Aaron I. Vinik, M.D., Ph.D. I IEastem Virginia Medical School The Diabetes Institutes Norfolk, Virginia 23510 This symposium, held in June 1991, was a gathering of international scientists to exchange their views on current concepts of cell growth and differentiation. Each scientist was asked to present a topic of their research related to cell growth and regeneration and to participate in a round table conference elaborating on current knowledge and sharing their experiences. By furthering this promising area of endeavor, a means of understanding ontogeny of cell development and of providing insights into tumor biology would prevail. Of prime importance was the anticipation that new information from a better understanding of the normal evolution of the pancreatic islet would generate alternative approaches to curing diabetes. This forward serves as a short introduction to the concept of pancreatic islet regeneration and the models currently in use to study the process. DEVELOPMENTAL ORIGIN OF ISLETS DURING EMRYOGENESIS The developing pancreas appears as a protrusion from the dorsal surface of the l embryonic gut. The different islet cell types appear sequentially during development in vivo. It therefore seems reasonable to propose that coordinated growth is dependent upon specificity of growth factors.

Oncology has developed as a subspecialty of medicine with unique and often complex clinical problems. This handbook ofhematologic and oncologic emer gencies provides a compact, concise, yet comprehensive guide to the manage ment of a variety of difficult clinical situations. The authors of the various chapters are all clinicians with experience in the management of these difficult patients. Their efforts provide insight and a ready source of practical infor mation which lends itself to use in the clinic and in the inpatient ward. The authors sincerely hope that this handbook will be of service to house officers and fellows alike, as they develop skills in the management of the emergent problems of patients with hematologic and other neoplasms. Janice P. Dutcher Peter H. Wiernik Bronx, New York;; Contents 1. Syndrome of Inappropriate Antidiuretic Hormone Secretion and Hyponatremia . . . . . . . . . . . . . . . . . . . . . . . . 000 . . . . . . . . . . . Stuart L. Marcus, M.D., Ph.D., and Joachim Z. Fuks, M.D. 1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2. Mechanisms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 3. Etiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 4. Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 5. Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 2. Acute Tumor Lysis Syndrome: Prevention and Management . . 9 Stuart L. Marcus, M.D., Ph.D., and Avi I. Einz;ig, M.D. 1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 2. Risk Factors for the Development of Azotemia in Acute Tumor Lysis Syndrome........................................... 10 3. Metabolic Abnormalities That Occur during Acute Tumor Lysis Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 . . . . . . . . . . . . . . 4. Prevention of Acute Tumor Lysis Syndrome: Management prior to Beginning Chemotherapy . . . . . . . . . . . . . . . . . . . . . . . . . 13 . . . . . . . . . . 5. Posttreatment Management: Indications for Dialysis . . . . . . . . . . 14 . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 . . . . . . . . . . . . . ."

This year marks the tenth anniversary of the International Symposium on Medical Virology. In the Foreword to the book of the 1980 Symposium, we stated, "However, the challenges still lying ahead are more numerous than our past accomplishments". Little did we know at the time, that within a few years the spread of human immunodeficiency virus type I was going to occur. This worldwide epidemic has, like no other disease in recent history, awakened the scientific community and the public at large. It is a reminder to all of us that regardless of our vast technical advances, Nature provides such great opportunity for biological diversity, that it will always be one step ahead of our scientific knowledge. Although our understanding of virology, molecular biology and immunology have increased by leaps and bounds over the last decade, we are still at the point of being unable to effectively control the spread of this viral infection. We hope that our Symposium this year has helped researchers to come together and exchange' ideas, so that our growing knowledge of viral infections will help produce better approaches to control them. Luis M. de la Maza Irvine, California Ellena M. Peterson March, 1991 v ACKNO~EDGEMENTS It would be impossible to single out all those individuals who helped us make this Symposium a reality, however, we would like to take this oppor tunity to express our appreciation for their efforts.

ACE inhibitors are one of the most exciting and interesting of recent medical developments. They fit the patho-physiologica1 processes of cardiovascular disease with fascinating precision and are a constant stimulus to the acquisition of greater understanding of the mechanisms involved and of the mode of action of the drugs themselves. There is still much to be learned, especially about the wider effects of the drugs, their precise mode and site of action and about differences between the different preparations. ACE inhibitors are of proven benefit to patients with chronic congestive heart failure and are the latest in the series of drugs used in the treatment of hypertension. Interest in the treatment of hypertension has paralleled the development of hypotensive drugs and the realisation that long-term prognosis could be significantly improved. The treatment of hypertension has progressed in stages following the development of a succession of increasingly effective drugs, each allowing a greater proportion of patients to be treated with fewer and fewer side-effects. First, the ganglion-blocking agents such as hexamethonium and guan ethidine transformed the outlook for patients with malignant hypertension but proved too unpleasant for routine use in other forms of hypertension."

As we move into the 21st century it is becoming increasingly difficult to offer appropriate introductory clinical experiences for medical students. Many schools offer clinical experiences in the first year of medical school, when the learner has little background in the traditions and origins of the doctor-patient interaction. Others begin this process in the second year, after a professional language base has been established, but concise educational materials are scarce that integrate the meaning of the privileged clinical encounter with the process and content of interviewing and examining patients. In the tertiary hospitals, where most medical schools are based, the educators must provide an orienta tion to the clinical encounter, an intensely personal experience, in the midst of glittering technological marvels that easily distract both the novice physician and the wizened teacher. Understanding the context and historical basis for the privilege of interviewing and examining another person about intimate matters relating to health and disease is essential to this process. Considering these factors, this textbook is written to assist medical educators and medical students involved in early clinical training. As the demand for "high-tech" medicine has accelerated, so has the public concern over the loss of "high-touch" or compassionate, humane interactions with physicians. Physicians are perceived as more concerned with readouts from machines and fiberoptic views of the patient than with understanding and car ing about the people we have labeled as patients."

Fundamentals of Clinical Practice, Second Edition presents medical students with a comprehensive guide to the social ramifications of a physician's work, and more experienced practitioners with the tools to augment their own patient-centered techniques.

This book has been written to provide general practitioners with an easy to read, easy to consult guide, to aid in the management of the large majority of practice emer gencies. Each presenting problem is approached logically with telephone assessment and advice followed by the assessment and management necessary when the patient is seen. The emphasis is on practical primary care with discussion of differential diagnosis only taken as far as is needed for deciding the best immediate course of action. Words are kept to a minimum though tables are liberally used to summarise useful information. For each situation the final management advice is highlighted by being presented within a heavily lined box. Our guiding principles for emergency care, which this book naturally reflects, are: (1) Visit first - argue or educate later. (2) If in doubt - see the patient. To use this book for ready reference by the telephone, in the car, or at the bedside: (i) If the patient is a child, look at the contents list at the beginning of chapter 4 and then turn to the relevant pages. (ii) If the patient is an adult, first decide the system involved then look at the contents list at the beginning of the appropriate chapter before turning to the relevant pages."

International researchers summarize the current understanding of peptic disease and trace the development of a novel new drug for peptic disease therapy-sucralfate. Contributors present laboratory research along side data from clinical trials as well as from the practice of medicine. Articles discuss the history of sucralfate's development, mechanisms of action, clinical efficacy, and future directions for research. This volume will be of interest to scientists and clinicians working in gastroenterology and gastrointestinal physiology.

This volume provides a history of Eosinophilic Esophagitis (EoE), a basic understanding of the physiology of the eosinophil, and a current understanding of the pathophysiology and genetics of EoE. The emphasis is on clinical applications including presenting symptoms, diagnosis and treatment options for patients with EoE. Written by both pediatric and adult experts in the fields of gastroenterology, allergy and pathology, this volume includes the most up to date information. Providing practical information useful in the treatment of patients, this book will be of great value to gastroenterologists, allergists, pathologists, medical residents, fellows, internists, and general practitioners who treat patients with eosinophilic esophagitis.

Cells have evolved multiple strategies to adapt the composItIon and quality of their protein equipment to needs imposed by changing conditions within the organism. Extracellular stimuli that inform cells about such needs are hormones, cytokines and neurotransmitters, which bind to specific cell surface receptors. Inside the cell, secondary signals are then produced which, ultimately, initiate the expression of proteins giving novel functional properties to the stimulated cells. This process can be controlled at a transcriptional, posttranscriptional, translational or posttranslational level. Extensive research over the past fifteen years has shown that transcriptional regulation is probably the most impor- tant strategy used to control the production of new proteins in response to hormonal signals. At the level of gene transcription, the initiation of mRNA synthesis is most frequently used to govern gene expression. The key elements controlling transcription initiation in eukaryotes are acti- vator proteins (transactivators) that bind in a sequence-specific manner to short DNA sequences in the proximity of genes. The activator binding sites are elements oflarger control units, called promoters and enhancers, which bind many distinct proteins that may synergize or negatively cooperative with the activators. The de novo binding of an activator to DNA or, if already bound to DNA, its functional activation is what ultimately turns on a high-level expression of genes. In this second volume of Inducible Gene Expression, leading scientists in the field review eight eukaryotic transactivators that allow cells to respond to hormonal stimuli by the expression of new proteins.

The philosophy of this NATO Advanced Research Workshop and the monograph it has yielded is that if you put a small number of very talented and creative scientists of different backgrounds and documented accomplishments together in a cloistered place for a few days to consider a very important and timely topic, many new ideas will be generated. The keynote of this conference was the Future. By this we mean the expected future developments of highly reliable sequential quantitative measurements of atherosclerotic plaque size and components in living human subjects. Some of the best minds and the most experienced and talented individuals at the leading edges of imaging of arteries were involved; some of the best scientists and students of the atherosclerotic plaque and its components participated; and some of the leading investigators of the cell biology or, as we call it in the USA, the pathobiology of atherosclerosis, contributed important new information. All of these individuals were actively involved in the conference and each obviously had carefully prepared and was able to communicate effectively.

Most of us spend at least two-thirds of our lives either sitting or standing. It is somewhat surprising, therefore, to find not a single book devoted to disorders caused by derangements of the normal physiological adjustments to changes in posture. In fact, until very recently, medical students have not even been advised to measure the blood pressure and heart rate in the upright posture as part of the routine physical examination. Although Bradbury and Eggleston first described orthostatic hypotension as a consequence of autonomic insufficiency in 1925, interest in orthostatic disorders has been slow to develop in the subsequent years. It is well known that the change from recumbency to the standing posture stimulates neurological, endocrine, and cardiovascular adjustments that ensure maintenance of a normal circulation despite the effects of gravitational forces. The mechanisms of these physiological responses to orthostasis have been stud ied by many investigators. Some of the defects to which antigravitational com pensatory mechanisms are subject, such as postural hypotension resulting from autonomic failure, have been studied intensively and have become part of the general knowledge of most medical practitioners. Other orthostatic disorders such as various other postural abnormalities of blood pressure control, and orthostatic edema-have received far less attention and have been unable to compete with the more dramatic and life-threatening ailments of humankind for a place in our standard medical texts. These disorders often give rise to distressing symptoms and may lead to severe impairment of health.

The understanding of pain has undergone extraordinary development over the last 25 years. Half of all medical visits are initiated because of pain. The need for all clinicians and trainees to have a foundational knowledge of pain has become more critically important than ever. Not surprisingly, most books on pain medicine are almost all written by "pain management doctors," physicians who've trained in "pain medicine" and devote their lives to treating pain. However, the burden of pain extends to all doctors, not just those who treat it every day. Managing Pain: Essentials of Diagnosis and Treatment offers a fundamental guide on the diagnosis and therapy of frequently encountered pain conditions for non-pain physicians and clinicians. Written using easily-accessible language, this book first reviews the basics of opioids and other therapies, including psychotherapy and complementary modalities. The second part of the book presents clinically-relevant cases chosen to reflect those conditions most frequently encountered by primary care providers. Edited by world-renowned experts in pain medicine, with many chapters written by non-pain physicians who are experts in their respective specialties, Managing Pain: Essentials of Diagnosis and Treatment is a useful guide for the non-pain-trained healthcare provider who is on the frontlines treating chronic pain.

This monograph is intended to compile the lectures presented at the 4th Annual Symposium "Cardiac Surgery:1992" held at the Frenchman's Reef Beach Resort, St. Thomas, US Virgin Islands, November 7-10, 1991. This symposium was organized by the Division of Cardiothoracic Surgery and the School of Cardiovascular Perfusion, Cooper Hospital/University Medical Center, Camden, New Jersey and sponsored by the University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School at Camden, Philadelphia Academy of Cardiovascular Perfusion and the American Society of Extracorporeal Technology -Region II. The symposium was devoted to cardiothoracic surgeons, cardiologists, cardiovascular perfusionists, and nurses involved in the management of the cardiac surgical patient. Therefore, the context of the book represents the multidisciplinary nature of cardiac surgery at its present level of development. The contributors to this book have critically examined their experience and discussed controversial issues regarding cardiac pathophysiology, surgical indications, operative techniques, and long term care and outcome. The co-editors wish to express their gratitude for the contributors' efforts in the production of this manuscript. We would also like to thank the members of the Organizing Committee, Jane V. Stewart MSN, RN, CCRN, Roger A. Vertrees BA, CCP, Rosemary Volosin, MSN, RN, Rosemary Morrone and Paul R. Cappola BS, CCP, who have greatly contributed to the success of the symposium."

The topics in this book represent the presentations given at the Fifth Annual Meeting entitled "Cardiac Surgery: Current Issues" held at the Frenchman's Reef Beach Resort, St. Thomas, U.S. Virgin Islands, November 18-20, 1993. This symposium was sponsored by the Division of Cardiothoracic Surgery, the School of Cardiovascular Perfusion and the Department of Nursing Education and Quality Assurance of Cooper Hospital/University Medical Center, the University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Camden, New Jersey, as well as the Academy of Medicine of New Jersey. Chapter authors were charged with the task of writing brief overviews of major issues related to the field of cardiac surgery. The book is specifically tailored to the needs of cardiothoracic surgeons, cardiovascular perfusion ists, allied health professionals and nursing personnel involved in all phases of caring for the cardiac surgical patient. Although intended as a reference source with emphasis on up-dated approaches applied in cardiac surgery, it is hoped that the discussion of these topiCS will compliment other texts and manuscripts. Obviously, a book of this length cannot cover the whole multidisciplinary and complex field of cardiac surgery. However, co-editors are certain that the annual appearance of this text will highlight comprehensive, new and Interesting approaches to the field of cardiac surgery."

This volume is the third in the Contemporary Geriatric Medicine series. As in previous volumes, information is presented in the form of easy-to read essays to bring the reader up to date on state-of-the-art develop ments in the area of geriatric medicine. Once again, a system approach is utilized. In addition, several new topics-including alcoholism, throm boembolic disease, and decubitus ulcer management-have been intro duced to enhance this volume's usefulness to the busy clinician and student. Each chapter is not meant to be an exhaustive review of all topics in the field, but rather to focus on issues currently receiving a great deal of attention. Our goal continues to be to create an exciting approach to contemporary issues in geriatric medicine. The editors are once again appreciative for having been given the opportunity to develop this series. Appreciation is also expressed to our professional colleagues, families, and administrative assistants, who have enabled this volume to reach fruition. As in the past, we thank, most of all, our elderly patients for providing the inspiration and impetus to improve our knowledge and understanding of the health care needs of the elderly. Steven R. Gambert, M.D. V alhalla, New York ix Contents Chapter 1 Geriatric Cardiology and Blood Pressure 1 Edmund H. Duthie, Jr., and Michael H. Keelan, Jr."

A solution to the protein folding problem has eluded researchers for more than 30 years. The stakes are high. Such a solution will make 40,000 more tertiary structures available for immediate study by translating the DNA sequence information in the sequence databases into three-dimensional protein structures. This translation will be indispensable for the analy sis of results from the Human Genome Project, de novo protein design, and many other areas of biotechnological research. Finally, an in-depth study of the rules of protein folding should provide vital clues to the protein fold ing process. The search for these rules is therefore an important objective for theoretical molecular biology. Both experimental and theoretical ap proaches have been used in the search for a solution, with many promising results but no general solution. In recent years, there has been an exponen tial increase in the power of computers. This has triggered an incredible outburst of theoretical approaches to solving the protein folding problem ranging from molecular dynamics-based studies of proteins in solution to the actual prediction of protein structures from first principles. This volume attempts to present a concise overview of these advances. Adrian Roitberg and Ron Elber describe the locally enhanced sam pling/simulated annealing conformational search algorithm (Chapter 1), which is potentially useful for the rapid conformational search of larger molecular systems."

Gastric secretions contain hydrogen ions at a concentration that is more than one million times higher than their intracellular concentration. This phenomenal gradient as well as the demonstrated ability of gastric juice to digest tissues has motivated clinicians and investigators alike to emphasize acid secretion and acid ablation in studying the pathogenesis and therapy of peptic ulcer disease. Conse quently, over the past 150 years, we have made considerable progress in under standing the mechanisms and regulation of acid secretion by the stomach. Not surprisingly, therapy for both peptic disease and mucosal injury has also been predominantly directed at either neutralizing acid or suppressing its production. During the past 10 years, attention has been focused on factors other than acid in the genesis and therapy of ulcer disease. Work done worldwide demon strated that acid hypersecretion is not a common event in peptic ulcer disease. Therefore, we began realizing that factors other than acid secretion may be important in the genesis of ulcer disease or in gastroduodenal mucosal damage. In addition, new physiological information has established that the gas troduodenal mucosa is normally protected by a complex series of events includ ing mucus and bicarbonate secretion, cell renewal, surface mucosal restitution, and preservation of the microvasculature and mucosal proliferative zone.

Why another series on infectious disease? The question is a fair one in view of the proliferation of monographs, texts, and periodicals on the vast subject of infectious disease. The goal of this series is to provide an additional service to the clinician in the form of clinical information not usually assembled in one convenient volume. One type of monograph presented in this series will cover a specific infection, detailing microbiologic, research and clinical aspects. It is hoped that such a compilation will be helpful in both its thoroughness and breadth to the clinician interested in this particular problem. The other type of monograph that this series will provide will discuss a clinical presentation that comprises many possible specific etiologies. Volumes in the series will be multiauthored, giving us the opportunity to invite authorities in each specific area to contribute their expertise and experience. Regular revisions are planned so that each volume will remain as current as it is thorough. We hope that our goals are met and that the present series of mono graphs establishes its own identifiable and valuable niche in the growing compendium of resource material available to the clinician. Preface to the Second Edition Since the first edition of Infectious Mononucleosis was published, we have seen exciting advances in our understanding of this disease."

DDDDDDDDDDDD Effective management logically follows accurate diagnosis. Such logic often is difficult to apply in practice. Absolute diagnostic accuracy may not be possible, particularly in the field of primary care, when management has to be on analysis of symptoms and on knowledge of the individual patient and family. This series follows that on Problems in Practice which was concerned more with diagnosis in the widest sense and this series deals more definitively with general care and specific treatment of symptoms and diseases. Good management must include knowledge of the nature, course and outcome of the conditions, as well as prominent clinical features and assess ment and investigations, but the emphasis is on what to do best for the patient. Family medical practitioners have particular difficulties and advantages in their work. Because they often work in professional isolation in the com munity and deal with relatively small numbers of near-normal patients their experience with the more serious and more rare conditions is restricted. They find it difficult to remain up-to-date with medical advances and even more difficult to decide on the suitability and application of new and rela tively untried methods compared with those that are 'old' and well proven. Their advantages are that because of long-term continuous care for their patients they have come to know them and their families well and are able to become familiar with the more common and less serious diseases of their communities."

This book has been designed, as its title implies, as a practical book for medical practitioners, although it should be of interest to medical students and nutritionists. It attempts to provide essential information about this important group of substances rather than be an all embracing monograph on the subject. For this reason biochemical and physiological considera tions have been kept to a minimum, and aspects of animal disorders and animal husbandry have not been considered. The material is often presented in a rather dogmatic fashion and, with rare exceptions, references are not included since this makes reading more difficult. The exceptions, where references are provided, are the therapeutic claims, and the series of recent studies which have indicated that vitamin deficiencies are still widely present among certain groups of the population of many industrially developed countries. To add to this reference list there is a reading list which has been selected to give key books, reviews with extensive bibliography and important articles over the past 10 years. From this reading list it is possible to trace most of the literature on the vitamins since they were first described over half a century ago."

In their second year in medical school, students begin to learn about the differences between "disease" and "illness." In their studies of pathology they learn to understand disease as pertubations of molecular biological events. And we clinicians can show disease to them by our scans, lay it out even on our genetic scrolls, and sometimes even point out the errant nucleotide. Disease satisfies them and us; at Yale, lectures on the gastrointestinal tract run from achalasia to proctitis. There is, alas, little mention of functional bowel disease or of the irritable or spastic colon, for that is not easy to show on hard copy. Functional bowel disease represents "illness," the response of the person to distress, to food, to the environment, and to the existential problems of living. In real life such matters are most important. Richard Cabot first found out at the Massachusetts General Hospital almost a century ago that 50% of the patients attending the outpatient clinic had "functional" complaints. The figure had grown to over 80% when the very same question was reexamined 60 years later.

The contributions to this volume were presented at a Symposium entitled "Current Topics in Muscle and Nonmuscle Motility" held in Dallas 19-21 November 1980 under the auspices of the A. Webb Roberts Center for Con tinuing Education, Baylor University Medical Center Dallas, and the Univer sity of Texas Health Science Center at Dallas. This very useful opportunity for a group of active investigators in motility to meet and discuss their latest findings was made possible in part by the income from an endowment fund established by a generous gift from Dr. Albert P. D'Errico in the Baylor University Medical Center. Dr. D'Errico was the first formally-trained neurosurgeon to practice in the Dallas area, the first Chief of Neurological Surgery, and a member of the Medical Board of the Baylor University Medi cal Center Dallas (1947 -1964). The income from this fund is used to promote the dissemination of up-to-date information in the Neurosciences, to provide intellectual stimulation, to add to the fund of knowledge, and improve the skills of neurosurgeons, neurologists, internists, and others in specialized fields of medicine. We are all indebted for this generous gift that made this enriching educational experience possible. We are also grateful for support the Symposium received from Electron Microscopy Sciences, Forma Scien tific, J. E. O. L. USA, Inc. , Ladd Research Industries, M. J. O. Diatome Co. , Or ganon Co. , Upjohn Co. , G. D. Searle & Co. , and Smith, Kline and French. Robert M.

During the past five years there has been a reawakening of interest in the psychotherapy of patients with medical disorders characterized as psychosomatic. For three decades, psychoanalysis and psychoanalytic psychotherapy were used extensively to treat and study psychosomatic disorders. Early in the 1960s, interest in this approach to these conditions faded, and the .Psychosomatic Service. in most hospitals became the .Consultation Liaison Service. (Lipowski, 1967). The recent focus of biofeedback on psychosomatic conditions provides a new technique with which the physician or psychiatrist may treat these patients (Rickles, 1981). In addition, the successful application of biofeedback training to a variety of complaints such as those presented in this volume has heralded the addition of biofeedback to the treatment modalities used for medical complaints. Frequently, psychological factors can still be seen; for example, when biofeedback treatment may require lifestyle changes on the part of the patient, the exploration of secondary gains or resistances before the disorder can be success fully treated, and the establishment of rapport and empathy which is so important for truly effective biofeedback training. Aside from certain psychological dimensions that are always present in biofeed back training, in this case biofeedback is being used in a primarily medical setting for primarily medical complaints."

In the last two years, a wealth of new information has accumulated regarding both clinical and research aspects of health care for the elderly. Although many controversial issues have been resolved, many still remain. Volume 2 of Contemporary Geriatric Medicine is once again dedicated to the clinician who cares for the elderly on a continuing basis. Although, for the most part, general topics first introduced in Volume 1 have been retained, all infor mation in this volume is new and represents the current state of the art. In addi tion, several new topics-including falls, interpretation of laboratory data, and oral health care-have been introduced to enhance this volume's usefulness to the busy clinician. Through these easy-to-read essays, we attempt once again to keep the non geriatrician abreast of the current state of the art regarding the special needs and problems of the elderly. Each chapter is not meant to be an exhaustive review of all topics in the field, but rather to focus on issues receiving a great deal of atten tion. Our goal is to create an exciting approach to contemporary issues in gerIatric medicine."