H. B. Stahelin "Under-or malnutrition is a frequent and serious problem in geriatric patients" (8). Today there is no doubt that malnutrition contributes significantly to morbidity and mortality in the aged. The immune function is impaired, the risk for falls and fractures increases, in acute illness, recovery is delayed, and complications are frequent. Acute and chronic illnesses lead to a catabolic metabolism and hence increase the signs and symptoms of malnutrition. Cytokines related to inflamma tion block the synthesis of albumin and shift protein synthesis to acute phase pro teins. The activation of the ubiquitine-proteasome pathway leads to a degradation of muscle protein, which leads to an additional loss of muscle mass which occurs as age-dependent sarcopenia, and adds to the already existing frailty (2, 4). It is often difficult to decide to what extent the metabolic alterations result from malnutrition or concomitant illness. Psychological factors contribute as a circulus vitiosus significantly to anorexia and, thus, aggravate the condition. They are the most important causes of failure to thrive in old age (7). It is evident that next to the therapy of the underlying illness, an adequate support with calorie and nutrient intake over weeks becomes essen tial under these conditions. Clear-cut improvements are often only seen after 6 or more weeks. Besides a clinical, clearly visible malnutrition, selective nutrient deficits are much more frequent. Numerous and highly different mechanisms may lead to a marginal or insufficient supply with micronutrients."

Now fully revised and updated, Clinical Biochemistry, third edition is essential reading for specialty trainees, particularly those preparing for postgraduate examinations. It is also an invaluable current reference for all established practitioners, including both medical and scientist clinical biochemists. Building on the success of previous editions, this leading textbook primarily focuses on clinical aspects of the subject, giving detailed coverage of all conditions where clinical biochemistry is used in diagnosis and management - including nutritional disorders, diabetes, inherited metabolic disease, metabolic bone disease, renal calculi and dyslipidaemias. The acquisition and interpretation of clinical biochemical data are also discussed in detail. From the author of the popular Clinical Chemistry medical student textbook there are many competing texts on clinical chemistry, the vast majority concentrate on the technology; this book concentrates on the clinical Ideally suited for preparation for the MRCPath and similar examinations Expanded sections on haematology and immunology for clinical biochemists provide a thorough understanding of both laboratory and clinical aspects New chapters are included on important evolving areas such as the metabolic response to stress, forensic aspects of clinical biochemistry and data quality management An extended editorial team - including three expert new additions - ensures accuracy of information and relevance to current curricula and clinical practice A superb new accompanying electronic version provides an enhanced learning experience and rapid reference anytime, anywhere! Elsevier ExpertConsult.com Enhanced eBooks for medical professionals Compatible with PC, Mac (R), most mobile devices and eReaders, browse, search, and interact with this title - online and offline. Redeem your PIN at expertconsult.com today! Straightforward navigation and search across all Elsevier titles Seamless, real-time integration between devices Adjustable text size and brightness Notes and highlights sharing with other users through social media Interactive content

The danger of infection remains the most serious drawback to internal fixation. Prevention, using all available prophylactic measures should be the central feature in every surgical department. Though the infection rate may remain below the acceptable level of 2 %, the infected patient derives little comfort from the large number of excellent results in other people. We must discover the best way to offer these patients a favourable prognosis. This should not be based on intuition but on clear proven guiding principles. Planning the treatment for a patient whose internal fixation has become septic must decide between steps which may have advantages or disadvan tages. The disadvantage of the presence of a foreign body must be weighed against the advantage of rigidity. The authors have taken up this challenge by planned animal experiments to study the healing of internally fixed fractures which have been infected with staphylococci. They have shown that under stable conditions, even massive infection did not destroy the healing process in cortical bone. Even under these circumstances fracture union, in the form of primary bone healing, can occur even if with less regularity than in unin fected internal fixation.

The book provides a comprehensive account of ticks and tick-borne diseases occurring in tropical and subtropical areas. It begins with a complete up-to-date overview of the systematics of the Ixodida (Ixodidae, Argasidae and Nutalliellidae) and is followed by a review of the problem of ticks and tick-borne diseases of domestic animals world wide. This leads on to multi-disciplinary approaches to planning tick and tick-borne disease control and to contributions on calculating the economic impact of a tick species such as Amblyomma americanum on beef production systems. Heartwater fever (cowdriosis) and dermatophilosis are endemic in Africa and pose a threat to the North American mainland. The epidemiology of these two diseases is discussed in detail as is the role of frozen vaccines to control bovine babesiosis and anaplasmosis. The book also includes chapters on tick transmitted zoonoses such as Lyme borreliosis, tick typhus and ehrlichiosis. It concludes with a review of the acaricidal treatment of tick infestation.

Current Review of Asthma comprises up-to-date information related to the field of asthma diagnosis and treatment. The book has broad appeal, because it features in-depth, concise discussions on concomitant diseases and treatment choices. Examples of some of these chapters include epidemiology, pathology, airway remodeling, and pathophysiology. The 37 contributors are well-known scientists and clinicians from the US and UK. Each chapter establishes an overview of the topic, followed by a detailed analysis of the information at hand, which is supplemented by charts, tables, and graphs. In addition, editor Dr. Michael A. Kaliner contributes his own chapter, entitled "The Pathogenesis of Bronchial Asthma," written from 30 years of experience treating patients with asthma. This book is an invaluable resource to both the primary care physician and the asthma specialist.

Oxidative stress and aging Over the past several years there has been an extraordinarily rapid growth in our knowledge of free radical chemistry and its possible involvement in both normal essential biology and age related disease and dysfunction. Much of this growth in the traditionally separate sciences of chemistry and molecular gerontology occurred independently, with little interaction or communi cation between the scientists working in these two fields. In view of the growing maturity of the two fields and the potential importance of advancing our knowledge in the area of oxidative stress and aging, we perceived a critical need to organize an international conference the "First Inter national Conference on Oxidative Stress and Aging" in Hawaii in 1994 to bring together the world's leading scientists in the fields of reactive oxygen species and molecular gerontology. The objective of this conference was to provide a unique opportunity for scholars working in these two related and rapidly growing fields to participate in the exchange, integration, and synthesis of new concepts and ideas, to engage in constructive criticism and to initiate new collaborative research projects. The conference focused on the molecular and cellular aspects of aging as related to oxidative stress. It was one of the largest and most comprehensive international conferences held in molecular gerontology. At this conference a call was made for submission of papers to be used in the publication of a book covering the major contributions of the meeting."

Neurologists and non-neurologists alike can no longer ignore diseases of the neuromuscular system. The old dogma that these disorders are both uncommon and untreatable has lost its validity. Recent technological advances have enabled us to study more precisely muscle and nerve anatomy, physiology and biochem istry. Because of this progress, we are now recognizing new neuromuscular di seases as well as diagnosing more subtle cases of myasthenia gravis, myotonia, and metabolic myopathies. Treatment of the neuromuscular diseases has also un dergone dramatic change based on new discoveries in the fields of immunology and pharmacology. No longer are myotonia, periodic paralysis, and malignant hyperthermia untreatable medical curiosities. No longer are cases of steroid-un responsive myositis given up as hopeless. Because of all these advances, non-sur gical physicians and especially neurologists must update their knowledge regard ing the neuromuscular disorders. This book, it is hoped, will help such clinicians in dealing with this task. Emphasis has been placed on the diagnosis and management of these disorders rather than on their pathophysiology. The more uncommon diseases and those of uncertain existence have been omitted purposely and left to the larger and more encyclopedic reference works. Chapter 1 discusses the clinical symptoms and signs of muscle disease and is designed to enable the reader to formulate a differential diagnosis on the basis of the patient's history and physical examination."

Looking back is a luxury for which scientists normally have little time. This XXV Anniversary Symposium, however, gives the opportunity of reminding us that in Belgium, where the risk of developing multiple sclerosis is among the highest in the world, a great man to whom we all pay tribute, I mean Dr Ludo van Bogaert, in 1957, took the initiative in founding the Belgian Research Group for Multiple Sclerosis. It may sound immodest but since that time members of the Belgian Research Group happen to have an honourable record of important contributions to MS research, quite out of proportion to the financial support they received for it. Indeed, when compared to the situation in English speaking countries, funding of MS research has always been neglected in our country in spite of the fact that in 1958, acting on the advice of the Belgian Research Group, the Belgian National MS Society was founded with the specific object of collecting money for research as well as for social care. At that time, the difficulty in raising funds for research was partly due to the fact that solving the problem of MS appeared almost impossible. Scientists could apparently only too slowly improve their ability to prevent and cure the disease. Media were indifferent to MS which was considered to have no news value, and the public remained uninformed.

There are many unanswered questions regarding the molecular nature of antibodies, components of complement, and other substances which participate in the immune response. The list of substances which need to be analyzed chemically is increasing. Plasma cell products, of course, have long been of great interest because the most prevalent ones are immunoglobulins. Other cell types, however, are the source of the broad spectrum of additional substances which classically fall into the sanctum of the molecular immunologist. It is these substances, and especially those more recently discovered, which are responsible for the broadening investigative interests of immunologists. In this volume we have provided you with descriptions of research being done with immunoglobulins and with complement. Additionally, we have in cluded two reports that deal with molecules which are among the more recent acquisitions of the molecular immunologist. The components of complement are known to react in a cascading manner which results in the lysis of cellular antigens. The first step in the classical pathway requires the activation of CI by the antibody-antigen aggregates. This volume of Contemporary Topics in Molecular Immunology begins with the report of Reid and Porter which describes their investigation of the mechanism of activation of C I. Their descriptions of C I q and of the reaction of C I with immunoglobulins are especially intriguing. It is clearly apparent from their report that activation of the components of complement is a complex phenome non.

The International Skeletal Society is now fifteen years old and as measured in human terms has outgrown its childhood. During this time the ISS has earned worldwide respect and praise for successful work. The International Skeletal Society is an interdisciplinary working group concerned with skeletal diseases, their pathogenesis, diagnosis, and treatment at all ages. At the Annual Closed Meetings of the ISS prominent scientists representing many countries from all over the world gather to exchange ideas in the fields of radiology, pathology, orthopedic surgery, nephrology, and endocrinology. Follow ing these meetings Refresher Courses are offered for students, physicians in train ing, and interested collegues from the various medical specialities. The purpose of these courses is to present the latest developments in clinical practice and research with regard to skeletal diseases. The Society's internationally well-known journal "Skeletal Radiology," which is published by Springer-Verlag, Heidelberg, adds in exchanging updated developments in the field of skeletal disorders. The hereby presented first Book of Members contains a record summarizing the most important milestones and events of the history of the International Skeletal Society up to 1987 in the form of short biographies regarding the members of the Society. The task of gathering all important informations for this book was accom plished by one of the members during his term as President of the ISS. The other one - honorary member - took upon himself the tasks related to publication."

Career changes are becoming common among professionals in recent years. Many physicians may want to change direction, but often do not know whether it is the right thing to do or if pursuing a career outside of clinical practice would achieve their professional goals. Doctors have the training and education to contribute to society in many beneficial ways in addition to traditional clinical practice. Yet, there is no formal mapped-out route for doctors who want to pursue alternative careers, which is where Careers Beyond Clinical Medicine comes in.
Doctors at any stage, from early in training to mid-career, to nearing retirement, can use Careers Beyond Clinical Medicine to clearly evaluate the issues involved when considering a career change. This book shows physicians how they can serve society and patients in innovative ways, and make a notable impact on health care delivery, policy and quality when they use their medical background in a non-traditional career pursuit. The numerous unadvertised opportunities for physicians are explored and a step-by-step route with practical advice for finding the best career is described.
Recent advances in healthcare technology, medical science, patient education require physicians to play new roles that have not traditionally been well-defined. Doctors can innovate and have a long-term productive impact on healthcare in the United States and throughout the world if they learn to seize the non-traditional career opportunities available to physicians, or even create a new way to fill a void in health care. Careers Beyond Clinical Medicine helps illuminate that path.

The Second Meeting of the International Society for Trace Element Research in Humans (ISTERH) was held in Tokyo from August 28 through September 1,1989. On August 27, the day preceding the opening of the meeting, a typhoon made a direct attack on Tokyo, welcoming guests from all over the world in a rather violent way. To our great relief, the weather during the week of the meeting turned out to be exceptionally agreeable for that time of year in Tokyo. We were also pleased to see the entire scheduled course of the meeting, including the social activities, carried out smoothly and the contents of the program favorably appraised. The meeting was attended by 518 scientists from 30 countries. Recent unrest following steps toward democratization in the Communist bloc gave rise to some apprehension; therefore, we were particularly pleased to see attendants from China, Eastern Europe, and the Soviet Union. No one could possibly have predicted the drastic change in Eastern Europe that followed, but again, we were relieved to learn (by a subsequent letter) of the safety of an attendant from Rumania, who had been our greatest concern. A total of 384 papers were contributed to the meeting. The abstracts for all have been published in the Journal of Trace Elements in Experimental Medicine, vol 2, No. 2/3 (1989). This proceedings carries 64 subjects introduced in the Special Session.

Genital Papillomavirus Infections provides a state of the art survey on the clinical aspects, diagnosis, treatment, and prevention of genital papillomavirus infections, written by experts in the respective fields. Two introductory sections on epidemiology and molecular biology are followed by chapters on new techniques for the detection of genital papillomaviruses and their presence in genital carcinomas. Contributions on the clinical aspects cover infections of the cervix, male and female external genitalia, urethra, and oral cavity. A discussion of the immunobiology of papillomaviruses ends in an evaluation of the prospects for vaccination, and the application of podophyllotoxin, cryosurgery, laser therapy, and interferon treatment are described in detail. This book is unique in placing a strong emphasis on clinical aspects of genital papillomavirus infections. Mainly addressed to clinicians, it provides practical guidelines on methods for their diagnosis and treatment.

The aging process involves changes in neurotransmission at different levels. The purpose of this book is to help define the state-of-the-art of the field and to give directives for future research on the aging brain. Following topics are presented: the comparison of normal and pathological aging at the anatomical and neurochemical level; the knowledge of the responses of the aging brain to drug treatment or environmental stress; the neuro/immune and neuro/endocrine setting during aging; and the definition of therapeutical approaches in normal aging. This book will interest physicians and pathologists as well as neurophysiologists.

nd This book stems from the 2 Parkinson's Disease Symposium on "Neurotoxic Factors in Parkinsons disease and related disorders", held on August 6-7,1999 at the University ofUlm Medical School in Ulm at the Danube, Germany. The symposium wasalso asatellite ofthejointmeetingofthe InternationalSocietyfor Neurochemistry (ISN) and the European Society for Neurochemistry (ESN) that followed immediately afterwards in Berlin. The specific topic, neurotoxic factors in Parkinson's disease (PD), was chosen in light of accumulating neurobiological and epidemiological evidence indicating that the causes of this second most common neurodegenerative disorder, and possibly of related conditions such as multiple systems atrophy, in some manner involve environ- mental (xenobiotic) and even endogenous toxic agents. This volume brings together much of that neurobiological evidence; and in epidemiology, several recent major studies ofPD - for example, a study of20,000 twins published in the Journal of the American Medical Association in 1999 - conclude that environmental and life style than genetics, appear to be critical in the idiopathic disease. However, factors, rather the precise roles of neurotoxic factors in the pathogenesis of PD and related basal ganglia disorders remain uncertain, despite the cascade of research resulting from the discovery of the prototype MPTP in the early 1980's, and frankly, we have been surprised by the paucity of concentrated attention on specific environmental agents other than MPTP.

International experts examine the role of nitric oxide in various metabolic events such as septic shock, cardiovascular dysfunction, and trauma and hemorrhagic shock. The nitric oxide pathway and nitric oxide synthesis regulation are also discussed.

5t The 1 International Moxifloxacin symposium took place in Berlin Germany February 18 - 20,1999. The purpose of this meeting was to introduce the medical and scientific communities to this exciting new fluoroquinolone and to define its role in the management of respiratory tract infections. The fluoroquinolones as a class are an important part of our therapeutic armamentarium and moxi floxacin is a unique addition to this class of compounds. This symposium brought together physician/scientists from around the world to present and discuss the moxifloxacin data. The information from this important meeting are presented in these proceedings and are organized under the following headings: Part I Antimicrobial chemotherapy Part II Pre-clinical microbiology Part III Pharmacology Part IV Clinical needs in the millennium Part V Round table discussion The modifications to the basic quinolone structure resulting in moxifloxacin have produced a drug with unique in vitro, and pharmacokinetic/pharmaco dynamic properties. The drug has a very broad spectrum of antimicrobial activity, is well absorbed and can be taken only once daily. Its profile makes it an excellent therapeutic option for many types of respiratory tract infections. It is hoped that our clinical and laboratory colleagues will be as excited by this data as we are and we look forward to further work with this unique and interesting compound."

Der ausserordentlich grosse Zuwachs an Wissen seit der ersten Auflage dieses Handbuches vor rund 70 Jahren dokumentiert sich in den hier vorliegenden bei den Banden, die das Gebiet der klinischen Osteologie in reprasentativer Form zur Darstellung bringen. Die Gliederung in einen mehr theoretischen und in einen mehr klinischen Teil erschien aus zwei Grunden notig: Erstens sind fur das Verstandnis der Pathophysiologie der einzelnen Krankheitsbilder heute breite Kenntnisse der physiologischen Grundlagen erforderlich. So schien es ratsam auf den aktuellen Stand der diesbezuglichen endokrinologischen Forschung in Schwerpunktform einzugehen und die modernen Vorstellungen vom Knochenumbau und Kalzium- phosphatstoffwechsel darzustellen. Zweitens gibt es inzwischen eine grosse Zahl osteologischer Untersuchungsmethoden, die - um Wiederholungen bei der Ab- handlung der einzelnen Krankheitsbilder zu vermeiden - ebenfalls der Klinik vorangestellt wurden. Mit diesen Untersuchungen haben eine Reihe neuer quan- titativer Verfahren Eingang in die moderne Osteologie gefunden, die erst in neuerer Zeit eine Objektivierung von Skelettprozessen in diagnostischer und therapeutischer Hinsicht ermoglichen.

The clinical biochemistry ofhepatobiliary diseases is very widely studied, and publica tions abound on this topic. However, there is no recent publication that provides a comprehensive collection of the various leading aspects that go to make up this complex theme. Therefore, we thought it useful to gather together a few scientists whose work has focused on the various clinical biochemistry-aspects of these disorders in order that they might discuss their experience and expertise. The aim of the International Satellite Symposium on Clinical Biochemistry in Hepatobiliary Disease, in addition to reviewing the individual aspects, was to describe the state-of-the-art so as to provide useful data for laboratory scientists and also for physicians working in the field of hepatobiliary diseases, and these two aims are clearly reflected in the chapters of this volume. The volume opens with an introductory chapter that gives a general overview of the various aspects of the clinical biochemistry of these disorders, while the closing chapter deals with an important aspect that deserves to be increasingly emphasized in laboratory medicine, i.e., strategies to integrate information coming from the laboratory to make them more useful for clinical diagnosis.

New findings involving the brain in traumatic and septic shock and after brain injury are reported in this book, including pathophysiological and pathohistological results. An experimental and clinical approach to treatment is presented together with specific results obtained from the encephalogram and from histopathological study with regard to the immunohistochemistry of toxic lipid peroxidant products. The latest results of clinical and experimental pathophysiology in inflammatory processes after traumatic brain injury and the therapeutic effects of hypertonic fluid therapy are also discussed.

The differentiation between the muscarinic and the nicotinic ef- fects of acetylcholine led to the subdivision of the cholinergic ner- vous system into two categories. Further studies showed that stimu- lating and inhibiting muscarinic effects could be demonstrated in different organs. For instance, gastric secretion and gastrointestinal motility are stimulated, while heart rate and the vascular muscula- ture are inhibited. For decades, it could not be determined whether the various ef- fects were mediated by different subgroups of muscarinic receptors, but eventually, with the availability of agonists and antagonists to muscarinic receptors, and using various techniques, the existence of at least two such subgroups could be ascertained . . Mt receptors are defined by their high affinity for the antagonist pirenzipine in comparison to M2 receptors. This subdivision of muscarinic receptors has since been proved beyond doubt by experi- ments in vivo and in vitro, by receptor binding studies, by histoauto- radiography, and by electrophysiological studies. However, these different classes of muscarinic receptors have not been found to relate to different types of effects; instead both excit- atory and inhibitory effects appear to be linked to each class. For ex- ample, excitation of gut motility and inhibition of cardiac contrac- tile activities both appear to be mediated by M2 receptors, while ex- citation of some nerves in sympathetic ganglia and inhibition of some myenteric nerves may be mediated by M receptors.

H. Hafner, G. Moschel, N. Sartorius The size of the world's population aged over 65 was estimated at about 250 million in 1980; by the year 2025 it is expected to grow to about 760 million (see Hauser, this volume). This sharp increase in life expectancy at birth, in some countries amounting to almost 100% in only a hundred years, has resulted from better nutrition and improved living conditions, hygiene and medical care. Not only life expectancy at birth, but also further life expectancy in advanced age has shown a clear, though more moderate increase. This increased life expectancy, together with a simultaneous fall in birth rates, has caused the mean age of the world population and, especially, the average age of the population of industrial nations to climb substantially in recent times, a development which will reach its peak only some decades from now. For these demographic reasons alone, health care authorities will have to devote more attention to the health problems of the elderly. The main task of medical research is to develop improved methods of disease prevention and treatment. Yet, because the full benefits of such research are only realized after many years of work, researchers have already begun to respond to demographic pressures by focussing part of their efforts on the study of illnesses characteristic of old age.

Immunology, in all its facets of immunochemistry, humoral immunity, cellular immunity, immunodiagnosis, and immunotherapy, is currently the most rapidly advancing discipline of clinical and experimental oncology. But as in most developing subjects, it is continually beset with problems of methodology and nomenclature, both of which are often intertwined. Indicative of this problem are our circular definitions of antigen and antibody. Another fre quent problem is the use of the words "specific" and "associated" when characterizing re actions to tumors or the antigenic properties of neoplasms. When applied to cancer, these terms are obviously very dependent upon the methods used to demonstrate these qualities. Indeed, the very diverse nature and multitude of types of cancer preclude our making gen eralizations or categorical statements regarding tumor "specificity. " Similar problems arise when one considers that many antigens found in malignant tumors share certain properties with embryonic or fetal tissues. First, these observations emphasize a lack of true tumor specificity, for which reason the category of oncofetal antigens has been established. Second, whether or not such antigens are truly oncofetal depends upon the method of detection used, and it has been found that here too specificity decreases as the antigen assay increases in sen sitivity. Thus, whether substances can be truly oncofetal in nature still remains a matter of debate, and such terms must therefore be used in an operational sense.