Since its launch in 1998 the European Society for Intravenous Anaesthesia (EuroSIVA) has come a long way in providing educational material and supporting the research and clinical application of intravenous anaesthesia. After the first two annual meetings held in Barcelona and Amsterdam in 1998 and 1999, three other successful meetings took place in Vienna, Gothenburg and Nice in 2000, 2001 and 2002. Next to these main meetings, starting in the year 2000, a smaller winter meeting has been organised every last week of January in Crans Montana, Switzerland. Both the main summer and the winter meetings breathe the same atmosphere of sharing the latest on intravenous anaesthesia research in the presence of a friendly environment and good company. Since the first meetings the educational tools of EuroSIVA have increased in quantity and technical quality allowing digital slide and video presentation along with the use of the computer simulation program TIVAtrainer during the speaker sessions and the workshops. Furthermore, EuroSIVA now exploits a website www. eurosiva. org that allows for continuous exchange of information on intravenous anaesthesia, the TIVAtrainer, the EuroSIVA meetings and online registration for these meetings. The EuroSIVA is currently engaged in friendly contacts with the Asian Oceanic Society for Intravenous Anaesthesia (AOSIVA), the United Kingdom Society for Intravenous Anaesthesia (UKSIVA), the Korean Society for Intravenous Anaesthesia (KSIVA), the European Society of Anaesthesiology (ESA) and the International Society for Applied Pharmacology (ISAP).

MICHAEL S. GAZZANIGA The investigation of the human brain and mind involves a myriad of ap proaches. Cognitive neuroscience has grown out of the appreciation that these approaches have common goals that are separate from other goals in the neural sciences. By identifying cognition as the construct of interest, cognitive neuro science limits the scope of investigation to higher mental functions, while simultaneously tackling the greatest complexity of creation, the human mind. The chapters of this collection have their common thread in cognitive neuroscience. They attack the major cognitive processes using functional stud ies in humans. Indeed, functional measures of human sensation, perception, and cognition are the keystone of much of the neuroscience of cognitive sci ence, and event-related potentials (ERPs) represent a methodological "coming of age" in the study of the intricate temporal characteristics of cognition. Moreover, as the field of cognitive ERPs has matured, the very nature of physiology has undergone a significant revolution. It is no longer sufficient to describe the physiology of non-human primates; one must consider also the detailed knowledge of human brain function and cognition that is now available from functional studies in humans-including the electrophysiological studies in humans described here. Together with functional imaging of the human brain via positron emission tomography (PET) and functional magnetic resonance imaging (fMRI), ERPs fill our quiver with the arrows required to pierce more than the single neuron, but the networks of cognition."

Hypoxia is a constant threat throughout life. International experts from many different fields, including clinicians, clinical researchers, and basic scientists, have contributed to this volume, presenting state-of-the-art information regarding normal and abnormal (pathophysiological) responses to hypoxia. The topics covered include visitors to high altitude, the latest developments on high-altitude cerebral and pulmonary edema, the brain in hypoxia, high-altitude headache, and similarities between ischemic and hypoxic injury to the brain. In addition topics are covered such as blood-brain barrier in hypoxia, hypoxia interactions with vascular growth, and how humans adjust to extreme hypoxia.

This monograph is essentially the outcome of corporate endeavour on the part of members of the Committee on Public Education of the International Union against Cancer, from the decision taken in September 1963, via a lengthy and arduous rework ing of the first draft in Philadelphia in 1964 to its final editorial meeting in September 1965. In between there has been a continuous exchange of ideas, suggestions, advice and material for inclusion. Nevertheless, as chairman I should be remiss if I did not acknowledge the Committee's indebtedness to Mr. MICHAEL S. GOOD STADT, formerly of the University of Manchester, who worked with me in Manchester and undertook the painstaking search of sources of published information and compiled the draft on which this monograph is based. If there are omissions from the bibliography, it is not for want of industry in seeking them out: our difficulty has been to obtain original material from certain sources. We hope that the material assembled here will both offer useful guidance to those engaged in public education about cancer and provide a baseline from which future research in this neglected field may stem. Committee on Public Education International Union Against Cancer Chairman: JOHN WAKEFIELD, U. K. Members: Dr F. DE AMESTI, Chile, Mr. A. J. BROWN, Australia, Dr. J. COURTIAL, France, Mr. T. CRAMER, Denmark, Dr. L. MEINSMA, The Netherlands, Dr. R. A. MUSTARD, Canada, Dr. L. V. ORLOVSKY, U. S. S. R. , Dr. J. C.

In the previous two volumes of this series, we presented classic problems in internal medicine as illustrated by actual cases cared for in our institution. It has been gratifying for us to see the interest that these volumes have generated with students and trainees. We remain committed to the case method of instruction, and believe that there is no better method to learn medicine than to have an individual patient problem as the basis for study of pathophysiology, natural history, diagnosis and management. We hope that our readers find this third volume as enjoyable and instructive as the editors found it. Juan M. Bowen, MD Ernest L. Mazzaferri, MD, FACP xiii Acknowledgement The editors are grateful to Jeff Smith and Jenny Riegler for their unflagging professionalism and patience. xiv Contents Case 1 Mitral Regurgitation - Chronic Versus Acute: Implications for Timing of Surgery * . * * * . . * . . . . . * . . . . . . . . . . . 1 Harisios Boudoulas, MD Charles F. Wooley, MD Advances and diagnostic imaging in a surgical technique have changed the approach to mitral valve regurgitation. This chapter provides an expert's perspective. Case 2 Cystic Fibrosis in Adults .. * ************ 36 Andrew Libertin, MD John S. Heintz, MD As children with cystic fibrosis grow into adulthood, the internist assumes a greater role in their care. Case 3 Thrombotic Thrombocytopenic Purpura . . . . . . . . . . 51 . . . Donald E. Thornton, MD Earl N. Metz, MD, FACP Patients with ITP continue to present difficulties in diagnosis and management. Two experts discuss the current approach to ITP.

Many residency programs in primary care specialties do not provide the education in pediatric orthopedics necessary to effectively deal with the field's challenges. Here, the authors present a framework for the effective evaluation of childhood musculoskeletal problems in a practical and problem-based manner. The volume contains case studies and over 200 illustrations.

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.

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 11-14. 1992. This symposium was sponsored by the Division of Cardiothoracic Sur gery. 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 perfusionists. 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.';ibook 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 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.

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 . . . . . . . . . . . . . ."

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."

In psichiatria dell infanzia e dell adolescenza il primo contatto con il paziente riveste una grande importanza clinica e puo far risparmiare tempo e risorse. Una consultazione ambulatoriale ben condotta permette di giungere a un ipotesi diagnostica rigorosa, orientando invii per approfondimenti e presa in carico; in alcuni casi, puo acquisire carattere terapeutico.

Questo volume guida il clinico, anche quando lavora da solo, verso una formulazione diagnostica il piu possibile precisa ed esauriente. Il libro illustra uno schema di procedura clinica che integra le diverse prospettive proprie del campo in un otticaevolutiva, esaminando la metodologia del colloquio, le tecniche per la valutazione cognitiva, neuropsicologica e psicopatologica, i contatti con genitori e scuola.

Questo testo e rivolto a neuropsichiatri infantili, pediatri, psichiatri e agli specializzandi in tali discipline; piu in generale, puo essere di interesse per chiunque abbia contatti con pazienti in eta evolutiva.

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."

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.

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.

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 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."

The primary purpose of this book is to bridge the gap be tween the practice of clinical medicine and diagnostic radi ology. It is intended primarily for utilization by medical students in training and by nonradiologist physicians. In this world of rapidly expanding knowledge in the many specialties of medicine, it is becoming increasingly difficult for many physicians to stay abreast of the newer and constantly changing modalities of diagnosis as well as the therapeutic regimens of the common as well as the less common disease processes within their realm of practice. This book will enable the busy clinician to utilize the consultative services offered by his or her colleagues in diagnostic radiology with maximum effectiveness. The most common clinical applications of the more recent imag ing modalities (i. e. , nuclear medicine, ultrasound, comput erized tomography, and magnetic resonance imaging) have been categorized and condensed into a format that will be both comprehensible and useful on a daily basis for those physicians routinely requesting these diagnostic examina tions for their patients. For simplicity, the book is divided, whenever feasible, into organ systems and subdivided into the multiple classifications of pathologic states (i. e. , con genital, trauma or iatrogenic, inflammatory, and neo plasm). In addition, there are brief comments related to the vii specific advantages and disadvantages as well as the cost effectiveness of each modality.

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."

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."