Among the more frequently quoted epidemiological facts in current public health discussions are: (a) the elderly today represent about 10% of the population of the industrialized world; (b) the third world nations are moving in the same direction; (c) the trend toward a growing proportion of the aged in the world population will continue over the next few decades; (d) people over 80 now represent the fa. stest growing sector in North America; (e) in the elderly, general morbidity - and particularly morbidity of the central nervous syste- is many times that in the younger popUlation; (f) 5% of those over 65 years of age and 20% of those over 80 suffer from some degree of dementia. A global tidal wave of patients suf fering from Alzheimer's disease (or senile dementia) is threat ening to engulf us by the year 2000. This disease, which is, at our present state of knowledge, ir reversible, and other age-related dementias are perhaps the most sinister forms of any disability. They deprive their vic tims not only of their physical capacities but also of their autonomy and their ability to think and to make decisions for themselves. The future cost of psychogeriatric diseases in terms of suffering for individuals, stress for families, demand for manpower, and budgetary requirements for governments could become astronomical."

"The Elderly" is the third monograph in a series on management and treatment in major patient groups and subspecialties. Each book is complete in its own right. The whole series, however, has fill a gap between standard text-books of medicine been prepared to and therapeutics and research reviews, symposia and original arti cles in specialist fields. The aim of the series is to present up-to-date authoritative advice on patient management with particular refer ence to drug treatment. The first two volumes in the series, on gastrointestinal diseases and rheumatic diseases, were addressed to major therapeutic areas or subspecialties. The present volume, "The Elderly," is intended to provide overall guidance on the manage ment of a range of medical problems in elderly patients. The elderly make up an increasing proportion of the population and require a substantial proportion of health care resources. The management of elderly patients falls not only upon specialist geriatricians but also upon a range of others, including general practitioners, general physicians and almost all other medical specialists with the excep tion of paediatricians. It has become apparent in recent years that the management of disease in the elderly in general and drug treatment in particular presents new problems and challenges. Some of these relate to the wide spectrum of disease in elderly patients, in whom there is often multiple pathology, while others concern age-induced changes in drug handling or drug effect."

Physician Associate placements can be daunting - you'll be working in a range of settings and supporting patients with a variety of conditions. There are new colleagues to work with, and newly learned theories to put into practice. This pocket guide is designed to make your placements much more enjoyable and less stressful. From ABCDE assessment to professionalism, it's full of practical detail, hints and tips. Written by two highly experienced Physician Associate educators with key input from students - this guidance is really produced with you in mind. Pocket-sized format - carry it with you at all times. Space to make your own notes - be it new terminology, your learning objectives, or just the names of your new colleagues! Be proactive and make the most of your placements by having this book to hand from the start.

Drugs may cause disease, or they may aggravate the morbidity of the condition for which they are prescribed, and certain patients may for one or other reason be particularly liable to drug injury. The inextricable relationships between the toxic profiles of drugs, the natural history of the diseases for which they are given, and the adverse drug effects that may develop in the course of such diseases are of considerable interest. It is the study of these rather neglected aspects of pharmacology and therapeutics which has formed the basis of this book. An explanation is required of the approach and the style which have been followed. The monograph does not purport to be comprehensive. Only important drug groups which are commonly used in practice are considered. Emphasis has been placed on achieving maximum benefit and safety of the appropriate drugs in the management of common illnesses. When treatment fails, either ab initio or subsequent to an initial response, the risk-benefit relationship of drugs inevitably alters. For this reason the main factors responsible for treatment failure have been considered, with special attention to the possible contribution of or implications for drug therapy in such a situation. Finally, proposals have been put forward for improving the diagnosis and reporting of adverse drug effects. In order to be practical and, as far as possible, constructive it has been necessary for me to "take a position" on numerous issues.

This third edition of Genetic Counseling has been thoroughly revised to reflect current practice. In particular, the chapter on prenatal diagnosis (Chapter 10) has been largely rewritten and considerably expanded, reflecting the rapid develop ment in this field and its increasing medical importance. This chapter provides a detailed description of the alpha-fetoprotein test and a brief description of ultrasonography for the diagnosis of morphologic defects. Further, we discuss fetoscopy and the sampling of fetal blood with the aid of a fetoscope. In this as in past editions, these descriptions are not meant as working instructions for actual practice, but rather as background for the general practitioner who is dealing with the problems of genetic counseling. We have added a chapter (Chapter 7) on the use of conditional probability (Bayes Principle) for the calculation of more exact specific risk figures. It is true that the daily practice of medicine sees far fewer situations in which these methods can reasonably be applied than some theoreticians like to think. However, the usefulness of these methods has recently increased, especially in cases of X-chromosomal recessive diseases where the termination of a preg nancy, if the fetus has been ascertained to be male and if the mother is "most probably" heterozygous, has become more commonplace. With such a trend, the degree of probability must be determined as exactly as possible."

This issue of Medical Clinics, guest edited by Drs. Jeffrey H. Samet, Patrick G. O'Connor, and Michael D. Stein, is devoted to Substance Use and Addiction Medicine. Articles in this outstanding issue include: Making Unhealthy Substance Use a Part of Behavioral Health Integration in Primary Care; The Inpatient Addiction Consult Medical Service: Expertise for Hospitalized Patients with Complex Addiction Problems; The Addiction Physician Workforce: Addiction Psychiatry and Addiction Medicine Collaboration in a New Age; Preventing Opioid Overdose in the Clinic and Hospital: Analgesia and Opioid Antagonists; The Role of Non-Traditional Maintenance Treatments: Injectable Opioid Agonist Therapies and Managed Alcohol Programs; Office-Based Addiction Treatment (OBAT) in Primary Care: Models that Work; Alcohol Use Disorder Pharmacotherapy: the Use of FDA and non-FDA Approved Medications; When and How to Treat Possible Cannabis Use Disorder; Clinical Presentations of New Drugs with Abuse Potential; Use of Technology in Addiction Therapy; Sleep Management Among Patients with Substance Use Disorders; Pain Management Among Patients with Substance Use Disorders; E-Cigarettes: A Path to Recovery or a Road to Hell?; Are Adolescent and Young Adults Different When Addressing Substance Use Disorders?; and Smoking Cessation for Those in Recovery from Substance Use Disorders.

Remarkable developments in the field of transplantation have created opportunities to address the formidable challenges of transplantation across histocompatibility barriers, stem cell expansion, and prevention of complications and generation of graft-vs-tumor activity to eradicate residual disease. Stem Cell Transplantation for Hematologic and Other Disorders, Second Edition provides a glimpse into potential future applications of bone marrow derived stem cells in the field of cardiac repair. The updated chapters introduce the biologic underpinnings of hematopoietic cell transplantation, basic stem cell biology, immunobiology, and histocompatibility, with emphasis on indications and results of transplantation for specific diseases. Written by experts in the field, Stem Cell Transplantation for Hematologic Disorders, Second Edition provides seasoned professionals with a complete understanding of the current state of transplantation biology as well as a clear vision into the future.

I have been much absorbed in David Cope's poetry as necessary continuation of tradition of lucid grounded sane objectivism in poetry following the visually solid practice of Charles Reznikoff & William Carlos Williams. Though the notions of 'objectivism' were common for many decades among U. S. poets, there is not a great body of direct-sighted "close to the nose" examples of poems that hit a certain ideal objectivist mark-"No ideas but in things" consisting of "minute particulars" in which "the natural object is always the adequate symbol," works of language wherein "the mind is clamped down on objects," and where these "Things are symbols of themselves. " The poets I named above specialized in this refined experiment, and Pound touched on the subject as did Zukofsky and Bunting, and lesser but inter esting figures such as Marsden Hartley in his little known poetry, and more romantic writers such as D. H. Lawrence. In this area of phanopoeiac "focus," the sketching of particulars by which a motif is recognizably significant, David Cope has made, by the beginning of his third decade, the largest body of such work that I know of among poets of his own generation. Allen Ginsberg Table of Contents Foreword, Allen Ginsberg. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v THE STARS The Line-up. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 . . . . . . . . . . . . Empty Street . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 The River. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Down on the Farm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 The Storm. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 American Dream. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 . . . . . . . . . . Baseball. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 . . . . . . . . . . . . Crash. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 . Lunch Hour. . . . . . . . . . . . . . . . . . . . . . . . . 9 . . . . . . . . . . . . . . . . . . . Winter Camp. . . . . . . . . . . . . . . . . . . . . . . . . . 10 . . . . . . . . . . . . . . . . . A Circle of Lights . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 . . . . . . . . . . GO Labor Day . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 . . . . . . . . . . . Peace. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 . . . . . . . . . . . . ."

Das vorliegende Buch umfaBt die Vortrage eines Symposiums, das von der Sektion Klinische Geriatrie der Deutschen Gesellschaft fUr Gerontologie im Oktober 1981 in Frankfurt unter dem Thema" Tagesklinische Behandlung im A Iter" ausgerichtet wurde. Diese Form der klinischen Behandlung alter Menschen stellt eine Herausforderung an das herkommliche Konzept der vollstationaren Versorgung im Krankenhaus und in anderen Institutionen dar. Die negativen Auswirkungen der Hospitalisierung und In- stitutionalisierung auf alte Menschen sind bekannt. Das Krankenbett bedeutet haufig Verlust der Eigenstandigkeit, zunehmende Abhangigkeit sowie Verlust familiarer und sozialer Bindungen. Dazu kommt die vollstandige Obertragung der Verantwortlich- keiten fUr den alten Patienten von Angehorigen auf die Institutionen. Die Tagesklinik kann fUr einen bestimmten Patientenkreis die vollstationare Behand- lung abktirzen oder ganz vermeiden und gleichzeitig medizinische Diagnostik und Therapie nach klinischen Gesichtspunkten anbieten. Wir haben aufgrund unserer Er- fahrungen in Frankfurt gelernt, daB der fUr die tagesklinische Behandlung geeignete Patientenkreis wesentlich groBer ist, als wir zu Beginn unserer Arbeit vermutet haben. In unserem Behandlungskonzept steht die Tagesklinik gleichberechtigt neb en der voll- stationaren Behandlung im Krankenhaus und ist keinesfalls ein untergeordnetes An- hangsel. Daruber hinaus mtissen angesichts der standig steigenden Kosten im Krankenhauswe- sen und der demoskopischen Verschiebungen in der Altersstruktur der Bevolkerung al- ternative Wege beschritten werden, urn den in Zukunft noch steigenden Bedarf an ma- teriellem und personellem Aufwand fUr die medizinische Versorgung alter Menschen bewaltigen zu konnen. Die tagesklinische Behandlung ist eine solche Alternative.

The last thirty years have seen an unprecedented increase in the discovery of new drugs, and moreover, these drugs, unlike many of the nostra of former times, have varied and powerful pharmacological actions. The occurrence of one or two "drug disasters," together with a change in public attitudes, has made it necessary for governments to introduce legislation to control the intro duction and release of new therapeutic agents, and most countries in the Western World have some form of drug licensing agency. Whole series of regulations have appeared which aim at discovering and defining the toxicity of new drugs. Many of these regulations rely heavily on testing drugs in animals before they are used in man, and at present very extensive and prolonged animal studies are required by most licensing authorities. It is most opportune that Professor Folb has decided to review the present position in this monograph. It is not only inhumane but also wasteful of time and money if extensive animal experiments which have little or no relevance to the human situation are carried out; furthermore, such results may even be dangerously misleading. There is little doubt that some preliminary animal investigations are necessary, but it is essential to keep their relevance under continuous review and to adopt a critical and flexible approach rather than heap regulation upon regulation."

Coronary heart disease is the principal cause of death in all Western countries. Abnormalities in the serum lipids are one of the major risk factors widely recognised as leading to this epidemic of heart disease. These abnormalities occur very com monly in the general community and in general practice, and practitioners are pre vailed upon daily to provide specific advice about diet and cholesterol and to interpret chemical estimations. This is a very emotive area of medicine, one where often the patients most active in seeking advice have the least to gain. On the other hand, there may be young people carrying a severe coronary risk, knowingly or not, who prefer to avoid risk factor in tervention. There are strong vested interests in the commercial world who would prefer to overlook any therapeutic value of dietary modification for selected in dividuals, and others who see great merit in a particular diet. The pharmaceutical in dustry has a vested interest in the cholesterol story as well. The individual doctor needs to decide for himself whether the cholesterol issue requires action or not, and for this he needs access to up to date and relevant data. This is one of the purposes of this book. The use of lipid-lowering therapy is usually quite a straightforward exercise for any medical practitioner, once the decision has been taken to initiate it.

Pravention lasst sich am besten mit vorausschauender Problemvermeidung ubersetzen. Seit der Ottawa-Charta der Weltgesundheitsorganisation gelten Pravention und Gesundheitsforderung als die geeignetsten Instrumente, dem Kostenanstieg im Gesundheitswesen durch Vermeidung des Sozialversicherungsfalls entgegenzuwirken; mit andern Worten: durch Vermeidung von Bedarf an Behandlung, Rehabilitation und Pflege. Die lange politische Missachtung des Praventionsansatzes und seine kaum mehr nennenswerte offentliche Forderung haben zu einer volligen Unterentwicklung hierzulande beigetragen. Der 1. Nationale Praventionskongress will einen Neuanfang in Sachen Pravention und Gesundheitsforderung, und er will in diesem Zusammenhang eine zukunftig starkere Zusammenarbeit zwischen Wissenschaft und Praxis anstossen."

Herbal Medicines Offer Hope for Combating Hepatitis C

More than 500 million people worldwide carry the deadly hepatitis C virus (HCV), and hepatitis C poses a public health crisis far greater than the AIDS epidemic. This deadly disease, which can go undetected for years, eventually attacks the liver, causing cirrhosis, cancer, and even liver failure. Conventional medical treatments for hepatitis C have limited effectiveness. In Herbs for Hepatitis C and the Liver, Stephen Buhner examines the most recent research on how hepatitis C affects the body. He offers important information, practical guidance, and hope. This book includes:

* Clear descriptions of the common medical tests and treatments for hepatitis C -- what they mean and how effective they are.

* A guide to knowing and using the top herbal medicines that work to protect the liver and stregthen the immune system.

* A protocol for cleansing and strengthening the body with a combination of diet, herbs, and lifestyle changes.

BURNT HUMAN REMAINS An all-encompassing reference and guide designed for professionals involved in the forensic analysis of burnt remains Burnt Human Remains: Recovery, Analysis and Interpretation presents an in-depth multidisciplinary approach to the detection, recovery, analysis, and identification of thermally altered remains. Bridging the gap between research and practice, this invaluable one-stop reference provides detailed coverage of analytical techniques in forensic medicine and pathology, forensic anthropology, forensic odontology, and forensic chemistry and forensic biology. Contributions from a panel of expert authors review the newest findings in forensics research and discuss their applicability to forensic case work. Opening with a historical overview of the discipline, the book covers the search and recovery aspects of burnt human remains, medico-legal investigations, determination of the post mortem interval of burnt remains, structural changes of burnt bone and teeth, DNA extraction from burnt remains, and much more. Throughout the text, the authors emphasize the importance of understanding the changes undergone by bodies when subjected to fire for establishing identity, reconstructing the events leading up to incineration, and determining the cause and manner of death. Provides a systemic framework that integrates established forensic methods and state-of-the-art analytical approaches Describes different forensic analyses from the macroscopical, microscopical, biochemical, and molecular level Features international case studies of challenging individual cases as well as natural or man-made mass fatalities requiring the identification of incinerated remains Demonstrates how changes to the macro- and microstructure of burnt remains can reveal information about incineration conditions Discusses organizations and programs focused on developing standards and best practice for the recovery and analysis burnt remains Burnt Human Remains: Recovery, Analysis and Interpretation is an indispensable resource for all practitioners engaged in the interpretation of burned human tissue, including pathologists, forensic chemists, forensic biologists, forensic anthropologists, forensic odontologists, and archaeologists.

Wahrend uber die Moglichkeiten und Grenzen bildgebender Verfahren in der Detektion und Diagnostik von Raumforderungen der Oberbauchorgane, insbesondere der Leber, eine Vielzahl von Publikationen existieren, sind Veroffentlichungen uber die Wertigkeit, die klinische Relevanz und den differenzierten Einsatz von bildgebenden diagnostischen Untersuchungsverfahren zur Abklarung von Milzveranderungen rar. Zudem wurden in der Vergangenheit meist nur einzelne Kasuistiken veroffentlicht. Der Grund hierfur liegt in der Seltenheit umschriebener Milzprozesse. In der vorliegenden klinischen Studie wurden retrospektiv die im Zeitraum von Januar 1996 bis Dezember 2003 am Institut fur Pathologie der Universitatsklinik Regensburg erhobenen makroskopischen histologischen Diagnosen von fokalen und diffusen Lasionen der Milz gesammelt, kategorisiert und analysiert. Durch anschliessenden Vergleich der Detektions- und diagnostischen Ergebnisse der bildgebenden Befunde aus den Ultraschalluntersuchungen (konventionell-native B-Mode- und kontrastmittelunterstutzte Sonographie), den Schnittbildverfahren (Computer- und Magnetresonanztomographie) sowie der nuklearmedizinischen bildgebenden Diagnostik (Positronen-Emissions-Tomographie) mit dem durch radikale oder partielle Milzexstirpation oder Probebiopsie gewonnenen histologischen Material und den daraus abgeleiteten Validitatsparametern lassen sich der klinische Stellenwert und die Grenzen dieser bildgebenden Verfahren in der Milzdiagnostik verdeutlichen. Besondere Bedeutung kommt dabei der Beantwortung der Frage nach einem moglichst effizienten und effektiven Einsatz der trennscharfsten bildgebenden Untersuchungsverfahren sowie der Entscheidung fur deren seriellen oder parallelen Einsatz in der Primar- und weiterfuhrenden Diagnostik zu

Im seit 1985 jährlich als Buch erscheinenden Arzneiverordnungs-Report werden die Rezepte für die Patienten der gesetzlichen Krankenversicherung (GKV) mit Methoden der evidenzbasierten Medizin analysiert.Seit dieser Zeit bietet der Report eine unabhängige Informationsmöglichkeit über die verschiedenen Komponenten der Arzneimittelverordnung und trägt damit zur Transparenz des Arzneimittelmarkts, zur Bewertung von Arzneimitteln und zu einer sowohl zweckmäßigen und sicheren evidenzbasierten als auch wirtschaftlichen Arzneitherapie bei.

Gas Bubble Dynamics in the Human Body provides a broad range of professionals, from physicians working in a clinic, hospital or hyperbaric facility, to physical scientists trying to understand and predict the dynamics of gas bubble behavior in the body, with an interdisciplinary perspective on gas-bubble disease. Both iatrogenic and decompression-induced gas bubbles are considered. The basic medical and physiological aspects are described first, in plain language, with numerous illustrations that facilitate an intuitive grasp of the basic underlying medicine and physiology. Current issues in the field, particularly microbubbles and microparticles, and their possible role in gas-bubble disease are included. The physical and mathematical material is given at several levels of sophistication, with the "hard-core" math separated out in sections labelled "For the Math Mavens", so that the basic concepts can be grasped at a descriptive level. The field is large and multi-disciplinary, so that some of the discussion that is at a greater depth is given separately in sections labelled "In Greater Detail". Skipping these sections for whatever reason, shouldn't materially hamper acquiring an overall appreciation of the field.

This book provides clear instructions to researchers on how to apply Structural Equation Models (SEMs) for analyzing the inter relationships between observed and latent variables.

"Basic and Advanced Bayesian Structural Equation Model""ing "introduces basic and advanced SEMs for analyzing various kinds of complex data, such as ordered and unordered categorical data, multilevel data, mixture data, longitudinal data, highly non-normal data, as well as some of their combinations. In addition, Bayesian semiparametric SEMs to capture the true distribution of explanatory latent variables are introduced, whilst SEM with a nonparametric structural equation to assess unspecified functional relationships among latent variables are also explored.

Statistical methodologies are developed using the Bayesian approach giving reliable results for small samples and allowing the use of prior information leading to better statistical results. Estimates of the parameters and model comparison statistics are obtained via powerful Markov Chain Monte Carlo methods in statistical computing.Introduces the Bayesian approach to SEMs, including discussion on the selection of prior distributions, and data augmentation.Demonstrates how to utilize the recent powerful tools in statistical computing including, but not limited to, the Gibbs sampler, the Metropolis-Hasting algorithm, and path sampling for producing various statistical results such as Bayesian estimates and Bayesian model comparison statistics in the analysis of basic and advanced SEMs.Discusses the Bayes factor, Deviance Information Criterion (DIC), and $L_\nu$-measure for Bayesian model comparison.Introduces a number of important generalizations of SEMs, including multilevel and mixture SEMs, latent curve models and longitudinal SEMs, semiparametric SEMs and those with various types of discrete data, and nonparametric structural equations.Illustrates how to use the freely available software WinBUGS to produce the results.Provides numerous real examples for illustrating the theoretical concepts and computational procedures that are presented throughout the book.

Researchers and advanced level students in statistics, biostatistics, public health, business, education, psychology and social science will benefit from this book.

Physiology is the study of the normal working of the body. It is essential that its principles should be understood by nurses and doctors, for only if you know how the body works normally can you understand what is happening during disease. This first chapter covers the whole of physiology in outline, so that as later you read the chapters devoted to giving details of the various systems, you will be able to see where each system fits into the scheme of things. THE CELL You can learn a great deal about physiology by considering the requirements of a simple, single-celled organism such as the amoeba. These requirements may be summarized as follows: 1. Supplies. All living organisms require a supply of energy if they are to survive. Plants can obtain their energy directly from the sun and by using very simple inorganic materials they can manu facture all the substances they need. But animals must obtain their energy from the complex materials which they take in as food. The energy is released by the process known as oxidation (burning), in which food is broken down and combined with oxygen to release all the energy which is required. Animals therefore obviously need a supply of food and a supply of oxygen. Since the animal body is largely made up of water, they need a supply of water as well. The amoeba finds it easy to obtain all these materials from the water which surrounds it."

In nearly all parts of the world, the consumption of alcohol is increasing, and the morbidity and mortality of diseases induced by alcohol are rising correspondingly. It has been stated that alcohol is consumed because it pro duces intoxication. This effect is due to its toxicological influence on the central nervous system with the resulting functional disturbances. For many years, the concept that alcoholic liver disease was of nutritional origin and only indirectly related to alcohol consumption and metabolism was accepted. Opinion has changed gradually in recent years and tends now to regard alcohol itself through its combustion, as responsible for many metabolic disorders. Interest in this problem has increased during the past decade, and numerous papers bearing on this subject have appeared. It seems that the oxidation of alcohol in the liver interferes in many ways with the intermediary metabolism of lipids, carbohydrates and proteins, including enzymes and hormones, and exerts damaging influence on the liver, the musculature, the heart, the brain and the kidneys. The "Workshop Symposium" brought together a limited number of the scientists involved in the new development, biochemists, physiologists, pharmacologists, pathologists and clinicians from eight European countries and from the United States and allowed a very lively and informal exchange. The symposium was honored by the presence of Sir Hans Krebs, whose vast experience stimulated the discussion. It is a great pleasure to dedicate this volume to Sir Hans on the occasion of his 70th birthday on August 25th."

69 but usually such a condition is terminal, and denotes irreversible pump failure. Many patients can, however, return to useful activity, avoiding sudden unaccustomed exertion, and being maintained on diuretics, potassium and digoxin with suitable surveillance. Curative surgery may be possible in those with heart valve lesions. Heart transplantation. Remarkable technical success has been achieved, and patients have survived for up to two years after opera tion. It is, however, difficult to decide which cases are suitable, for early cases may benefit from less drastic measures, and late cases have involvement of lungs and liver, lessening the changes of success. There are problems too, of transplant rejection, immunosuppression and of the ethics of obtaining donor hearts. There may be a greater place for the use of plastic pumps, which are being developed for use as temporary supports to the circulation, e.g. in myocardial infarction, until the heart function improves. Prevention of cardiac disease; a summary Congenital heart disease should be recognized early, for cure is often possible. Rheumatic heart disease has diminished with the conquest of the streptococcus, but where it has occurred, early recognition and treat ment of valvular complications will prevent heart failure. Hyper tension and its effects can be remedied before the stage of heart failure. We are left with arteriosclerotic heart disease, and while alleviation of its effects is possible, prevention awaits understanding of the arteriosclerotic process. Meantime, we can advise the control of obesity and the cessation of cigarette smoking.