This volume contains the lectures presented at the International School of Radiation Damage and Protection at the "Ettore Majorana" Centre for Sci entific Culture in Erice, Italy, September 6-15, 1985. The sixth course of the School, entitled "Advances in Applications, Biological Effects, and Dosimetry of Ultrasound," provided an in-depth review of all facets of ultra sound interactions and their biological effects on living systems, allowing an assessment of the hazard potential of the various applications of ultra sound. Particular reference was made to possible health risks associated with medical ultrasound exposure since this use is by far the most prevalent. Since the initial application of ultrasound to submarine detection, medical diagnostic and therapeutic applications have become predominant over the past 20 years. The question of safety of this physical agent is an extremely important one. In many industrialized countries most pregnant women receive at least one diagnostic ultrasound examination before the birth of the child. Thus, potential hazards to the fetus are of prime concern. This problem has been aggravated by the fact that the medical diagnostic applications of ultrasound have far outpaced research efforts on biological effects. A further compounding factor of concern to clinicians and scientists has been the use of higher and higher intensities by the manufacturers of ultrasound equipment, particularly higher peak pulse intensities."

There continue to be disagreements concerning the embryology of the ventric ular septum and the nomenclature of its various parts, as well as on its phylogenetic derivation. It must be obvious that until such time as these uncertainties have been resolved it will not be possible to understand the pathogenesis of ventricular septal defects and other anomalies involving the ventricular septum. In an effort to clarify some of these difficulties a number of individuals, including anatomists, embryologists, pathologists, cardiologists, and sur geons, all acknowledged experts in their respective fields of endeavor, were invited to present their views and concepts in sessions devoted to the ventric ular septum. In this "Boerhaave Course," detailed descriptions of the normal anatomy, embryology, and phylogeny of the septum were followed by papers on ventricular septal defects, atrioventricular defects, straddling valves, and various forms of univentricular heart. Major contributions were made through clinical accounts of these anomalies. This course again clearly demonstrated the value of and the need for a multidisciplinary approach to the recognition, understanding, diagnosis, and management of congenital cardiac disease. While obviously it could not be ex pected that all of the problems and uncertainties concerning the normal and abnormal ventricular septum would be resolved, the lively and frank dis cussions among all participants of the course undoubtedly contributed to a better understanding of the still existing difficulties. All ofthe contributors to this monograph should be congratulated for a job superbly well done."

Sudden death is probably the greatest challenge facing modem cardiology today. This is mainly due to the impact of its brusque appearance and the socioeconomic implications. The incidende is presently decreasing somewhat, mainly due to the decline in new cases of ischemic heart disease on one hand, and to better preven tion in risk patients on the other. Nevertheless, the figures are still high and represent over 300.000 patients per year in the United States alone. This book is an updating of the problem of sudden death from a multifactorial standpoint. It includes not only electrophysiologic data but also covers aspects ranging from epidemiology to prevention. Risk markers and triggering mechanicsms of sudden death are reviewed, with special emphasis on the role of electrical instability, ischemia and depressed ventricular function. The book includes the contributions from many experts, often pioneers in their respective fields. It is our hope that the book serves as an Updating for those cardiologist who are not specialized in these subjects, but may also be of interest to the expert. We wish to express our sincerest gratitude to the authors for sending in their work so promptly, and also Kluwer Academic Publishers for their exactitude and perfection in this edition."

Recent technological developments have brought long-term ambulatory electro cardiography to the front of clinical cardiology. Its application for solving clinical problems potentially related to cardiac arrhythmias is rapidly increasing. In the meantime, the method has found widespread use in the identification of patients at risk for cardiac death as well as in the assessment of therapeutic interventions. It was the purpose of this symposium to bring together an international group of authorities in order both to provide an overall view of the field and to discuss critically the value of clinical, epidemiological and research applications of long term ambulatory electrocardiography in the light of new concepts and recent advances. The first section of this volume discusses the methodology and the performance criteria of the equipment and analysis systems. In the second section, the potentials and problems encountered in the use of long-term ambulatory electrocardiography for solving clinical questions and for predicting the occurrence of clinically important arrhythmias are extensively as continuous ST segment monitoring, blood dealt with. New applications such pressure measurement and other physiologic parameters are also included. Prevalence variability and prognostic aspects of ventricular arrhythmias, both in normals and in patients with cardiac disease, are the subject of section 3. The last section provides a critical review of the use of the method for the evaluation of therapeutic interventions with drugs. The editors feel that this volume represents the 'state of the art' in this newly important area of clinical cardiology."

For many years, clinicians have relied on cardiac marily be categorized into two camps

The processes of distention and recoil have an essential role in the functions of arteries and lungs. In both organ systems, these processes involve to a great extent the connective tissues, in particular the manner in which the extracellular materials are arranged to afford such movements. This book concerns the microenvironment of the connective tissues in the walls of arteries and the stroma of lungs. Proteoglycans, collagen, and elastic fibers and their interrelationships are discussed by eight scientists who are established researchers in this area. Their reports include important findings on how this microenvironment is altered in diseases such as atherosclerosis, emphysema, and pulmonary fibrosis. The concepts developed result from studies at the biochemical, macromolecular, ultrastructural, and light microscopic levels. Taken col lectively, the reports focus attention upon the role of the connective tissues in arterial and lung distensibility and how alterations in the connective tissues result in the loss of this function. Medical researchers and physicians interested in arterial or lung functions or diseases will find the scientific approaches and findings of the authors innovative and provocative. Students of stereologic morphometry will be particularly interested in the quantitative studies of cells and fibers in arterial walls; histologists and pathologists will find the chapter on histochemical staining interesting from both a scientific and historic viewpoint.

In 1980, Furchgott and Zawadzki demonstrated that the ability of a blood vessel to relax to acetylcholine is entirely dependent upon the presence of an intact endothelium b1. This startlingly simple and elegant observation heralded a decade of basic research into endothelium-derived vasoactive factors (EDRF). Initially, interest focused on Furchgott's endothelium-derived relaxing factor, which was later identified as the extremely simple molecule, nitric oxide [21. However, bioassay systems suggested the presence of other dilator and constrictor factors. Many of these additional putative factors remain elusive but one constrictor factor was revealed to the world in an impres- sively complete piece of science published in 1988. Yanagisawa, Masaki and colleagues [31 demonstrated the synthesis of a twenty one amino acid peptide which accounted for the constrictor activity found in the supernatant of endothelial cells. They identi- fied its structure, synthesised the peptide, showed its biological activity in vitro and in vivo, proposed mechanisms of action and cloned and sequenced the gene. They named the factor endothelin. The identification of nitric oxide and endothelin has also rekindled interest in established endothelium-derived mediators, including the prostanoids and other arachidonic acid metabolites, and has led to exploration of the possible roles of oxygen radicals such as superoxide. The vascular endothelium has become a major focus for research into disease states or cardiovascular risk factors associated with abnormal vascular tone or reactivity, alterations in cellular adhesion to the vessel wall, increased smooth muscle cell growth and the chronic process of atherogenesis.

The thrust here is for those who want to know more than the answer to an exam question - an approach to disease diagnosis and treatment which emphasizes thoughtful consideration of alternatives, finding ones way through uncertainties and lack of knowledge. The annual seminar on which this volume is based has evolved into a forum for open discussion of puzzling questions - actually old questions in the light of new data. To me, the adventure of life is in recognizing the openendedness of all things. So you thought that a certain disease was a settled question? In medicine a "settled" question is a transient conclusion. Even the solutions to the so-called simplest problems have another side. Our aim this year was to air out concepts and conclusions about hypertension, fluid-electrolytes, and tubulopathies. The stars were Drs. Juan Rodriguez-Soriano, Alan Gruskin, and Donald Potter, along with Drs. Gustavo Gordillo, Ronald Kallen, and Antonia Novello as guest faculty. Local stars included Drs. Mary Jane Jesse, Jacques Bourgoignie, and Carlos Vaamonde. Their contributions added to those of the other faculty and registrants, coalesced into vibrant exchanges which are reproduced here for the reader's perusal.

This monograph contains the contributions to the NATO Advanced Studies Institute on "Vascular Endothelium: Responses to Injury", which took place in Crete, Greece from June 18 to 27, 1994. This was the fourth in the series of NATO-supported ASIs in selected specific areas of endothelial cell biology, which began in 1988. Each time, it has combined clinical with basic scientists and renowned experts with novices in the field, in an attractive setting conducive to dissemination of knowledge, high quality discussions and exchange of ideas. This, as well as previous ASIs, reflects the hard work of numerous people. As Co- Directors, we have been particularly fortunate to benefit from the expert advice of the Organizing Committee, which included Elizabetta Dejana, Alberto Mantovani and Magdi Yacoub. Their insightful suggestions helped formulate the scientific program of the ASI. We are also grateful for the work and dedication of the local organizing committee of Thomie Douraki, Stylianos Orfanos, Panayotis Behrakis, Michael Maragoudakis and Lydia Argyropoulos who tirelessly looked after the main details necessary to ensure that all of us enjoyed the meeting. Similarly, we wish to thank Jim Parkerson, Connie Snead, Andreas Papapetropoulos and Nandor Marczin for their assistance in various aspects of the many preparations for the conference. A very special thanks goes to Annie Cruz, the ASI Co- ordinator, for her efficient, solicitous and pleasant demeanor during the months prior to the ASI and especially during the ten days of the conference.

This book comprises the essential records from a Boerhaave course given in June 1971 for specialists in cardiology and other fields of internal medicine interested in the subject of quantitation in cardiology. It is evident that in the wide field of medicine, and particularly in cardiology, there is a growing need for exact and detailed information in conjunction with existing diag nostic methods. This is apparent in the greater precision in anatomical and haemodynamic details required by the thoracic surgeon as the number of available heart operations gradually increases. In retrospect it is hardly surprising that the high initial mortality after the introduction of each operation depended to a large extent upon the degree of accuracy with which the diagnosis was made. Another urgent need for precise and quantitative information became apparent when monitoring of high-risk patients, in order to forestall compli cations and/or death, became routine. The same applies for the diagnostic procedures used to estimate the patient's chances of surviving an operation and/or rehabilitation after a serious incident, such as myocardial infarction. In these fields there is a vast amount of data to be handled and - in modern diagnostic procedures - it must be processed so rapidly that the human mind cannot suffice and computer equipment has becomeindispensable."

S. TRACY Late in the 1940s, a virus was isolated from a young patient with a flaccid par alysis in the sleepy Hudson River town of Coxsackie in the state of New York. Within the next few years, it was apparent that this and other similar viruses were not polioviruses but were indeed a new group of viruses, viruses that by the mid- 1950s had been found to be commonly associated with pediatric inflammatory heart disease. Two groups of coxsackieviruses (A and B) were differentiated on the basis of the type of paralysis induced in suckling mice by these viruses. Group B coxsackieviruses, because of their primacy as etiologic agents of human acute viral myocarditis and its relatively common sequela, dilated cardiomyopathy, are the focus of this volume. of the century approaches, the massive international effort to eradi As the end cate polioviruses through vaccination as causes of human disease has been success ful in the Western Hemisphere and in many parts of Europe, and it is expected that worldwide eradication may be achieved within the near future. While this is wonderful news, there are sadly no similar efforts being planned to combat the numerous other human enteroviruses that daily incur widespread morbidity and mortality throughout the world. While this is due in part to the lack of specific know ledge about the other human enteroviruses, it is also due to the perceptions of industry that there is insufficient profit to be made by developing these vaccines.

F.J.Th. WACKERS Metabolic imaging: The future of cardiovascular nuclear imaging? Since cardiovascular nuclear imaging emerged as a new subspecialty in the mid-1970s, the field has gone through an explosive growth. Radionuclide techniques became readily recognized as important new diagnostic aids in the armamentarium of the clinical cardiologist. Initially, cardiovascular nuclear imaging focused on static myocardial imaging using either thallium-201 or technetium-99m-pyrophosphate for diagnosing acute myocardial infarction. Shortly thereafter, multigated equilibrium radionuclide angiocardiography became the most widely used noninvasive method for assessing cardiac function. Furthermore, attention and clinical application shifted towards the use of radionuclide techniques in conjunction with exercise testing, either with thallium-20 1 myocardial perfusion imaging or technetium-99m left ventricular function studies. The future of cardiovascular nuclear imaging appeared exciting and promising. However, around 1980 pessimists predicted the premature demise of cardiovascular nuclear imaging with the introduction of digital subtraction angiography and nuclear magnetic resonance imaging. These doomsayers have been proven wrong: in 1985 cardiovascular nuclear imaging is thriving and, in many centers, even expanding. Although digital substraction angiography and magnetic resonance imaging provided exquisite anatomic detail, for practical evaluation of patients with ischemic heart disease - in the Coronary Care Unit or exercise laboratory - nuclear techniques appeared to be more practical.

A clinical manual on hypertension for primary care physicians.

Serves as an up-to-date reference on hypertension for use in clinical practice.

Includes dozens of clear and informative tables and figures to maximize comprehension.

Addresses the most recentand crucial developments in a very common chronic condition.

Gives a comprehensive review of currently available medications and combination therapy.

Approximately one billion people worldwide are affected by hypertension. About 24% of the adult population in the US are hypertensive, and the number is expected to increase with the rising rates of obesity and diabetes. As hypertension affects so many and spans across varying ages, genders, ethnicities, and socioeconomic classes, all clinicians are likely to encounter patients with hypertension on regular basis. Hypertension is one of the major causes of cardiovascular diseases, and timely diagnosis and treatment are essential.

The manual will give the reader a thorough overview of antihypertensive lifestyle modifications, first-line therapy, combination therapies, comorbid conditions, therapeutic challenges, and the latest trends in antihypertensive therapy.

Pharmaceutical companies can use this clinician s manual as an excellent educational giveaway, as the booklet includes the latest clinical research results and treatment options for hypertension.

The manual will give the reader a thorough overview of antihypertensive lifestyle modifications, first-line therapy, combination therapies, comorbid conditions, therapeutic challenges, and the latest trends in antihypertensive therapy.

Pharmaceutical companies can use this clinician s manual as an excellent educational giveaway, as the booklet includes the latest clinical research results and treatment options for hypertension.

The manual will give the reader a thorough overview of antihypertensive lifestyle modifications, first-line therapy, combination therapies, comorbid conditions, therapeutic challenges, and the latest trends in antihypertensive therapy.

Pharmaceutical companies can use this clinician s manual as an excellent educational giveaway, as the booklet includes the latest clinical research results and treatment options for hypertension.

Approximately one billion people worldwide are affected by hypertension. About 24% of the adult population in the US are hypertensive, and the number is expected to increase with the rising rates of obesity and diabetes. As hypertension affects so many and spans across varying ages, genders, ethnicities, and socioeconomic classes, all clinicians are likely to encounter patients with hypertension on regular basis. Hypertension is one of the major causes of cardiovascular diseases, and timely diagnosis and treatment are essential.

The manual will give the reader a thorough overview of antihypertensive lifestyle modifications, first-line therapy, combination therapies, comorbid conditions, therapeutic challenges, and the latest trends in antihypertensive therapy.

Pharmaceutical companies can use this clinician s manual as an excellent educational giveaway, as the booklet includes the latest clinical research results and treatment options for hypertension.

The manual will give the reader a thorough overview of antihypertensive lifestyle modifications, first-line therapy, combination therapies, comorbid conditions, therapeutic challenges, and the latest trends in antihypertensive therapy.

Pharmaceutical companies can use this clinician s manual as an excellent educational giveaway, as the booklet includes the latest clinical research results and treatment options for hypertension.

The manual will give the reader a thorough overview of antihypertensive lifestyle modifications, first-line therapy, combination therapies, comorbid conditions, therapeutic challenges, and the latest trends in antihypertensive therapy.

Pharmaceutical companies can use this clinician s manual as an excellent educational giveaway, as the booklet includes the latest clinical research results and treatment options for hypertension.

Approximately one billion people worldwide are affected by hypertension. About 24% of the adult population in the US are hypertensive, and the number is expected to increase with the rising rates of obesity and diabetes. As hypertension affects so many and spans across varying ages, genders, ethnicities, and socioeconomic classes, all clinicians are likely to encounter patients with hypertension on regular basis. Hypertension is one of the major causes of cardiovascular diseases, and timely diagnosis and treatment are essential.

The manual will give the reader a thorough overview of antihypertensive lifestyle modifications, first-line therapy, combination therapies, comorbid conditions, therapeutic challenges, and the latest trends in antihypertensive therapy.

Pharmaceutical companies can use this clinician s manual as an excellent educational giveaway, as the booklet includes the latest clinical research results and treatment options for hypertension.

The manual will give the reader a thorough overview of antihypertensive lifestyle modifications, first-line therapy, combination therapies, comorbid conditions, therapeutic challenges, and the latest trends in antihypertensive therapy.

Pharmaceutical companies can use this clinician s manual as an excellent educational giveaway, as the booklet includes the latest clinical research results and treatment options for hypertension.

The manual will give the reader a thorough overview of antihypertensive lifestyle modifications, first-line therapy, combination therapies, comorbid conditions, therapeutic challenges, and the latest trends in antihypertensive therapy.

Pharmaceutical companies can use this clinician s manual as an excellent educational giveaway, as the booklet includes the latest clinical research results and treatment options for hypertension.

"

Within the field of general medicine, the last two decades have seen the curative procedures increasingly supplemented by func tions that can be summed up under the heading of "preventive health care." There is a close link between this development and the changing morbidity pattern. In highly developed countries the morbidity rate attributable to infectious diseases has been much reduced, while the various types of arteriosclerosis, some tumorous conditions, and so-called functional syndromes have attained massive incidence rates. Systematic epidemiologic studies have yielded the concept of risk factors, i. e., certain exogenous and endogenous factors whose elimination, ideally, would make it possible to avoid the manifestation of an illness or to ensure it did not become mani fest until later in life or in a milder form. The socioeconomic and sociomedical significance of these aspects is considerable, as can be seen from all the statistics on the reasons for incapacity and early retirement and on the relative contributions of different ill nesses to total mortality. Effective avoidance of illnesses by primary prophylaxis (elimi nation of the causes of disease) or early detection of the symp toms of disease (secondary prophylaxis) leading to early treat ment would be a particularly significant step forward, since in the case of most of the conditions mentioned above only pallia tive forms of treatment are available, and none that have any cu rative effect."

What medicine lacks in an increasingly specialised world is the medical polymath (or should it be medical bimath?) - the man who is an acknowledged expert in more than one field of medicine. Superpecialisation in the professional sense is an attempt to know more and more about less and less. It can be the microscopist's view of reality and such a microcosm can become also a refuge from realities. One reality difficult for the very specialised doctor to accept is that diseases don't exist. Only people with diseases exist and people do not always conform to convenient categories and compartments. It would be nice if they did but somehow they never do. A cherished medical tradition in Britain is that specialists are not hatched straight from medical schools. Indeed, young doctors are actively discouraged from taking too narrow an interest but are plunged for at least four years into the unspecific pool of general medicine until they have developed a broad awareness of the totality of human disease. Before this they are not allowed to narrow their sights on one particular target.

Just a very few years after Edler and Hertz had described the clinical use of M-mode echocardiographyl Satomura reported the application of Dop 2 pler ultrasound to the study of cardiac function. Yet Doppler ultrasound has been integrated into diagnostic practice in cardiology much more slowly than conventional (M-mode and two-dimensional) echocardiogra phy. Now, however, tremendous growth in the interest of clinicians in the diagnostic use of Doppler ultrasound can be observed and may in fact be due to the recent advent of color flow imaging. The reason for this growth may be that this method makes it possible to directly visualize the blood flow in the cardiovascular system in cross-sectional views. Moreover, the results are reproducible and much easier to understand than the older mapping techniques using a single-gate Doppler. In its short existence many different names have been used to describe this method, for instance, color Doppler, color flow imaging, real-time two-dimen sional Doppler echocardiography, and Doppler flow imaging. This diver sity reflects the large interest that many researchers have shown in this method. The technical development of color blood flow imaging (CBFI) - as this method will be called in this book - has not yet reached a universally accepted standard of performance in cardiology. Despite this state of flux and the uncertainty about future developments, I think it is justified to dedicate an entire book to this fascinating method."

. . . we do not know a truth without knowing its cause. Aristotle Perhaps the greatest hope that may be entertained for a scientific work, whether experimental or theoretical, is that it leads to new thoughts and new avenues of investigation on the part of its readers. In microvascular mechanics, the interplay of rheology, anatomy, and cellular and organ function has only just begun to be addressed. To understand the operational behavior of microcirculation, there is a need to integrate studies at the cellular or molecu lar level with a quantitative, biomechanical description of the circulatory system. The symposium entitled "Frontiers in Cardiopulmonary Mechanics" held in June 1988 at the University of Virginia was intended to provide a fundamental approach to the description of the circulation from the per spective of microvascular mechanics and to examine new methodology that may advance this effort. This book arose out ofthe work presented at the symposium. Aristotle expressed well the need to pursue the causes of a phenomenon in order to achieve a truthful understanding of its nature. In this spirit has each of the quantitative sciences progressed, and in this spirit we hope that this book will provide some understanding of the microvascular events and bio mechanical mechanisms underlying the behavior of circulation in general, and of pulmonary and skeletal muscle microcirculation in particular. The integrated treatment of pulmonary and systemic microcirculation provided here is intended to encourage the cross-fertilization of these two research fields."

This volume represents a part of the scientific proceedings of the Sixth Annual Meeting of the American Section of the International Society for Heart Research that was held in Oklahoma City from September 13-15, 1984. The chapters have been grouped according to the content of invited symposia on cardiovascular topics ranging from electrophysiology, autonomic control of the circulation, aging of the myocardium, mechanisms of cardiovascular injury, cultured heart cell studies, etc. Abstracts of all the papers presented at this meeting are included in Volume 16 (Supp. 1) of the Journal of Molecular and Cellular Cardiology. Since our understanding of the pathobiology of cardiovascular injury requires integrating knowledge from both basic and clinical sciences, the information presented in this volume extends from fundamental biochemical processes to pharmacological agents required to treat complex cardiac arrhythmias. At the molecular level, the structural lipids of the sarcolemma may be altered during myocardial ischemia; the role of free radicals in this process is one emerging area of active study. At the subcellular level, plasma membranes provide the anatomical basis for maintenance of optimal potentials of excitable cells; the anatomy and physiology of the sarcolemma ultimately determines the response to drugs and metabolic perturbants. At the cellular level, much progress has been made in our understanding of cultured and adult myocytes during ischemia and hypoxia; in particular, the electrophysiology of these model systems is well understood and several chapters address this approach.

Some 25 years ago, the coronary care unit concentrated high technology and the acutely ill patients who might benefit from it in a single, recognizable space. Since then, that space and its technical equipment have changed, as has part of its population. Acute ischemia, silent and manifest, occurs within and outside of the coronary care unit as pain, arrhythmia, or pump failure. Its detection and treatment require the utilization of many diagnostic techniques and skills, not the least of which is two-dimensional Doppler echocardio graphy, which is gaining importance. Future developments, in tandem with computer technology, may add to this importance by enabling tissue identification, spatial representation, and Doppler flow mapping. This book describes the state of the art for the practicing clinician using Doppler echocardi?graphy at the bedside of patients with acute ischemic manifestations of coronary heart disease. The first requirement is to move from the echo laboratory to the coronary care unit, emergency department, operating room, or catheterization laboratory, using equipment suited for that purpose. The second, more trying imperative is to secure good cooper Ition between those treating the acutely ill patient and the investigator who interferes with his probes. If successful ceeding in both, rewarding results can be obtained, since echocardiography is a very sensitive and specific tool for recognizing and quantifying early ischemia."

In summary, there are many animal models that are useful in selecting new antiarrhythmic drugs. The selection of which model is most idea depends upon precisely what question is being asked. The large number of experimental models used to evaluate antiarrhythmic compounds points out the inability of anyone model to define the probability of antiarrhythmic efficacy in man. It has therefore become standard practice to utilize a batter of animal models for the evaluation of new antiarrhythmic agents. Each model has its own advantages and disadvantages and it is necessary to understand each model fully in oder to evaluate experimental findings and apply them to clinical settings. We believe that the availability of the chronic myocardial infarction ventricular tachyarrhythmia model provides 1) an excellent opportunity to more precisely understand arrhythmia mechanisms, 2) to develop new techniques such as signal averaging for evaluating late low level potentials identifying hearts at high risk of sudden death 3) to identify new antifibrillatory drugs versus drugs that are effective primarily against PVC's and ventricular tachycardia 4) to identify new surgical techniques to eliminate VT/VF, and 5) to evaluate new pacing modalities including implantable cardioverters. Although all animal models are wrong, many are very useful in furthering our knowledge directed at decreasing the distressingly high mortality from heart disease. NORMAL HtART TACHYCMDIA HtART , .. '" \ I I I I I I I I I .

This monograph represents an attempt to collect the methods developed within the past decade in which echocardiography was being used to guide or to assess the results of some cardiovascular interventions or to overcome the imaging limitations of transthoracic approaches. I have entitled this book Echocardio graphy in Cardiac Interventions, although I am aware that this title is not entirely applicable to all the included methods. In these interventive procedures echocar diography preserves its noninvasive nature, and by combining it with invasive procedures, they become more accurate, safer and less invasive. The book is divided into 8 sections and 42 chapters written by many authorities in the field. When such comprehensive contributions from many authors are used, some overlapping cannot be avoided. I would like to express my appreciation to the individual contributors for their A. 1. Tajik dedication and cooperation in preparing this book. I am indebted to Dr. from the Mayo Clinic, who created a pleasant milieu for preparing the book during my sabbatical year at the Mayo Clinic. It is hoped that the reader will derive from this book a sense of where and how the ultrasound can be used in cardiovascular interventions today and what new approaches might be forthcoming. Iva Cikes List of contributors M. L. Antunes, MD., Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York, USA. J. Areeda, Cedars-Sinai Medical Center, Los Angeles, California, USA."

AIMS OF THE COLOGNE-SYMPOSIUM ON RADIOLABELLED PLATELETS In 1976, M. Thakur et al (1) were the first to publish a paper concerning the in vivo thrombus detection with 111- In-labelled platelets. Previous attempts at scintigraphic thrombus localisation had been disappointing because of the unspecific binding of a number of the isotopes used, as well as the poor labelling efficiency or an insufficient low gamma-emitting property. Because of its physical characteristics (2.8 days half-life, 94% gamma emission) 111 Indium turned out to be the best isotope for platelet kinetic studies as well as for the measurement of platelet incorporation by Thrombi to be used up until now. The lipophile complexes of Ill-In (8-hydroxyquinoline, acetylacetone, tropolone) diffuse passively into the platelets without altering the function or the life span of the platelets. This advantage has let to an increase in the clinical applications of 1211-In labelled platelets. Today, radiolabelled platelets are used for thrombus detection in several different medical areas such as cardiology, nephrology. angiology or neurology. Even though many scientists and hospital doctors now routinely use radiolabelled platelet as a diagnostic tool, there is as yet not a standardized labelling method. In addition to this, there are neither standardized image procedures for the different clinical applications nor an agreement about specificity and sensitivity of the method. In 1983, a symposium on Radiolabelled Cellular Blood Elements was organized by M.Thakur, M.R.Hardeman and M.D.

In any textbook, basic scientific knowledge, and the art of clinical practice should be brought together in a rational manner and this volume on cardio vascular therapy attempts to achieve this aim. It deals with five selected areas - hypertension, angina and coronary artery disease, heart failure and anticoa gulant therapy. Clearly not all branches of cardiovascular therapeutics could be included; a separate section on anti-arrhythmic drugs is noticeably absent but it is proposed that this omission will be rectified in other volumes in the series. In general, textbooks on therapeutics tend to be ephemeral; as new discoveries are made and evaluated, medical practice changes. This volume then summarizes current opinion up to mid 1984 and gives, we believe, a reasoned account of present views. The contributors are all clinical pharma cologists with a wealth of clinical experience. The therapeutic advice given is well founded and the underlying scientific basis is clearly explained. The book is aimed at postgraduates, but should the undergraduate care to dip into it, we hope he will be informed and thereby educated. A. Breckenridge vii Series Editor's Note The last few decades have seen an explosion in our knowledge of cardiovas cular disease as a result of research in many disciplines. The tempo of research is ever increasing, so that it is becoming more and more difficult for one person to encompass the whole spectrum of the advances taking place on many fronts."

Seymour Glagov The last meeting, devoted exclusively to an examination of the atherosclerotic plaque, took place in Chicago 25 years ago under the joint auspices of the Council on Arteriosclerosis of the American Heart Association and the Chicago Heart Association. The proceedings were published subsequently in a volume entitled "Evolution of the Atherosclerotic Plaque", edited by Richard J. Jones (1). Both experimental and human lesions were considered and several provocative new approaches to the disorder were discussed. The electron microscope was being applied systematically to the study of blood vessels at that time, so that details of the infrastructure and cellular composition of the artery wall and of atherosclerotic lesions were presented in some detail. There was, as one result of these explorations, considerable discussion of morphologic evidence suggesting that the principal cell involved in the atherogenic process was neither the fibroblast nor the macrophage, as had been supposed, but the smooth muscle cell. In particular, the findings indicated that this cell could incorporate lipid and become a foam cell.

In recent years there has been an increasing interest in quantitative analysis of coronary cineangiograms and already for a longer time of left ventricular cin- eangiograms. The needfor quantitationofcoronary arterialdimensions has been stimulated by the introduction ofnew therapeutic procedures in the catheteriza- tionlaboratory, suchas the balloon dilatationtechnique (PTCA) and thromboly- tic therapy, by the need to study the vasoactive responses of pharmaceutical agents, and also by the desire to study the progressive nature ofcoronary artery disease with the ultimate goal to find ways to bring a halt to the progression of coronary atherosclerosis or even achieve regression of the disease. Parallel with these clinical developments, rapid technical developments in computerarchitect- ures and semiconductor memories have made it possible to digitize and store cineframesor selected portions thereof in image processors and to analyze these pictorial data quantitatively at affordable prices. More than 15 years of research have been directed by various groups towards the semi- or fully-automated delineation of the left ventricular boundaries on a frame-to-frame basis. Yet not a single system with fully-automated capability is commercially available. In the mean time many different left ventricular wall motion models have been developed, again with little consensuson which model is to be preferred as no golden standard exists.