The last volume in the series Fibrin Sealing in Surgical and Nonsurgical Fields discusses various uses of fibrin glue in endoscopic surgery. During the last years fibrin sealant has been established in the treatment of gastrointestinal ulcers and esophageal fistulae.

Fibrin sealant is used for numerous indications in gynecology, especially for the McIndoe Operation and Cohn biopsy, the Marshall-Marchetti-Krantz-Hirsch-Stoll-Operation, urethrocysopexy, or in vitro fertilization for embryo transfer. The use of fibrin sealant in urology has also been extended, especially in operations of the spermatic cord, reconstruction of the urethra and closing of nephrotomies.

Biofragmentable anastomoses rings represent a fascinating concept: Stan dardization of anastomoses, secure technique in application, expulsion of the material without residuals. In addition, one single technique allows to perform the classical end to end, end to side, and side to side anastomoses in most areas of the gastrointestinal tract, without any auxiliary tool. This means a great advantage of practicability. Controlled studies evidenced that the rate of complications is very small for the intestinal tract. Therefore, it is important to establish the localization for present indication and contra indications. Two chapters especially deal with upper GI anastomoses in cluding esophagus anastomoses and with BAR anastomoses in inflammatory bowel disease. This is done by analysing the data and by an exchange of experience between the clinical research groups. This book is to communi cate experimental data and to increase understanding about pathophysiology of the healing of anastomoses by means of compression anastomoses. Wiirzburg, Germany, Prof. Dr. R. ENGEMANN October 1994 Prof. Dr. A. THIEDE Contents Experimental Research Histological and Clinical Aspects of Early Healing of the Valtrac Anastomosis in the Colon R. GULLICHSEN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Colorectal Intramural Blood Supply and Microcirculation in Man M. A. R. AL FALLOUJI (With 5 Figures) . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Biofragmentable Anastomosis Ring Versus Stapled Anastomoses in the Extraperitoneal Rectum: Experimental Study in Dogs N. G. CZECZKO, B. POLONIO, L. F. COLA"

In this book, the recent developments in immunology and the impact on the treatment of infections in critical care and in surgery are presented, also describing how cellular immunology influences clinical treatment. This information helps in understanding the pathogenesis of infections in surgery and critical care. The impact of a standard treatment such as antibiotic therapy is evaluated and possible future therapy modalities outlined. This book will be of interest to clinicians and immunologists as scientists of both specialties have contributed to the book.

Craniopharyngioma represents a major challenge for neurosurgeons, pediatricians, and endocrinologists. This so-called benign tumor is a real threat to quality of life and life itself. This book discusses the various therapeutic strategies and suggests multimodal treatment approaches, including microsurgery, stereotaxis, and alternative treatments. The rationale for choice of therapy is supported by biological, clinical, and neuroradiological data and therapeutic results of a large series of case studies from all over the world are reported. Finally, guidelines for further development and new topics for research and treatment are offered.

Chronic critical limb ischemia remains one of the most frequent causes of illness and hospitalization in the western world. Interest in critical limb ischemia has increased markedly in recent years. There have been significant achievements in diagnostic pro cedures as well as in the medical, invasive, and surgical treatment of patients with critical limb ischemia. Despite a considerable research effort, the pathophysiological mechanisms of critical limb ischemia in humans remains to be established. Prominent is the increasing interest in the microcirculation, as well as in the hemorheological, hemostatic and inflammatory changes which may promote critical limb ischemia. Further research is necessary to quantify the relevance of microcirculatory in vestigations in terms of predicting the prognosis or to evaluate the effects of new therapies. Our main task is to offer the patient the best possible therapy in order to avoid limb loss and to improve quality of life. The various methods of treatment, their suc cess rates, and their complications, must be carefully evaluated and discussed. This volume presents the complex field of diagnosis and treatment of critical limb ischemia. The diagnosis and treatment involves different specialists including angio logists, interventional radiologists, vascular surgeons, plastic surgeons, diabeto logists, etc. Individual chapters have been written by Belgian and German experts in the various specialities, who present their own experience. We are very grateful that these experts have joined us to produce this book on the epidemiology, pathophysiology, and rational therapy.

"Advances in Neurosurgery 22" is devoted to three main topics, the first one being Cerebellar Infarcts. Following the introduction with the microsurgical anatomy and the neuropathology of cerebellar infarction, the indication for operative treatment and its results are then discussed. The neuroradiological treatment with local and antifibrinolytic therapy for vertebrobasilar occlusion completes this section. The management and surgical approaches to the various forms of midline lesions are then presented. Special interest is centred on minimal invasive endoscopic neurosurgery (MIEN), (intraventricular tumors, optic pathway gliomas, endoscopic brainstem tumors and vascular malformations). Furthermore the special equipment and fields of indications are extensively discussed.

This is the first revision book to be published specifically for candidates sitting the FRCS(Urol) examination, which tests the required standard of a recognised Urology specialist. It provides a selection of common clinical scenarios together with a guide to answering the FRCS(Urol) questions. Each chapter is written by Consultant Urological Surgeons or Senior Urology Trainees who have already been successful in passing the examination. This second edition responds to continual changes in practice: The chapters on urological cancers including prostate cancer, bladder cancer and renal cancer have important updates due to emergence of new evidence and changes in NICE, EAU and AUA guidelines. Substantial revisions to other sections such as paediatric urology, female urology, urinary stone disease, benign prostatic hyperplasia and uro-technology to meet standards of current best practice. Adds an extra chapter on the TNM classification of urological cancers. The book remains an invaluable revision tool for the FRCS(Urol) and will also be useful for individuals sitting the FEBU and equivalent postgraduate urological examinations in the USA, Australia and Asia. Established consultants will also find value in the text as a 'refresher' in areas outside their subspecialist interest.

These eight volumes, which developed out of the international congress "Update and Future Trends in Fibrin Sealing in Surgical and Nonsurgical Fields" held in November 1992, present the state of the art in fibrin sealing. In itially, fibrin sealant played an important role in surgery. During the past few years, it has been increasingly applied nonsurgically, and we can now say that it has become an integral component of medical treatment. The doubts which have been raised by nonusers about the efficacy of fibrin sealant are no longer valid. The correct indication and technique continue to be basic prerequisites for effective treatment. Even today - 20 years after fibrin sealant was first used - the three most prominent effects of fibrin sealant are still hemostasis, sealing of the wound, and support of wound healing. The problems posed by the transmission of viral infections have gained sub stantially in importance because of the potential transmission of AIDS via fi brin sealant. Fortunately, this is so unlikely today that it no longer represents a cause for concern, which does not mean, however, that research in this field can be discontinued.

These eight volumes, which developed out of the international con gress "Update and Future Trends in Fibrin Sealing in Surgical and Nonsurgical Fields" held in November 1992, present the state of the art in fibrin sealing. Initially, fibrin sealant played an important role in surgery. During the past few years, it has been increasingly applied in nonsurgical applications and we can now say that it has become an integral component of medical treatment. The doubts which have been raised by nonusers about the efficacy of fibrin sealant are no longer valid. The correct indication and technique continue to be basic prerequisites for effective treatment. Even today - 20 years after fibrin sealant was first used - the three most prominent effects of fibrin sealant are still hemostasis, sealing of the wound, and support of wound healing. The problems posed by the transmission of viral infections have gained substantially in importance because of the potential transmission of AIDS via fibrin sealant. Fortunately, this is so unlikely today that it no longer represents a cause for concern, which does not mean, however, that research in this field can be discontinued.

Cell transplantation to the brain and spinal cord is a well-established research tool for studies on cellular and molecular mechanisms, but can it be developed into a useful therapuetic approach in human neurological disorders? Clinical trials in patients with Parkinson's disease have provided encouraging evidence, however, no treatment based on transplantation is available yet. An overview of current research is given in this book. It summarizes the status of grafting in humans and discusses scientific problems that have to be solved before intracerebral transplantation can become a useful routine approach to treatment.

This book is the result of the 3rd Wiggers Bernard Conference. The Wiggers Bernard Conferences, named after two great physiologists of the past, are biannual gatherings of the leaders in the field of shock. The meetings focus on specific areas of interest, where a lot of new informations is available, but needs to be focused. There are informal presentations during which the seminarian can be intenupted in order to clarify a pat1icular point; formal discussions follow each presentation; these are followed by infOlmal gatherings in which these discussion continue in a very relaxed environment. The 1992 meeting took place in Obermayerhofen, a small but charming castle in the soft green hills of Eastern Styria in the South-Eastern part of Austria. The castle was built in 1130, restored and turned into a hotel in 1977. The renaissance court yard and the generous and exclusive decors make it one of the most beautiful castles in Austria. The frank beauty and hospitality of this area acted as a catalyst to crystalize the thoughts of this interdisciplinary group of scientists as they discussed new findings in the cytokine area.

Advances in Neurosurgery presents the experience and research results of modern neurosurgeons confronted with urgent diagnostic and therapeutic problems. The first topic here is spontaneous intracerebral hematomas, whose localization determines the form of treatment and usually its outcome. Newer therapeutic approaches such as stereotactic removal, endoscopy and fibrinolysis supplement the results of standard operative methods. Secondly, the hydrocephalus malresorptivus is covered, presenting experience with the diagnostic value of intrathecal infusion tests, CT-cisternography, evoked potentials, and MRI CSF-flow studies, as well as aspects of neurosurgical intensive care such as barbiturate treatment, respiratory problems in head injury patients, auto-regulation mechanisms, and hospital infection. The last section is devoted to peripheral nerve surgery, reports on experience with microsurgery and various forms of anastomosis in both traumatic and tumorous nerve lesions.

These eight volumes, which developed out of the international con gress "Update and Future Trends in Fibrin Sealing in Surgical and Nonsurgical Fields" held in November 1992, attempt to present the state of the art concerning fibrin sealing. Initially fibrin sealant played an important role in surgery. During the past few years, however, it has been increasingly used in nonsurgical applications, and we can now say that it has become a component of medicine in general. The doubts about the efficacy of fibrin sealant, which had been raised by nonusers, are no longer valid. The correct indication and method ology continue to be basic prerequisites, and even today - after 20 years of fibrin sealant renaissance - the three most prominent effects of fibrin sealant still retain their validity: hemostasis, sealing and sup port of wound healing. The problems posed by the transmission of viral infections have gained substantially in importance because of the potential transmission of AIDS via fibrin sealant. Fortunately the transmission of AIDS via fi brin sealant is today so unlikely that it no longer poses a cause for con cern. This does not mean, however, that research in this field can be discontinued.

The anastomotic technique plays a predominant role in gastrointestinal surgery. A feared complication is leakage due to the sutures. Such leakage cannot be detected early; consequently, infection spreads locally and systemically. An anastomotic method is generally evaluated according to its rate of leakage, related to the localization, bur real scientific comparisons, i.e., controlled studies, are almost totally lack ing. The criteria of evaluation include the type of suture, the localization, the auxiliary technical tools, practicability, the different forms of wound healing, angiogenesis, and vascularization, among others. The postoperative criteria are complications shortly after surgery, such as bleeding, ruptures, and stenoses of the anastomosis. A standard comparison is made difficult by the variety of cytophysiological and biochemical factors that influence wound healing. In the comparison of larger series one must always take into account differences of auxiliary tools, strategies, and inhomogeneity of patients. A change of one auxiliary tool or of one strategy implies the modification of various target criteria. Often enough, however, one does not sufficiently consider the surgeon's most. important role."

Das Buch richtet sich an Chirurgen, die in vertrauter Sprache und Form Antworten auf spezifische juristische Fragen und Probleme suchen. Die gemeinsame Erarbeitung durch einen Juristen und Chirurgen erlauben eine hohe Praxisrelevanz bei gleichzeitiger juristischer Genauigkeit. Typische Situationen und Probleme des chirurgischen Alltags in Klinik und Praxis werden juristisch durchleuchtet. Sofort umsetzbare Antworten werden erganzt durch Checklisten und Praxistipps. Zukunftige Entwicklungen wie der Einfluss des europaischen Rechts auf die tagliche Arbeit oder auch Netzstrukturen werden berucksichtigt. Ein detailliertes Stichwortverzeichnis erleichtert das Auffinden der entsprechenden Themen. Das Buch richtet sich an Chirurgen aber auch an Arzte in der chirurgischen Weiterbildung in Klinik, Praxis und Verwaltung, um insbesondere Unsicherheiten in Bezug auf juristische Fragen dieses Fachgebietes zu nehmen.

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Introducing this monograph by expressing our heartfeIt thanks to all those who have contributed to its success may seem no more than a rhetorical exercise. However, at the same time we feel duty bound to add our sincere apologies, for we know that many of the dis tinguished authors of the various chapters have been hard put to find any relevant information in the existing literature. The plain fact is that very little has been said and written about pancreatic fistulas compared with other aspects of pancreatic disease. Why is this? Essentially, we believe there may be two main reasons: one practical explanation may be their relative rarity, while the other reas on is, as it were, "psychological," i. e., pancreatic fistulas tend almost invariably to be regarded as complications of an imperfectly performed surgical procedure. However useful it might be if we were to do it more often, it goes against the grain to public1y admit one's own mistakes. Ever since I (P. P. ) started practising in medicine, it has been my destiny and privilege to work alongside Professor Dagradi, the pioneer ofpancreatic surgeryin Italy, and to assist him over the years in something like 2000 operations on the pancreatic gland. Clearly, then, any complication due or related to such surgery however rare, has become part and parcel of my practical day-to-day c1inical experience and scientific interests."

Three topics of major interest for neursurgeons are covered in this volume of the Advances in Neurosurgery series, as the title suggests. First, neurosurgical standards of diagnosis and treatment are viewed from several points of view, including the legal one. Second, the many aspects of aneurysm surgery are dealt with: timing and grading, monitoring during the operation, postoperative vasospasm, Doppler sonography and new research in subarachnoid hemorrhage. Third, the diagnosis and treatment of malignant gliomas are discussed; there are preliminary reports on interstitial laser-assisted thermal therapy, immunotherapy and radiopharmaceutical substances as well as the standard forms of neurosurgical and radiation treatment.

Divided into five sections focusing on perioperative, surgical, pediatric, endoscopic and laparoscopic, and miscellaneous complications, this guide supplies state-of-the-art strategies for the identification, prevention, and management of the myriad complications that can arise during urologic surgical treatment. With contributors from leading health centers across the United States, this source reviews the potential complications of the latest laparoscopic procedures, as well as those related to systemic conditions.

Epidural opioids are widely used in the management of post- operative pain. On the basis of an extensive review of the literature the authors here present their own interpretation of current knowledge of how the distribution and effectiveness of epidurally administered opiods are fundamentally determined. They conclude that all opioids that are currently being used to treat postoperative epidural pain carry the potential risk of severe side effects if the dose regimens are not tailored to the patients individual analgesic need. This book will serve to stimulate new ideas among pain specialistst.

This second edition of Pediatric Diagnosis is a colour atlas of clinical conditions in pediatric surgery. It provides an illustrated guide to the diagnosis of all common and most rare paediatric surgical conditions. Extensively used for examination preparation, the atlas comprises 1400 photographs of congenital and acquired anomalies. This book offers extensive coverage of all the common, and many of the rare conditions in paediatric surgery.

In den Bereichen Laser/Optoelektronik/Mikrowellen werden Forschungsergebnisse in rasantem Tempo in technische Entwicklungen und Anwendungen umgesetzt. Der seit 1973 alle 2Jahre in M}nchen veranstaltete internationale Kongress gibt, in Verbindung mit der bedeutendsten internationalen Fachmesse der Optoelektronik, einen ]berblick }ber den aktuellen Stand in Forschung, Technik und Medizin. InFortsetzung dieser Tradition vermittelt der 10. Internationale Kongre~ LASER91 neue Erkenntnisse aus Grundlagenforschung, Entwicklung und praxisbezogener Anwendung. Zur Abdeckung des breiten Interessenspektrums von Forschern, Ingenieuren, [rzten und Anwendern wurde der Kongre~ in unterschiedliche Darbietungsebenen strukturiert. Die Vortr{ge, die sich mit medizinischen Anwendungen befassen, wurden in folgende Themengruppen gegliedert: Chirurgie/Surgery.-Urologie/Urology.-Photodynamische Therapie/Photodynamic Therapy.-Gyn{kologie/Gynecology.- Neurochirurgie/Neurosurgery.-Angioplastie/Angioplasty.- HNO/ENT.-Ophtalmologie/Ophtalmology.- Zahnmedizin/Dentistry. -Optische Methoden in der Diagnostik/Optical Methods in Dia- gnosis.-Dermatologie/Dermatology.-Photobiologie/Photobiolo- gy.- Laserstrahlenschutz in der klinischen Forschung und Routine/Laser Ray Protection in clinical research and practice.

Complementary therapies can benefit many people with disabilities. This text gives disabled people, and those who care for them, the information required to make informed decisions about their health and health care. "Disability" is defined broadly, to include conditions causing long-term physical disabilities and potentially disabling conditions such as multiple sclerosis, stroke or arthritis.;Designed to be of use to a wide range of people, this book: offers practical advice on finding qualified and competent practitioners in complementary medicine; describes and analyzes each major complementary therapy; and uses clear, non-technical language.

Here is the ideal book for preparing for the new Part One of the FRCS exam. To conform to the recently introduced syllabus the questions used are now much more surgically relevant. Answers, many with explanations, are provided to make the use of the MCQs a more useful learning exercise. The book follows the format of the examination and is split into the following sections: Anatomy (including histology, embryology and medical imaging); Physiology and Biochemistry; Clinical Pharmacology; General and Systemic Pathology; Microbiology; Clinical Immunology; Haematology.

The second edition of Single Best Answers in Surgery, Second Edition continues to provide invaluable guidance to this widely used question format, written by authors who understand that detailed explanations accompanying each answer are the key to a successful revision aid. This book presents more than 500 SBA questions arranged into topic areas as well as a section of random questions for self-testing under examination conditions. A clear discussion of how the correct answer was reached and other options ruled out for every question is given at the end of each section, making this book an excellent learning aid for all stages of undergraduate surgical studies, and particularly during revision for final examinations.