After a practical description of the endoscopic anatomy, the first part of the book deals with such topics as preparing and positioning the patient, anaesthesia, operation theatre layout and operating team, inducing pneumothorax, general operative steps, after-care in the hospital, prevention of thrombosis, prophylactic antibiotics, dangers and risks of the method, and the use of documentation. General operative steps such as thoracoscopic exploration and palpation intervention haemostasis andparenchymal leaks are described in a separate section. A special part isdevoted to the diagnostic possibilities and current indications for thoroscopy including: spontaneous pneumothorax, haemothorax, chylothorax; pleural empyema, bronchopleural fistula, extrathoracic and intrapulmonary cysts and tumours, pericardial fenestration, treatment of malignant effusions, and thoracal sympathectomy.

J. E. Fischer, M.D. Professor Greep, ladies and gentlemen. It is a great pleasure for me and the participants to be present at this International Meeting of Parenteral Nutri tion. This meeting would not have been possible five years ago. At that time we were still arguing about central vs. peripheral routes, efficacy of the tech nique, and still getting accustomed to our ability to support patients nutri tionally. Within the last five years these discussions, which seem almost futile in retrospect, have been put aside. Both techniques, we know how, work quite well and have their own indications. Having become comfortable with the technique, it is now time to enter the second phase of parenteral nutrition, and that is the differentiation of the technique for the benefit of different patients. Over the next two days we will be discussing several problems which at the present time are central to the entire subject of parenteral nutrition. Is a fat calorie the same as a carbo hydrate calorie? What is the effect on protein metabolism of the fat calorie as opposed to the carbohydrate calorie? Are they equivalent? Are'there situations in which one is superior to the other? Perhaps we will find out tomorrow in the panel."

It is fashionable in professional circles to deplore the difficulty of intellectual discourse between "academicians" - men of letters, researchers, rationalist- and "practitioners" - surgeons, radiologists, physical therapists. How benefi cial it would be if educated non-academicians could speak intelligently about t-tests and chi-square tests and men of academia could appreciate the travail, spirit, and needs of a busy office and practice Even this suspected gap between "two cultures" came very near together in the wonderful town of Groningen (The Netherlands) as wise men from both practice and scholarship gathered to talk about the unfathomables of the temporomandibular joint. There were keen discussions about the intense bio logical changes which occur about the complex temporomandibular joint after excessive use or injury. These papers were followed by talks outlining the experiences of those involved in the imaging and non-surgical and surgical management of patients who were enduring such changes. The pitch and interchange of opinions and evidence as to why a disc or its position could effect little or profound disturbance of the temporomandibular apparatus were en lightening to each who listened - and thought. And even more sobering was to hear the report of a well-documented, multiple decades long study of a large number of patients with osteoarthrosis and internal derangement which defined a natural course and eventual end of the disease. With this understanding, one is now faced with the obvious question of how much treatment patients with osteoarthrosis really require."

After the Second World War the number of biliary diseases has abruptly risen and lithiasis has become in many regions the most frequent surgical disease of the abdomen. At present, though there are perspectives of rational conservative treat ment and though endoscopic techniques permit removing some of its complications even without laparotomy, the basic treatment method still remains, and probably shall remain for long the classical surgical intervention. On the contrary, the indications for such intervention are always widening, as its risks become always smaller and the requirements for prevention higher. Many books have been written on the surgery of biliary ducts, but recent knowledge is growing so rapidly that it forces within short periods its new integration and critical assessment. Attention is mostly paid to interventions on the biliary ducts with their wide scope of problems and to the prevention and treatment of postoperative disturbances. New and more perfect diagnostic possibilities and some more suitable technical procedures as well require comparison and verification, introduce new aspects on old problems, and even change some established rules."

The MD Anderson Solid Tumor Oncology series presents cutting-edge surgical treatment and medical therapy for specific sites. This volume, Pancreatic Cancer, addresses epidemiology and molecular biology, inherited syndromes, staging, surgical techniques, multimodality therapy, and emerging therapies. The individual chapters focus on narrow, specific topics to produce a reference work of value to those interested in pancreatic cancer from a clinical and translational research perspective. A must-have for surgical oncologists and general surgeons.

close circle of anaesthetic scientists but, with the help of computer technology, has greatly influenced the practice of the modern clinical anaesthesiologist. The efforts of anaesthesiologists, pharmaceutical companies, and the development of the internet has lead to a situation that now almost every anaesthesiologist can be in close contact to anaesthetic pharmacology computer simulation pro grams and target controlled infusion devices. These two tools allow us to in crease our understanding and improve the controllability of anaesthetic drug administration, on site, in the operating theatre. In Europe the growing enthusi asm regarding the study and practice of intravenous anaesthesia has lead to an increased output of manuscripts on this subject, the initiation of workshops on the pharmacology of anaesthetic agents and the formation of a society that embodies this spirit; the European Society for Intravenous Anaesthesia, the EuroSIVA. EuroSIVA The concept of EuroSIVA has been to provide a forum to co-ordinate, facilitate and promote high quality presentations in the area of intravenous drug admini stration. The first two meetings held in 1988 in Barcelona and 1999 in Amster dam achieved these aims. During the Barcelona and Amsterdam meetings pre senters of over 10 countries shared their knowledge with 250 and 400 partici pants, respectively. In addition to the EuroSIVA meetings the international board aims to promote education for those involved with intravenous anaes thesia."

It gives us great pleasure to contribute a short introduction outstanding book. This comprehensive work provides an to this important volume. immense fund of information, and will be an invaluable The transplantation of thoracic organs - heart, heart source of knowledge to physicians, surgeons, and scientists lung, lung - is a field of surgery that is expanding annually. for many years to come. The use of mechanical assist devices and artificial hearts to support patients awaiting transplantation is also developing rapidly, and further advances in this field may eventually April 1990 Christiaan Barnard lead to a totally implantable device that will function Cape Town, South Africa successfully for many years. It is therefore timely that such a volume as this should be made available to those who wish to be brought up-to date with the current state of knowledge in these related fields. The editors have done us all a great service in bringing together experts in every aspect of heart and Nazih Zuhdi lung transplantation and replacement to contribute to this Oklahoma City, USA Xl Preface The fields of the transplantation and replacement of thoracic Refinements in bioengineering have enabled mechanical organs have expanded immensely since the first human assist devices and the total artificial heart to support patients to-human heart transplant was performed in 1967. This successfully until a suitable donor becomes available."

Many pathologists have little acquaintance with ear, nose concomitant biopsy have become commonplace in the and throat pathology. Some receive few specimens from management of throat disorders. It is hoped that. by ENT tissues; others are deterred from deeper study of the publication of this Atlas, pathologists receiving only material that emanates from regions the normal anatomy occasional specimens will be guided in their provision of of which is so forbidding in its complexity and holds no a report helpful to the clinician and those who are involved familiarity through autopsy investigation, for, apart from with a larger ENT service may be providec with a guide the larynx, there is usually no compelling indication for to the deeper understanding of the subject. examination of the ear, nose or throat at postmortem. Yet. The modern tendency in publication of ristopatholog equally with biopsy specimens from other parts of the ical microphotographs is to omit any statement of their body, the pathologist's report is consequential for the magnification, since it will usually be clear to the reader efficient handling of ear, nose and throat illnesses and what order of enlargement is involved. I n this Atlas, sometimes even for the patient's survival."

This book contains the proceedings of the ARW NATO conference on Lipid Mediators in Immunology of Burn and Sepsis held in He1singor, Denmark, July 20-25, 1986. This meeting brought together some of the most distinguished re- searchers in the fields of thermal injury, the immune system and lipid mediator biochemistry. It is well known that there is a substantial impairment of the immune response during sepsis, burn, trauma and other kinds of shock. These conditions are characterized by a massive inflammatory process which occurs during the early phase following injury. Among the various mediators released at this time are 1euko- trienes, thromboxane, histamine and platelet-activating factor. This latter autocoid possesses potent proinf1ammatory properties and toge- ther with the other mediators may account for some of the post-injury pathophysi 01 ogi ca 1 phenomena such as extravasati on, hypotensi on, chemotaxis...It is of great interest to note that recently 1euko- tri enes and plate 1 et-acti vati ng factor have been shown to be potent mediators of the immune response. Thus, the purpose of this meeting was to bring together clinicians, immunologists and biochemists in order to examine and hopefully clarify the putative role of various lipid mediators prominent in the early stages after injury. This book is divided into the following six sections. Section 1 provides a general overview of the physiological con- sequences of burn, sepsis and shock.

In recent years, a series of excellent textbooks have been published dealing with pathology of the thyroid gland. The present volume of CURRENT TOPICS IN PATHOLOGY provides further information for both pathologists and clinicians interested in the thyroid gland. The contributions deal with surgical pathology of the thyroid as well as with basic aspects of thyroid metabolism, hormone transport, and growth factors in thyroid cells. The topics covered in this book should mainly be considered as adjuncts to common textbooks on thyroid pathology. The contributions should help pathologists in their routine diagnosis and should stimulate further thyroid research.

ThisbookcomprisesthescientificproceedingsoftheInternationalWorkshop onDigitalMammography(IWDM),heldinBremen,Germany,fromJune22 toJune25,2002. Sinceitsinceptionin1992,IWDMhasgrownintotheIn- ternationalForumonDigitalMammography. TheuniquenessofIWDMisits attractivenesstoresearchers,medicalpractitioners,andindustrialdevelopers. F6rmerworkshopswereheldinSanJose,USA(1992),York,UK(1994), Chicago,USA(1996),Nijmegen,NL(1998),andToronto,Canada(2000). Each ofthesescientificeventshasbeencombinedwithverysuccessfulandfocused industrialandresearchexhibits,whichdemonstratedthemilestonesofdigital mammographyhard-andsoftware. Now,thatdigitalmammographyisenteringroutineclinicaluse,wewitness itsstrongimpactonscreeninganddiagnosticmammography,computeraided detection,minimallyinvasiveprocedures,andthedevelopmentofsystemicand integrateddisease-orientedbreastcare. Inviewofthis,the2002workshoppro- videdawindowtogiveusaglanceatthefuture,andtheworkwhichwas presentedintalks,postersandexhibitshasdemonstratedthatIWDM2002will takeaspecialplaceintheverysuccessfulsequenceofIWDMevents. Finally,asconferencechair,Iwouldliketothankallwhohavehelpedtopre- pareandrunIWDM2002:theScientificAdvisoryBoardforitsexcellentworkin guaranteeingscientificsignificance,theOrganizationalBoardforitshardworkto accomplishanappropriateframeworkfortheevent,andtheindustrialexhibitors andsponsorsfortheirgeneroussupport. Bremen,January2003 Heinz-Otto Peitgen ConferenceChair ProfessorofMathematicsand BiomedicalSciences VI Scientific Committee SusanAstley UniversityofManchester,UK UlrichBick CharitBerlin,Germany/UniversityofChicago,USA MichaelBrady OxfordUniversity,UK HiroshiFujita GifuUniversity,Japan MaryellenGiger UniversityofChicago,USA NicoKarssemeijer UniversityHospitalNijmegen,TheNetherlands Heinz-OttoPeitgenUniversityofBremen,Germany EttaD. Pisano UniversityofNorthCarolina,USA MartinYaffe UniversityofToronto,Canada IWDM 2002 was supported by (MeViS SIEMENS BreastCare medical I' General Electric ARC-0 Fllmle. . Perfection for DI I JMammography Table of Contents Imaging Systems and Detectors...1 DigitalMammographicApplicationofaSinglePhotonCountingPixel Detector...3 Amendolia SR, Bisogni MG, Delogu P, Fantacci ME, Novelli M, Quattrocchi M, Rosso V, Stefanini A, Zucca S BreastCancerScreeningUsingaDedicatedBreastCTScanner:A FeasibilityStudy...6 Boone JM, Lindfors KK, Seibert JA, Nelson TR PhysicalEvaluationofaPrototypefortheSectraMicrodose MammographySystem...12 Lundqvist M, Bergstrom D, Cederstrom B, Chmill V, Chuntonov A, Danielsson M, Aslund M DoseMeasurementsonaScanningMulti-slitDigitalMammography System...17 Hansson B, Cederstrom B, Danielsson M, Aslund M DigitalMammographyvs. toScreen-FilmMammography:aPhantom Study...20 Heid P, PagliuchiC, Seradour B, Motte N, Langlois L, Kurkdjian S, Piana L MammographyTaxonomyforImprovementofLesionDetectionRates...27 Howard D, Roberts SC, Tabar L AHighResolution(25 p. m)HybridSelenium/CCDSlotScanDetector forDigitalMammography...33 Hunter DM, De CrescenzoG, Mainprize JG, Mawdsley GE, SmithC, Kasap SO, Rowlands JAR, Tumer T, Yin S, Yaffe MJ Co-registeredBreastImagingwith3DX-Raysand3DUltrasound...38 Kapur A, Eberhard JW, Abdalmajeid AM, Thomenius K ImagingCharacteristicsofaDirectConversionFull-FieldDigital MammographyDetectorusingSelenium...4 3 Lee DL, Yorker lG, ling Z, leromin LS SimultaneousAcquisitionofDiffraction,ScatteringandPhase-Contrast ImagesbyMeansofaMulti-LayerEdge-OnMicrostripDetector 48 Olivo A, Arfelli P, Bergamaschi A, Dreossi D, Longo R, Menk RH, Montanari F, Pani S, Poropat P, Rigon L, Vallazza E, Castelli E VIII FullFieldDigitalMammographywithaCCDBasedSlot-Scanned Detector. PhysicalCharacteristicsMeasurements...

Increased intra abdominal pressure as used in laparoscopic surgery produces various changes in the human organism. This book provides surgeons and anesthesiologists with a complete overview on these changes and the consequences for the patient in the perioperative and postoperative period. Special emphasis is laid on the management of pneumoperitoneum related complications.

During the past decade, significant progress in molecular and cellular te- niques has greatly advanced our understanding of the wound healing p- cess. Many of these new techniques have been utilized in the context of more classic models of wound healing. The combination of new and classic approaches has allowed scientists to make exciting discoveries in the field of tissue repair, resulting in an explosion of information about the healing p- cess. Importantly, these new findings have great relevance beyond wound healing itself. The injury repair process cuts across many disciplines, exte- ing to such broad fields as cancer, inflammation, and atherosclerosis. The relevance of the field to these many disciplines has generated great interest in models and methods for the study of wound healing. The goal of Wound Healing: Methods and Protocols is to provide scientists from many dis- plines with a compendium of classic and contemporary protocols from r- ognized experts in the field of wound healing. We hope this volume will be useful not only to those working within the field itself, but also to scientists from other disciplines who wish to adapt wound healing models to their own experimental needs. The process of wound healing encompasses many different biologic p- cesses, including epithelial growth and differentiation, fibrous tissue prod- tion and function, angiogenesis, and inflammation.

With his keen analytical mind and penchant for organization, Charles Darwin would have made an excellent clinical investigator. Unfortunately for surgery, his early exposure at Edinburgh to the brutality of operations in 1825 convinced him to reject his father's plan for his career and pursue his interest in nature. His subsequent observations of how environmental pressures shaped the development of new species provided the essential mechanism to explain evolution and the disappearance of those species that failed to adapt. Today, surgeons face the same reality as new technology, progressive regulation by government and payers, medico-legal risks, and public demands for proof of performance force changes in behavior that our predecessors never imagined. We know that surgeons have always prided themselves on accurate documentation of their results, including their complications and deaths, but observational studies involving a single surgeon or institution have given way to demands for controlled interventional trials despite the inherent difficulty of studying surgical patients by randomized, blinded techniques. That is why this book is so timely and important. In a logical and comprehensive approach, the authors have assembled a group of experienced clinical scientists who can demonstrate the rich variety of techniques in epidemiology and statistics for reviewing existing publications, structuring a clinical study, and analyzing the resulting data.

An authoritative panel of researchers and clinicians critically reviews the entire field to provide a comprehensive guide to modern brain tumor immunotherapy and thereby enhance future research in this area. The contributors detail many of the key laboratory experiments and clinical protocols that are currently being investigated, integrate the available information from previous and ongoing research, and help define the current status of the field. Topics range from adoptive cellular and antibody-mediated immunotherapy of brain tumors to tumor vaccines and related strategies, and include many vanguard experimental strategies and immunological techniques for studying brain tumor immunotherapy. Cutting-edge and comprehensive, Brain Tumor Immunotherapy brings together all the important recent advances in our understanding of central nervous system tumor immunology and illustrates in powerful detail the many new applications now harnessing the immune response for brain tumor therapeutics.

Mr. Chairman, ladies and gentlemen, with great pleasure I like to welcome you in the cityofGroningen and hope that you will have an enriching and enlighten ing discussion on the conference theme on risk management in blood trans fusion. The organisation of this symposium aims at scientific networking by discussing in an international forum the most important themes of current interest in relation to the state of the art in transfusion medicine. Dr. Cees Smit Sibinga took the initiative in 1976 to start organising the blood bank symposia as they were named in the beginning. Without doubt these symposia have contributed considerably to the development of transfusion medicine. To illustrate the fact that these symposia came to my attention I recollect that I have attended the symposium in 1978, chaired by Dr. Leo Vroman, in my capacity in those days of alderman deputy mayor of the city. So, it has been a long time since. After having been away from Groningen for 18 years I have been inaugurated last week as a mayor and it is a plcasure to be again in your midst. The scries of annual symposia on blood transfusion have contributed to mark the city of Groningen on the map of the international scientific world. A great number of prestigious institutes all over the world involved in the development of transfusion medicine have linked to Groningen and we are proud of that."

An invaluable work that will help dentists and oral surgeons to recognize and diagnose gross dental abnormalities. This book provides practically applicable knowledge on histology and histopathology of the changes that are seen in diseases of the dental and periodontal tissues. It includes the disturbances in tooth formation, acquired dental diseases including caries and its sequelae for the tooth-surrounding tissues, periodontal disease and odontogenic tumours. Also, attention is paid to the histological alterations induced by dental treatment.

Advances of cardiovascular engineering prompt one to consider innovative device technology - that is, the development of new replacement heart valves or engineering of a totally implantable energy source for an artificial heart. However, these kinds of advances have often proved unable to achieve a long-lasting benefit as the cardiovascular field has matured so fast. Cardiovascular engineering has matured to the point where a major innovation must not only function, but must continuously function better than existing devices. This is difficult to accomplish in the complex cardiovasculature system, in which energy source, biocompatibility, compliance, and functionality all must be considered. The maturation of the field is evident from the fact that many engineered prosthetic systems perform well - for example, heart valves function for long periods of time, large-vessel vascular grafts are quite adequate, extracorporeal membrane oxygenation has significantly prolonged the feasible length of heart bypass and other surgical operations, and total artificial hearts can be used as a bridge to transplant without serious complications, yet none of these systems is as good as the natural ones it replaces. The reasons for this are many and incompletely understood. The next stage of progress must be better to alterations understandings of the various components of vasculature and their response by our devices, be they at the micro- or macro-circulatory levels, in the blood, or associated with the vascular wall.

This book addresses the contemporary multidisciplinary management of liver metastases. Throughout the text, experience from the paradigms of colorectal cancer metastases treatment strategies are used to point to new directions in the management of liver metastases from other cancers. The book will be invaluable for surgeons in general surgery, hepatobiliary surgery, upper GI surgery, colorectal surgery, medical and clinical oncologists with an interest in liver tumours, and radiologists with an interest in liver disease.

Epidermolysis bullosa (EB) is a heterogenous group of genodermatoses characterized by the formation of blisters and erosions on skin and mucous membrans from birth on. The cause are mutations in the genes of structural proteins of the junction between epidermis and dermis. This book deals with the treatment of this skin disease itself and its many extracutaneous complications. There is no previous book which has been focused on the therapy and it will be based on evidence-based data derived from the world?'s largest cohort of inherited EB-patients, the American EB Registry. An important chapter will discuss gene therapy in hereditary EB which has been recently successfully performed within a localized skin site on a single EB patient as a proof-of-principle test. Given its unique collective contents, the monograph will provide the primary source for clinical informations of this oftentimes severe multiorgan disease.

- Over 200 exquisite illustrations, ranging from intraoperative photographs, line drawings, diagnostic images, pathology slides, tables and graphs are available to make each case discussed comprehensible and easy to follow.

- Traditional and novel therapeutic recommendations are introduced and the latest developments in minimal-access operative techniques are discussed and reviewed.

- Focuses on a teamwork oriented approach that identifies the necessary communications amongst the many medical disciplines when dealing with adrenal disorders.

This book covers a wide range of topics in oral surgery with detailed, step-by-step analysis of surgical techniques, with many examples. Various aspects of surgical techniques are analyzed. These include the instruments and materials used in oral surgery, types of flaps and suturing techniques, radiographic techniques, complications and treatment, and odontogenic infections. Also covered is the latest scientific information concerning preventive and therapeutic use of antibiotics in dentistry. The abundant photographic material, together with figures which are of excellent quality, make this book a must in every dental library.

Presents both current and future aspects of diagnosis and treatment.

Presents evidence-based knowledge of pressure ulcer aetiology.

Contains over 90 illustrations.

Explores the possiblities of tissue repair using new tissue engineering strategies.