Pancreatic Disease: Towards the Year 2000 provides a clear picture of the current research activity in pancreatic disease and its related basic science. Experts currently contributing to advances in understanding and treatment have provided concise and clear reviews of their subject. Each contribution summarises the relevant literature and describes recent advances whilst highlighting those areas where current research will impinge on clinical practice in the next few years. The reader will find in this book all the latest material related to pancreatic disease, cancer, acute and chronic pancreatitis and a number of other topics including transplantation and the relationship between endocrine and exocrine disease and cystic fibrosis. The book will supplement existing texts and will be of value to practising specialists who deal with pancreatic disease as well as specialist trainees in surgery and medical gastroenterology.

It is an honour and a pleasure to welcome you all at this 20th annual International Symposium on Blood Transfusion in the Netherlands. This year you celebrate its 20th anniversary and I congratulate the Staff of the Blood Bank Noord Nederland and especially Dr. Smit Sibinga for this great achievement. As most of you know, the name of the person of Dr. Smit Sibinga is unbreakably con nected with the annual symposium in Groningen which he has organized each year from the very start, 20 years ago. The reputation of any symposium depends heavily on the quality of the lectures. I think it is not possible to organize 20 symposia in a row if the topics lack actual relevance and the speakers are not of excellent reputation. Dr. Smit Sibinga has proven to have a keen eye for selecting interesting themes and eminent speakers. Although a lot of different topics have been dealt with in the past 20 years, which each attracted the attention of a different group in the field of blood transfusion, it is not surprising that after a tradition of 20 years several speakers but also a lot of attendees are not for the first time in Groningen to participate in this event. It gives the symposium a unique atmosphere of intimacy. It is not hard to admit that most of the newer developments in transfusion medicine take place outside the Netherlands."

Varicose veins are a very common problem. The precise aetiology of primary varicose veins remains unclear. It seems likely from the available evidence that inherited structural weakness combined with haemodynamic or microcirculatory abnormalities eventually lead to reduced vein wall elasticity, dilatation and the formation of varicosities. Increasing age, female gender, parity and occupation may all promote the development of varicose veins in susceptible individuals. Further clinical and experimental studies are necessary if the relative contribution of each of these factors is to be fully elucidated. References 1. Editorial. The treatment of varicose veins. Lancet 1975;ii:311. 2. Prerovsky I. Diseases of the veins. World Health Organisation, internal communication, MHO-PA 10964. 3. Weddell JM. Varicose veins: pilot study. Br J Surg 1969;23:179-186. 4. Hobsley M. Pathways in surgical management. 2nd ed. London: Edward Arnold, 1986. 5. Browse NL, Burnand KG, Lea Thomas M. Diseases of the veins. London: Edward Arnold, 1988. 6. Logan WPD, Brooke EM. The survey of sickness. Studies on medical and population subjects no. 12. London: General Register Office, 1957. 7. The committee on the Danish national morbidity survey. The sickness survey of Denmark. Copenhagen, 1960. 8. US Department of Health. Education and welfare: national health survey 1935-1936. Washington, DC, 1938. 9. The Department of National Health and Welfare and the Dominion Bureau of Statistics. Illness and health care in Canada. Canadian Sickness Survey 1950-1951. Ottawa, 1960.

Posttraumatic cerebral contusions, lacerations and hematomas in the past could often only be suspected by clinical symptomatology and be visualized by angiography in a restricted manner, but they are now diag nosed with precision through CT and MRI; they remain in the limelight in our daily management of severe head injuries. Stalhammar's longlasting research in biomechanics is he re condensed in a concise review of the current knowledge in this field, thus providing the basis for our understanding of the parenchymal cerebral posttraumatic lesions. The neuropathological investigations and findings remain fundamental to the clinical features, and in this text there is the advantage that they were carried out and interpreted by a very experienced neurasurgeon, Ion Oprescu, who most regretfully died before the completion of this volume. The special morphological and clinical investigations by Nakamura, concerning diffuse brain injury, contribute to our necessary diagnosis and treatment of this phenomenon where, without grass visible lesions of cerebral tissue, a high mortality occurs. The clinical features, the princip1es of therapy and the outcome are described by Vigouroux and Guillermain, whose clinical study clearly demonstrates the limitations of all our efforts in severe brain injuries, in spite of decades of clinical experience and research."

Cancer is one of the major health problems of our time and liver cancer is responsible for over one million deaths per year world-wide, making it the fourth most common cause of death from cancer. Surgical resection of the tumour(s) is the treatment of choice and offers the only chance of prolonged survival. Yet the best attempts are often frustrated by either advanced or co-existent disease that renders the patient non-resectable. This book tackles the many options available to doctors and patients in an attempt to combat this desperate disease.

The result of a European-American co-operation, whose joint efforts have dramatically reduced the rate of recurrent groin hernia, burst abdomen and incisional hernia in patients.
The contributors to this updated volume are among the most renowned specialists in the field and here they present personal accounts of the once controversial techniques they have now perfected.
New sections have been added to include such revolutionary techniques as prosthetic mesh and laparoscopic surgery.

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."

Pelvic pain in the female patient is common in gynaecological practice, but the specialties of general surgery, urology and orthopaedics provide a significant number of patients and problems. These patients may suffer a multitude of symptoms, and only careful analysis and investigation of each individual problem by the doctor concerned will lead to correct diagnosis and management. The subject matter of this book lies in the practice of many specialties, and all are combined here in a coherent whole. This emphasises the close collaboration necessary between family practitioners, junior hospital staff and consultants. The authors are consultants who work together in a busy district general hospital, and their experience and collaboration is evident in the approach to the diagnosis and management of pelvic pain in the female. Emphasis is laid on the careful evaluation of history and examination and the correct interpretation of diagnostic investigations. Full details of radiology, ultrasound scanning, endoscopy, peritoneoscopy and bacteriological investigation are given. Full consultation between members of staff who have special experience in these investigative procedures is of paramount importance. Details of treatment for relief of pain are important to all doctors concerned with this aspect of clinical management. and this section will be of particular value. The blending of these specialties allows full consideration of the problems affecting the patients. Careful management leads to better treatment for the patient and better satisfaction for the doctor.

This book starts appropriately in considering the principles which should govern our care of the injured child and the background factors which influence fracture epidemiology. Knowing how to manage the multiply injured child and recognizing the one who has been non-accidentally injured are essential skills in our specialty. Injuries to the growth plate are not always easy to recognize and manage but, if we fail to do so, the long-term consequences may be serious. Succeeding chapters describe childhood injuries and fractures regionally. Conservative fracture management has not been forgotten amidst the plethora of newer methods of surgical fixation.

Surgery an essentially manual exercise in its early days, has progressively grown richer in complementary techniques helping the surgeon to perfect his movements and increase efficiency. This is particularly the case with digestive surgery, which has been thoroughly transformed by radiology, endoscopy and extemporaneous examinations effected during surgical intervention. Such methods make it possible for surgeons to develop subtle nuances in operative techniques and to specify indi cations more and more precisely. Ultrasonography must now be included among such techniques. It supplements them and can sometimes even replace them. For these reasons, this work devoted to the use of ultrasound by the surgeon during surgical intervention is of great interest. Two general conditions had to be met before ultrasonography could be em ployed in abdominal surgery: the method and apparatus had to be adapted to its surgical utilization, and the surgeon had to adapt to a nonsurgical technique. The first condition has been fulfilled for all purposes. Intraoperative sonograms can be generated at a very high rate and are proving to be more and more useful. The miniaturization of probes permits their application almost everywhere with opti mal results. Of course, the costs are still high, but one can expect them to decrease.

Modern surgical oncology is characterized by multimodal therapy. In recent years numerous therapeutic approaches of pre-, peri-, intra-and postoperative treatment have been in vestigated with regard to their use in combination with surgi cal intervention. It now is time to analyze and to define the state of our knowledge. For tumors of the gastrointestinal tract there are several encouraging therapeutic approaches, such as preop erative chemotherapy in esophageal and perioperative chemotherapy in colon cancer. For some special tumors, like anal carcinoma, we have clearly defined combined therapies which even now must be viewed as standard treatment. It is also time to demonstrate the results of several clini cal studies that have been conducted within the last few years that combined surgical efforts with pre- or postinter ventional chemotherapy or radiotherapy. It is necessary to evaluate whether these trials contribute to progress in onco logical therapy. The editors of this volume - surgeons at the university hospitals of Heidelberg and Zurich - must be given the mer it of achieving these goals. It was especially appropriate for the Department of Surgery in Heidelberg, in close coopera tion with the Comprehensive Cancer Center Heidelberg/ Mannheim, to prepare a review of our present knowledge of surgical oncology as it is in the tradition of attempting to combine different therapeutic approaches to cancer therapy.

The regenerative capacity of the liver cell is almost unlimited. Therefore after acute liver damage, be it viral, toxic, hypoxic, or surgical in origin, restitutio ad integrum is the usual outcome. In two forms of liver disease, however, this is not the case: in fulmi nant hepatic failure, liver regeneration often is not fast enough to keep the organism alive; in end-stage cirrhosis, regeneration is dis turbed by a hypertrophic architecture of fibrotic tissue. For these extreme forms of liver disease and for critical situations before and after liver surgery, artificial liver support is needed. This book contains the latest results in this area of research pre sented by scientists from allover the world at an international symposium held in Celle, Germany, June 2-4, 1980. Exciting new methods like continuous membrane plasma sepa ration and liver cell transplantation into the spleen have been de veloped. The older methods of hemoperfusion and dialysis have been improved. Enzymological methods and liver transplantation have made good progress. We hope that this volume will help the clinician in his decision-making and stimulate ingenious new re search for the benefit of our liver patients."

Professor Philip Bromage From the earliest stirrings of modern surgical anesthesia, novice surgeons struggling to learn from the living what there was a strong intuitive feeling that anesthesia of part they were denied an opportunity to learn from the dead_ of the body would be better for the patient than complete But that is largely nostalgia for a past era_ Today, the visual anesthesia of the whole organism. In 1848, James Young arts and the plastics industry have united to give us superb Simpson spent some time and effort seeking this elusive teaching models and techniques that did not exist a few goal, but after a few ingenious though unsuccessful experi decades ago, and they have developed two- and three ments, he gave up the search and turned back to general dimensional surrogate cadavers that are imbued with a anesthesia as the only practical solution to surgical pain more vivid artistry than ever existed on the marble slabs relief at that time_ amid the formalin reek of our old dissecting rooms_ earl Koller's simple but brilliant application of cocaine to This book is a fresh and highly successful attempt to repair some of the bridges that were burnt with the passing of the the eye in 1884 opened the door to a whole new universe of neural anatomy and pharmacology_ Within a decade or old anatomy days_ Together, the authors have contributed"

Leading medical ethicists, theologists, lawyers, transplant surgeons and physicians discuss 5 major ethical topics concerning the transplantation of human organs.

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 ...

Main focus of the new book will be the description and discussion of rat and mouse models for organ transplantation. Various microsurgical techniques will be presented which allow transplantation of functional organs in syngeneic systems. In particular, the extremely difficult methods necessary for organ transplantation in mice will be presented and evaluated. Besides these practical aspects the book will also cover the theoretical sides of organ transplantation like the immunobiology of allotransplantation. Special emphasis will be given to the resurgent field of xenotransplantation. The results from xenograft models developed in the recent years using rats or mice will be reviewed and their impact on future human xenotransplantation will be discussed.

The comparison of established methods in surgery is necessary in order to evaluate the advantages or disadvantages of each. We have therefore tried to include discussions of all the problems which arise in the treat ment of long-gap esophageal atresia. The long-term results of different types of colonic interposition, of different "stretching" procedures, and of simple staged surgery seemed especially worthy of discussion. It was also important to describe the role of complications caused by special pathology of the trachea in esophageal atresia and their management. Second, new problems continue to arise with regard to the prenatal diagnosis of malformations. These new aspects will continue to exert an influence on our surgical field. Malformations pose severe problems for parents, the growing fetus, and the doctors and are lasting burdens on our task. PETER WURNIG, Vienna Contents I. Long-gap Esophageal Atresia Current Surgical Strategies in Long-gap Esophageal Atresia with Regard to Endoscopy Anastomosis. D. BooB and J. Kotlarski. With 7 Figures .......................... 1 Long-gap Esophageal Atresia: Experience with Kato's Instru mental Anastomosis, with Cervicothoracic Procedure and P- mary Anastomosis, and with Retrosternal Colonic Interposition. W. Ch. Hecker. With 6 Figures . . . . . . . . . . . . . . . . .. 9 Esophagus Replacement by Free, Autologous Jejunal Mucosa Transplantation in Long-gap Esophageal Atresia. H. Halsband. With 10 Figures ......................... 22 The Outcome of Colonic Replacement of the Esophagus in Ch- dren. A. Ahmed and L. Spitz. With 3 Figures ........ 37 Gastric Tube Esophagoplasty. K. D. Anderson. With 1 Figure 55 The Significance of Tracheal Stenosis in Esophageal Atresia."

A clinician's guideline for intra-abdominal infections written by experts in the field.

- A manual to help physicians to quickly recognize and better understand the pathogenesis of intra-abdominal
infections
- Includes several high-quality black and white and color photographs from real-life clinical cases
- Adheres to a simple format to serve as essential and quick reference guide for all non-surgical residents and physicians

The first edition of Surgery of the Hip loint has had certain measures of success. Its cover won the Outstanding Award for art at a publishers trade show. A year later it was translated into Spanish for exposure to the vast world of the Spanish speaking peoples. As I traveled through Europe, it was repeatedly a pleasant surprise to have the book recognized as an authorita tive reference. This was a great tribute to the experts whose diligent efforts made it all possible. Apparently the book has stood the test of time to judge from the many inquiries and constructive comments made toward urging us on to write a second edition. It was not an easy task to gather another cadre of authorities to update our knowledge of the hip joint. People who have earned respected positions in their field are unavoidably burdened with a busy schedule, so a chapter in this text must be appreciated as coming from someone devoted to giving up some of his precious time for the sake of sharing his knowledge with peers and students."

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.

Endoscopic Sinus Surgery examines the surgical techniques for tackling nose and sinus disease. With the advent of multi-angled endoscopes, better optical instruments and imaging techniques, the impact of endoscopic sinus surgery has been greatly increased in recent years as it considers the problem at its root cause. The book combines a clear, practical text with extensive visual material and many colour illustrations. All aspects of functional endoscopic sinus surgery are covered including an assessment of the technique and a detailed account of both morbid and endos copic anatomy which are important to an understanding of the techniques involved. Post-operative care, complications (and how to avoid them) and radiology of the sinuses are also covered. This is an accessible and practical book for the novice which will broaden diagnostic skill and improve patient care. The many tips included will also aid established surgeons.

Thyroid carcinoma is an uncommon malignan ing the available non-human lines, as models cy. In the vast majority of patients, if treated for cell cycle studies and oncogene/anti appropriately, it is associated with a benign oncogene regulation, because they are unaware clinical course. Why then does it hold a con of the often fundamental dichotomy between tinuing fascination for so many physicians? thyroid malignancy and prognosis. Third, the The answer is probably directly dependent very nature of the benign clinical course has suggested to the major health research fund on the very benign nature of most thyroid ing agencies that thyroid cancer is not worthy maligllancies. While there are terrible excep of study in a time of scarce resources. tions, the follicular and papillary thyroid can Nothing could be further from the truth. cers behave in a way quite alien to "common" This gratifying clinical course is the very reason neoplasia, since they grow and metastasize why the study of human thyroid cancer has the slowly. We believe that if only we could under potential for contributing further to our fun stand such a transformed state, we would be able to learn a great deal about the normal and damental understanding of malignancy and, abnormal regulation of the cell cycle and im perhaps more importantly, the mechanisms by prove our understanding of cancer. which the human body can resist neoplastic However, recent advances in the biology of cells."

Every year, in the United States and the third world combined, 13.3 million boys and 2 million girls are circumcised. Whether because of perceived medical, cultural, or religious necessity, most of these parents feel they have no alternative but to allow their children to undergo this surgery. Sparking intense debate, the circumcision of children is a highly controversial and complex phenomenon that touches a variety of sociological areas, such as religious beliefs, identity issues, medical conceptualizations, fear, and superstition. The contributors to this volume comprise an international panel of experts in the fields of medicine, psychology, law, ethics, sociology, anthropology, history, theology, and politics. In 18 chapters they discuss the history of circumcision; document the physical and psychological consequences of circumcision; present the latest anatomical discoveries about the male prepuce; analyze the role of circumcision in various traditions; reveal the medical industry's investment in the practice; describe current legislative efforts to protect children from circumcision; and outline effective, culturally sensitive methods that are being implemented today to safeguard the human rights of at-risk children. For its insights into this troubling aspect of culture, Understanding Circumcision: A Multi-Disciplinary Approach to a Multi-Dimensional Problem is a critically important contribution to the growing body of literature on this subject.

Distinguishing between CVDs, e. g. , hemangiomas and vascular malformations, often presents special problems. The clinical symptoms can be misleading and di- agnosis requires complete and careful evaluation of the patient's history and in some cases further diagnostic measures. A clear histologic classification is limited to cases in which a surgical resection is indicated and the minimally invasive therapy is no longer possible. However, the diagnosis should be made in a very early stage as the different types of congenital vascular disorders require different types of management. While hemangiomas should be treated in their very early stages, the treatment of some vascular malformations can be postponed until the diagnostic and therapeutic measures are of acceptable risk for the patient. References 1. Belov S, Loose DA, Weber J (1989) Vascular malformations. Einhorn, Reinbeck (Periodica Angiolo- gica 16), pp 19-30 2. Berlien HP, Cremer H, Djawari D, Grantzow R, Gubisch W (199311994) Leitlinien zur Behandlung angeborener GefaBerkrankungen. Paediatr Prax 46: 87-92 3. Finn Me, Glowacki J, Mulliken JB (1983) Congenital vascular lesions: clinical application of a new classification. J Pediatri Surg 18 (6): 894-900 4. Grantzow R, Schmittenbecher PP, Klima-Lange D, Spreng G (199011991) Problematik der Therapie von Riesenhamangiomen. Paediatr Prax 41: 311-320 5. Jacobs AH, Walton RG (1976) The incidence of birthmarks in the neonate. Pediatrics 58 (2): 218-222 6. Philipp e, Poetke M, Berlien HP (199311994) Klinik und Klassifikation angeborener GefaBerkrank- ungen.

Laparoscopic Colorectal Surgery, Second Edition is fully revised and updated and reflects an authoritative, team-oriented approach to the latest state-of-the-art laparoscopic colorectal procedures and surgical techniques. Written by pioneers in the field, this text will supply surgeons with all the information necessary to accomplish advanced laparoscopic procedures. Comprehensive discussions of positioning, instrumentation, cannulas, surgical techniques, special considerations, and considerations in cancer surgery are featured for a wide variety of major operative procedures.

This new Second Edition includes updated information on laparoscopic colorectal procedures, including hand-assisted laparoscopic procedures and new chapters on the physiology of pneumoperitoneum, laparoscopic anatomy of the colon and rectum, and evidence-based discussion of outcomes. The text is complemented by over 200 line drawings created exclusively for the textbook.