J. Navratil The performance of operations on the heart and its replacement by a trans planted or artificial heart has been an age old dream of man. Rehn for example in an early attempt, in 1868 performed a closure of a heart wound after a thoracic puncture. At that time noone thought that this attempt was the beginning of cardiac surgery. The dream was partially realized when the replacement of the heart function by the heart-lungmachine became possible. Immediately following the first operations, cardiac surgeons and cardiologists saw with great enthusiasm that this machine could be an important tool for correcting congenital and non congenital heart diseases. However, the heart-lungmachine was soon seen to not be an optimal instrument for controlling cardiac failure after cardiopulmonary bypass or myocardial infarction. then arose for the development of mechanical assistance to the heart. Concepts The rollerpump was first designed for assisted circulation and could be applied clinically in 1962. A new concept of mechanical assistance to the heart was pro vided by the intra aortic balloon pump and later by the bypass ventricles. Use of the intra aortic balloon pump can reduce cardiac work by counterpulsation in accord with the natural ECG. The bypass ventricle can functionally replace the heart in series or parallel to the natural heart. The intra aortic balloon pump, now an established method, has reduced the number of patients who used to die from cardiac failure."

Many pathologists have little acquaintance with ear, nose concomitant biopsy have become commonplace in the and throat pathology. Some receive few specimens from management of throat disorders. It is hoped that. by ENT tissues; others are deterred from deeper study of the publication of this Atlas, pathologists receiving only material that emanates from regions the normal anatomy occasional specimens will be guided in their provision of of which is so forbidding in its complexity and holds no a report helpful to the clinician and those who are involved familiarity through autopsy investigation, for, apart from with a larger ENT service may be providec with a guide the larynx, there is usually no compelling indication for to the deeper understanding of the subject. examination of the ear, nose or throat at postmortem. Yet. The modern tendency in publication of ristopatholog equally with biopsy specimens from other parts of the ical microphotographs is to omit any statement of their body, the pathologist's report is consequential for the magnification, since it will usually be clear to the reader efficient handling of ear, nose and throat illnesses and what order of enlargement is involved. I n this Atlas, sometimes even for the patient's survival."

Ultrasonic surgical techniques were first used by Dr. Kelman in the 1960s to fragment cataracts through a 2-mm incision allowing for minimally invasive surgery. The results from this procedure stimulated the development of a larger, move powerful ultrasonic unit that was used in neurosurgery. This instrument allowed the neurosurgeon to selectively remove tumor tissue with decreased blood loss and tissue trauma. The ability now of ultrasonic equipment to selectively fragment, irrigate, and aspirate tissue with minimal coagulation effect spurred its rapid use in surgery on the liver, spleen, kidney, and other intra-abdominal organs. This instrument has been invaluable in ovarian cancer cytoreduction and intricate segmental organ resection. The newest technical developments include electro cautery capability built into the hand piece and extended hand pieces for laparoscopic surgery. The impetus for assembling this volume has been to provide an extensive review of the field of ultrasonic surgery as it has currently developed including principles, equipment features, and surgical tech niques. It is hoped that the information will be of use to physicians in training and surgeons in practice. The book takes a multidisciplinary approach with chapters authored by a diversity of subspecialists in gen eral surgery, urology, surgical oncology, and gynecologic oncology. Each chapter contains basic information on surgical techniques. Together, these chapters cover surgery of the GI tract, kidney, liver, and lower genital tract, and present a number of personal approaches."

All general surgeons, and especially hernia surgeons, will benefit from this book. It contains a complete update on the research and pathogenesis of the incisional hernia. The volume describes all important diagnostic and therapeutic procedures and evaluates the appropriate use of each procedure for each particular case. Pitfalls and unresolved issues are discussed in depth, and experts of international standing weigh in on each topic.

Increased intra abdominal pressure as used in laparoscopic surgery produces various changes in the human organism. This book provides surgeons and anesthesiologists with a complete overview on these changes and the consequences for the patient in the perioperative and postoperative period. Special emphasis is laid on the management of pneumoperitoneum related complications.

This volume has been written specifically for the practising clinician. All aspects of clinical transplantation have expanded enormously in recent years, but many of the doctors involved have received little or no tuition in immunology as medical students. The various chapters, written by physicians, surgeons, pathologists and immunologists present many of the currently important issues in transplantation and demonstrate that a basic undertaking of immunology is now essential in many areas of clinical practice. Perhaps this book will not only produce an increasing awareness of immunological technique but also and, more importantly, stimulate an abiding interest in this clinically relevant topic. Graeme R. Catto Aberdeen Royal Infirmary vii Series Editor's Note The modern clinician is expected to be the fount of all wisdom concerning conventional diagnosis and management relevant to his sphere of practice. In addition, he or she has the daunting task of comprehending and keeping pace with advances in basic science relevant to the pathogenesis of disease and ways in which these processes can be regulated or prevented. Immunology has grown from the era of antitoxins and serum sickness to a state where the study of many diverse cells and molecules has become integrated into a coherent scientific discipline with major implications for many common and crippling diseases prevalent throughout the world.

Surgical Diseases of the Spleen written and edited by internationally renowned scientists will be a masterpiece for any institution. It provides an updated multidisciplinary review of diseases of the spleen. Experts in the field have customed their chapters to further ease the readers understanding offering all the information needed to progress in this area. Different sections on basic concepts, specific splenic diseases and operative techniques cover new aspects in immunology, infectious, traumatic and neoplastic conditions.

Where do you begin to look for a recent, authoritative article on the diagnosis or management of particular malignancy? The few general oncology textbooks are generally out of date. Single papers in specialized journals are informative but seldom comprehensive; these are more often preliminary reports on a very limited number of patients. Certain general journals frequently publish good in-depth reviews of cancer topics, and published symposium lectures are often the best overviews available. Unfortunately, these reviews and supplements appear sporadically, and the reader can never be sure when a topic of special interest will be covered. Cancer Treatment and Research is a series of authoritative volumes which aim to meet this need. It is an attempt to establish a critical mass of oncology literature covering virtually all oncology topics, revised frequently to keep the coverage up to date, easily available on a single library shelf or by a single personal subscription. We have approached the problem in the following fashion. First, by dividing the oncology literature into specific subdividions such as lung cancer, genitouri nary cancer, pediatric oncology, etc. Second, by asking eminent authorities in each of these areas to edit a volume on the specific topic on an annual or biannual basis. Each topic and tumor type is covered in a volume appearing frequently and predictably, discussing current diagnosis, staging, markers, all forms of treatment modalities, basic biology, and more."

In recent years, a series of excellent textbooks have been published dealing with pathology of the thyroid gland. The present volume of CURRENT TOPICS IN PATHOLOGY provides further information for both pathologists and clinicians interested in the thyroid gland. The contributions deal with surgical pathology of the thyroid as well as with basic aspects of thyroid metabolism, hormone transport, and growth factors in thyroid cells. The topics covered in this book should mainly be considered as adjuncts to common textbooks on thyroid pathology. The contributions should help pathologists in their routine diagnosis and should stimulate further thyroid research.

J. E. Fischer, M.D. Professor Greep, ladies and gentlemen. It is a great pleasure for me and the participants to be present at this International Meeting of Parenteral Nutri tion. This meeting would not have been possible five years ago. At that time we were still arguing about central vs. peripheral routes, efficacy of the tech nique, and still getting accustomed to our ability to support patients nutri tionally. Within the last five years these discussions, which seem almost futile in retrospect, have been put aside. Both techniques, we know how, work quite well and have their own indications. Having become comfortable with the technique, it is now time to enter the second phase of parenteral nutrition, and that is the differentiation of the technique for the benefit of different patients. Over the next two days we will be discussing several problems which at the present time are central to the entire subject of parenteral nutrition. Is a fat calorie the same as a carbo hydrate calorie? What is the effect on protein metabolism of the fat calorie as opposed to the carbohydrate calorie? Are they equivalent? Are'there situations in which one is superior to the other? Perhaps we will find out tomorrow in the panel."

This book contains the proceedings of the ARW NATO conference on Lipid Mediators in Immunology of Burn and Sepsis held in He1singor, Denmark, July 20-25, 1986. This meeting brought together some of the most distinguished re- searchers in the fields of thermal injury, the immune system and lipid mediator biochemistry. It is well known that there is a substantial impairment of the immune response during sepsis, burn, trauma and other kinds of shock. These conditions are characterized by a massive inflammatory process which occurs during the early phase following injury. Among the various mediators released at this time are 1euko- trienes, thromboxane, histamine and platelet-activating factor. This latter autocoid possesses potent proinf1ammatory properties and toge- ther with the other mediators may account for some of the post-injury pathophysi 01 ogi ca 1 phenomena such as extravasati on, hypotensi on, chemotaxis...It is of great interest to note that recently 1euko- tri enes and plate 1 et-acti vati ng factor have been shown to be potent mediators of the immune response. Thus, the purpose of this meeting was to bring together clinicians, immunologists and biochemists in order to examine and hopefully clarify the putative role of various lipid mediators prominent in the early stages after injury. This book is divided into the following six sections. Section 1 provides a general overview of the physiological con- sequences of burn, sepsis and shock.

New surgical techniques for the treatment of anal incontinence have given the increasing number of afflicted patients hope for a cure. Colorectal surgeons and more and more general surgeons are performing operations, yet until now they have not had a text that they can use as a reference work. The guidance and instruction that surgeons need are now available in this atlas. It describes every operation in technical detail, and the two-color illustrations clearly show the essential points of each procedure. The authors discuss thoroughly the indications for surgical treatment, its application to the individual patient, and post-operative care. The comprehensive scope of this book makes it a rich source of information for surgeons working outside highly specialized centers. For specialists, it is the only practical reference available on the subject.

Developmental Perspectives on Craniofacial Problems presents a developmental approach to psychological research on craniofacial anomalies. Craniofacial anomalies represent one of the most commonly occurring birth defects, and although recent surgical advances have been substantial, little has changed in over forty years with regard to the assumption that facial disfigurement must result in psychological problems. This book advances current understanding of the psychological impact of craniofacial anomalies by reevaluating the prevailing view in light of the most current perspectives and findings in developmental psychology. Distinguished scholars have applied their expertise in social, emotional, and personality development to understanding the psychological development of children with craniofacial anomalies, covering a wide range of topics in developmental psychology.

One of the first applications of lasers was for surgery on the retina of the eye. That, and the evident analogy to the old dreams of powerful heat rays, led many to predict that lasers would quickly be used for all kinds of cutting and welding, including surgical applications. It was soon apparent that laser sur gery could be performed in ways that caused little bleeding. Nevertheless, other surgical applications have been slower to arrive. One difficulty has been the enormous range of possibilities provided by the many different kinds of lasers. Infrared, visible, and ultraviolet light beams each interact very differently with human tissues. Light pulses of enor mously great peak powers became available from lasers, but their effects dif fered in surprising ways from those obtained with continuous beams. That provided both opportunities (i.e., treating or removing a very thin surface layer without affecting the underlying tissue) and problems with undesired side effects. Moreover, techniques were needed to deliver a precisely con trolled amount of energy just where it was desired. Lasers also had to be engineered and manufactured with the desired power levels and a high reliability."

ThisbookcomprisesthescientificproceedingsoftheInternationalWorkshop onDigitalMammography(IWDM),heldinBremen,Germany,fromJune22 toJune25,2002. Sinceitsinceptionin1992,IWDMhasgrownintotheIn- ternationalForumonDigitalMammography. TheuniquenessofIWDMisits attractivenesstoresearchers,medicalpractitioners,andindustrialdevelopers. F6rmerworkshopswereheldinSanJose,USA(1992),York,UK(1994), Chicago,USA(1996),Nijmegen,NL(1998),andToronto,Canada(2000). Each ofthesescientificeventshasbeencombinedwithverysuccessfulandfocused industrialandresearchexhibits,whichdemonstratedthemilestonesofdigital mammographyhard-andsoftware. Now,thatdigitalmammographyisenteringroutineclinicaluse,wewitness itsstrongimpactonscreeninganddiagnosticmammography,computeraided detection,minimallyinvasiveprocedures,andthedevelopmentofsystemicand integrateddisease-orientedbreastcare. Inviewofthis,the2002workshoppro- videdawindowtogiveusaglanceatthefuture,andtheworkwhichwas presentedintalks,postersandexhibitshasdemonstratedthatIWDM2002will takeaspecialplaceintheverysuccessfulsequenceofIWDMevents. Finally,asconferencechair,Iwouldliketothankallwhohavehelpedtopre- pareandrunIWDM2002:theScientificAdvisoryBoardforitsexcellentworkin guaranteeingscientificsignificance,theOrganizationalBoardforitshardworkto accomplishanappropriateframeworkfortheevent,andtheindustrialexhibitors andsponsorsfortheirgeneroussupport. Bremen,January2003 Heinz-Otto Peitgen ConferenceChair ProfessorofMathematicsand BiomedicalSciences VI Scientific Committee SusanAstley UniversityofManchester,UK UlrichBick CharitBerlin,Germany/UniversityofChicago,USA MichaelBrady OxfordUniversity,UK HiroshiFujita GifuUniversity,Japan MaryellenGiger UniversityofChicago,USA NicoKarssemeijer UniversityHospitalNijmegen,TheNetherlands Heinz-OttoPeitgenUniversityofBremen,Germany EttaD. Pisano UniversityofNorthCarolina,USA MartinYaffe UniversityofToronto,Canada IWDM 2002 was supported by (MeViS SIEMENS BreastCare medical I' General Electric ARC-0 Fllmle. . Perfection for DI I JMammography Table of Contents Imaging Systems and Detectors...1 DigitalMammographicApplicationofaSinglePhotonCountingPixel Detector...3 Amendolia SR, Bisogni MG, Delogu P, Fantacci ME, Novelli M, Quattrocchi M, Rosso V, Stefanini A, Zucca S BreastCancerScreeningUsingaDedicatedBreastCTScanner:A FeasibilityStudy...6 Boone JM, Lindfors KK, Seibert JA, Nelson TR PhysicalEvaluationofaPrototypefortheSectraMicrodose MammographySystem...12 Lundqvist M, Bergstrom D, Cederstrom B, Chmill V, Chuntonov A, Danielsson M, Aslund M DoseMeasurementsonaScanningMulti-slitDigitalMammography System...17 Hansson B, Cederstrom B, Danielsson M, Aslund M DigitalMammographyvs. toScreen-FilmMammography:aPhantom Study...20 Heid P, PagliuchiC, Seradour B, Motte N, Langlois L, Kurkdjian S, Piana L MammographyTaxonomyforImprovementofLesionDetectionRates...27 Howard D, Roberts SC, Tabar L AHighResolution(25 p. m)HybridSelenium/CCDSlotScanDetector forDigitalMammography...33 Hunter DM, De CrescenzoG, Mainprize JG, Mawdsley GE, SmithC, Kasap SO, Rowlands JAR, Tumer T, Yin S, Yaffe MJ Co-registeredBreastImagingwith3DX-Raysand3DUltrasound...38 Kapur A, Eberhard JW, Abdalmajeid AM, Thomenius K ImagingCharacteristicsofaDirectConversionFull-FieldDigital MammographyDetectorusingSelenium...4 3 Lee DL, Yorker lG, ling Z, leromin LS SimultaneousAcquisitionofDiffraction,ScatteringandPhase-Contrast ImagesbyMeansofaMulti-LayerEdge-OnMicrostripDetector 48 Olivo A, Arfelli P, Bergamaschi A, Dreossi D, Longo R, Menk RH, Montanari F, Pani S, Poropat P, Rigon L, Vallazza E, Castelli E VIII FullFieldDigitalMammographywithaCCDBasedSlot-Scanned Detector. PhysicalCharacteristicsMeasurements...

It gives us great pleasure to contribute a short introduction outstanding book. This comprehensive work provides an to this important volume. immense fund of information, and will be an invaluable The transplantation of thoracic organs - heart, heart source of knowledge to physicians, surgeons, and scientists lung, lung - is a field of surgery that is expanding annually. for many years to come. The use of mechanical assist devices and artificial hearts to support patients awaiting transplantation is also developing rapidly, and further advances in this field may eventually April 1990 Christiaan Barnard lead to a totally implantable device that will function Cape Town, South Africa successfully for many years. It is therefore timely that such a volume as this should be made available to those who wish to be brought up-to date with the current state of knowledge in these related fields. The editors have done us all a great service in bringing together experts in every aspect of heart and Nazih Zuhdi lung transplantation and replacement to contribute to this Oklahoma City, USA Xl Preface The fields of the transplantation and replacement of thoracic Refinements in bioengineering have enabled mechanical organs have expanded immensely since the first human assist devices and the total artificial heart to support patients to-human heart transplant was performed in 1967. This successfully until a suitable donor becomes available."

Cyclosporin has had a remarkable effect on clinical organ transplantation. Prior to its introduction, considerable advances had been made in the grafting of vital organs, particularly the kidney, heart and liver. In many developed countries, however, transplantation was not considered wo-rthwhile in terms of gain for the investment of resources. The improved results of kidney grafts following the use of cyclosporin has changed this attitude. For all types of organ transplantation, cyclosporin has resulted in an improvement of functional graft survival and has allowed a reduction in steroid dose and, in some cases, no steroids at all. It has permitted the first successful experimental transplantation of the heart and lungs in primate species by Reitz and colleagues and their results were applied directly to the clinic. It was largely due to the introduction of cyclosporin that the Washington Consensus Meeting on Liver Transplantation came to a favourable recommendation and the result has been the proliferation of units performing liver transplantation, approximately fifty in North America and another fifty in Europe, where previously there had been a handful. Having been involved in cyclosporin for organ grafting from the beginning, I have been able to witness these developments which have far exceeded my expectations once the nephrotoxicity of cyclosporin was demonstrated in man. It is fitting that Dr.

Rectal cancer is a major killer. Most of those dying after curative surgery suffer from recurrent disease in the pelvis. Local recurrence is also the only site of failure in up to 50% of patients. A disturbing fact is that the local recurrence rate shows considerably surgeon-related variances. There is now strong evidence that optimizing surgical technique by adopting the principle of total mesorectal excision (TME) will reduce local failure rate, increase the use of sphincter-saving operations, and improve functional results. Surgeons applying this surgical principle will consistently achieve similarly low recurrence rates.

Manfred Georg Krukemeyer beschreibt zunachst das Magnetic Drug Targeting, unter dem man die zielgerichtete Arzneimittelapplikation - z. B. das Schleusen eines Zytostatikums - versteht und das eine Optimierung des lokaltherapeutischen Effekts erreichen soll. So erreicht der Autor am Ort des Tumors eine hohe Konzentration des Zytostatikums. Die Partikeln mussen gross genug sein, um von einem Magnetfeld angezogen zu werden, und wandern so in den Tumor, um dort ihren Wirkstoff freizusetzen. Ziel der Hypothese einer Studiengruppe des Autors war es, in einem wissenschaftlichen Experiment darzulegen, dass in diesem Fall Zytostatika an Eisenpartikeln gekoppelt [Fe3O4], in einen Tumor geschleust werden koennen. Das zielgerichtete Schleusen von Medikamenten - Magnetic Drug Targeting - fuhrt zu einem schnelleren Erreichen des Wirkstoffs am Zielort bei einer verminderten Menge an Wirksubstanzen. Von daher ist das Magnetic Drug Targeting auch unter oekonomischen Aspekten interessant.

The MD Anderson Solid Tumor Oncology series presents cutting-edge surgical treatment and medical therapy for specific sites. This volume, Pancreatic Cancer, addresses epidemiology and molecular biology, inherited syndromes, staging, surgical techniques, multimodality therapy, and emerging therapies. The individual chapters focus on narrow, specific topics to produce a reference work of value to those interested in pancreatic cancer from a clinical and translational research perspective. A must-have for surgical oncologists and general surgeons.

close circle of anaesthetic scientists but, with the help of computer technology, has greatly influenced the practice of the modern clinical anaesthesiologist. The efforts of anaesthesiologists, pharmaceutical companies, and the development of the internet has lead to a situation that now almost every anaesthesiologist can be in close contact to anaesthetic pharmacology computer simulation pro grams and target controlled infusion devices. These two tools allow us to in crease our understanding and improve the controllability of anaesthetic drug administration, on site, in the operating theatre. In Europe the growing enthusi asm regarding the study and practice of intravenous anaesthesia has lead to an increased output of manuscripts on this subject, the initiation of workshops on the pharmacology of anaesthetic agents and the formation of a society that embodies this spirit; the European Society for Intravenous Anaesthesia, the EuroSIVA. EuroSIVA The concept of EuroSIVA has been to provide a forum to co-ordinate, facilitate and promote high quality presentations in the area of intravenous drug admini stration. The first two meetings held in 1988 in Barcelona and 1999 in Amster dam achieved these aims. During the Barcelona and Amsterdam meetings pre senters of over 10 countries shared their knowledge with 250 and 400 partici pants, respectively. In addition to the EuroSIVA meetings the international board aims to promote education for those involved with intravenous anaes thesia."

The ability of an epithelial cell to adhere to its neighbor and to the extracellular environment is an essential process that defines in part a normal multicellular organism. In the post-genomic era of cancer biology, it is known that epithelial tumors are multi-clonal and are genetically unstable. In contrast, during the process of tumor metastasis, which is the major cause of death from cancer, a restricted set of adhesion molecules are displayed on the tumor cell surface. The adhesion molecules provide a selective advantage for migration of the tumor cell to a distant site. In this volume, the expression of specific adhesion molecules within human cancer tissues are highlighted. The expression signatures from published DNA microarray and immunohistochemistry studies are detailed. The concept that the alteration of specific adhesion molecules influence the cancer migration ability and cancer damage responses is detailed in this volume; both features are essential for the survival of an invading tumor cell. Defining the minimal adhesion receptors preserved on cancer cells during tumor progression will define the metastatic adhesion signature. Understanding the metastatic adhesion signature will reveal vulnerabilities that could be exploited for the prevention and/or eradication of the invading cancer cell.

During the past decade, significant progress in molecular and cellular te- niques has greatly advanced our understanding of the wound healing p- cess. Many of these new techniques have been utilized in the context of more classic models of wound healing. The combination of new and classic approaches has allowed scientists to make exciting discoveries in the field of tissue repair, resulting in an explosion of information about the healing p- cess. Importantly, these new findings have great relevance beyond wound healing itself. The injury repair process cuts across many disciplines, exte- ing to such broad fields as cancer, inflammation, and atherosclerosis. The relevance of the field to these many disciplines has generated great interest in models and methods for the study of wound healing. The goal of Wound Healing: Methods and Protocols is to provide scientists from many dis- plines with a compendium of classic and contemporary protocols from r- ognized experts in the field of wound healing. We hope this volume will be useful not only to those working within the field itself, but also to scientists from other disciplines who wish to adapt wound healing models to their own experimental needs. The process of wound healing encompasses many different biologic p- cesses, including epithelial growth and differentiation, fibrous tissue prod- tion and function, angiogenesis, and inflammation.

With his keen analytical mind and penchant for organization, Charles Darwin would have made an excellent clinical investigator. Unfortunately for surgery, his early exposure at Edinburgh to the brutality of operations in 1825 convinced him to reject his father's plan for his career and pursue his interest in nature. His subsequent observations of how environmental pressures shaped the development of new species provided the essential mechanism to explain evolution and the disappearance of those species that failed to adapt. Today, surgeons face the same reality as new technology, progressive regulation by government and payers, medico-legal risks, and public demands for proof of performance force changes in behavior that our predecessors never imagined. We know that surgeons have always prided themselves on accurate documentation of their results, including their complications and deaths, but observational studies involving a single surgeon or institution have given way to demands for controlled interventional trials despite the inherent difficulty of studying surgical patients by randomized, blinded techniques. That is why this book is so timely and important. In a logical and comprehensive approach, the authors have assembled a group of experienced clinical scientists who can demonstrate the rich variety of techniques in epidemiology and statistics for reviewing existing publications, structuring a clinical study, and analyzing the resulting data.