Smart Advice on the leading causes of back problems and the best ways to relieve the pain
Smart Ways to stretch, exercise, and strengthen the muscles in your back
Smart Tips on how today's leading medical techniques and therapies can make your back feel good again
An all-you-need-to-know introduction to understanding why your back hurts and how to make it feel good again
* Smart Insights into the causes of back pain and the many factors--including

Cancer is a major issue in the provision of health care. It is estimated that one in four people in developed countries are likely to develop it at some time. As longevity steadily increases, the incidence of malignant disease is expected to rise further. Important advances in the control of cancer have taken place and curative treatment has improved, notably in some of the rarer tumours, particularly in children. Advances in the more common cancers have been less marked, although adjunctive systemic treatment and population screening are lowering mortality from the most prevalent cance- carcinoma of the breast. Despite this progress, complete control of malignant disease is still a long way off. However, our understanding of the molecular biology of cancer has increased enormously in recent years and the application of this knowledge holds considerable promise for developing new therapeutic strategies. As for prevention, the cause of most cancers is still poorly understood although it is clear that tobacco avoidance would prevent most lung cancers and several others. Cancer is studied at many different levels: molecular and cellular biology, pathology in patients (particularly clinical trials), and prevention and populations (epidemiology). The psychosocial problems caused to patients and their families are being increasingly recognized and subjected to systematic study. Workers in the field, therefore, range from basic scientists to epidemiologists, from hospital specialists to community support teams. Each needs to have at least some knowledge of the role the others play.

Das 4. Heidelberger Symposium uber "Hamostase in der Anasthesiologie" hat es sich zum Ziel gesetzt, fachubergreifend die noch ungelosten Fragen in der Hamostaseologie offenzulegen und auf der Basis einer kritischen Wertung der bekannten Studien klare Handlungsanweisungen fur den praktisch tatigen Arzt zu geben. Die angesprochenen Themen sind haufig in der Klinik auftretende Probleme wie die perioperative Einstellung von Hamophilen, die Betreuung von Patienten mit Massivtransfusion, Protein Z-Mangel, Lungenembolie, Katheterthrombose und Probleme der Gerinnungsanalyse und die Sicherheit von Praparaten mit Gerinnungsfaktoren. Das vorliegende Buch hat es sich zum Ziel gesetzt, den Leser uber die neuen Entwicklungen zu informieren und Anleitungen zum praktischen klinischen Handeln zu geben.

This book contains a compilation of papers based on pres entations made at the International Symposium on Penile Disorders held in Hamburg, Germany, 26-27 January 1996, under the Chairmanship of Hartmut Porst. This was a unique conference in that it comprehensively addressed various disorders that affect the organ situated at the "center of the male," the penis. As an important beginning, the sociocultural aspects of the erect phallus were presented by G. Wagner from Copen hagen. The anatomy of the penis and the physiological con ditions of erection were then discussed by K. -P. J Unemann from Mannheim, Germany. Previous conferences on the penis had concentrated only on specific areas of disease such as impotence. However, it became readily apparent that at this conference something new for almost every as pect of disease would be discussed, including congenital disorders such as hypospadias and epispadias, sexually transmitted and noninfectious dermatological diseases, and congenital and acquired penile curvatures and penile fractures. An excellent presentation of managing penile cancer by stage related therapeutic decision was presented by S. C. MUller from Bonn, Germany. There is no better per son to present a discussion of Peyronie' s disease in 1996 from a historical and management perspective than J. Pryor from London, UK. This same degree of expertise was also demonstrated by I. Saenz de Tejada from Madrid, Spain, re garding priapism."

}The emerging picture of medicine looks gloriously sunny for the 21st century, promising untold rewards for humanitys future health. The 20th century, in contrast, has proved disappointing in eradicating disease. Surgery today, still in the Dark Ages, relies on scalpels and other such Medieval tools. Is the end of illness within our grasp for the next century?Alexandra Wykea correspondent for The Economist and one of the worlds most experienced medical journaliststraveled the globe in search of an answer to the future of medicine. She interviewed the most celebrated and innovative doctors, researchers, and medical scientists, and visited their laboratories. What she discovered is revealed in this astonishing work through her observant eye and splendid prose. Cancer, heart disease, and devastating ailments, she predicts, will be blights of the past.One of the greatest revolutions in medicine will be created by the advances in computers and telecommunications. Surgery, we learn, will be performed from afar. After too many years, medicine is at long last poised to absorb and exploit the triumphs of the computer and the information revolution.This comprehensive, must read book not only illuminates the seemingly miraculous cures and advances that may soon prevail, but delineates how this wealth of stunning innovation will serve to shake up and streamline the entire health care industry. Wyke introduces us to the wonders that await us: } *Special cocktails will counteract heart disease and eradicate genetic ailments *Energy beams will search out and destroy malignant cells *Robots will perform surgery with speed and precision *Gizmos on our wrists will monitor our blood for trouble before it happens *Top-level expertise will be delivered worldwide..

Die Grundungsversammlung der "Deutschen Gesellschaft fur Tropenchirurgie e. V. (DTC)", die am 25. 9. 1992 in Homburg/Saar aus der "Vereinigung zur Forderung der Chirurgie in Entwicklungslandern e. Y. " hervorging, verlief nicht ohne Geburtswe- hen. Allein die lebhafte Diskussion um die Anerkennung des Begriffs "Tropenchirur- gie" wird noch allen Beteiligten gegenwartig sein. Mittlerweile ist die Existenz der DTC ebenso selbstverstandlich und vertraut geworden wie der BegriffTropenchirurgie. Die DTC hat sich zum Forum der operativ tatigen und praxisorientierten Tropenmediziner entwickelt. Die wachsende Beliebt- heit der tropenchirurgischen Workshops in Homburg/Saar sowie der tropenchirurgi- schen Symposien zeugen von einem lebhaften Bedurfnis nach praktischer Weiterbil- dung und fachlichem Austausch. Auch das H. Tropenchirurgische Symposium in Ulm beschrankt sich wiederum thematisch auf zwei Schwerpunkte: "Sonographie in der Tropenchirurgie" und "Neu- rologie/Neurotraumatologie". Auch wenn die tropenchirurgische Realitat von mate- riellen Engpassen gekennzeichnet ist, die haufig nur die Anwendung einfacher und kostengunstiger Mittel erlaubt, so ist damit in keiner Weise ein Verzicht auf moderne Technologien verbunden. Nicht zuletzt unter dem Gesichtspunkt der Kosten-Nutzen- Re~ation verdient die Sonographie gebuhrende Aufmerksamkeit. Durch eine recht- zeitige und prazisere Diagnostik lassen sich nicht selten operative Eingriffe besser planen, risikoarmer gestalten oder gar vermeiden. Teure Verlegungen in oft weit ent- fernte medizinische Zentren werden mitunter uberflussig, Verlaufskontrollen unter konservativer Therapie zuverlassiger. Die Frage nach der Wertigkeit der Sonographie fur Tropenmedizin und Tropenchirurgie wird von P. Langenscheidt und Mitarbeitern sowie von H. Diefenthal positiv beantwortet.

Der wirtschaftliche Druck auf Arzte nimmt standig zu. Fehlentscheidungen in der Arztpraxis kosten nicht nur Gewinn, sondern gefahrden die Selbstandigkeit.

Dieses Praxis-Buch hilft Ihnen

- die Erfolgsfaktoren Ihrer Arztpraxis zu steuern
- wirtschaftliches Handeln konkret anzuwenden
- fit in Fachausdrucken zu werden
- Gesprachskompetenz bei Steuerberatern, Anwalten, Banken und Behorden zu erlangen
- Ihren Erfolg zu planen

Steigern Sie Ihren Praxis-Erfolg in wenigen Schritten Konzentrieren Sie sich auf die wirklich wichtigen Massnahmen. Senken Sie Kosten und Steuern Mit zahlreichen Checklisten."

This textbook provides practical advice for junior surgical trainees on basic procedures in all surgical specialties. There are concise descriptions of minor and intermediate procedures that the trainee may be expected to perform and they are illustrated by clear line diagrams.

Updated, revised and organized, the new Second Editions in the Clinical Sciences Series reflect the format of the USMLE Step 2. Each volume systematically presents the core information of a single segment of the medical curriculum, from Family Medicine to Psychiatry. You will also learn time-honored tricks of the trade,as well as the latest advances in clinical medicine: new diagnostic tools, new therapeutic interventions, and new pharmacologic options.

Adhesions can cause a wide range of problems, complaints and hazards, even after simple abdominal procedures, such as appendectomy, with complications ranging from recurrent discomfort and pain to intestinal obstruction. Postsurgical adhesions increase the risk of following operations of the abdominal and thoracic cavity. They impair peritoneal dialysis and chemotherapy and play a crucial part in laparoscopic procedures. Adhesion-related problems account for a large amount of clinical work and have a significant socioeconomic impact. This book presents the current knowledge on the aetiopathogenesis of adhesion formation as well as the available methods for their prevention and control. Experts in the field contribute to clinical standards for preventive measures to control the formation of postoperative adhesions

The Illustrated Handbook of Cardiac Surgery is adapted from the Second Edition of the color illustrated Manual of Cardiac Surgery (Springer-Verlag, 1995). The Illustrated Handbook of Cardiac Surgery communicates all the important informa tion, but eliminates the detailed explanation of judgment and technique that is relevant only to cardiac surgeons or other individuals intensely interested in these details. The chapters covering operations explain the basic concepts and fundamentals of the operations. A selection of the most important biblio graphic sources follows each chapter, but are not cited in the text. Individuals interested in more exhaustive coverage of information sources should consult the Second Edition of the Manual of Cardiac Surgery. The Illustrated Handbook of Cardiac Surgery should appeal to all individuals caring for cardiac surgical patients: cardiologists, anesthesiologists, radiolo gists, general surgery residents rotating on cardiac surgery, medical students, physician assistants, nurses, perfusionists, and all other members of the car diac surgery team. It should even appeal to laypeople who want to read about cardiac surgery in more depth than is available in lay publications. Our attempt has been to produce a book that is clearly written, clearly illustrated, and affordable. The techniques chosen are those developed over three decades of clinical practice and resident training at the Oregon Health Sciences University and St. Vincent Hospital, Portland, Oregon, and Sutter Memorial Hospital, Sacra mento, California. These techniques have served us well."

Im Chirurgischen Forum werden ausgewahlte Beitrage vorab veroffentlicht, die auf dem Kongress der Deutschen Gesellschaft fur Chirurgie vorgetragen werden. Der Forumsausschuss achtet dabei auf hochste Qualitat der Beitrage. Der Leser findet hier die neuesten Ergebnisse aus Forschung und Klinik ubersichtlich in einem Band.

In the last few decades an abundance of publications have accumu lated on the clinical implications of subarachnoid haemorrhage (SAH) due to aneurysmal rupture. In contrast, until about 6 years ago, SAH due to traumatic head injury mainly, if not only, drew the attention of the forensic pathologist. In their analysis of the data from the American Traumatic Coma Data Bank, Eisenberg et al. concluded in 1990 that the presence of SAH on the initial computed tomographic scan (tSAH) had an un favourable effect on outcome. This conclusion has since been con firmed in other series. Dr. Kakarieka, the author of the present monograph, has been fascinated by tSAH since his participation in 1989 as International Trial Coordinator of the large European Trial on the effect of nimodipine on outcome after severe injury (HIT 2). This study re vealed a statistically significant, favourable effect in the subgroup of patients with tSAH, a result which warranted a further trial on the efficacy of nimodipine administration in patients with tSAH. This trial, the so-called German trial which was completed in 1995, not only revealed that tSAH is an important and independent factor predicting unfavourable outcome in head injury, but also showed convincingly the statistically significant, favourable effect of nimodipine adminis tration in patients with tSAH."

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. Initially, 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 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.

Ein vertieftes pathophysiologisches Verstandnis der respiratorischen Insuffizienz und die technischen Entwicklungen der letzten Jahre haben die Beatmung, uber die reine Substitution bei Atmungsausfall durch zentrale oder periphere Atemlahmung hinaus, zu einer Therapie der respiratorischen Insuffizienz und pulmonaler Erkrankungen werden lassen. Es gibt heute ein breites Indikationsspektrum fur vielerlei Beatmungsverfahren, die von einfachen Atemhilfen bis hin zu komplexen, computergesteuerten Beatmungsmustern und zur Lungenersatztherapie reichen. Dieses Buch enthalt neben den pathophysiologischen Grundlagen eine systematische Darstellung der Verfahren und Gerate und gibt Anasthesisten und Intensivmedizinern wertvolle Hinweise fur indikationsgerechte Entscheidungen.

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.

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.