Almost 50 million persons visit another continent each year. It is mainly those 15-18 million travelers from industrialized nations who visit or reside in developing countries that are at increased health risk. To develop effective health protection advice, the health risks of travel and the benefits of prophylaxis (vaccines, new and old drugs, behaviour modification, etc.) should be assessed systematically. The purpose of this book is to improve the protection of the travelers' health by more effective and more uniform recommendations. It contains many data on recent research and represents the first comprehensive account on travel medicine for professionals.

It is a pleasure to present the book, Evaluation and Treatment of Obesity, for reference and textbook use. The text is an outgrowth of the Obesity Weight Control Track of the 1982 La Crosse Health and Sports Science Symposium, sponsored annually by the La Crosse Exercise Program, Uni versity of Wisconsin-La Crosse. With versatile faculty, topics, and attend ing professionals, the Obesity-Weight Control Track stimulated an effort to produce interdisciplinary resources on obesity. Out of this effort, three books have been compiled and edited. This book, Evaluation and Treatment of Obesity, introduces an interdis ciplinary, practical approach to obesity management. The other two books, Nutrition and Exercise in Obesity Management and Behavioral Management of Obesity, expand on the basic theories introduced in this book, providing in-depth information of value to the practicing profes sional. These three books apply the latest information from the fields of medicine, nutrition, exercise, and psychology to the problem of obesity. The information is intended to guide health professionals in the inter disciplinary management of obesity. In 1983 the Obesity-Weight Control Track focused on controversial issues of theoretical and practical concern. The speakers from this track contributed their expertise to the compilation of two additional books. Thus, Trends and Controversies in Obesity Research and Innovation in Obesity Program Development will complete the series. Consider the five volumes a consolidated, comprehensive reference related to the growing, interdisciplinary field of weight control."

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.

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."

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.

In spite of a long history of intense investigation the transmissible spongiform encephalopathies remain a poorly understood family of neurodegenerative diseases. This group of diseases has been described in a wide variety of animal species and includes kuru, Creutzfeldt-Jakob disease, and Gerstmann-Straussler syndrome in humans, and scrapie, bovine spongiform encephalopathy, and related syndromes in ruminants and rodents. In all cases spongiform degeneration and astrocytosis are seen in specimens of brain and a filterable transmissible agent is present in the brain and some other tissues of affected individuals. However, the precise nature of this agent remains unknown. Agent infectivity, which can so far only be assayed by serial transmission to new individuals, be remarkably resistant to inactivation has been shown to by heat, chemicals, and irradiation. These properties create significant biohazard possibilities during exposure to infected tissues. Transmission between humans was originally reco gnized in the unique epidemiology of kuru in New Guinea tribesmen, and concern about transmission from animals to humans has re-emerged as a result of the current epidemic of bovine spongiform encephalopathy in dairy cattle in Great Britain. Although interspecies transmission has often been achieved experimentally, its efficiency is highly variable. There fore, the possibility of spread of bovine spongiform encephalopathy from cattle to humans or various animal populations cannot be accurately predicted at this time. This volume presents a comprehensive update of know ledge concerning the transmissible spongiform encephalo pathies."

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.

This book assumes that it is no longer tenable to work in healthcare without considering the person as a whole being constituted by a rich weaving of mind, body, culture, family, spirit and ecology. The MindBody approach embraces this "whole." But how does it transform clinical practice and training for the clinician and treatment for the patient/client? The book collects together the experiences from a diverse range of clinical practitioners (including psychotherapy, specialist medicine, general practice, physiotherapy, occupational therapy, dietetics, nursing, and complementary and alternative medicine practitioners) who have deliberately chosen to integrate a MindBody philosophy and skill set in their clinical practices. All reflect deeply on their unique journeys in transforming their clinical encounters. Most have been trained in the dominant Western framework and have inherited the classical dualistic approach which typically keeps mind and body apart. This dualistic clinical ethos values clinician expertise, labeling, diagnosis, measurement, and grouped phenomena. The MindBody approach retains the best of the classical model as well as valuing personal experience, patient/client story, the unique patterning of the individual s illness and disease, and the healing elements of the relationship between the clinician and the patient/client. The MindBody transformation of the clinician is a challenging journey, and each clinician experiences this uniquely. From these stories the reader can see vividly the ways in which conventional healthcare can break out of its current restrictive paradigm creating new satisfaction for the clinicians and much wider treatment outcomes for patients and clients."

An up-to-date overview of acute and chronic pancreatitis. The two authors with special interests in this field deal with the aetiology, pathophysiology, and clinical features of these diseases, as well as complications, treatment strategies, and prognostic factors. Two chapters on congenital abnormalities and hereditary pancreatic diseases round off this book. Intelligently-structured for everyday practice, this can also be used as an actual reference book. For gastroenterologists in clinic and practice.

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.

The acute abdomen is one of the most frequent, most dangerous and most difficult problems that the diagnostic radiologist has to deal with. This comprehensive manual presents a clinico-radiologic approach to the use of diagnostic imaging techniques for acute abdominal conditions. Imaging techniques, radiologic symptoms and clinical conditions are treated separately. This lucid format, together with a detailed subject index, offer the reader a quick and reliable reference aid in daily practice. The text is clearly structured and concise in style, and provides helpful practical hints, including discussion of diagnostic pitfalls. It is supported by a wealth of illustrations covering native diagnosis, ultrasonography, computer tomography and angiography.

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.

The decisive factor in trauma is that many processes first occur at the cellular level before they can be determined in laboratory tests, and recognition of them has only recently found its way into intensive care practice. Yet knowledge of the pathophysiology of these processes is essential for an early diagnosis of multiple organ failure and the implementation of adequate therapy, which ultimately make the patient's survival possible. Professor Schlag, an internationally renowned scientist and clinician, has been concerned with the basic pathophysiological principles of shock for many years. In this book he has brought together for the first time an international team of authors primarily from the USA and Europe, who present their collective findings of trauma, shock, development of the organ in shock and early failure and of sepsis-like syndrome, and development of septic multiple organ failure. Patienten mit Multiorganversagen haben immer noch eine schlechte Prognose in der intensivmedizinischen Behandlung, insbesondere wenn sie noch zusatzlich in einen septischen Schock geraten. Hier hilft auch oft eine breite Abdeckung mit modernsten Antibiotika nicht weiter. Neue Ansatze fur eine Therapie dieser problempatienten haben sich in den letzten Jahren durch Erkenntnisse der pathophysiologischeen Vorgange die zum Schock fuhren ergeben. Herr Professor Schlag hat als anerkannte Kapazitat auf dem Gebiet der Traumatologie und Schockforschung fur dieses erste umfassende Werk zu den Grundlagen des Multiorganversagens eine beeindruckende Liste von mehr als 50 international renommierten Autoren zusammenbekommen. Das Buch ist nicht nur eine Aufarbeitung aller Grundlagen des Schocks und Multiorganversagens sondern zudem ein ausgezeichnetes Nachschlagewerk fur jeden intensivmedizinisch tatigen Klinikarzt, egal ob er aus der Anasthesie, der Inneren Medizin oder der Unfallchirurgie kommt."

Surgery as a medical discipline has from its beginnings appealed to the imagination of many. It is therefore not surprising to find that its colourful past has induced quite a few authors to take up their pens. The truth of this in the Netherlands is witnessed by a number of dissertations and monographs and especially by the numerous articles related to the history of surgery which have appeared in the medical weekly Nederlands Tijdschrift voor Geneeskunde, particularly during the two decades preceding the Second World War. The memorial volume, published in 1977 by the 'Nederlandse Vereniging voor Heelkunde' (Association of Surgeons of the Netherlands) has thoroughly covered the history of Dutch surgery since the tum of the century, but a chronological survey of the earlier events which led to these modem achievements is still wanting. This book has been written with a view to meeting this need. In it, Dutch surgery has by no means been taken as an isolated phenomenon, but considered in its context with European surgery as a whole. Foreign influences on the on surgery abroad are discussed Netherlands and, conversely, Dutch influences whilst contemporary medical thinking is set against a cultural and political back ground. It is hoped that this approach will allow the book to exceed the narrow boundaries of'campanilismo' and make it of interest to non-Dutch readers as well."

"De Motu animalium" is sometimes referred to in the medical literature. But who has read it? The book, originally published in Latin, seemingly constitutes the very first treatise on biomechanics. The author, Giovanni Alfonso Borelli (1608 - 1679), was professor of mathematics and physics in Pisa where he worked with Malpighi, who was professor of theoretical medicine and focused Borelli's interest on the movements of living creatures. This was the time of Galileo, Descartes, Newton and many others, when sciences exploded, sometimes leading to conflicts with religious authorities. "De Motu animalium," Borelli's life work, has two parts. In the first part, he analyses the action of the muscles, the movements of the limbs and motions of man and animals, including skating, running, jumping, swimming and flying. The second part deals with what is now called physiology, considered from the point of view of a mechanist: heart beat, blood circulation, breathing, separation of urine from the blood in the kidneys, liver function, reproduction, fatigue, thirst, hunger, fever, and so on. This work shows Borelli to be a genial precursor. He expresses his opinion as a mathematician on problems which afterwards further stimulated the curiosity and endeavours of many generations of researchers. This book will be welcomed by anybody who is interested in the working of living bodies and in the history of human knowledge.

Nutritional support of critically ill patients is a major treatment modality which will enhance recovery and shorten convalescence. New knowledge has emphasized that much of the organ dysfunction associated with sepsis and altered blood flow is related to oxidative injury. Specific nutrients are highly effective in counteracting these effects and their early administration may attenuate cellular damage and multi-organ failure. Patient outcome may also be enhanced by the route of feeding, administration of newer nutrient combinations, utilization of evolving methods of monitoring and the use of growth factors. This new knowledge has evolved to a new area of metabolic support which is addressed for the first time by a group of international experts. The topics presented and general conclusions are of major importance to the practitioners in this field, for they show, for the first time, a departure from the more traditional approaches of nutritional support in patients with life-threatening diseases.

The application of immobilized enzymes in medicine is the main objective of this book. The author reviews natural and synthetic carriers for enzyme immobilization, chemistry of enzyme binding, and in-vitro and in-vivo properties of immobilized enzymes. Four chapters are dedicated to clinical use of immobilized enzymes.

This book brings together a range of academic, industry and practitioner perspectives on translational medicine (TM). It enhances conceptual and practical understanding of the emergence and progress of the field and its potential impact on basic research, therapeutic development, and institutional infrastructure. In recognition of the various implications TM has for public health policy and commercial innovation, the book addresses the major systemic aspects of the field. The contributors explore the dynamic interactions and key challenges in translating new science into viable therapies for the clinic, which includes recognizing the importance of social, commercial, and regulatory environments in addition to good science.