Despite numerous reports of cerebral damage in cardiac surgery, the subject has not been given the attention it requires. This book, with a preface by Torkel Aberg, will remedy that situation. The causes and incidence of pre- and post-operative cerebral damage are considered in the first section. Cardiac surgery patients frequently have preoperative cerebral impairment, not suprising when one considers the impaired circulation from a damaged heart and the brain's prodigious need for blood. Moreover, several perioperative aspects of surgical procedures have been considered as possible causes of cerebral dysfunction, for example: microbubbles, toxic by-products, non-pulsatile blood flow. The second section describes how imaging techniques (CT scan, MRI, regional cerebral blood flow imaging), and functional assessment techniques. (PET scan, EEG, BEAM and evoked potentials) can be used to measure cerebral damage. In the third section, psychometric and neuropsychological techniques are used to assess impaired mental abilities (abstract thinking, language, memory, visuo-spatial ability, mental flexibility, attention and concentration). The final section explores the relationship between cerebral dysfunction and psychopathology (several types of depression, anxiety, and aspects of organic brain syndrome, delirium and dementia).

The New Contract which came into force on April 1st 1990 includes proposals for the provision of minor surgery services by the General Practitioner. The aim of this book is to assist those doctors undertaking minor surgery in their Practices. It is intended to present a practical, clear and concise text. This is accompanied by easy to follow illustrations. The contents of the book are governed by two considerations. Firstly, it covers only those procedures which are safe for the patient. Secondly, it only includes minor surgery which it is possible for the ordinary General Practitioner in a busy practice to undertake. Vll Chapter One The Advantages of Minor Surgery in General Practice Minor Surgery:- Despite this descriptive term, no surgery can be considered "minor" no matter where it is carried out! It requires a knowledge of anatomy and basic surgical principles. There must be an understanding of the procedures and technical skills required. Careful planning is needed at all stages. Arrangements must also be made to deal with any complications and disasters which may occur. Having stated these provisos, however, surgical procedures can and should be an important part of general practice within the British National Health Service (NHS). There are many advantages to be gained, both for patient and doctor, when minor surgery is undertaken by the general practitioner.

Key Features: 1. Addresses the necessary gap in the literature with a concise yet comprehensive approach. 2. Overhauls and updates the content to provide an exam-oriented text for students of oral and maxillofacial surgery, and professionals.

Key Features: 1. Addresses the necessary gap in the literature with a concise yet comprehensive approach. 2. Overhauls and updates the content to provide an exam-oriented text for students of oral and maxillofacial surgery, and professionals.

Larry L. Hench June Wilson OBJECTIVE Millions of people presently enjoy an improved quality of life due to prostheses which repair, augment or replace parts of their skeletal system: bones, joints, teeth, etc. However, all replacement parts have a finite probability of survival. The goal of this book is to compare the survivability data for various skeletal prosthesis systems. All data derive from previously published clinical studies. Where possible statistical comparisons are made and the reasons for failure are discussed. THE NEED FOR SKELETAL PROSTHESES We are an aging population with more than 100 million people in the U. S. and Europe over the age of 50 years. An unfortunate consequence of aging is a progressive deterioration of the quality of skeletal tissues. From the age of 30 years there is a decrease in bone mass for both men and women (Fig. 1. 1). However, for women it is much greater and between 40 and 60 years of age the rate of deterioration of long bones and vertebrae of women is especially severe due to hormonal changes. By the age of 70 most women will have lost from 35 to 60% of their bone mass. The loss of volume of cancellous or trabecular bone leads to a large decrease in mechanical compressive strength (Fig. 1. 2). The clinical consequence is an increasing incidence of vertebral collapse. Cortical bone decreases in tensile strength with age (Fig. 1.

Recent Developments in Graves' Ophthalmopathy offers an overview of the pathogenesis, assessment and management of patients with thyroid-associated eye disease. Each chapter is written by an expert and truly represents the current state of the art on the particular topic. This book can therefore almost be considered a textbook on this enigmatic disorder. Recent Developments in Graves' Ophthalmopathy is designed for all those interested in this disease, including basic scientists, clinical endocrinologists, ophthalmologists, radiotherapists, and orbital surgeons. The book gives a comprehensive overview of all aspects of Graves' ophthalmopathy. Subjects covered include the pathology of Graves' eye disease and the controversial views on its autoimmune pathogenesis; assessment of the eye changes using reliable measurements; medical management of Graves' eye disease with an overview of the many treatment options available to the clinician, including orbital radiotherapy and other immunosuppressive treatments; management of the thyroid disease; and finally, the techniques for performing various surgical procedures, which are explained and illustrated.

Currently blood is a volatile issue. The safety of blood and the quantification of transfusion risks have been dominant themes that have stimulated the development of alternative approaches in this rapidly developing area. In clinical medicine conventional blood and its components are used in supportive therapies dependent on the choice of apparent uncritical trigger factors. A compounding factor is depth of prospective clinical trials for evidence. Such trials in critical care areas would be of enormous value, not only in recording adverse effects and under-transfusion, but also indicating the value of decision analysis and cost-effectiveness in transfusion practice. Alternative approaches include the use of cytokines, growth factors, humanised monoclonal antibodies, recombinant plasma factors, and buffy coat derived natural human interferons. These are being increasingly implemented in the clinic. Solutions for oxygen transport are being developed and fibrinogen coated microcapsules are being investigated for thrombocytopenia. In surgical patients, various crystalloid and colloid combinations are explored as volume replacements. To avoid allogeneic transfusions, beneficial blood saving methods include various strategies, such as autologous deposits, normovolemic haemodilution and various agents including aprotinin, tranecamic acid, desmopressin and erythropoietin, but their use in hospital shows considerable variations. That umbilical cord blood could be a significant source of allogeneic stem cells in related and unrelated transplantation is illustrated by the increasing number of cord blood banks in Europe and elsewhere. Future blood resources are likely to face several challenges: immediate challenges relate to increased regulatory and political oversights; intermediate solutions would offer some improvements in public health and alleviate public fear but probably not address the economic challenges thrust upon the medical care system. As we approach the year 2000, the major concerns about transfusion medicine remain its logistics, safety and effectiveness. This theme is presented in the proceedings of the 22nd International Symposium on Blood Transfusion, developed in 21 up-to-date topics, collected and discussed in four sections. This book will be of timely value to students, professionals and all others interested or involved in the field of transfusion medicine, whether clinical or related.

Despite recent advances in the diagnosis and treatment of various cardiac illnesses, including ischemic, valvular and cardiomyopathic disease, the most cost-effective means of employing laboratory testing and treatment modalities remains an issue in most practice settings. With the advent of managed care and vigilant third-party payer evaluation of the use of diagnostic tests and hospital length of stay, the most effective medical and economic method of managing everyday cardiac illness is a question that arises daily in practice. To this end, we have selected well-known and widely published experts in cardiac diagnosis and therapy to develop practical and informative approaches outlining the most cost-effective methods of patient management. The topics include the entire range of cardiac diseases and emphasize the economic impact on decision-making. We develop guidelines and present general strategies for the practicing cardiologist and general internist. Additionally, the editors, who have 10 years of experience in this area, discuss the methods necessary to bring critical pathways and practice guidelines into clinical use. Both hospital and out-patient phases of illness are considered. Special concerns of hospital, private practice managed care and group practice settings are specifically addressed.

Strain Measurement in Biomechanics will provide a valuable reference source for all research workers in biomechanics and biomaterials as well as orthopaedic manufacturers and orthopaedic surgeons.

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."

The topicS in this book represent the presentations given at the Fifth Annual Meeting entitled "Cardiac Surgery: Current Issues" held at the Frenchman's Reef Beach Resort. St. Thomas. U.S. Virgin Islands. November 11-14. 1992. This symposium was sponsored by the Division of Cardiothoracic Sur gery. the School of Cardiovascular Perfusion and the Department of Nursing Education and QUality Assurance of Cooper Hospital/University Medical Center. the University of Medicine and Dentistry of New Jersey. Robert Wood Johnson Medical School. Camden. New Jersey. as well as the Academy of Medicine of New Jersey. Chapter authors were charged with the task of writing brief overviews of major issues related to the field of cardiac surgery. The book is specifically tailored to the needs of cardiothoracic surgeons. cardiovascular perfusionists. allied health professionals and nursing personnel involved in all phases of caring for the cardiac surgical patient. Although intended as a reference source with emphasis on up-dated approaches applied in cardiac surgery. it is hoped that the discussion of these topics will compliment other texts and manuscripts. Obviously.';ibook of this length cannot cover the whole multidiSciplinary and complex field of cardiac surgery. However. co-editors are certain that the annual appearance of this text will highlight comprehensive. new and interesting approaches to the field of cardiac surgery."

A thorough review of the operative techniques as well as the indications, pitfalls, strategies and timing, complications, and long term results involved in the surgical treatment of ulcerative colitis and Crohn's Disease. As IBD is characterised by a high incidence of re-operations and complications, independent sections of the text are devoted entirely to surgical treatment of specific complications and the management of recurrent diseases. Exquisitely illustrated with over 200 line drawings, this book contains important information on medical treatment, endoscopic evaluation, pathology, radiology, and aetiology.

The aim of this symposium was to provide basic and clinical investigators with the latest information on the biology of wound healing and tissue repair. Written and edited by eminent experts in the field, the papers cover the general concepts of wound healing; the role of nutrients; endogenous growth factors; clinical applications of growth hormone and IGF-1 therapy; and clinical applications of peptide growth factors.

A description of the latest methods of oncological and hematological diagnostics, such as immunological, molecular genetic and histological essays. All methods are described in principle in their different variations and compared with regard to their effectiveness and cost. Written for scientists, clinicians and personnel in research, specialised and routine diagnostic laboratories in hospitals, this book satisfies the increased demand for information on new methods in hematology and oncology.

This reference book is for anyone involved in generating surgical training scenarios, as well as in VR-based training in general. It examines the main components required to define a scenario, in the context of surgical scene generation: Generation of the scene geometry; modelling of organ appearance; definition of biomechanical parameters. The book is the ideal reference for any reader involved in generating training scenarios, as well as in VR-based training in general.

With the introduction of new post-graduate Medical training in the UK, virtually all doctors will be exposed to some form of surgical training prior to specialization. Many of these doctors will have little exposure to surgical emergencies in medical school. Thus, they may unnecessarily refer to a senior doctor when not needed, or catastrophically neglect a patient needing urgent surgical opinion. Surgical Emergencies in Clinical Practice is a compact resource which allows any clinician, without previous surgical knowledge, to be able to make an accurate diagnosis and have a treatment plan for the whole spectrum of surgical emergencies. The essential steps of initial management of all surgical emergencies is outlined in a manner that can be used on a day-to-day basis for clinical management. Written by experts in the field, Surgical Emergencies in Clinical Practice is a valuable tool for all junior doctors and medical students in the UK, Europe, Asia and North America. It will also be of interest to nurse practitioners, general practitioners and allied health professionals managing these patients.

As recently as 20 years ago, ceramics were widely ignored as potential biomaterials. Interest in bioceramics has increased dramatically over the past decade to the point where it is anticipated they will be the materials of choice for many orthopedic, otologic, maxillofacial and dental applications during the decade of the '90s. Alumina ceramics are being used extensively as articulating comJ1onents in total joint prostheses because of Ithe materials low coefficient of friction and excellent wear resistances. Alumina ceramics are also being used in dental and maxillofacial applica tions because of the materials excellent biocompatibility. Because of its ability to chemically bond to bone, hydroxyapatite is rapidly becoming the material of choice for many dental and maxillofacial applications. For the past decade, one of the most widely researched topics in the field of orthopedics has been the clinical evaluation of joint prostheses based upon stabili zation via tissue ingrowth. It appears that the next generation of joint prostheses will be based upon direct chemically bonding to bone using hydroxyapatite, surface-active glass or surface-active glass ceramics coatings. Resorbable bioceramics are limited to temporary bone space fillers, periodontal pockets treatment and resorbable pharma ceutical delivery systems. Bioceramics is a comprehensive reference textbook covering the history of bio ceramics, present status of bioceramics, and prediction for future use of bioceramics. This book will serve as a major reference for students, as well as experienced bio material researchers. The book presents the state-of-the-art of bioceramics as of 1991."

Focuses primarily on aortic and mitral valve disease. Special attention devoted to optimal timing and the role of echocardiography to assess prosthetic valve function and dysfunction. Discusses techniques for aortic valve surgery and choosing valve replacement devices. Part of the series: Developments in Cardiovascular Medicine

Xenotransplantation could have an impact on at least three aspects of medicine. The first is as a means of overcoming a severe shortage of human donor organs for the treatment of organ failure. The second aspect relates to the possibility that a xenogeneic organ would not be susceptible to infection by a "human" virus and thus the xenograft might resist injury caused by such viruses. The third and, as of yet, unexplored aspect relates to a means of delivering genes for therapeutic purposes thus overcoming some of the limitations of "conventional" gene therapy.

In the past ten years, full-scale simulation training has become dramatically more evident in undergraduate and graduate medical education. This increase has been due pri marily to two factors: the development of new computer-driven technology and an interest in simulation-specific training techniques. Technologically, simulators have evolved from simple anatomical reproductions to full-scale accurate reproductions of anatomy and physiology powered by multiple computers. High-technology simulation centers run by teams of faculty are emerging as integral tools in fulfilling medical centers' educational missions. In addition, educational techniques specific to simulation, which have been de veloped and used by other industries for over half a century, are being applied to medical training. Aviation and aerospace have used sophisticated simulation since the 1950s to train pilots and astronauts. Extrapolating these methods for use in the medical world has been a natural course of events, particularly in specialties that require some of the same basic thought processes and interactions required of the pilot or astronaut. It is not surprising, then, that anesthesiology would be the medical specialty to take the lead in adding simula tion training to its educational programs. The anesthesiologist's job in the operating room is similar to that of a pilot in a cockpit, not in the specific tasks, but in decision making, technological and human interfaces, and crisis management."

- Unlike previous atlases that deal with overall surgical techniques, this book goes into greater detail and focuses on individual cases.

- Lavishally illustrated with 534 illustrations, 133 of which are in color.

-

****VERKAUFSKATEGORIE*** 0 e

Lung cancer is the most common cause of cancer-related death in the world. Recently, better understanding of the biology of lung cancer has led to the development of newer targeted therapies for specific subpopulations of lung cancer patients. While this has led to multiple exciting advances that promise to improve outcomes in the future, there has also been a significant increase in the complexity of care of the lung cancer patient. Part of the Oxford American Oncology Library, this concise handbook identifies best-practice guidelines, as well as differences of opinion in the field. It presents the most current procedures for the diagnosis and management of lung cancer in a succinct and easy-to-read manner. Chapters focus on topics such as the biology, pathology, and staging of lung cancer, special populations, and supportive care. Lung Cancer is a must-have tool for busy oncologists.

It gives me particular pleasure to write the foreword to this book; this is largely due to the fact that I have devoted a substantial part of my life to the improve ment of the methods used in ophthalmic research. Rarely has one of my students taken the opportunity of dealing systematically with the possibilities of these methods. Dr. Eisner is, however, one of these exceptions. First, he has substantially improved the indentation contact glass; secondly, he has, with untiring enthusiasm, made a systematic collection of the normal and pathologic findings, which, with the help of the indentation contact glass and the slit lamp, can be observed in the outermost periphery of the fundus and the ciliary body. He has compared them to findings obtained with slight magnification in autopsy eyes and to histological sections. Owing to a fortunate circumstance, W. Hess, who is both an excellent draughts man and a master of the special examination technique, was able to reproduce the visual phenomena faithfully. The reader who tries to interpret these illustrations spatially will discover that this was often not easy. It is a process which requires a certain effort of imagi nation of space, but which is very rewarding. Dr. Eisner's monograph is an introduction to a little-known branch of biomicroscopy which broadens our means of diagnosis and promises further interesting aspects for the future. I wish him well-earned success.

From the foreword: "Microsurgery of Retinal Detachment is an important contribution to the practice of vitreoretinal surgery. In this comprehensive volume, Dr. Bonnet shares her extensive experience in the management of conditions ranging from retinal tears and primary retinal detachment to giant retinal breaks and vitreoretinal surgery. The field of microsurgery has continued to evolve over the last twenty years, both for the anterior segment surgeon and, since 1970, for the vitreoretinal surgeon. Although there have been extensive descriptions of vitrectomy techniques, little has been written about microsurgical techniques for scleral buckling operations. This subject is well covered in the present edition, which consequently will be a valuable resource to the majority of retinal surgeons who do not as a rule employ microsurgery in the repair of retinal detachments."