Re-EngineeringoftheDamagedBrainandSpinalCord isdedicatedtoTetsuoKanno,M. D. ProfessorofNeurosurgery Bypresenting theoriginal papers thatmakeupthis thefeaturesofthelocalmedicallandscapeinthe- third supplement we wish to make a further contri- gionswheretheyareenacted. Whatismore,progr- bution to the issue of functional rehabilitation, this sivenew?ndingsmustbealsosubjectedtoafrequent soimportantandfascinatingmodernareaofresearch revision. Ontopofthis,itshouldnotbeforgottenthat inthe?eldofneurosciences. Thecongresspaperswe even when committal therapy guidelines are c- haveselectedconstituteagoodre?ectionofthetrans- sistentlyapplied,thereareconsiderablevariationsin disciplinary objectives. The literature references are therangeofpotentialcomplicationsandintheo- designedasaguidetoleadtheinterestedreadertoa comeofprospectivecontrolledmulti-centreandmul- deeperandmoredetailedunderstandingoftheindi- nationalstudiesontheissueofqualitymanagement. vidualissues. Functionalrehabilitationhasbeenanoriginaltask The demand for "evidence-based medicine" is well ofneurosurgeryfromtheveryoutset. The1990shave justi?ed; however, it rapidly comes up against the enteredtheannalsofbrainresearchasthe"Decadeof limitsoffeasibility,especiallywherecontrolledthe- theBrain". Sincethentherehasbeenaneverstronger peuticstudiesareconcerned. TheCochrancollection growthofneuroscienti?cinterestworldwide,accom- of high-quality evidence-based healthcare databases paniedbysubstantial?nancialengagement. Thishas hasthusfarbeenofnohelptousindrawingupthe- primarily resulted in advances in basic neuro- peutic recommendations for the re-engineering of biologicalandneurophysiologicalresearchandalsoin brain and spinal-cord lesions. Today as ever, the thegrowthofneuroscienti?cknowledgeaboutbasic opinion of experts and empirically based medical mechanismsformotor control,paincontrol,aware- treatment and posttraumatic neurorehabilitation ness, cognition, learning and memory. The conse- continuetooccupyanindispensablepositionforthe quencemustbetoensurethattheadvancesmadeinthe everydayclinicalpracticeofneurosurgicalandneu- neuroscienti?cresearchareaareadequatelyexpanded traumatological therapies. Promising adjunct - intopracticalneurosurgicalcareandre-engineeringof proachesincludeneuropharmacology,forcascadesof brainandspinalcordlesionsandtoensureuponnew molecular interactions are known to be underlying approaches. Following this a fundamental path will activity-dependent plasticity and skills learning, as resultinanimprovedandmoree%ocientpreventionin many of these processes involve the major tra- thefuture,themeasuresthatstandrightatthefore- mitters. Furthermore,biologicalinterventionsby- front of all rehabilitation principles, meaning that ingendogenousneuronsandgliaaswellasexogenous conventionalconceptsmustbemodi?edtokeeppace stemcells,bone-marrowcells,macrophages,andother withthemoretask-speci?c,intensive,andprogressive types may promote the regeneration of nerve cells, demands. In this connection a series of guidelines, tissue, and neural circuitry. Class one studies have recommendations, and expert opinions and also beenmade,andnowclasstwostudieshavebeeni- algorithms have been elaborated by national and tiated, for example in connection with acute spinal international expert panels and multidisciplinary as- cord injury (SCI). The clinical application of fu- sociationsfortheacutemedicalcareofpatients.

Quantitative coronary angiography has become an invaluable tool for the interventional cardiologist, providing objective and reproducible measurements of coronary artery dimensions, which can be used to study progression or regression of coronary atherosclerosis, as well as the immediate and long term effects of percutaneous interventions. Until recently, this powerful imaging technology was confined to a small number of so-called high level institutions. Fortunately, with the development of digital cardiac imaging equipment and adaptation of cine-angiographically based computer software for on-line use in the catheterization room, quantitative coronary angiography is now available to all interventionalists. This book is a timely guide for the impending QCA user, providing practical as well as theoretical and scientific information. A comprehensive evaluation of the clinical usefulness of QCA is covered, from the fundamental principles through experimental validation studies, application to clinical trials of a wide range of pharmacological and interventional therapies in the full spectrum of clinical presentation of coronary disease syndromes, evaluation of the therapeutic efficacy of various new devices for coronary intervention, together with extensive presentation of its physiological, functional and anatomical correlations, by comparison with other intracoronary measurement and imaging techniques. In addition, evolving theories and concepts in the ever topical restenosis phenomenon' after percutaneous intervention, based on serial QCA studies, are presented and discussed and a potentially unifying methodological approach to further study of this ubiquitous problem is offered. Thisbook, thanks to the collaboration of many experts in the field of intracoronary imaging and measurement, provides stimulating, interesting and practical information, both for the academic scientist and practising clinician.

This manual reviews the definitions and typical approach to quality assurance in healthcare and includes a review of the most prominent quality studies. A program for quality management in surgery is presented with chapters reviewing patient safety and external reporting requirements. An introduction to medical malpractice and risk management is also provided and followed by a chapter on how to implement the necessary behavioral changes to improve quality practices. The appendix includes useful protocols, forms and order sets.

This manual reviews the important critical functions of a department of surgery which are synthesized into specific departmental roles. A departmental organizational structure and the required personnel is presented along with the appropriate job descriptions and the role of hospital committees for a department of surgery. To help with process management, a listing of policies, protocols and communications are provided. To ease the access to external oversight, the conditions of participation from CMS related to surgery are reproduced and this is followed by a chapter on change management and program development. The appendix includes useful forms and templates.

Reoperation is one of surgery's greatest challenges. This book provides a practical reference on how to prevent, identify and treat all abdominal complications. Organised primarily by body system Reoperative Abdominal Surgery covers the spectrum of conditions and complications faced by the general surgeon. Separate chapters also cover safety issues, and specific issues related to diagnosis, surgical technique and patient presentation. Combining the expertise and advice of leading international surgeons the book offers a clinical instructive manual for trainee and practising surgeons. Focus on abdominal surgery the key province of the general surgeon Expert guidance on the prevention, identification and management of post-operative complications Key reference on difficult surgical area for residents and young surgeons Experience and advice from best surgeons around the world Covers entire spectrum of reoperative abdominal surgery

This book opens with a unique historical review of natural amputations due to congenital absence, disease, frostbite, animal trauma, and to punishment and ritual. The advent of surgical amputation and its difficulties form a major part of the book, summarising the evolution of the control of haemorrhage and infection, pain relief, techniques, instrumentation, complications, prostheses, results and case histories. Alternative procedures, increasingly important in the last two centuries, are also debated.

The Tohoku University Graduate School of Dentistry first introduced the concept of "Interface Oral Health Science", designed to establish and maintain healthy oral cavities, which are home to a number of mixed systems. Included in those systems are: (1) host tissues such as teeth, mucosa, muscle and bone, (2) parasites and microorganisms cohabiting the surfaces of the oral cavity and (3) biomaterials that are used for the rehabilitation of oral functions. In addition, (4) these systems are subject to severe and complex mechanical forces. Therefore, it is critical to promote dental studies that integrate a wide range of interdisciplinary research as medicine, agriculture, material science, engineering, and pharmacology. With this incentive, international symposiums for interface oral health science have been held several times in the past. The concept has since refined and expanded, the result being the "Biosis-Abiosis Intelligent Interface," and projects aiming at the creation of highly functional and autonomic intelligent interfaces are ongoing. This book brings together a number of studies on incentives and projects by leading authors. Topics include biosis-abiosis interface of dental implants, biomaterials in interface science, biomedical engineering interface and cell manipulation and tissue regeneration. Readers not only from the field of dentistry but also many related areas will find this book a valuable resource.

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.

are then selected and must meet the general 'biocompatibility' require ments. Prototypes are built and tested to include biocompatibility evalua tions based on ASTM standard procedures. The device is validated for sterility and freedom from pyrogens before it can be tested on animals or humans. Medical devices are classified as class I, II or III depending on their invasiveness. Class I devices can be marketed by submitting notification to the FDA. Class II and III devices require either that they show equivalence to a device marketed prior to 1976 or that they receive pre-marketing approval. The time from device conception to FDA approval can range from months (class I device) to in excess of ten years (class III device). Therefore, much planning is necessary to pick the best regulatory approach. 2. Wound Dressings and Skin Replacement 2.1 Introduction Wounds to the skin are encountered every day. Minor skin wounds cause some pain, but these wounds will heal by themselves in time. Even though many minor wounds heal effectively without scarring in the absence of treatment, they heal more rapidly if they are kept clean and moist. Devices such as Band-Aids are used to assist in wound healing. For deeper wounds, a variety of wound dressings have been developed including cell cultured artificial skin. These materials are intended to promote healing of skin damaged or removed as a result of skin grafting, ulceration, burns, cancer excision or mechanical trauma."

Developments in the field of instrumentation of innovative instrumentation. Although laser applications have permeated nearly every aspect are among the major contributions to human advancement. The history of surgery has seen of surgical therapy, the expectations have fre many revolutionary developments cause quantum quently been unrealistic and the evaluation of leaps in progress. Electrocautery, the anesthesia technological development has always been machine, computed axial tomography, and the painfully slow. The properties of vaporization, surgical microscope are all revolutionary in coagulation, and cutting unified in an invisible struments that have irrevocably changed the shaft of light have enabled the neurosurgeon to direction of neurological surgery. vaporize inaccessible tumors of brain and spinal In the early stages of application, there are cord, harness recalcitrant bleeding sites, and cut always detractors and valid controversy concern through the most formidable calcified tumors. ing the value of a new instrument. Some will The application of this new energy form in remember those who argued that the magnifica tandem with the surgical microscope has, in my tion and illumination provided by the micro opinion, extended the scope of all aspects of scope were not valuable to the skilled surgeon neurosurgery. We have much more work to do. and would prolong the operative time and in lt is necessary to document improved results and crease infection rates. Others may recall that demand technological advances and safe inno Cushing was told to abandon the blood pressure vations."

Principios de fisiopatologia quirurgica Actualmente, en la mayoria de las escuelas de Medicina y durante las residencias medicas, se acostumbra tener para cada materia, un libro de texto unico, el que frecuentemente es traducido de una lengua ajena al castellano. Los autores hemos pensado que el estudio de la Cirugia General, requiere no solo poder repetir algo escrito en una sola fuente de informacion, y menos que sea ajena a nuestro medio, sino que esta especialidad, al igual que las demas quirurgicas, obliga a un proceso ordenado de razonamiento, que dote al cirujano de una vision panoramica, basada en la informacion suficiente, que le permita entender el por que de las enfermedades a las que se enfrenta en su practica cotidiana. Esta obra, precisamente pretende sumarse al arsenal bibliografico del estudioso de la cirugia, para hacerle agradable el aprendizaje, dotarle de suficientes elementos para facilitar su quehacer cotidiano y, sin duda, proporcionarle no solo de principios para simplificar el proceso diagnostico, sino para justificar el tratamiento que le va a ofrecer a su paciente. Nos sentiremos mas que satisfechos si alcanzamos a despertar su curiosidad mas alla del contenido del texto, para verse obligado a complementarlo, con otras fuentes de informacion, asi como im genes, tratamientos, tecnicas quirurgicas etc.; es decir si logramos inquietarlo a seguirse preguntando por que? Pero...habremos, sin duda, superado nuestro proposito si ademas, conseguimos con ello, el que se maraville al descubrir los recovecos del inmenso universo que es la cirugia.

Recent advances in technology have opened up new possibilities in the diagnosis and treatment of cerebrospinal vascular diseases. It is now possible to use magnetic resonance imaging to map brain function and metabolism as an aid to diagnosis. Novel applications of magnetic resonance angiography allow three-dimensional imaging, and the magnetization transfer contrast technique gives us a new window on cerebral vascular function. This volume presents work in all these fields as well as previewing the techniques of endovascular surgery for cerebrospinal vascular diseases. These include modern stereotactic radiosurgery for arteriovenous malformations and for angiographically occult vascular malformations of the brain. This book presents an overview of the latest applications of technology to this rapidly developing and challenging field.

Speed and accuracy are the two most important qualities that candidates for the MRCS Viva are expected to demonstrate. Revision Notes for the MRCS Viva has been written to prepare candidates for this most daunting of exams. The book provides a comprehensive exam preparation tool for intercollegiate MRCS oral examinations. It is organised into two sections, the first devoted to chapters on basic sciences, the second to system specific surgery. Each chapter is broken down into topics most likely to appear in current examinations. For each topic, succinct notes provide candidates with a framework for answering the stem and secondary questions encountered in the exam.

The use oflasers has entered almost every facet of medicine and biology. Therefore, it is to be expected that the reviews contained in this vol urne will reflect this diversity. As dinical acceptance has grown with various diagnostic and therapeutic applications, so has the need for a more thorough understanding of the theoretical background for each. This is especially true where a correlation is to be made between the theoretical background and the experimental data. It is only in this way that we can attain the optimal form of any therapy. The basic coupling ofenergy into biological tissue and its conversion into heat is characterized by many parameters. One ofthe most important is pulse duration. The review by Bimgruber in Chapter 6 shows how our knowledge ofthis parameter has been extended.The need for a more basic understanding of the interaction of electromagnetic energy with various kinds of materials has led to investigations on the nature of plasmas their stability and instability, and how theyexist. Docchio reviews the factors that cause them to occur at a specific locale and then to move away from that site. The availabilityofmany types ofoptical fibers has extended our ability to deliver laser energy from various types oflasers into almost anyselected location. This is particularly useful in medicine, where less invasive ap proaches to surgery and diagnosis are always helpful. However, as Rol and his colleagues explain, the power-handling capabilities ofoptical fibers limit many applications, particularly for short-duration, high-peak-power laser pulses."

In this issue of Surgical Clinics, guest editor Dr. John D. Horton brings his considerable expertise to the topic of Pediatric Surgery. Top experts in the field cover key topics such as management of anorectal malformations and Hirschsprung's disease; management of abdominal tumors; management of congenital diaphragmatic hernia; management of esophageal atresia and tracheoesophageal fistula; and more. Contains 16 relevant, practice-oriented topics including management of disorders of gut rotation; surgical support of the developmentally delayed/neurologically impaired child; management of intestinal failure and nutritional support; management of biliary atresia and biliary cysts; chest wall malformations and congenital lung lesions; and more. Provides in-depth clinical reviews on pediatric surgery, 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.

Complications of Female Incontinence and Pelvic Reconstructive Surgery reviews the prevention, evaluation and management of complications arising from female pelvic surgery. Potential complications of both routine and specialized female pelvic procedures such as transvaginal slings, cystocele and rectocele repairs, urethral diverticulectomy, and transvaginal mesh repairs are reviewed. The chapters are divided by procedure allowing the reader to easily find what they are looking for. Images and figures of methods of evaluation and repair of these complications are included throughout. The volume is organized based on the specific types of surgeries performed and the user is able to look up the type of surgery performed and immediately find all of the potential complications and their treatments. This text will serve as a comprehensive guide and reference allowing the surgeon quick and ready access to information about the complications of female pelvic surgery.

Principios de fisiopatologia quirurgica Actualmente, en la mayoria de las escuelas de Medicina y durante las residencias medicas, se acostumbra tener para cada materia, un libro de texto unico, el que frecuentemente es traducido de una lengua ajena al castellano. Los autores hemos pensado que el estudio de la Cirugia General, requiere no solo poder repetir algo escrito en una sola fuente de informacion, y menos que sea ajena a nuestro medio, sino que esta especialidad, al igual que las demas quirurgicas, obliga a un proceso ordenado de razonamiento, que dote al cirujano de una vision panoramica, basada en la informacion suficiente, que le permita entender el por que de las enfermedades a las que se enfrenta en su practica cotidiana. Esta obra, precisamente pretende sumarse al arsenal bibliografico del estudioso de la cirugia, para hacerle agradable el aprendizaje, dotarle de suficientes elementos para facilitar su quehacer cotidiano y, sin duda, proporcionarle no solo de principios para simplificar el proceso diagnostico, sino para justificar el tratamiento que le va a ofrecer a su paciente. Nos sentiremos mas que satisfechos si alcanzamos a despertar su curiosidad mas alla del contenido del texto, para verse obligado a complementarlo, con otras fuentes de informacion, asi como imagenes, tratamientos, tecnicas quirurgicas etc.; es decir si logramos inquietarlo a seguirse preguntando por que? Pero...habremos, sin duda, superado nuestro proposito si ademas, conseguimos con ello, el que se maraville al descubrir los recovecos del inmenso universo que es la cirugia.

Recent Advances in Surgery 31 is the latest volume in the successful and well-established Recent Advances series. This title is updated annually, covering the latest trends within surgery and reflecting any changes to the professional examinations for surgeons. Suitable for experienced medical professionals, as well as students and candidates of the MRCS/AFRCS, this edition reviews the latest trends within surgery and forms a useful update of general surgery for candidates of the Intercollegiate examination. Over 30 contributors, who are recognized experts in their particular field, provide in-depth reviews of important topics relevant to the management of all surgical patients and advancing areas in surgical subspecialties.