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.

"

Originally published in 1992, Medical Theory, Surgical Practice examines medical and surgical concepts of disease and their relation to the practice of surgery, in particular historical settings. It emphasises that understanding concepts of disease does not just include recounting explicit accounts of disease given by medical men. It needs an analysis of the social relations embedded in such concepts. In doing this, the contributors illustrate how surgery rose from a relatively humble place in seventeenth century life to being seen as one of the great achievements of late Victorian culture. They examine how medical theory and surgical practices relate to social contexts, how physical diagnosis entered medicine and whether anaesthesia and Lister's antiseptic techniques really did cause a revolution in surgical practice.

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.

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.

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 majority of amputations in the western world today are due to vascular disease. Despite the advances in surgical treatment of this disease, particularly by reconstruction, it is a sad fact that the number of amputations performed in these countries each year for vascular disease is increasing. Most of these amputees are elderly and their life expectancy is short, so it is important that the treatment and rehabilitation that they receive is informed, appropriate, efficient and swift to enable them to return successfully to life in the community for their remaining years. Management of this group of patients has proved to be successful only if a multidisciplinary team approach is adopted. Until recently in the UK, this approach sadly has only been implemented by a few centres. However, with the publication of the McColl report into the prosthetic and wheelchair service in 1986, interest in the care of the amputee is growing throughout the country. This book covers all aspects of amputation from disease and diagnosis to rehabilitation and community discharge with emphasis on the man agerneut of the largest group, the vascular lower limb amputee. A team approach is described and emphasized as being essential for good results and subsequent successful return into the community. The role of each of the important disciplines is described in relation to the appropriate part of the rehabilitation phase."

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.

Practical Procedures in Aesthetic Dentistry presents a comprehensive collection of videos demonstrating clinical techniques in aesthetic and restorative dentistry, and is accompanied by a handbook summarising the key points of each procedure. * Interactive website hosting over nine hours of video * Accompanying illustrated handbook summarising key points * Expert teaching across a comprehensive range of aesthetic and restorative procedures * International team of contributors with clinical and academic expertise

Emerging Electromagnetic Medicine presents the latest research findings in the field of electromagnetic radiation. The book discusses the research of current active researchers in terms of synthesizing and sharing their ideas on the use of electromagnetic fields in diagnostic and therapeutic medicine, now and in the future, including the benefits and risks involved. The book consists of three parts prefaced by a brief historic perspective. Section I describes the theoretical concerns and actual mechanisms involved; Section II covers current preclinical studies, performed in vivo and in vitro, concerning the biological action of the electromagnetic radiation; and Section III reports on actual clinical applications of electromagnetic therapy and also the current machinery used to do so.

A book that compiles symposia papers from the International Journal of Colorectal Disease on issues that are highly controversial and hotly debated.

This study sets out to describe all aspects of a congenital anomaly which has been described as "the epitome of modern surgery" and "the raison d'etre of pediatric surgery". The book is presented in eight sections, commencing with a summary of the historical events of significance, followed by epidemiology and genetics, embryology, anatomy and pathophysiology. The clinical aspects commence with chapters dealing with diagnosis, transport, anaesthesia and intensive care. This is followed by a section which addresses the surgical aspects of the specific variants of the anormaly.;A major problem in a baby with oesophageal atresia is the associated anomalies which are present in over 50% of the patients; therefore section 4 is devoted to the consideration of these anomalies with emphasis on the most important specific anomalies.;It also includes the overall care of the child and family and to complete the monograph by describing the management of specific problems and complications, and the longterm results of surgery.;This book is presented in the hope that it will be of help to all concerned with the care of the baby with oesophageal atresia and its family, recognizing that the field is wide, involving as it does representatives of many medical and paramedical disciplines.

Interventional Radiology has as its main goal the performance of surgical techniques using a percutaneous approach to simplify patient care. Percutaneous cholecystostomy now has many advocates; still, it is practised in comparatively few centers. Over many years it was used as a last resort at failed transhepatic cholangiography to provide images of the bile ducts in biliary obstruction. Transhepatic cholecystostomy is reputed to be safer than transperito- neal puncture, since bile leaks do not enter the peritoneum. The advo- cates of percutaneous cholecystolithotomy, almost without exception, fa- vour subcostal cholecystostomy and puncture of the fundus of the gall- bladder. There is no evidence of bile peritonitis after successfully making a track to the gallbladder 18 F in diameter or larger for stone removal. After 1-7 days a postlithotomy drain is removed from the gallbladder and the patient is allowed home. Transhepatic cholecystostomy for gallstone lysis, in contrast, requires only a 5-F track to the hepatic surface of the gallbladder. Loss of the gallbladder is not as great a fear with this technique as it is during dilata- tion of a subcostal track for cholecystolithotomy. During the latter pro- cedure this may result in laparotomy to avoid bile peritonitis, while in the former, if the gallbladder is still visualised, the procedure may be re- commenced immediately. Catheter dislodgement is a fear when prolon- ged catheterisation is considered.

It is both a pleasure and a privilege to be invited to contribute a foreword to this book, which deserves - and needs - to be read by virtually everyone who is concerned with the treatment and subse quent welfare of the victims of severe injuries of the brain. Some friends, relatives and workmates might be helped by reading some parts of it, but, if the book has the effect it deserves to have on therapists, nurses, doctors, and others working in both hospitals and the community, these laymen will be suitably informed and assisted by one or more members of the necessarily large therapeutic team. The improvements in methods of resuscitation that have taken place during the last 40 years or so have abolished the previously fatalistic readiness to accept that a week or two in coma after a head injury was virtually a sentence to death from pneumonia. After it had become possible to save lives it gradually became clear that survival of the patient was not necessarily followed by recovery of the brain and that the price of success, in saving lives, was a popula tion of cerebral cripples that was increasing at the rate of 1000 or more a year throughout the country. Although this figure has remained about the same for more than 20 years, there has been a great improvement in the amount of interest, the standard of care and the quality of results that are being achieved."

PTA has proven to be an essential tool in the diagnosis of peripheral occlusive vascular disease. It substantially contributes to economize therapy. This volume presents the results of several working groups, gives technical information about new devices such as Laser-PTA and Rotator-PTA, atherectomy, thrombolysis and stent application, and shows the risks. These results are presented with critical appreciation of the advantages and disadvantages and with early and late results. These new developments within the scope of PTA indicate the trends for the future.

This book presents a comprehensive survey in which internationally recognized experts discuss specific topics. The wide spectrum of experimental and clinical investigations include the pathophysiologic, diagnostic and therapeutic aspects. Update 1989 represents the series' continuous effort to combine the most recent developments in one reference source for all those involved in cardiology, internal medicine, pediatrics, anesthesia, intensive care and emergency medicine.

During the last meeting of the European Association of Neurosurgical Societies (Barcelona 7-16 September 1987), a Symposium was devoted to the use of calcium antagonists in cerebral vasospasm. As shown by its title "Prevention and treatment of delayed ischaemic dysfunction in patients with subarachnoid haemorrhage: an update," papers presented at the Symposium covered a broad spectrum from some basic data on pathophysiology of subarachnoid haemorrhage (SAH) and delayed ischaemic dysfunction, to the clinical use of nimodipine, which has been largely documented among calcium inhibitors for its cerebrovascular properties. This supplementum of Acta Neurochirurgica is based upon the papers presented. Some articles, however, have been extended to take into account further results in order to present a broad view of the subject. The Symposium started with two presentations concerning general aspects of SAH: in the first one, B. Voldby reviewed the pathophysiological events following SAH: if modifications of intracranial pressure (ICP) and decrease of cerebral blood flow (CBF) are the primary alterations, metabolic changes (particularly reduction in CMR0 ) 2 contribute rapidly to disturbances of brain circulation. A variety of mechanisms may be responsible for the neurological dysfunction: most of them are directly related to the reduction in cerebral perfusion pressure (CPP) which may result in ischaemia. This fall in CPP (either due to elevation of ICP or reduction of mean arterial blood pressure) is observed under different pathophysiological conditions, discussed in the paper by A. D. Mendelow.