The traditional education of the neurosurgeon and duce simultaneous contrast preparations of the ar- the clinician working in related specialties is based teries and veins and thus obtain a complex photo- on their presumed knowledge of the macroscopic graphic representation of the structures of the prep- anatomy of the brain as traditionally taught. Most aration. neurosurgical textbooks, therefore, provide macro- The manuscript and drawings were completed in the scopic views of sections of the operative site. The years 1974-1976 after almost two decades of neu- literature that has accumulated in recent years on rosurgical work. The data worked out in the early the subject of microneurosurgical operations also stages (Chapter 1 in particular) were used by the follows this principle. author as the basis for teaching programmes at the For some years, however, the customary macro- University of Giessen. Chapters 2-7, dealing with scopic representation of the anatomy of the brain the operative technical aspects, were produced after has been inadequate for the needs of the neurosur- mid-1975 and used by the author as the basis for geon using refined modern operative techniques. microneurosurgical teaching of his colleagues at the Furthermore, despite their detailed presentation, University of Freiburg. stereotactic atlases are also insufficient for neuro- My thanks are due to Doz. Dr. E.

Dupuytren's Disease: A Scientific Review offers consolidated, up-to-date coverage of both the basic normal (nonpathologic) science and cutting-edge science of this progressive disorder. Drs. Lawrence C. Hurst, Marie A. Badalamente, and David Edward Komatsu break down the complex topic of Dupuytren's contracture into its basic scientific components. Hand surgeons, plastic surgeons, and orthopaedic surgeons will find this unique, concise title to be especially helpful in their practices. Includes chapters on prevalence of Dupuytren's disease, normal genetics and the genetic abnormalities associated with Dupuytren's disease, and collagen and collagen synthesis in healthy fascia and Dupuytren's disease. Provides numerous illustrations throughout. Contains an in-depth bibliography and a useful, complete glossary of related terms. Consolidates today's available information on Dupuytren's science into a single, convenient resource.

In this issue of Clinics in Geriatric Medicine, guest editor Dr. Al Haitham Al Shetawi brings his considerable expertise to the topic of Management of Melanoma in the Head and Neck. Top experts in the field cover key topics such as reconstruction of melanoma defects, management of mucosal melanoma, adjuvant therapies in melanoma, future treatments in melanoma, and more. Contains 10 relevant, practice-oriented topics including classification and staging of melanoma, management of the regional lymph nodes, imaging and laboratory work-up for melanoma, principles of melanoma surgery, and more. Provides in-depth clinical reviews on melanoma management in the head and neck, offering actionable insights for clinical practice. Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize and distill the latest research and practice guidelines to create clinically significant, topic-based reviews.

Effective leadership is critical to ensuring safety, efficiency and maximum productivity in the operating room (OR). This practical, evidence-based book unpicks the dynamics of a successful OR environment to underline the key techniques for management of policies, systems, staff members and teams. Fully updated to include recent clinical guidelines, the book provides the 'A-Z' of OR management, including sections on metrics, scheduling, human resource management, leadership principles, economics, quality assurance, recovery and ambulatory practice. New chapters include future healthcare models, emergency preparedness and budgets amongst other topics. Written by authors with unrivalled experience in the field, chapters are laid out in an easy and clinically helpful format to assist learning, and real-life case studies cover seventy-three different clinically relevant pain topics. This book is an essential guide for anyone working in the OR including anaesthesiologists, surgeons, nurses, and administrators.

Our knowledge of postoperative thromboembolic complications has increased enormously over the past 2 decades, particularly where diag nosis and prophylaxis are concerned. The 125 I-fibrinogen method of diagnosing thrombosis has completely changed our concept of the frequency, occurrence, and natural course of thrombosis, and it has formed the basis of most thromboprophylactic studies. Concurrently with the development of this diagnostic method, two methods for the prophylaxis of thrombosis have come into vo gue, namely low-dose heparin and dextran. Both these methods were tested in very extensive studies during the seventies, and their value has been unequivocally proved, for reducing both the frequency of thrombosis with and without symptoms, and the frequency of fatal pulmonary embolism. Thromboprophylaxis is not particularly common in surgery; how ever, and its general use is far from uncontested. It has been argued that not only does it complicate surgical activities and make them mo re expensive, but it also involves an unacceptable number of other complications."

Written by internationally acclaimed specialists, Peripheral, Head and Neck Surgery expands on surgical procedures for the neck, head, hands and feet. Chapters provide pertinent and concise procedure descriptions creating a book that is both comprehensive and accessible. Stages of operative approaches with relevant technical considerations are outlined in an easily understandable manner. Complications are reviewed when appropriate for the organ system and problem. The text is illustrated throughout by photographs that depict anatomic or technical principles. Forming part of the series, Surgery: Complications, Risks and Consequences, this volume Peripheral, Head and Neck Surgery provides a valuable resource for all general surgeons and residents in training. Other healthcare providers will also find this a useful resource.

International surgical meetings with thousands of participants speaking a dozen different languages tend to be frustrating for the individual who comes with the hope of learning about progress in his fields, but who additionally would like to be able to ex change ideas on controversial topics and to meet competent people with whom to discuss specific problems. In the "one-way" ses sions in which long papers are presented, details or specific points may be missed. Differing views often are not adequately discussed, because the meeting and its participants are pressed for time. The 44 breakfast and luncheon sessions, covering different topics of interest to the practicing surgeon, were mainly planned to overcome these classical "congress handicaps" and also to do away with the anonymous atmosphere of such a large congress. Slides and formal papers were banished from these sessions. The outcome of these very lively and pleasant discussions taking place around small well-dressed tables was unexpected by most participants. A chairman and several panel members shared their repast, caloric and intellectual, with some 10-30 congress par ticipants. The result was in each instance a lively, informative intimate discussion, very different from the anonymous atmo sphere of a large meeting. In the hope of preserving these ex changes, the chairmen were requested immediately the session finished to "distill the essence" of the 90-minute exchange into a summary captured on tape."

Of the joints of the body commonly afflicted by serious pathology the knee is the most accessible. Because it is so accessible drastic treatment may be undertaken prematurely and incorrectly. This does not threaten life but may cause permanent morbidity. Dr Stoker has set about examining this joint in depth as a radiologist. As a direct result the surgeon will be helped to make a correct diagnosis and avoid pitfalls, by a diagnostic procedure that is of little inconvenience to a patient. Arthrography is not new but a fresh appraisal is timely. This is not to suggest that there can be any slackening in clinical examination, or that other methods of examination do not have a place. But there are knee joint problems, particularly in teenage girls, in which a clinical diagnosis is very difficult, but must be made exactly. Arthrography must be accepted as a very useful method of examination of the knee joint and an essential one in certain circumstances. More radiologists should be interested in undertaking this examination and surgeons should ask for it. E.L. Trickey, F.R.C.S.

Congenital Malformations of the Head and Neck offers a unique conceptual and visual approach to children with congenital malformations of the head and neck. Developed by renowned leaders in the field, this title is richly illustrated with a wealth of patient photos, radiology and endoscopic images of malformations. Starting with the genetics of common congenital syndromes, Congenital Malformations of the Head and Neck goes on to comprehensively cover malformations of the ear, nose, nasopharynx, oral cavity, oropharynx, cleft lip and palate, larynx, trachea, and neck. Easy-to-read and an indispensable reference and teaching resource, this title will serve as an invaluable reference for clinicians, neurologists, pediatricians, otolaryngologists and head and neck surgeons. It should also be of great interest to fellows and residents.

The number of patients with occlusive peripheral vascular disease of the lower ex- tremities is still growing as rapidly as the number of patients with coronary heart disease and cerebrovascular disease. Due to the increase in average life expectancy during the last few decades, more patients now need surgical vascular reconstruc- tion. This actually means a demand for more centers specializing in vascular surgery and equipped with intensive care facilities, since the number of patients with cardio- vascular and bronchopulmonary complications is increasing as well. In addition, the number of patients needing repeated vascular surgery has been growing. Therefore, the search for simple procedures to recanalize the arterial lumen which could be performed under local anesthesia is no surprise. Unfortunately peripheral vascular disease is still frequently treated by amputations. In 1967, the fIrst report in German on percutaneous recanalization of arteries with thrombotic occlusions and stenoses appeared in Rontgenfortschritte. The meth- od described in this report had been published by Dotter and Judkins in 1964. Today, 10 years after their report, more data have been systematically collected on this method in Europe than in the United States, where it was developed. Possibly an explanation of this state of affairs is that nonsurgical treatment is favored more in Europe than in the United States. The scientifIcally based angiology established by Ratschow served as the foun- dation for the development of diagnostic work-up and therapy in other directions beyond the questions of operability and surgical results.

The application of the caval catheter in emergency medicine and intensive care has today become routine. Generally, even in severe shock this route of access to the cardiovascular system is available in order to apply life saving volume substitution. It also permits longterm infusions in modern intensive care, particularly continuous administration of high-osmolarity solutions in par enteral nutrition. In both fields it represents one of the most important diagnostic parameters of circulatory disorders, enabl ing the registration of central venous pressure. Its undeniable advantages are counterbalanced by the dangers inherent in all invasive methods. Since sufficient experience and precise sta tistics are now at our disposal, the time has come for a provisional survey. While a few years ago it was considered mandatory to propagate the central venous access in order to advance new therapeutic and diagnostic methods, it is now necessary to recon sider and reformulate indications for its use. In this task it is essential to weigh the expected advantages against the possible complications in each and every case of catheter application. Cri tical scrutiny must include evaluation of techniques, approaches, and finally catheter materials; this paper presents the results of such a survey. The physician is hereby given the opportunity of being completely informed of evaluating the validity of his standard procedures. VIm, April 1977 C. BURRI F. W. AHNEFELD Table of Contents I. Introduction. . . . . . . . . 1 II. Indications for Caval Catheter 3 A. Caval Catheter in Emergency Situations 3 B."

In this book are published papers presented at the first meeting about tomodensito metry (Computer Tomography) which the CEPUR organized in Luxembourg in March 1977. CEPUR (College d'enseignement post-universitaire de Radiologie) is an international medical association having as its main aim the promotion of courses in advanced radiology. Several sections deal with the subspecializations, one of which is Com puter Tomography. Thanks to the fruitful cooperation of several University Hospitals (Ancona, Leuven, Montpellier, Bruxelles, Strasbourg), the two-day meeting organized by Dr. Capesius in Luxembourg covered a certain number of aspects of clinical tomodensitometry in the brain as well as in the trunk. We hope that this volume will be the first of a series dealing with the actual problems in clinical radiology. Leuven/Bruxelles/Strasbourg A. BAERT L. JEANMART A. WACKENHEIM Contents I. Introduction to the Technology of Computer Tomography K. Ungerer. With 18 Figures ... 2 II. Head Sellar Region: Normal and Pathologic Conditions. U. Salvolini, F. Menichelli, and U. Pasquini. With 40 Figures ...... 14 Empty Sella and Pituitary Gland. J.L. Dietemann and A. Wackenheim. Wi th 3 Figures . . . . . .... . ., 38 Midline Lesions. D. Baleriaux-Waha, L.L. Mortelmans, M. Dupont, and L. Jeanmart. With 17 Figures ....... .. 39 Ventriculocisternal Pathology in Children. D. Touitou. With 9 Figures . . . . . . . . . . . . . . .. ....... 47 Endocranial Calcifications. J.H. Vandresse, G. Cornelis, and A."

Anesthesia and Analgesia in Laboratory Animals focuses on the special anesthetic, analgesic, and postoperative care requirements associated with experimental interventions. Fully revised and updated this new edition provides the reader with agents, methods, and techniques for anesthesia and analgesia that ensure humane, reproducible, and successful procedural outcomes. The content is structured in six sections. The first deals with ethical, regulatory, and scientific considerations. Chapters in this section include US and international regulatory considerations, and optimization of anesthesia and analgesia. Part two is dedicated to the principles of anesthesia and analgesia with chapters covering topics in a non-species-specific way, but with a slant towards laboratory animals, including relevant pharmacology of the agents. Part three covers Anesthetic equipment and monitoring. Section four deals with periprocedural care including dedicated chapters to the assessment and management of pain in laboratory species. Part five provides practical considerations by species, including relevant anatomy, physiology, and behavior of a broad range of lab animal species. Part six closes the book with special topics covering management of chronic pain, fetus and neonate interventions, considerations for in-vivo imaging and the study of pain. Anesthesia and Analgesia in Laboratory Animals is the complete reference for veterinarians involved in lab animal research as well as senior graduate, graduate students, post-docs, and researchers who utilize animals in biomedical research.

The thrust forward into small dimensions with the aid of high magni- fication (6-40 power) under the operating microscope marks an important development in almost all fields of surgery. Neurosurgery, ophthalmology and otorhinolaryngology have already integrated the binocular mono- scope as an indispensable tool into their armamentarium. General surgery is also making increasing use of it-as is the case with transplantations of autogenous free intestinal grafts. A great "victory march of microsurgery", however, appears to be taking place in plastic and reconstructive surgery. Reimplantation of arms, hands, and especially digits are hardly thinkable today without the possibility of high magnification. New microsurgical anastomosing techniques (interfascicular neurorrhaphy) have also improved the func- tional results after nerve injuries. Time-consuming reconstructive proce- dures, such as the transfer of a distant flap with its physical and psycho- logical burden, are being increasingly replaced by free flaps transplanted by microvascular suture techniques-the most popular free flap being the groin flap in which the superficial circumflex iliac artery and vein is reanastomosed to the recipient vessels. Nevertheless, the writer was sceptical when Dr. TSCHOPP set about with his ambitious plan to transplant a free autogenous rib graft in combination with its adjacent intercostal musculature. The evidence of the results obtained has given the lie to my scepticism. Dr. TSCHOPP has not only succeeded in securing the complete arterial and venous supply to the musculoskeletal graft at the recipient site but has also managed to preserve the functioning entity of nerve and muscle.