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 18-20, 1993. This symposium was sponsored by the Division of Cardiothoracic Surgery, 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 perfusion ists, 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, a book 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."

B. Raymond Fink Sheldon Roth and Keith Miller have asked me to record that the Third Conference on Molecular and Cellular Mechanisms of Anesthesia was held in Calgary last May "in my honor. " Such was my dear friends' gracious way of continuing a series that began at the University of Washington, where I hosted two, four, or five previous ones, 1,3-6 depending 2 on how far back one wishes to count. At that, Seattle took up where Paris left off in 1951. These occasions create their own unforgettable memories. This book captures the fine, invigorating ambience of the University of Calgary and the exciting explorations and com panionship of a gathering in a frontier territory of neuroscience. So, floreant symposia. They have progressively refined the quarry, from pathway to synapse to lipoprotein membrane to receptor and single channel, in heuristic convergences of neuronal physiology, biochemistry, and pharmacology. Nevertheless, the anesthesiologist in me senses a certain disquiet, a certain claustrophobia provoked by the narrow confines of micropipettes. How much more tubular must tunnel vision become before the desired broad view emerges? At present, the advances in molecular neurobiology seem continually to increase the apparent complexity of the total problem and the conceptual distance between the reductionists in the laboratories and the holists in the operating rooms. Happily, what is also growing is the excitement in trying to bridge the gap. Perhaps it would be timely to regard general anesthesia not as a state but as a syndrome."

Dermatosurgery cannot readily be therefore be to impart the knowledge assigned to anyone branch of medical that gives the dermatologist this free- science, and as with any borderline dom of choice. This involves the teach- case, this assignation is a matter of con- ing not only of the basic principles of troversy. Since the end of the last cen- dermatosurgery but also of the ability tury, the place of the subject in the field to discriminate according to the most of dermatology has been firmly estab- varied criteria. In this field, technical lished. This is hardly surprising, since knowledge, motivation, and enthusi- a number of specialists in dermatology asm are not enough; talent is also re- spent the first part of their professional quired. C. Moncorps was engaged in work life as surgeons: for example, E. Lang of Vienna, famous for his treatment of on a monograph on dermatosurgery lupus by plastic surgery; and K. Linser (unfortunately nowhere near comple- of Tiibingen, one of the originators of tion) at the time of his death. As a for- varicose-vein stripping. H. T. Schreus mer pupil and long-standing colleague and C. Moncorps were distinguished of his, it is particularly gratifying to me to see colleagues past and present con- members of a later generation of sur- gery-oriented dermatologists; the der- tinuing a tradition in their work.

The volatile anesthetics continue to be one of the most mysterious yet commonly used class of drugs in medical practice today. A prominent and troublesome side effect of volatile anesthetics is their ability to alter hemodynamics. This arises from two diverse but interrelated phenomena, depression of cardiac contractility and dilation of the vasculature. These effects of volatile anesthetics on cardiac and smooth muscle plus the action of volatile anesthetics on skeletal muscle in the malignant hyperthermic syndrome have led to concern about the interaction of volatile anesthetics (and other anesthetic agents) with calcium metabolism in the muscle cell. Many of the phenomena caused by anesthetics appear to have common mechanisms in all of the muscle types; however, the differences among skeletal, cardiac and smooth muscle also lead to distinct effects of the anesthetics in each. Given the diverse research disciplines which have been brought to hear on the mechanism of anesthetic alteration of contractility, the symposium from which this book originates was convened for the purpose of gathering those with common interests in anesthetic agents and their cellular and subcellular actions in muscle. The recent symposium had its origins in a small but exciting meeting that took place at the University of Texas at Houston in 1984. At that time, Robert Merin and Jacques Chelly convened a group of people who had interest in cardiac muscle and calcium antagonists.

Despite recent advances in adjuvant therapies of cancer, the regi mens of postoperative adjuvant chemotherapy treatment which are presently available fail to cure the majority of cancer patients. Pre operative (neoadjuvant) chemotherapy represents a new approach in drug scheduling, based on sound theoretical, pharmacokinetic, and experimental principles. The preoperative timing of chemotherapy before definitive sur gery is not a minor change in the therapy of cancer. To be successful, large numbers of practitioners and their patients must participate. Substantial alterations of many aspects of the present management of cancer will have to follow. Therefore, before such therapy can be fully and routinely implemented, results of the novel treatment and its rationale have to be carefully evaluated. In preoperative treatment, other features will likely gain impor tance. For the first time, clinicians have a chance to follow the in vivo response of the tumor exposed to preoperative chemotherapy. The subsequent histological assessment of the tumor sample may likely become an important prognostic guide, permitting more re fined individual approaches to the planning of postoperative adju vant treatment. The value of such a treatment strategy can already be appreciated in the clinical setting, as seen from the therapy of osteosarcoma. Furthermore, preoperative chemotherapy might render previously inoperable tumors operable and hence resectable with a curative intention. The preoperative reduction of tumor bulk may also effectively decrease the need for more radical operations, permitting a more uniform adoption of conservative surgery."

In spite of today's increasing body of knowledge in regard to central nervous func tion and/or the mode of action of centrally active compounds, little is done to monitor those patients which are at risk of cerebral lesions either in the OR or in the ICU. Due to the inconsistency of reports regarding the application and the benefits computerized EEG and/or evoked potential monitoring will bring to the clinician, physicians still are reluctant to get involved with a technique, which they think, will have little or no effect on the outcome of a patients well being. However, due to the development in computer technology, data acquisition and comprehension, it now is possible to monitor such a viable organ as the Central Nervous System (CNS) on a routine base without being a specialist in neurology or electroencephalography. Thus, the book is intended to guide the clinician to use BEG and evoked potential monitoring in a day to day situation, without going too deep into technical details. As an improvement of cerebral care is needed, various representative cases underline the interpretation of EEG power spectra and evoked potential changes in regard to the underlying clinical situation. It is hoped that this book will serve as a guide to anyone who considers cerebral monitoring a necessity in today's patient care. This may be the anesthesiologist, the intensive care therapist, the nurse anesthetist as well as the medical personnel in the lCU setting."

R. Y.Calne Surgeons are transplanting kidneys in ever increasing numbers-more than 10000 renal allografts have now been reported to the Transplant Registry. With related donors 75% of grafted kidneys continued to function after 2 years, compared with 50% when the donors were unrelated. The therapeutic value is obvious, but the management is largely empirical and results have improved little in the past 5 years. The basic sciences related to tissue transplantation have advanced rapidly. New serological and tissue culture techniques and chemical analysis of antigens and anti bodies have produced complicated data that is almost incomprehensible to the non specialist. Mathematical treatment of genetic probabilities and of immunological kinetics are similarly difficult to follow for those not especially trained. There has always been a gulf between the practical clinician whose patients do not behave like inbred rodents and the biologist who likes carefully controlled experiments with easily observed results. Both realize, however, that predictable and safe control of rejection must involve close collaboration and co-operation between the laboratory and the clinic. Unfortwlately, the different nature of the work and the workers has widened the gap between them. The clinicians tend to improve their techniques and patient care, whilst the biologists seek clearer and more precisely deflned experi ments which lead them to use increasingly artiflcial experimental models."

Endocrine conditions requiring surgical intervention in the pediatric age group are uncommon. When diagnosed, they are the source of great in terest and, often, considerable debate. This is understandable, since few centers and even fewer individual surgeons can draw on vast experience of this subject. The great divergence of opinion regarding management is also understandable in that pediatric endocrine lesions often differ considerably from their adult counterparts in histology, natural history and response to treatment. Pediatric endocrine lesions are also, as a rule, less frequently malignant. In addition to the great strides made in surgical and anesthetic technique and operative monitoring, progress in four areas has substantially advanced the management of endocrine dis orders in the pediatric age group in the last decade: imaging, pathology, pharmacology and genetics. The new imaging tools, ultrasonography, computed tomography and magnetic resonance imaging, have added great diagnostic possibilities. More recent developments, such as radio nuclide imaging for the adrenal gland and the possibility of using tagged antibodies, promise to expand our imaging horizons even further. In the field of pathology, the develop ment of immunocytochemical markers (e. g. , monoclonal antibodies), the refinement in special stains and the continuous perfection of fine needle aspiration biopsies offer great new diagnostic as well as research capabil ities. Newer pharmacological agents, such as the alpha and beta blockers, the calcium channel blockers and thyroxine analogs, add a whole new level of safety to the management of the potentially lethal pheochromocytoma.

Dr Bovill is a remarkable person and this book is an eloquent expression of remarkable achievement. When, some seven years ago, I came to the North West from the relative psychotherapeutic luxury of London, I was amazed to discover a busy whole-time general psychiatrist who claimed that she and her staff were giving a comprehensive service for the treatment of psycho neurosis by psychological means. I did not accept the facts but I believed in the genuineness of the person, Diana Bovill. After careful observa tion and enquiry, my initial scepticism turned to admiration. I do not know of any psychotherapist who before has provided such skilled therapy for so many people at once. Another, and in some ways greater, surprise awaited me. Dr Bovill has consistently, dedicatedly, striven to describe clearly, and to evalu ate scientifically, her work - an attempt all too rare amongst psycho therapists. Entering psychiatry at a somewhat advanced age, she achieved the rare, and perhaps unique, distinction of being awarded a Doctorate of Medicine at London University for a study in psycho therapy research, approved by the doyen of British psychiatry Sir Aubrey Lewis."

Starting in 1986, the European School of Oncology has expanded its activities in postgraduate teaching, which consisted mainly of traditional disease-orientated courses, by promoting new educational initiatives. One of these is the cloister seminars, short meetings intended for highly qualified oncologists and dealing with specific, controversial aspects of clinical practice and research. Another is the institution of permanent study groups, also called task forces, where a limited number of leading experts are invited to meet once a year with the aim of defining the state of the art and possibly reaching a consensus on developments and treatment in specific fields of oncology. This series of ESO Monographs was designed with the specific purpose of disseminating the results of the most interesting of the seminars and study groups, and providing concise and updated reviews of the subjects discussed. It wa& decided to keep the layout very simple in order to keep costs to a minimum and make the monographs available in the shortest possible time, thus overcoming a common problem in medical literature: that of the material being outdated even before publication.

What is the best way to plan surgical research? What problems are most often encountered in clinical research? How should a research report be presented at a scientific meeting? These questions and more are all answered in Principles and Practice of Research.The second edition has added new sections on animal research models, the molecular and cellular dimension of surgical research, and practical guidelines for obtaining government and third-party funding. Other improvements include a friendlier discussion of statistics and updated material about on-line computer literature searches. This book provides every clinical researcher with a roadmap around the pitfalls of poorly designed studies, through the jungle of incomprehensible statistics, and over the hurdles of research reporting to a successful study from start to finish. From the reviews of the first edition: "For me, it is a bible and a "must" for every Ph.D. or M.D. involved in clinical research, especially in the field of surgery. It should be on the table - not on the book shelf - of both the young as well as the experienced investigator as a readily accessible source of information to avoid the trial-and-error approach to problems in surgical research." #"World Journal of Surgery"#1 ..".a carefully conceived, concise blend of factual theory and principles, practical guidelines, and philosophical perspective... ...I have found it hard to identify any omission (even a selected bibliography on laboratory animals, their care, handling, and anatomy is included) and impossible to single out any individual contribution: each is a treasure - well written, concise, and complete." #"The " "Lancet"#2 "The feature of the book is that, despite attention to detail, it maintains a clear and practical approach to the whole field, beginning with the reasons for carrying out research, the types of research, and above all the reporting of research... ...Almost all aspects of research are covered, from small retrospective studies to departmental, institutional, national and international projects... ...The chapter on writing for publication should be compulsory reading for all budding authors." #"Journal of Bone and Joint" "Surgery"#3

The only book to attempt any perspective on methods of assessing cell proliferation is published to satisfy the growing interest amongst pathologists and clinicians in areas which have for more than three decades been the preserve of experimental biologists

In the last 10 years, total prosthetic replacement has become the hip oper ation for many but not all surgeons. In our clinic the increasing frequency of TP has been paralleled by a reduction in the frequency of 10 and HA. For the experienced orthopaedic surgeon and hip surgeon, hip disease has so many facets that it could not possibly be tackled with one operation alone. Thus, HA seems recently to have won renewed recognition. It has once more become the procedure of choice in specific cases, possibly because of certain disadvantages and complications associated with TP which have somewhat tempered the original optimism. Currently, the risk of infection or loosening of the pros thesis is such that the operation cannot justifiably be recommended for patients under 55-60 years of age. In contrast with HA, in the majority of cases the results of TP or 10 are not fully predictable. The loss of joint motion is offset by two important advantages: -complete freedom from pain - full weight bearing is possible on the arthrodesed hip. On following up our HA operations from 1961 to 1971, we examined the development of the operative procedures in our clinic. We found that the range of indications had narrowed as stricter criteria were applied in choosing patients for operation. Adequate and precise operative tech niques were developed. We studied the biomechanics of the hip joint exten sively (effect of arthrodesis on the statics and dynamics of the hip joint and neighbouring joints).

For many years, patients who complained of prostatism had only a few treatment choices. The patient was either a candidate for an elective prostatectomy, or the operation was deferred until the patient became more symptomatic. The present text summarizes the multiple options which have become available to the practicing urologist. Minimally invasive techniques such as transurethral incision of the prostate, balloon dilatation, hyperthermia, laser therapy, and prostatic stents are described. Medical treatment with alpha-blockers, 5 alpha-reductase inhibitors, and flutamide are addressed by authors who have had extensive clinical experience with the use of these agents.

Severe, protracted pain defying control is being seen with in creasing frequency as a symptom of chronic disease. It accompanies many, mostly serious, disorders in various organs and parts of the human body, making the sufferer's life increasingly intolerable. It no longer fulfillR its mission of warning signal of disease present, protecting health, but on the contrary arises as an important factor in systematically reducing and preparing the final collapse of the defensive forces of the body, both in the somatic and psychic spheres. It can surprise nobody that patients tormented and plagued by severe pain do not wish to live under conditions primarily caused by incurable disease, and are looking forward longingly to their release by deat. h, if no help is forthcoming. Attempts to control such pain are, therefore entirely justified, necessary and logical. The treatment of intractable pain is without exception sympto matic in character. Efforts to control it by drugs are, even at present and despite the striking progress in pharmacology, unsatisfactory and inadequate. So far we know of no drug capable of effectively and systematically alleviating such pain without concurrently inter fering with the other sensitive-sensory components. In addition to the direct changes and dist. urbances of consciousness and personal ity, protracted conservative therapy results in addiction to narcot ics."

Immunology is a rapidly developing subject. The contributors in this book present some components of immunological knowledge which relate to the present and the possible future practice of surgery. Aspects of cellular and humoral immunity necessary for understanding are described and considera tion given to the mechanisms underlying immunological diseases. Whilst the original interest in immune response was related to microbial resistance, the recent impetus to surgical immunology has been the resurgence of organ grafting. Separate sections of the book deal with clinical organ transplanta tion, the allograft reaction, graft rejection and immunogenetics. A pre-requi site of successful organ grafting is suppressive control of immune responses. Approaches to conventional immunosuppression and specific non-reactivity are therefore considered. One method of cancer therapy is strengthening of the host's immune responses. Both experimental and clinical immunotherapy are discussed and components of tumour immunology necessary for their rational understand ing are dealt with separately. Successful immunotherapy requires monitoring of immune responses but another method for improving results of cancer treatment is earlier diagnosis by immunological methods. The book is aimed at practising surgeons who want to know the relevance of immunology to clinical surgery and laboratory scientists needing to understand the applications of their basic concepts. I am very grateful both to the authors for their contributions and the editorial staff of MTP Press Limited, for their considerable help."

Endocrine Neoplasia is a comprehensive, updated, and clearly-written text covering the diseases for which endocrine surgical expertise is often needed. We look towards advances in the science and the art of endocrine surgery to continuously improve outcomes for our patients. The goal of this text was to provide a detailed description of both the underlying science of disease as well as the art of clinical management.

The book is divided into five sections addressing neoplasms of the thyroid, parathyroid, adrenal gland, neuroendocrine pancreas, and multiple endocrine neoplasia. Experts from the United States, Canada, and Australia have contributed chapters addressing both the biology of endocrine tumors and the clinical management of disease. Recent discoveries regarding the genetic underpinnings of disease are highlighted. Updated consensus guidelines were used for clinical recommendations. The management of complex and often confusing clinical problems is discussed in detail.

Cryosurgery is a method of therapy that uses treatment could be viewed easily and at frequent freezing temperatures to achieve specific effects intervals. Though endoscopic cryosurgical tech on tissues. Depending upon the technique of niques were used for the treatment of prostatic treatment, the tissue response varies from an in disease and of laryngeal disease, the restricted flammatory reaction, which is associated with a visualization of the lesion, as well as some limi minor freezing injury, to the destructive effect tations in apparatus, precluded continued de which is characteristic of severe freezing injury. velopment at that time. In the following years, some early uses of Cryosurgical treatments require the use of special apparatus cooled by cryogenic agents to produce cryosurgery have fallen into disfavor, mostly be the freezing temperatures necessary in the tissues. cause of effective competing methods of thera As with any other method of therapy, the physi py, but other uses of cryosurgery have become cian must place emphasis on the selection of ap part of standard medical practice, as demonstrat propriate patients, on the careful determination ed by incorporation into textbooks of surgery and its specialities. Today, the commonly accepted of the nature and extent of disease, and on pre cise cryosurgical technique in order to achieve uses of cryosurgery are for the treatment of many types of skin disease, including cancer, for the good results."

During the past 10 years, there have been many international meetings on the storage of organs prior to transplantation, and several have led to the publication of proceedings; there have also been a number of other books on this subject-. Most of these publications have concentrated on practical clinical aspects of organ preservation and on empirical animal experiments directed towards well-defined clinical objectives. Progress was rapid at first, but it is now generally agreed that there has been little improvement in techniques during the past 5 years, although understanding has certainly increased. In 1980 the Tissue Preservation and Banking Committee of the Transplantation Society decided that a fresh approach to the problem of improving preservation methods was needed: it was decided to hold a conference at which an opportunity would be provided to return to basic principles and to examine some of the advances that have occurred in recent yelns in areas of physiology that might be important for further improvements in preservation. The conference was held in Cambridge, UK, in April 1981 and this book is based upon the papers presented to that meeting and the work of a small discussion group that met after the main meeting. The book starts with six basic review chapters, followed by sections on the effects of ischaemia and anoxia, and on biochemical and pharmacological aspects of hypothermia. Chapters dealing with organ preservation by initial perfusion followed by hypothermia, and by continuous hypothermic perfusion, follow.

The past 15 years have witnessed a marked increase in attempts to identify safe and effective treatment alternatives to prostatectomy. This book is a review of the current therapeutic efforts in the management of patients with benign prostatic hyperplasia. It is presented by a group of highly regarded basic and clinical scientists with a major interest in prostatic diseases.
The information provided in this book is aimed at a wide audience including private practice and academic urologists, research fellows and doctors in postgraduate training, and basic scientists interested in prostatic pathology.

In the last decade, physicians have witnessed a publication will serve as a stimulus to surgeons growing awareness of and concern with diseases of concerned with male reproductive disorders to in the male reproductive tract. Stimulated by this tensify their personal research attempts to develop interest, a refinement and re-evaluation of existing better therapy for diseases referable to the male reproductive system. It is finally hoped that this surgical techniques for treatment of male repro ductive disorders has been concurrently appreci publication will stimulate critical analysis of what ated. Rapid progress in this area has resulted we feel are currently accepted surgical modes of primarily from a cooperative effort from those therapy and to better promote a general inter specialists in the areas of microsurgery, medical change of clinical information referable to these and surgical oncology, endocrinology and neuro disorders. physiology, pathology, immunology, genetics and Those who have provided the text and illustra biochemistry. tions for this volume have contributed a significant As the surgical treatment of diseases and ab amount of work, and we hope that they feel their normalities of the male reproductive system has material has been well used. The editors also wish to expanded, so have the articles describing these often thank Mr."

Sepsis is still the leading cause of death in surgical and general intensive care units. Although our knowledge of this complex syndrome has increased in recent years, it is still far from com- plete. New therapeutic approaches have been developed. Some did not fullfill the high expectations for their use in clinical prac- tice; others are still under clinical evaluation. is the aim of this monograph to offer basic information on the It etiology, definition, pathophysiology, prevention and therapy of sepsis and septic shock to both the clinician and the scientist. We believe that it presents an extensive overview that may help the clinician to better understand and treat sepsis and septic shock. We also hope that this work will give some directions for future research both in the clinical field as well as the laboratory. Jena, Berlin, Jerusalem, K.Reinhart February 1994 K.Eyrich C.Sprung TableofContents I.Definition/Prognosis Sepsis and Septic Shock: Update on Definitions (Jo-L.Vincent) 0 0 0 0 0 0 0 0 0 0 0 0 ******** 3 Clinical Manifestations and Prognostic Indicators in Sepsis (R.C.Bone) ...0 * * * * * * * * * * * * * * * * * * * 16 What Determines Prognosis in Sepsis? Evidence for a Comprehensive Individual Patient Risk Assessment Approach to the Design and Analysis of Clinical Trials (W.A.Knaus, D.P.Wagner, F.E.Harrell, Jr.

How to treat advanced prostatic cancer remains controversial, despite intense basic and clinical research investigating the pathogenesis and natural history of this unique cancer highly prevalent in elderly males. Nine experts were asked to meet and discuss the facts. This resulting monograph gives an overview of the available knowledge on all aspects of the subject. The objective evaluation and consensus opinion of the authors presented here set this book apart from other publications with conflicting viewpoints. For readers eager to obtain a comprehensive and balanced view of the thousands of clinical contributions and clear advice on the choices, this book is a must.

In the past two decades, considerable interest in skin cancer has developed in the public and scientific communities. There may have been several reasons for this: - The rise in the global incidence of cutaneous cancers - New molecular biology techniques resulting in a better understanding of pathogenesis and improved diagnostic procedures - The advent of new pathological entities, e. g. , the endemic form of Kaposi's sarcoma - A constantly increasing range of therapeutic modalities, providing even more efficacious treatment and manage ment of skin cancers As N. E. Fusenig describes in the first chapter of this volume, basic research is only beginning to unravel the complex mechanism involved in cellular dedifferentiation and tumor progression. Progress is dearly needed, especially in dermato oncology, where the rise in the incidence of epithelial tumors has inflated the overall skin cancer incidence. The incidence of tumors of the skin exceeds that of all other neoplasias in humans, with recreational sun exposure being a suspected primary cause. Several studies on the effects of UV radiation have been included at the beginning of this volume. Even the role of long wavelength UV (UVA) has become a focus of research activities. The main concern is that the low carcinogenicity of UVA, in comparison to UVB, may be outweighed and exceeded in its effects by increased UV A exposure, e. g.

The European School of Oncology came into existence to respond to a need for informa tion, education and training in the field of the diagnosis and treatment of cancer. There are two main reasons why such an initiative was considered necessary. Firstly, the teaching of oncology requires a rigorously multidisciplinary approach which is difficult for the Univer sities to put into practice since their system is mainly disciplinary orientated. Secondly, the rate of technological development that impinges on the diagnosis and treatment of cancer has been so rapid that it is not an easy task for medical faculties to adapt their curricula flexibly. With its residential courses for organ pathologies and the seminars on new techniques (laser, monoclonal antibodies, imaging techniques etc.) or on the principal therapeutic controversies (conservative or mutilating surgery, primary or adjuvant chemotherapy, radiotherapy alone or integrated), it is the ambition of the European School of Oncology to fill a cultural and scientific gap and, thereby, create a bridge between the University and Industry and between these two and daily medical practice. One of the more recent initiatives of ESO has been the institution of permanent study groups, also called task forces, where a limited number of leading experts are invited to meet once a year with the aim of defining the state of the art and possibly reaching a consensus on future developments in specific fields of oncology.