The European School of Oncology came into existence to respond to a need for informa tion, education and training in the field of the diagnosis and treatment of cancer. There are two main reasons why such an initiative was considered necessary. Firstly, the teaching of oncology requires a rigorously multidisciplinary approach wh ich is difficult for the Univer sities to put into practice since their system is mainly disciplinary orientated. Secondly, the rate of technological development that impinges on the diagnosis and treatment of cancer has been so rapid that it is not an easy task for medical faculties to adapt their curricula flexibly. With its residential courses for organ pathologies and the seminars on new techniques (laser, monocional antibodies, imaging techniques etc.) or on the principal therapeutic controversies (conservative or mutilating surgery, primary or adjuvant chemotherapy, radiotherapy alone or integrated), it is the ambition of the European School of Oncology to fill a cultural and scientific gap and, thereby, create a bridge between the University and Industry and between these two and daily medical practice. One of the more recent initiatives of ESO has been the institution of permanent study groups, also called task forces, where a limited number of leading experts are invited to meet once a year with the aim of defining the state of the art and possibly reaching a consensus on future developments in specific fields of oncology.

H.-J. Senn Adjuvant Chemotherapy (ACT) of breast cancer has now emerged as one of the controversial su):>jects in clinical and also experimental oncology. Driven by growing frustration about stagnating cure rates in breast cancer [1,4] and stimulated by elegant demonstration of highly curative effects of adjuvant systemic therapy in animal models [6, 11] and in several childhood neoplasias [15], researchers introduced ACT to the primary treatment of breast cancer with great hope some 15 years ago. After a first wave of isolated "historic" trials with generally limited but in one case remarkable success [5, 9], a second generation of ACT studies was initiated by NSABP investigators and oncology centers in Europe [2, 6, 13]. These trials were well conducted statistically and diagnostically, and all in the early 1970s included a surgical control arm. Early and intermediate beneficial effects on relapse-free survival (RFS) after 2-3 years median observation time then prompted a whole series of ACT studies in breast cancer. These "third-gener ation" studies usually regarded some positive influence of ACT as a given fact, dropping surgical control regimens and comparing different ACT regimens, hopefully in a prospective, randomized way 1984 Fig. 1. The mushrooming of adjuvant studies in breast cancer XII Introduction [reviews in 3, 14]. The "mushrooming" of ACT studies in breast cancer during the last 10 and especially 5 years is demonstrated in Fig. 1, and it gets really cumbersome even for the insider to keep on top of the multitude of sometimes conflicting data.

The use oflasers in clinical practice is increasing rapidly, both in the definitive treatment of disease and in the palliation of symp toms. Consequently, this sixth contribution to the Bloomsbury Series in Clinical Science is particularly timely. It opens with an introduction to the basic physics of lasers and then focuses on the current use of lasers in urological practice, and concludes by reflecting on their potential for the future. Edited, and with several contributions by Tom McNicholas, the book also contains contributions from a number of workers at the National Medical Laser Centre in University College Hos pital. London. Given their ever widening application, there can be little doubt that lasers will be a subject the series will return to again. To date, the series has been concerned with a wide range of topics of fundamental importance in clinical science. It has now gained momentum and future titles continue to reflect its wide sphere of interest. As Series Editor, I would welcome suggestions from readers of topics and issues that could usefully be addressed in the series.

Gastric cancer has been one of the great malignant scourges affecting man kind for as long as medical records have been kept. Until operative resection pioneered by Bilroth and others became available, no effective treatment was feasible and death from cancer was virtually inevitable. Even with resection by total gastrectomy, the chances of tumor eradication remained small. Over recent years, however, the situation has been changing. Some changes have resulted from better understanding of the disease, early detec tion, and better management techniques with applied clinical research, but the reasons for other changes are poorly understood. For example, the incidence of gastric cancer is decreasing, especially in westernized societies, where it has fallen from one of the most common cancers to no longer being in the top five causes of cancer death. Still it remains the number one killer of adult males in Japan and Korea. Whether the reduced incidence in western societies is a result of dietary changes or methods of food preservation, or some other reason, is as yet uncertain. Improvements in outcome have been reported from mass screening and early detection; more refined techniques of establishing early diagnosis, tumor type, and tumor extent; more radical surgical resection; and resection at earlier stages of disease."

This work is derived from the International Symposium on Advanced Laparo-Endoscopic Surgery, reknowned for being a comprehensive program that brings together international leaders in the field to discuss the current state of practice, the emerging possibilities and the future directions for research. The program focuses on the experiences in large series which have set the standard of practice and won acceptance for laparo-endoscopic surgery in recent years; the panelists and lecturers span the field from concept to realization. The program also addresses the evaluation process by which innovations should be judged in the interest of safety, clinical efficacy and cost effectiveness to improve the delivery of surgical care in the world. The symposium clebrates the firm establishment of laparo-endoscopic surgery and the promise of the future. Together, members of the panel outline future innovations that will change the practice of laparoscopic surgery, showcasing the future of robotics, virtual reality, telesurgery, needlescopic surgery, minimally-invasive breast surgery, cryotherapy and live donor nephrectomy.Highlights include contributions by John Hunter (Endo-Gastric Surgery), Dana Anderson (Repair Common Bile Duct Injury), Jack Jackimowicz (European Laparoscopic Hernia Multi-Institutional Study), Alfred Cuschieri and John Flowers (Role of Clinical Trial for New Procedures).

The examination of the human fallopian tubes was, until recently, restricted to observations on gross anatomical disposition and tubal patency. These studies, for decades, were the domain of doctors and physiologists whose primary interest was population control and family planning, funded largely by organisations and agencies seek ing alternatives to steroidal contraceptives. For a "worrying" but short period after the birth of Louise Brown in 1978 as the conse quence of successful in-vitro fertilisation and embryo transfer, the fallopian tube was considered to be "dispensable" given that the metabolic milieu in which human fertilisation takes place could be effortlessly reproduced in a Petri dish, in in-vitro fertilisation procedures. However, a number of factors have acted together to renew in terest in the fallopian tube, namely new techniques in cell biology, microinstrument developments (in particular in imaging), an inter disciplinary transfer of skills from interventional radiology and car diology to gynaecology, the surgeon's wish to improve surgical tech niques, and better techniques to monitor early pregnancy. These factors have led surgeons to develop the new diagnostic and ther apeutic strategies and techniques listed here. This volume contains contributions from the majority of keynote speakers at a conference held in London in April 1992 from which its title is derived. Better diagnostic procedures should lead to the implementation of rational effective treatments.

The roentgenologic visualization of excretory ducts of a secreting organ is a longe-stablished diagnostic method in roentgenology. For a long time, radiologists have felt the need to establish a method for filling the excretory duct system of the pancreas with contrast material, in the way that intravenous retrograde urography is used to diagnose pathologic changes such as displacement of the renal collecting system or of the urethra. This need to establish a method became more urgent the more the pancreas resisted conventional roentgenologic clinical di- agnostic methods. From time to time in peroperative or postoperative cholangiography mostly incomplete reflux into the pancreatic duct in 10-14% was observed (Stiller, 1948; San Julian und Pascual y Megias, 1952; Wapshaw, 1955; Bergkvist und Seldinger, 1957). However, there was no possibility of obtaining reliable and complete opacification of the pancreatic duct. Peroperative Pancreaticography It was in 1951 when Leger and Arway achieved this goal, though only by surgery. It should be mentioned that, when performing their first peroperative examination, these French surgeons already had the impression, that cannulation of the pancreatic duct was easier than cannulation of the common bile duct. This observation has been con- firmed by hundreds of examinations after ERPC had been established for several years; however, up till now this phenomenon has not been sufficiently explained. During the following years, peroperative pancreaticography develop- ed into a routine examination, above all by Doubilet et al.

The most meaningful reward to clinicians and researchers is the absence of recurrent malignancy in their patients. While in some patients the disease will be cured by resection alone, in other similarly staged cases the disease will recur despite adequate loco regional and systemic therapies. Hence, risk assessment is a complex issue with many related or unrelated prognostic factors determining outcome. The purpose of this volume is to review some of the most relevant prognostic factors of newly diagnosed breast cancer, focusing on fea tures determining the magnitude of risk. The ultimate value of establishing the significance of each prognostic factor in a given patient will be the resulting ability to plan individu alized therapies for patients at different risk of recurrence at the time of diagnosis. To secure the maximum benefit for high-risk patients, while avoiding undue toxicity in those with low-risk lesions, a well-integrated analysis of all known prognostic factors will be essential in the early postdiagnos tic period. In addition to well-established staging criteria such as axillary nodes, tumor size, receptors, scanning and radiographic examinations, the more sophisticated labora tory techniques, as discussed by several authors herein, will playa crucial role in risk assessment. Most of them, - ploidy determination, oncogenes, tumor markers, monoclonal anti bodies, growth factors, etc. -are presently available in only a minority of treatment centers.

Obstetric fistula is as old as mankind. While the incidence has diminished progressively with better health care in Western societies, the situation has changed little in many developing countries. Fistulae of pelvic organs, often monstrous defects, still are a major complication of child-birth causing misery to uncounted young women, and if they cannot find help in one of the very few hospitals with trained specialists, they became urological cripples losing everything: family, home and job. The magnitude of the problem is illustrated by some figures given by Reginald and Catherine Hamlin-about 700 fistula patients treated each year-a total of over 10,000 cases operated upon in their fistula hospital in Addis Ababa, Ethio pia. Most of these injuries could be prevented by better health care at the village level as some studies have shown conclusively. The incidence of fistula is an indicator of the standard of health and obstetrical care. The author of this book-Obstetric Fistula-is an internationally known Australian gynaecologist who for many years has been interested in all aspects of gynaecological urology, especially urinary stress inconti nence, other forms of involuntary loss of urine, and associated gynaeco logical conditions. He has devised a number of new operations to treat pelvic defects. Robert Zacharin's interest in obstetric fistula was a con sequence of his surgical activity in developing countries."

The European School of Oncology came into existence to respond to a need for information, education and training in the field of the diagnosis and treatment of cancer. There are two main reasons why such an initiative was considered necessary. Firstly, the teaching of oncology requires a rigorously multidiscipli nary approach which is difficult for the Universities to put into practice since their system is mainly disciplinary orientated. Secondly, the rate of technological development that impinges on the diagnosis and treatment of cancer has been so rapid that it is not an easy task for medical faculties to adapt their curricula flexibly. With its residential courses for organ pathologies and the seminars on new techniques (laser, monoclonal antibodies, imaging techniques etc.) or on the principal therapeutic controversies (conservative or mutilating surgery, primary or adjuvant chemotherapy, radiotherapy alone or integrated), it is the ambition of the European School of Oncology to fill a cultural and scientific gap and, thereby, create a bridge between the University and Industry and between these two and daily medical practice. One of the more recent initiatives of ESO has been the institution of permanent study groups, also called task forces, where a limited number of leading experts are invited to meet once a year with the aim of defining the state of the art and possibly reaching a consensus on future developments in specific fields of on cology.

Important contributions about the treatment modalities of breast cancer are presented in this book. The risks and limitations of breast conserving therapy of mammary carcinoma are dealt with. Newest findings show that this form of therapy has the same outcome as conservative treatment modalities. The book also considers controversial issues such as the treatment of mastopathy, precancerous, and non-invasive lesions of the breast. New, but not yet approved, regimes for the prevention of mammary carcinoma and open questions concerning adequate operative treatment are discussed. Latest results presented here show that all modern palliative chemotherapy has a certain but limited effect on outcome and that early detection and preventive therapy (surgical and hormonal) will be of great importance for improved chances of survival of breast cancer.

A thorough knowledge of normal radiological anatomy is necessary for detection and evaluation of pathological changes. In pediatric radiology, normal anatomy and normal proportions of anatomical structures may differ considerably from the adult, and may vary during growth. Therefore, in pediatric radiology there is a multitude of measurements, that in the individual patient is important, but that for the radiologist is not meaningful or even possible to keep in mind. This holds true both for the experienced pediatric radiologist, and for those who practise pediatric radiology only occasionally. This volume is written for both categories. In the literature, normal values are calculated and presented in many different ways, that are not always easy to compare, or easy to use in daily work. Therefore, we have revised and recalculated the data given by authors, in order to present the statistical upper and lower normal limits as between plus and minus two standard deviations (+/- 2SD). This means that about 2% of a normal population will be assessed as abnormally large and around 2% abnormally small with respect to the parameter assessed. In this way, the presentation throughout the book is uniform, and hopefully easy to use. All figures have been redrawn and computed in an attempt to make them as clear as possible.

A workshop was organised in order to achieve multi-discipli- nary review of the pathogenesis and management of acute failure, particularly as it occurs and is managed in intensive therapy units. The book deals with the realities and practicalities of this important area of acute medicine. Each chapter is followed by a discussion, so that a concen- sus view is obtained from an international body of experts.

Primary and metastasizing malignant carcinoma of the liv er represent a challenge to both the diagnostician and the therapist. For this reason, it appears a worthwhile task to review the current status of knowledge about the treatment of primary and metastasizing tumors of the liver. The ques tion is whether modem diagnostic methods and new thera peutic concepts can help to improve the prospects of treat ment. Of particular interest is the role played by therapeu tic procedures directly involving the liver. Thus, it is equally important to discuss the pathophysiological and pharmacological bases for a modem therapy concept as it is to consider diagnostic issues and possible definitions of stages of progression. Therapeutic concepts comprise sys temic therapy and organ-related therapeutic methods, in cluding surgical resection, changes in the blood supply, re gional selective chemotherapy, and other localized or regional, highly specialized forms of therapy. This survey of the various possibilities in the field is meant too to stimulate further scientific research, given that methods of treatment are as yet by no means stan dardized, but are still in the stage of clinical research, where experimental models can find an application. The only well-established operative procedure is surgery on the isolated liver tumor. In this area, specialized techniques and various intraoperative procedures are discussed. There is a wealth of information available on all the top ics covered."

If a consecutive series of patients with lung cancer is followed up until the decision is made about therapy, it emerges that the role of surgery is quite small. Only a very limited proportion will ultimate ly qualify for rationally conceived surgical therapy; most patients are inoperable. In a series of 397 patients investigated at our hospi tal, 78% were inoperable on the basis of preoperative evaluation and a further 3% proved nonresectable at thoracotomy; therefore, only 19% were suitable for resection. On the other hand, surgery is still thought to offer the best, if not the only realistic chance of cure. The question "operable or not?" is therefore of vital importance for the individual patient. The answer to this crucial question must be based on valid guidelines for pa tient selection and preoperative evaluation, and it should be clearly defined what extent of resection is necessary in order to realize any curative intention. In 1972 a thorough analysis of the literature revealed that re section of bronchial carcinoma - although 40 years old - was being undertaken with very variable indications. There was hardly any systematic staging, and assessment of results was hampered by the fact that most communications in the literature were based on retrospective analysis.

In contrast to the continuously increasing success in kidney, liver, heart, and pancreas transplantation, small-bowel transplantation has not shown simi larly impressive progress until recently. The few clinical attempts at small-intestinal transplantation in the late 1960s and early 1970s were unsuccessful. In spite of these initial failures, a few groups of surgeons continued to investigate the problems of small-bowel transplantation from the technical, functional, and immunologic point of view. Now, about 15 years later, conditions have changed. Total parenteral nutrition has made tremendous progress, thus maintaining patients with short-bowel syndrome who are potential recipients of small-bowel grafts in an acceptable physical condition. Immunologists and clinicians have furt hermore been able to expand our knowledge of basic immunologic reactions induced by transplanted organs. In addition, within the last 8 years, new immunosuppressive drugs and regimens have been introduced which have proved to be extremely effective. Taking all these aspects into account, we regarded it as an extremely worthwhile and effective undertaking to invite scientists from all over the world who are working in the field of small-bowel transplantation to participate in a symposium on this topic. This meeting, the first to deal exclusively with small-bowel transplantation, was held in Kiel, West Ger many, in October 1985. Its aims were twofold: 1. ) To'stimulate direct communication between basic scientists and clini cians 2."

Technical improvements over the past twenty years have made endos copy the procedure of choice for examination of the hollow organs of the genitourinary and gastrointestinal tracts. The development of electro surgical techniques, laser technology, injection therapy, and a wide variety of other modalities now allow the endoscopist to treat many problems that in the past required open surgery. The simultaneous development of transcutaneous abdominal sonography has had an equally dramatic impact on the practice of gastrointestinal and geni tourinary surgery. The marriage of these proven technologies, known as endoscopic sonography, provides an exciting new modality that promises to further revolutionize the diagnosis and management of many intraabdominal diseases. Endoscopic sonography opens new frontiers by overcoming the primary limitations of its parent technologies. Fiberoptic endoscopy is limited by the inability to see beyond the luminal surface, this is particularly important when considering neoplastic disease because depth of wall invasion is a key factor in determining treatment. The limiting factor in transcutaneous sonography is the distance between the transducer and the target organ. With endoscopic sonography, the transducer is placed in close proximity to the target organ. This allows the use of high frequency waves (greater than 5 MHz), which provide better tissue resolution and eliminates the image distortion caused by overlying structures.

This monograph, which was more than five years in preparation, represents a very detailed account of pheochromocytoma, a tumor that is almost invariably lethal if untreated. In addition to its definitive presentation of the subject, this volume contains the most cur rent information regarding the diagnosis and management of pheochromocytoma. It is im portant to reemphasize the seriousness of diagnosing and treating pheochromocytoma with the aphorism of Esperson and Dahl Iversen that although a pheochromocytoma may be morphologically benign it is physio logically malignant (280) and with Aranow's characterization of this tumor as a "veritable pharmacological bomb" (20). If managed ap propriately by a highly skilled and profes sional "bomb squad," this tumor can be re moved and the patient cured in at least 90 percent of cases. The secret lies in first sus pecting and recognizing the patient who has and then offering the ex pheochromocytoma pert management such a patient requires. These facts more than justify this publication, since the internist, pediatrician, obstetrician, ophthalmologist, otolaryngologist, urologist, neurologist, surgeon, anesthesiologist, derma tologist, psychiatrist, radiologist, and also the dentist must be made acutely aware of the varied manifestations of this condition and of the pathologic entities which sometimes co- xiv Preface exist with pheochromocytoma. Furthermore, have included a large number of instructive they should have a thorough knowledge of the figures and have emphasized teaching tables."

The interrelated syndromes of shock and the adult respiratory distress to attract the attention of both clinical and syndrome (ARDS) continue laboratory scientists. This reflects both the size of the problem and its unresponsiveness to current lines of treatment. Doubtless, a greater appreciation of the underlying pathophysiological disturbances during the past two decades has led to appropriate action and increased survival in the early stages but once established these syndromes have remained remarkably immune to a wide spectrum of therapeutic modalities. This observation stresses the importance of prevention but also indicates the need for continued research into the nature of the established syndromes and the means whereby they may be reversed. Drs Kox and Bihari are to be congratulated on bringing together within the covers of this volume many of the acknowledged European experts in these two fields of investigation. Each author has provided an up-to-date account of his current experimental and clinical research, and their com bined contributions makes fascinating reading. Undoubtedly, these are exciting times in the development of understanding of shock and ARDS. Inevitably, more questions are raised than answers provided, but the accumulated knowledge presented here adds significantly to our under standing of this complex biological jigsaw. From this corporate endeavour will come the clinically useful developments of the future and with them the ultimate hope that the term 'refractory' shock may be finally removed from our vocabulary.

Over the past few years, a wealth of new insights have been gained and put to use in basic gastrointestinal tumor research, including tumor suppressor genes, oncogenes, cell-cycle con- trol, apoptosis, adhesion receptors, signal transduction, and gene therapy. Similarly, progress has been made in preven- tion, molecular diagnosis, laparoscopic staging, and antibody- based immunotherapy, and new drugs such as thyrnidylate and topoisomerase I inhibitors have been developed espe- cially for the treatment of colorectal carcinoma. Despite this burgeoning of knowledge in both basic and clinical research, however, we have just begun to put these results into clinical practice. Therefore, the key goal of this volume is to bring together basic and clinical research findings so as to facilitate the translation of these advances into the clinical manage- ment of gastrointestinal tumors. We hope that this volume, which covers a broad spectrum of research and clinical medicine, will impart new insights and greater understanding to all those interested in the therapy of gastrointestinal tumors and will stimulate further scientific research. Berlin, January 1996 E. D. Kreuser P. M. Schlag Contents 1 I. Basic Research S. J. Meltzer The Molecular Biology of Esophageal Carcinoma 1 E. R. Greenberg Preventing Colorectal Cancer...9 M. Streit, R. Schmidt, R. U. Hi/genfeld, E. Thiel, and E. -D. Kreuser Adhesion Receptors in Malignant Transformation and Dissemination of Gastrointestinal Tumors...19 R. Kaiser, E. Thiel, and E. -D. Kreuser Human Gene Therapy in Gastrointestinal Diseases: In Vivo and In Vitro Approaches ...

This book has been conceived as a reference for all those who want to deepen their knowledge of technical details, design concept and interac tion of the individual modules of Zeiss operation microscopes. The sub jects of the book are classified in accordance with our intention. Special emphasis has been placed on practical hints for the user of opera tion microscopes to avoid operating errors. Parameters which are of para mount importance for surgeon and assistant such as PD and diopter set ting are therefore described in detail. The effects of wrong adjustments are indicated. The above statements also apply to the ample selection of acces sories for Zeiss operation microscopes. That is why much attention has been given to the accessories for co-observation and documentation. The most frequently used formulae are liste in the last chapter of the book, supplemented by nomograms which allow the reader to determine the most important data of a specific piece of microscope equipment without calculation. Our thanks are due to all those who assisted in preparing the manuscript, drawings and photographs, to Mrs. Ursula Gabler for making the English translation and Miss Helen Robertson for editing it, and last but not least to the Springer-Verlag for the most careful, qualified and excellent pro duction of the book."

One reason for failure to cure solid tumors by surgery appears to be the impossibility of controlling metastases that are present but latent at the time of operation. This failure is a common clinical experience with aggressive neoplasms. but it is not always appreciated in tumors with longer survival times. e. g . breast and colon cancer. In addition. recent evidence indicates that after resection of a primary tumor micrometas tases from it might be enhanced by suppression of immune and reticu loendothelial functions of the host. Other factors, such as increase of coagulability and stress in the perioperative period, can also promote tumor growth. The development of new metastases might be facilitated by cells forced into the circulation during operative manipulations. Such events could be important for the outcome of treatment and it is suggested that preventive measures should be directed to this systemic component of solid tumors. Radical surgery can reduce the number of tumor cells to a subclinical 3 6 stage (10 to 10 cells) in which chemotherapy might be more effective than in advanced stages. Chemotherapy, on the other hand, might aggravate the surgical morbidity by influencing the wound healing pro cess, by decreasing the immune response, and/or by toxicity to the bone marrow and to the gastrointestinal tract, for example."

This book is a unique work devoted to the subject of disordered defaecation. It contains chapters written by experts in the field of ano-rectal physiology and management of disordered defaecation. The various contributions present personal views and special clinical experience of individuals. There are some personal views which we felt should be commented upon and a few areas where the experience of others has been included into the text. For the sake of completeness of each chapter, a slight overlap in some cases was inevitable. We hope the book will serve as a useful collection of opinions on a subject which until recently has been largely ignored by the medical profession. The editors Major contributors H. O. ten Cate Hoedemaker Department of Surgery, University Hospital, Rijnsburgerweg 10,2333 AA Leiden, The Netherlands G. Coremans Department ofInternal Medicine, University Hospital Gasthuisberg, Here- straat 49, 3000 Leuven, Belgium S. Fasth Department of Surgery II, Sahlgrenska Hospital, S-413 45 G6teborg, Swe- den H. G. Gooszen Department of Surgery, University Hospital, Rijnsburgerweg 10, 2333 AA Leiden, The Netherlands J. A. Gruwez Department of General Surgery, University Hospitals KU, Brusselsestraat 63,3000 Leuven, Belgium M. M. Henry Department of Gastroenterology, Central Middlesex Hospital, Acton Lane, London NWlO 7NS, United Kingdom M. R. B. Keighley Department of Surgery, The General Hospital, Steelhouse Lane, Bir- mingham B4 6NH, United Kingdom J. H. C. Kuypers Department of Surgery, University Hospital St. Radboud, Geert Groote- plein Zuid 14,6500 HB Nijmegen, The Netherlands Ph. B.

This book has its roots in a monograph on cancer of the esophagus and gastric cardia edited by us in 1965 and published in Chinese on ly. Along with a number of colleagues in various fields, we summa rized our work in the epidemiology, pathology, diagnosis, radiother apy, and surgery of carcinoma of the esophagus and gastric cardia, carried out chiefly at Peking Union Medical College Hospital, Fu wai Hospital, and the Cancer Institute of the Chinese Academy of Medical Sciences during the 25 years from 1939 to 1964. In the 18 years since the publication of that monograph, further progress has been made in China in various aspects of research and surgical treatment. Abundant material has been accumulated on the long term results of surgery, and a number of newer principles and meth ods for diagnosis and management have been evolved. In order to meet the need for the exchange of scientific and technical informa tion, both domestically and internationally, we have invited a group of our current colleagues working on the different aspects of carci noma of the esophagus and gastric cardia to contribute to the pre sent volume, which is being printed in both Chinese and English. The Chinese edition, like the original monograph, is being publish ed by Shanghai Science and Technology Publishers. Through the kind invitation of Dr. Heinz Gotze, the English text is being publish ed for international circulation by Springer-Verlag.

The Medicines Act 1968 together with its delegated legislation comprehensively controls the manufacture, packaging, labelling, distribution and promotion of medicines for both human and animal use in the United Kingdom. It also controls the import and export of such medicines. It replaced a patchwork of controls which evolved over a century. Since its enactment, more than 150 items of delegated legislation (orders and regulations) have been made under its provisions and about 130 are still operative. The sheer physical bulk of this mass of material causes difficulty, not only in comprehension but also in finding the detail so often required. The situation is exacerbated by the fact that some pieces of legislation have been amended several times. My principal aim is to provide a reference book which contains all of the provisions of the Act and its various orders, regulations as amended to date. The material is arranged to facilitate the search for detail. In order to assist the reader in finding his way through this maze, Chaper 1 consists of a survey of the situation which existed before the Act came into being, together with a synopsis of the present controls. This should enable the reader to appreciate the changes which have occurred and how the system works.