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."

Recent Advances in Coloproctology provides a thorough overview of modern developments in the surgical treatment of disorders of the lower intestine including ulcerative colitis/severe acute colitis, Crohn's disease, carcinomas, haemorrhoids and anal incontinence. Recognizing that the surgeon does not work in isolation, the book also integrates recent progress in imaging techniques for the anal canal and rectum, and highlights medico-legal considerations in separate chapters. Aimed at current practitioners and trainees, Recent Advances in Coloproctology discusses key concepts that will assist general surgeons and colorectal consultants in their management of patients with a broad spectrum of anorectal and colonic disorders. With a problem-oriented slant, this book is essential reading for all those with interest in coloproctology.

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.

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.

2014 BMA Medical Book Awards Highly Commended in Surgery category! General Surgical Operations is a highly-praised and comprehensive textbook of operative surgery. It is a practical manual aimed at the surgeon who is about to carry out an operation, rather than just a description of the principles suitable for an examiner. Kirk's General Surgical Operations continues to be aimed at a broad readership: the candidate preparing for the Intercollegiate FRCS in General Surgery or international equivalents; the trained surgeon faced, through necessity, with undertaking an infrequently performed procedure; and the many surgeons working in hospitals throughout the world without access to specialist services. It remains above all a practical text which will guide the surgeon in training, or one unfamiliar with a procedure, on how to perform it, but more importantly on how to manage the uncertainties which so often arise This is a 'What to do' book. Using it the reader can aspire to gain diagnostic, decision making and operative surgical competence with confidence. The book is written in a clear and direct style and providing explicit instructions using descriptive headings for easy reference. The contents covers standard routine operations in full; non-routine and rarely performed operations are included only where appropriate and in lesser detail The text includes advice on topics such as patient selection; preparation and access to the site of operation; how to accomplish the procedure; closing and aftercare Difficulties are highlighted and advice given on how to respond to unexpected findings Each procedure is fully described thus avoiding repetitions and cutting cross-references to a minimum Regular summaries of key points in the decision making process are included. This Sixth Edition is now known as Kirk's General Surgical Operations in recognition of its distinguished founding editor, Professor RM Kirk, who is now Editor Emeritus on the textbook. The new editorial team for the Sixth Edition comprises a colorectal surgeon, a vascular surgeon and an orthopaedic surgeon The contents have been restructured and radically revised into 42 chapters, the majority of which have been completely rewritten. Laparoscopic techniques have been incorporated into all relevant chapters. All the illustrations have been redrawn to improve their clarity.

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."

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.

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.

The many advances in breast cancer research, as well as the large quantity of published material, make it very difficult to gain insight into the global aspects of cancer management. To follow and understand all the new developments is becoming a major challenge. For this reason, the editors decided to bring together a group of top researchers in breast cancer to provide a comprehensive, yet readable conceptual review of the state of the art of breast cancer diagnosis and therapy. The proposal to focus the review on the quantitative assessment of the risk at diagnosis, the determination of which may permit selective therapies for individual patients, was met with enthusiastic approval, resulting in the present volume with contributions by the leading investigators in the field. While the volume relating to diagnosis, published re cently, focused on efforts leading to refinement at diagnosis of risk criteria sensitive enough to reliably distinguish the low- and high-risk categories, the second volume, by provid ing a review of the main problems and results of therapy given to high-risk patients, can be considered as a continua tion of the first book. A refined risk assessment at diagnosis and the application of the most suitable treatments to well selected individuals are the most important steps towards avoiding the present worrisome reality of overtreating the low risk and undertreating the high-risk patients. The first few chapters of the present volume offer an insight into the general management of early breast cancer.

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.

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."

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

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.

In 1968 the first contacts were arranged with the publishing house of Urban & Schwarzenberg concerning the establishment of a periodical to be produced in English with the aim of publishing important scientific work in pediatric surgery and related disciplines. I thought especially of certain excellent inaugural disser tations and theses. When Urban & Schwarzenberg promised to start such a series, I recruited Peter Rickham, then in Liverpool and now in Zurich, and Jean Prevot of Nancy as executive editors. We chose the title Progress in Pediatric Surgery - Fortschritte del' Kinderchirurgie - Acquisitions en Chirurgie Enfantile as the name of our new series. The first volume was published in 1970, followed by another 16 volumes during the next 14 years. At the suggestion of Michael Urban, we turned from the publication of long papers to theme-based volumes, which proved to be extraordinarily useful. Mr. Urban, the head of Urban & Schwarzenberg, told us in 1982 that his firm could no longer look after Progress in Pediatric Surgery. With the agreement of Mr. Urban, we had to look for another' publisher and found Springer-Verlag, who agreed to continue publishing Progress in Pediatric Surgery in the approved lay-out. We cordially thank Dietrich G6tze of Springer-Verlag for his helpful support. This volume (No. 18) is the first of Progress in Pediatric Surgery to appear under the guidance of Springer-Verlag. We want to express our thanks to Mr. Urban and Dr."

At first sight it may appear strange that a volume of Progress in Pediatric Surgery should be devoted to the history of our specialty. One assumes that progress is concerned primarily with recent developments whilst history deals with matters of the past. However, in the past there has also been considerable progress in the development of our understand ing of paediatric surgical problems, otherwise we would not have pro gressed to our present achievements. The editors, therefore, do not apologize for compiling this volume but, on the contrary, feel that the publication of this volume is most timely. Modern paediatric surgery has now been practised for three genera tions. The handful of pioneers who were the founders of our specialty worked mainly before the last world war. A few dozen of the inter mediary generation started work immediately after the war, while the new generation who are now dominating our specialty must be counted in thousands. Two factors have radically altered paediatric surgery as practised by the intermediary and the present generation of surgeons."

This book is the product of long years of close collaboration between two physicians, a pediatric endocrinologist and a pediatric surgeon, who are interested in the complex field of human malformations. Their efforts have set a new standard in the treatment of children with intersexual or mal formed female genitalia. It is impossible to convey the details of complex surgical procedures without the help of meticulous illustrations. It is fortunate that happened to meet an academically trained artist, Mrs. Siri Mills, M.A., while visiting in the United States. Her excellent knowledge of anatomy, her remarkable skills as an artist and technical illustrator, and her readiness to include all details of interest to the surgeon have found their fruitful expression in the illustrations of this book. We express our thanks to Springer-Verlag and especially to Prof. Diet rich Goetze, at whose suggestion this book was written, for their amiable compliance with all our wishes, and particularly for their willingness to retain Mrs. Mills as our illustrator. Munich, May 1985 WALDEMAR HECKER Contents In trod ucti on 1 Part 1: Endocrinologic Diagnosis in Pediatric Patients with Genital Anomalies General Rules . . . . . . . . . . . 4 Endocrinology of Antenatal Sex Differentiation 6 Male Differentiation 6 Female Differentiation 7 Specific Endocrinologic Diagnosis and Therapy 8 Virilization of the Female External Genitalia 8 Congenital Adrenogenital Syndrome with a Defect of 21-Hydr- ylase . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Intersexual Genitals Due to Deficient Androgenization of the Male 11 Defects of Testosterone Biosynthesis 11 Androgen Receptor Defects . . ."

It is estimated that the functionally significant body of knowledge for a given medical specialty changes radically every 8 years. New specialties and "sub-specialization" are occurring at approximately an equal rate. Historically, established journals have not been able either to absorb this increase in publishable material or to extend their readership to the new specialists. International and national meetings, symposia and seminars, workshops, and newsletters suc cessfully bring to the attention of physicians within developing spe cialties what is occurring, but generally only in demonstration form without providing historical perspective, pathoanatomical corre lates, or extensive discussion. Page and time limitations oblige the authors to present only the essence of their material. Pediatric neurosurgery is an example of a specialty that has de veloped during the past 15 years. Over this period neurosurgeons have obtained special training in pediatric neurosurgery and then dedicated themselves primarily to its practice. Centers, Chairs, and educational programs have been established as groups of neuro in different countries throughout the world organized surgeons themselves respectively into national and international societies for pediatric neurosurgery. These events were both preceded and fol lowed by specialized courses, national and international journals, and ever-increasing clinical and investigative studies into all aspects of surgically treatable diseases of the child's nervous system."

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 volume is dedicated to the Third International Symposium on Microneurosurgical Anastomoses for Cerebral Ischemia, which took place in Rottach-Egern, June 2&-30, 1976, under the sponsorship of Professor F. Marguth, Director of the Depart- ment of Neurosurgery, Ludwig-Maximilians-University of Munich (West Germany). It contains the continuing devel- opments of the extra- intracranial arterial bypass (EIAB) for cerebrovascular occlusive disease since the First International Symposium in Lorna Linda, California, in June, 1973, and the Second International Symposium in Chicago, Illinois, in June, 1974. The EIAB was developed by Donaghy and Yasargil, and it consists of a microsurgical anastomosis of the superficial tem- poral artery or the occipi tal branch of the external carotid artery to the middle cerebral artery on the surface of the brain and, very recently, the anastomosis of the occipital artery to the posterior-inferior cerebellar artery for the treatment of verte- brobasilar insufficiency. From the presentations at the sym- posium it became evident that the greatest potential in the pre- vention of a stroke in a susceptible patient is the presence of an adequate collateral cerebral blood flow. The basic diagnostic procedure is cerebral angiography in- cluding both carotid and vertebral arteries. Regional cerebral blood flow (rCBF) studies and computerized tomography add further diagnostic information and are particularly important in the selection of potential surgical candidates.

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."

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."

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.

In 2006, when my colleague Andrea Renda proposed multiple primary malignancies (MPM) as the subject of the Biennial Report to the 2008 Congress of the Italian - ciety of Surgery, I, together with the Steering Committee, quickly agreed. Recent progress in our understanding of the etiopathology of these neoplasms has led to - novative and significant progress on the clinical level. Importantly, the incidence of the onset of two or more tumors in the same patient suggests a more than casual - lationship. Furthermore, the occurrence of MPM derives from several different me- anisms-viral, iatrogenic, immunologic, environmental, and hereditary-such that any form of treatment must take into account the etiology of these tumors. After an epidemiological introduction, this monograph analyzes various aspects of multitumoral syndromes based on the experience of the Department of Surgical Sciences, along with that of other clinical departments of the University Federico II of Naples. In the discussion of inherited tumors, reference is made to the series of patients treated at the Department of Surgery at the University of Siena. The many topics that comprise this volume range from carcinogenesis to diagnostic strategies, and from epidemiology to innovations in imaging and endoscopic techniques. Among the clinical aspects, particular emphasis is given to sporadic and hereditary syndromes, as these patients are frequently treated by general surgery departments.