches topics that can often trip up the candidate, including communication and history-taking skills. Revision is aided by over 130 images and illustrations, as well as boxes highlighting clinical tips and exam hints.
Volume 2 addresses the stations that exam the four specialty areas: Trunk and Torso; Limbs and Spine; Head and Neck, and Neuroscience. It covers the anatomy, physiology and pathology in each of these four speciality areas along with detailed clinical exam scenarios and a bank of likely clinical questions and model answers.

Following on from the success of the international best-seller "Key Questions in Cardiac Surgery", the long-awaited "Key Questions in Thoracic Surgery" will be the next book in the Key Questions series to be released. This book will systematically cover all the main topics involved in the current practice of a thoracic surgeon. It will incorporate current guidelines for practice (such as from the American College of Chest Physicians, British Thoracic Society and European Respiratory Society) and up-to-date information based on current literature. Each chapter will be structured to include aetiology, pathophysiology, clinical features, indications for surgery, perioperative management, surgical options and postoperative care. Possible complications will be discussed and the results of current practice presented. Importantly, there will be a section on basic sciences related to the practising thoracic surgeon and a further section on thoracic investigations with many images illustrating the variety of pathologies. Each chapter will also contain important references for further reading and greater depth of knowledge. The data and body of knowledge presented in this book is strictly evidence-based and is relevant to all thoracic surgical trainees, at any stage of their training programme. It will provide residents, fellows and specialist registrars the necessary information to carry out their daily duties. Respiratory physicians and thoracic intensive care unit specialists will also find the book useful in terms of the indications and surgical management of these patients, as they are integral to the thoracic surgical process. Another important group is the nursing staff, physiotherapists and other professions allied to medicine working with patients with adult thoracic disease either pre-operatively or post-operatively, as it will help to give a detailed understanding of the principles surrounding thoracic surgical disease. Most importantly, the book is ideal as a revision aid for residents/registrars undertaking their Cardiothoracic Surgery Board examinations around the world. Although these examinations vary in format in different countries, this book is applicable to all cardiothoracic surgical trainees. Its concise, yet complete coverage of the important topics, make it the ideal guide to answer the key questions in thoracic surgery that are asked within the confines of an examination.

Despite the exponential growth in the use of peripheral CTA in the diagnosis and follow-up of vascular disease patients, practical sources from which to gain valuable expertise in this field remain scarce. There is becoming a great need for experts in the field of peripheral CTA, yet learning this imaging modality may be intimidating and time consuming. Very few if any, small, concise and portable books exist to ease training in this field and current books in this field are overwhelming, difficult to manage, text books that often combine CTA and MRI. A so called " how to manual" and reference guide to explain this technique from beginning to end, which compiles valuable, and difficult to obtain clinical pearls and descriptions of disease processes will be of tremendous value. The Peripheral CT Angiography Manual aims to make learning this intimidating technique and the diseases for which it applies simple and fun.

This book comprehensively covers aortic dissection and acute aortic syndromes. Topics covered include the pathology, genetics, diagnosis, medical treatment and surgical management of uncomplicated and complicated aortic dissection, including endovascular stenting. In addition, imaging and follow-up procedures after initial surgical treatment are reviewed along with acute and chronic type A and type B dissection. Potential complications that can be encountered at various treatment stages and management strategies are also detailed. Aortic Dissection and Acute Aortic Syndromes comprehensively reviews aortic dissection in an easy to read, illustration-rich book. It is therefore an essential resource for both trainee and experienced cardiologist, cardiac surgeon and any other medical professionals involved in the management of these patients.

This book focuses on congenital heart disease (CHD) and emerging imaging technologies. It covers all clinically relevant aspects of the fascinating new cardiac imaging technologies, including a comprehensive explanation of their basic principles, practical aspects of novel clinical applications, and detailed descriptions of specific uses in the broad spectrum of clinically important adult CHD. Innovations and emerging technologies for diagnosis and therapeutics, evaluation and treatment are continually evolving, and due to these advances in non-invasive diagnosis, there has been a significant improvement in the survival rates for CHD patient. Novel approaches to trans-catheter interventions and advances in echocardiography, MRI and CT imaging are being developed and incorporated into routine clinical practice, while emerging three-dimensional printing technologies are fundamentally affecting patient care, research, trainee education, and interactions between multidisciplinary teams, patients, and caregivers. In addition, translational technologies on the horizon promise to take this nascent field even further. Exploring the applicability of these emerging technologies in improving our understanding of complex congenital cardiac defect anatomy and physiology will provide new treatment options for this unique population. Written by experts in the field who are also involved in patient care, this book discusses the practical application of innovations in advanced multimodality imaging in the daily clinical routine and offers tips and tricks for beginners.

Malignant pleural mesothelioma, a malignancy due largely to asbestos exposure, represents an increasingly common challenge to clinical and medical oncologists, respiratory physicians, and cardiothoracic surgeons, as well as researchers in the field. The disease has yet to reach its peak and is expected to kill over 100,000 people worldwide. As malignant pleural mesothelioma gains in profile, Kenneth O'Byrne and Valerie Rusch present a comprehensive overview of the subject, aimed at all health care professionals who come into contact with patients with the disease. The book includes chapters on epidemiology, diagnosis, histopathology, radiology, surgery, chemotherapy, immune therapy, radiotherapy, and palliative medicine, written by an international team of contributors. A molecular biology section focuses on the carcinogenic effects of asbestos fibres and simian virus 40, angiogenesis and angiogenic growth factors, the immune response, and genetic abnormalities detected in the disease. Future therapies are also covered, as is a perspective on the distinct legal issues related to the disease. This highly-illustrated, full colour book provides the ultimate, timely resource on this devastating disease.