Since the small bowel except the duodenum and (1961), Pygott et al. (1960), Gianturco (1967) terminal ileum is largely inaccessible during en- and Bilbao et al. (1967). doscopic examination, radiology of the small Sellink, however, was really responsible for bowel attains special significance as a diagnostic the widespread recognition of enteroclysis method. Owing to the length and position of (1971, 1974, 1976). In spite of the increasing this organ, good images are difficult to obtain. popularity of this method, the necessity for sub- Furthermore, the considerable variation oftran- stituting this apparently viable method for the sit time, unpredictable response of the contrast peroral examination is still equivocal (Rabe medium, and superimposition with the filled etal. 1981; Fried etal. 1981; Maglinte etal. loops make small bowel radiology difficult. As 1982; Ott et al. 1985). Comparisons of both methods, however, (Fleckenstein and Pedersen a result, few radiologists specialize in this field. With the exception of Crohn's disease, disorders 1975; Sanders and Ho 1976; Ekberg 1977; Val- lance 1980) have confirmed the superiority of of the small bowel are relatively rare. Thus, not many clinicians and radiologists are interested enteroclysis. It achieves a high accuracy (Antes in the small intestine. and Lissner 1983).

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 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.

With improvements in respirator therapy and intensive care, congenital malformations and various acquired pathologic deformities of the trachea or bronchi are more often observed than used to be the case. For a while it seemed that tracheostomy would be unnecessary, but it has since become quite clear that severe disturbance of the trachea would be the outcome owing to primary or secondary pathologic changes that had not been given adequate consideration previous. These changes can lead to urgent life-threatening episodes or definite mutilation for the rest of the child's life. Tracheal surgery thus repre sents a new and special challenge for the pediatric surgeon. A solution to these serious problems must be found and merits discussion. Further more, it seems worthwhile to review cases of surgical pulmonary dis eases, except for the already widely discussed problems ofempyemas or bronchiectasis. P. WURNIG, Vienna Contents Pathophysiology of Subglottic Tracheal Stenosis in Childhood. B.MINNIGERODE and H.G.RICHTER. With2Figures 1 Subglottic Stenosis in Newborns After Mechanical Ventilation. M.MARCOVICH, F.POLLAUF, and K.BURIAN. With 3 Figures ... 8 Treatment of Congenital Cricoid Stenosis. R.N. P. BERKOVITS, E.J. VAN DER SCHANS, and J. C. MOLENAAR. With 7 Figures . . .. 20 Surgical Correction of Laryngotracheal Stenoses in Children. E. HOF. With 6 Figures . . . . . . . . . . . . . . . . . . . . .. 29 Surgical Treatment of Congenital Laryngotracheo-oesophageal Cleft. R.N.P.BERKOVITS, N.M.A.BAX, and E.J. VAN DER SCHANS."

The development and improvement of new technologies have made pancreatic disease more accessible to diagnosis in the last decade. The cooperation and coordination of experts in the fields of gastro enterology, radiology, biochemistry, immunology, and pathology are necessary if the methods are to be made available and the progress made to be fully exploited. Each of the new methods requires special training, and extensive experience is needed to guarantee high standards in the diagnosis of pancreatic disease. New methods have to be tested carefully against established diagnostic procedures, though at the same time we must be ready to adopt a new approach to diagnosis. The aim of this book is to update the material already published and to focus on the various imaging methods and functional tests currently available, the features specific for each, and their integrative potential in the detection of pancreatic disease. The various pathologic findings are analyzed with reference to the clinical stages of pancreatic disease. As an introduction to the morphological and functional features of acute pancreatitis, chronic pancreatitis, and pancreatic cancer revealed by the different imaging methods and functional tests, basic knowledge of the patho-physiological and pathomorphological events is provided by research workers. This knowledge is essential for the understanding and interpretation of the diagnostic findings recorded in pancreatic diseases.

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.

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."

Edited by the respected pediatric orthopaedic surgeon Ali Kalamchi, M.D. with contributions from other experts in the field, Congenital Lower Limb Deficiencies is a single source reference guide for rare complex congenital defects of the lower limb. The text is divided into three sections. The first section discusses normal limb development; the genetic, familial, and historical nature of lower limb defects; and the evaluation and categorization of such defects in pediatric patients. The second section characterizes and classifies the congenital defects and covers early long-term planning of patient management based on clinical and radiographic findings. The third section analyzes the treatment modalities, including several chapters on the relationship of sports therapy to the treatment plan. In addition, the authors contribute their wealth of expertise by sharing their experiences and preferences in the treatment of congenital lower limb defects. The team approach for geneticists, pediatricians, orthopedists, therapists, prosthetists and other health care professsionals involved in each case is emphasized.

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."

Trauma to the abdomen, both accidental and willful, has become increasingly common in this era of increasing violence. Large numbers of patients all over the country are admitted to emergency rooms because of abdominal trauma of varying degrees of severity. All too often the correct diagnosis is suspected belatedly or not at all, so that proper treatment is not initiated in sufficient time to be lifesaving. Not infre quently, the injured patient is examined by an intern or an insufficiently experienced resident physician. Even in instances where more senior internists and surgeons are available, detailed knowledge about the necessary methodology to establish the correct diagnosis and institute the appropriate treatment is lacking. This monograph, representing the felicitous collaboration of a surgeon and a radiolo gist together with several other contributors, is timely and important. The authors (and their contributors) have approached their subject with a wealth of clinical experi ence obtained in several very active acute-care municipal hospitals in the largest city in this country. They have observed and treated a very large number of patients with a multitude of traumatic causes, including firearm injuries, stab wounds, vehicular accidents, falls, and assaults. The authors have divided this work into four main sections: General Perspectives on Abdominal Injury, Types of Abdominal Injuries, Specific Diagnostic Techniques, and Specific Organ or Supporting-Structure Injury."

The most complete presentation of basic and advanced laparoscopic techniques available, due to its integration of procedures from general surgery and other subspecialities. Enhanced by over 750 illustrations (113 of them in full colour) and written by no less than 132 international, interdisciplinary experts, this definitive reference covers all aspects of this still new and expanding technique. Four main sections deal with: basic laparoscopy; laparoscopy and thoracoscopy in general surgery; laparoscopy in surgical subspecialities (gynaecology, urology, angioscopy); plus the technological aspects of laparoscopy. Throughout this authoritative volume, the surgeon will find in-depth reviews of the literature and extensive clinical and scientific data on the rationale for using laparoscopic procedures.
Certain to become a standard in the field.

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.

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.

Although the disease is not very often, every otorhinolaryngologist will experience some patients suffering from vocal fold paralysis.

This is the first and unique book solely devoted to this topic.

Offers step-by-step descriptions and evaluations of the materials and/or methods of well-established techniques and new therapeutic options and approaches.

Written by leading experts: Blitzer is speaker of the American Academy of Otorhinolaryngology and Head and Neck Surgery (AAO-HNS); Sulica, also a speaker of the AAO-HNS, works in his department.

Vocal Fold Paralysis is a clinically useful reference for evaluation and treatment, as well as a summary of current knowledge and investigational approaches.

This is a comprehensive textbook of Hodgkin's and non-Hodgkin's lymphomas written by leaders in the field of childhood lymphomas. It includes clinical, pathologic and molecular biology of each subtype of lymphoma. The pathology chapters are comprehensive and include excellent photographs. The book is at the level of subspecialists in pediatric hematology and oncology, radiation oncology, pediatric surgery and hematopathology.

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.

Who owns your sex organs? Different cultures today and in different epochs have given a variety of answers to this question. It may seem self evident that every individual owns and has sovereignty over his or her own body parts, such as the head, legs, nose, stomach, pancreas, and other body parts. The sex organs, however, seem to be an exception. Even though they are as much an integral part of the individual as a leg or a liver, the sex organs are unique in that many cultures have established laws and taboos over the use and even the mere display of the sex organs. Thus, certain cultures have placed constraints over the individual's ownership of his or her sex organs and actively regulate and restrict the individual's access and use of those organs. In other cultures, the question of ownership of the sex organs is more decisively answered. In any culture where circumcision to any degree of either the male or female is practiced, permitted, encouraged, or even merely tolerated, it is clear that the individual is not considered to own his own sex organs. In the United States today, the medical establishment has created an is considered acceptable and desirable that anyone for environment where it any reason can authorize or execute the amputation of the foreskin from a male child's penis."

Beginning with the scientific basis of tumors, "The Surgery of Childhood Tumors" provides up-to-date information on epidemiology, cytogenetics and molecular biology, before looking at current treatments, integrating surgery, neoadjuvant and adjuvant chemotherapy and radiation therapy. Additionally, a chapter on counseling reflects the book's holistic approach to treating children with cancer.

The chapters are written by world-renowned international authorities on pediatric cancer from major children's cancer groups in the UK, Europe and the US. Contributors discuss geographical variations in treatment for each type of tumor. Excellent full-colour pictures and detailed line drawings illustrate all aspects of managing childhood tumors, including technical details of operation which are often neglected in other texts. This comprehensive book provides a contemporary approach for pediatric, general and urological surgeons dealing with childhood tumors. New chapters in this second edition provide the latest developments and strategies in pediatric surgical oncology.

This user-friendly definitive reference work presents the full spectrum of current cancer treatment options available to the practicing general surgeon or trainee. Through the pairing of 4-color algorithms and concise, clinically oriented text, the reader can quickly visualize and understand the decision-making process. Separate algorithmic branches highlight surgical treatment, adjuvant therapies such as chemotherapy and radiation therapy, as well as combined modality treatment. Over 90 chapters address organ systems from head to toe and tackle special topics, including oncologic emergencies and diagnostic and therapeutic challenges, and surgical adjuncts. More than 200 illustrations augment the textbook.

There are numerous textbooks detailing almost every aspect of the different laparoscopic procedures. However, in this era of evidence-based medicine, a text focusing on the controversies - from the laparoscopic as well as the general surgeon's point of view - is missing.

This book is not intended to be yet another textbook of laparoscopy; instead, its main purpose is to address unsettled issues of controversy. This will significantly enhance evidence-based knowledge of this developing field, stimulate thinking and discussions in rounds and meetings, assist surgeons in their decision making and stimulate further research.

This book is not aimed only at laparoscopic surgeons - with their steadily increasing number - but also at general surgeons and surgical trainees. It will define and sharpen points of controversy by internationally recognized authors, and thus provide 'state of the art' quality to each topic.

Surgery continues to be the most effective treatment of solid tumors in terms of recovery, while its combination with other treatments improves the survival curves especially in the advanced forms of the disease. The aim of my task first of all has been to provide readers with both the current and constantly evolving pathophysiologic knowledge required for building the foundation of a specific education enabling surgeons to meet the fundamental targets in surgical oncology. Secondly, this volume aims to present an update on the real possibilities offered by the cooperation between surgeon and pathologist and by chemotherapy, radiotherapy and gene therapy in the treatment of tumors in the light of the most recent scientific achievements. Lastly, the report presents the experiences and cases drawn mostly from our School regarding some of the major issues in oncologic surgery. This overview does not pretend to elucidate or to summarize all aspects of oncologic surgery, but rather to be the result of a general consideration on cancer surgery, on its rational bases, on its interaction with other treatment modalities, on its desirable and expected developments and on its probable future evolution.

This text covers new innovations and concepts in pediatric thoracic surgery practice, basic science and evidence, and the technical aspects of common and rare operative procedures.

It is essential for pediatric surgical trainees and consultants with interest in pediatric thoracic surgery. Providing comprehensive coverage of newer developments, it is also a useful reference work for pediatric and thoracic surgeons and a valuable guide for surgeons (adult or pediatric) managing pediatric thoracic surgery on occasional basis or only during acute emergency.Covering the subjects within pediatric thoracic surgery (non-cardiac) in significant depth, this book acts as a reference text for consultants undertaking pediatric thoracic work as well as for pediatric respiratory, anesthetists and fetal medicine doctors. Topics within this book will also be of interest to pediatric respiratory physicians and pediatric oncologists.

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.

Most surgeons are familiar with the techniques of laparoscopic surgery, however, in children there are variations in size and technical appraoch. The book describes the differences and characteristic aspects of laparoscopy in small children. The emphasis is on little text and numerous drawings. Technical guidelines are given on how to perform laparoscopy safely even in small children. The most frequent indications for laparoscopy in children are presented and discussed. The aim of the book is to provide surgeons with the knowledge to extend their expertise in adult laparoscopy to children.

Combining the clinical expertise of internationally renowned specialists with the latest research and surgical techniques, this detailed reference guides the reader through the wide range of applications for minimally invasive surgery in urology, as well as the many diagnostic and therapeutic procedures utilizing minimally invasive technologies.