Proceedings of the Second International Workshop on Epidemiology and Prevention of Gallstone Disease, held in Rome, December 4-5, 1989

This is a user-friendly guide to the principles of complete denture construction. It is a practical, extensively illustrated book for the general dental practitioner, starting with the examination of the edentulous patient and progressing through the different treatments in a logical way. A range of procedures has been described in sufficient detail so that the dentist can apply the best treatment measure to the specific clinical problem. A final chapter on domiciliary treatment has been included because elderly, housebound patients often present problems such as denture retention (because of the patients' residual ridge atrophy or insufficient muscular control). Reference to original research work has been included so that the reader can explore the research evidence for himself.

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.

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).

Investigation of anorectal disorders has become a very wide field reaching from case history and simple plain radiography to advanced techniques such as defecography, nuclear medicine, endosonography, computed tomography, and magnetic resonance imaging. The place and value of defecography, thedynamic demonstration of bowel evacuation, have not previously been clearly defined. In this highly illustrated volume, radiologists experienced in thisfield describe techniques, radiation risks, and the interpretation of normal and abnormal findings using the aforementioned techniques of investigation. Anorectal surgeons and gastro- enterologists also participatein the discussion of indications and the influence of abnormal findings on patient management. This book will be helpful as a practical guide tothe choice, performance, and interpretation of the appropriate investigationfor a patient with functional anorectal disorders. As such it represents an excellent addition to the library of every physician and specialist withan interest in anorectal disease.

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

Within the past twenty years, the field of robotics has been finding many areas of applications ranging from space to underwater explo rations. One of these areas which is slowly gaining popularity among the users group is the notion of service robotics. This book is an in vestigation and exploration of engineering principles in the design and development of mechanisms and robotic devices that can be used in the field of surgery. Specifically the results of this book can be used for designing tools for class of Minimally Invasive Surgery (MIS). Generally, Minimal Invasive Surgery (MIS), e. g. laparoscopic surgery, is performed by using long surgical tools, that are inserted through small incisions at the ports of entry to the body (e. g. abdominal wall) for reaching the surgical site. The main drawback of current designs of en doscopic tools is that they are not able to extend all the movements and sensory capabilities of the surgeon's hand to the surgical site. By im proving surgical procedures, training, and more practice, it is possible for surgeons to reduce completion time for each task and increase their level of skill. However, even in the best cases the level of performance of a surgeon in Minimally Invasive Surgery is still a fraction of the con ventional surgery. Any dramatically improvement is usually driven by introduction of new tools or systems that in turn bring totally new pro cedures and set of skills.

This book is dedicated to the memory of Walter Brendel, late Professor of Experimental Surgery and Chairman of the Institute for Surgical Research at the University of Munich, Germany. For 20 years Walter Brendel organized the renowned Round Table Symposium on Applied Immunology, first in Kitzbiihel and later in Axams, Austria. On the occasion of the 20th symposium in January 1989 he gathered together a number of scientists who have been leaders in the field of transplantation immunology and clinical transplantation for the past two decades. All of them had participated at previous meetings, some on a regular basis. Many of the new discoveries in applied immunology and transplantation medicine were first presented and vividly dis cussed at the Round Table Symposia. The annual Kitzbiihel! Axams meetings became well-known and invitations much sought after, not only for this reason but also because of the uniquely intimate atmosphere that promoted the free exchange of research findings and theoretical cut and thrust.

Tumours in Urology is an up-to-date review of the advances in clinical management, clinical science, and basic science aspects of urological oncology. The text is divided into four parts for ease of reference: In these sections the molecular biology and biochemistry of bladder cancer, prostate cancer, and renal cell cancer are examined. There are authoritative reviews of the risk factors in superficial bladder cancer, the role of chemotherapy and bladder reconstruction in invasive cancer, along with comparative views of conservative treatment and the role of radical surgery in prostate cancer. Current methods of hormonal manipulation are also discussed. Conservative surgery for renal cancer, the use of interleukins, and the use of radical lymphadenectomy for testis cancer are comprehensively set out for the reader. A unique feature is the review at the beginning of each section of the controversial areas within each major topic. This gives the reader an excellent overview of recent advances in the field.

Present knowledge in regional cancer therapy is presented in this volume. The latest research addresses the questions of optimal drug development, the best galenic form and schedule to control tissue distribution at the tumor site and efficient treatment of specific anatomical regions.

Sepsis and Innovative Treatment: The Odyssey R. C. Bone The Odyssey by Homer, dates back to the 8th century, B. C. [1]. It is a great epic adventure of Odysseus's dramatic journey from Troy back home to Ithaca. Odysseus survives the ordeals of this journey and returns with new powers and insights. The study of the pathogenesis and treatment of sepsis has also been an odys- sey. I feel we will return from this odyssey with new insights and treatments. However, as with Odysseus, this will occur only after considerable struggle. In the 1980s we had a rather simplistic view of sepsis. It was a highly lethal complication caused by infection and often charac- terized by shock and multi-organ failure. Our knowledge of the inflammatory responses associated with sepsis was embryonic compared to today. The inflammatory response was often treat- ment with mega-dose corticosteroids along with fluid resuscita- tion, vasopressors and antibiotics. Because of the paucity of mul- ti-center controlled trials documenting the risk/benefit ratio of the treatment of sepsis with corticosteroids, two large multi-cen- ter controlled trials were organized to evaluate the role of corti- costeroids in sepsis [2, 3]. Because animal models showed bene- fits of corticosteroids only with pre-treatment or early treatment, a definition of sepsis was used that did not require positive cul- ture documentation or septic shock to be included in the studied population.

The editorial group has selected these papers for publication in Progress in Orthopaedic Surgery from contributions to the "Reisensburg Workshop of Clinical Trauma Surgery" dealing with the lesions of knee ligaments and cartilage in 1975. They represent a survey of today's knowledge of pathophy siology, diagnostic means, and therapy of these lesions in the German-speaking countries. There are two "Reisensburg Workshops" annually, covering current topics of traumatology sponsored by the Ulm trauma group. Primary attention is focused not upon review lectures but rather upon the extensive discussions thus resulting in recommendations to the practising trauma surgeon in order to facilitate his clinical work. Ulm, November 1977 C. Burri, A. Ruter Introduction This volume of Progress in Orthopaedic Surgery presents a selection of papers dealing with injuries to the ligament support and articular surfaces of the knee. The menisci are not discussed as separate entities, but rather in their correct perspective as part of the knee jointsupport mechanism. As the editor for this volume, I have tried to select the most representative articles which cover this subject. These are publications from our European colleagues and reflect their opinion and experience. I have tried not to change their content or meaning in any way. This volume has been divided into six basic segments. Each deserves comment."

Implantable jOint prostheses which have been under development for more than 25 years, are today being used with success in the rehabilitation of many cases, including patients with extremely severe joint pathology. However, artificial joint designs still pose problems with respect to their function, anchoring, materials employed and the interaction of the prosthesis with the surrounding biological tissues. Some of these problems are associated with considerable therapeutic complications. Further improvement in the artificial joint requires the application of all the modern experimental and research techniques and the close cooperation of medical doctors, engineers and scientists. The International Symposium on Advances in Artificial Hip and Knee Joint Technology held at Erlangen on October 30 and 31, 1975 under the auspices of the Societas Physica Medica Erlangensis, had as its aim the promotion of just this interdisciplinary cooperation. One of the traditional objectives of the Societas has been the advancement of diagnosis and therapy by the adaptation of medical skill to modern technology and scientific engineering concepts. The major objective of this volume is to present, in expanded form, the lectures given by internationally recognized scientists and clinical researchers in the field of artificial joints in the locomotor system, and to make that information available to a wider public. The experience discussed covers the principles and primary methods of joint replacement.

The use of the compressed air-driven turbine for the activation of surgical burs and saws as developed by Dr. Robert M. Hall has been a boon for the plastic, max illofacial, and oral surgeon. The development of air instrument surgery coincided with the opening of new vistas in surgery in the area of craniofacial surgery. Cranio facial osteotomies for orbital (ocular) hypertelorism, for the deformities of cranio stenosis (Cronzon's disease, Apert's syndrome) and subcranial osteotomies at various levels of the facial skeleton have brought about dramatic improvements in the form of the facial substructure in patients with gross deformities. In many of these maxillofacial deformities the facial skeleton and dento-alveolar processes must be advanced, recessed or expanded in the lateral dimension. In such cases maloc clusion of the tceth is usual; this is corrected by intermaxillary fixation of the mo bilized bony structures which also reestablishes adequate relationships between the dento-alveolar processes of the upper and lower jaws. This brings us to the subject of surgical orthodontics, a field that is just beginning to expand; its development should bring about closer collaboration between surgeon and orthodontist, resulting in rapid and efficient improvement of malocclusion. The absence of vibration characteristic of the air-driven turbine, in contrast to the mechanically driven drill, allows the surgeon to carry out delicate and precise surgical procedures with less fatigue to himself."

Surgery as a medical discipline has from its beginnings appealed to the imagination of many. It is therefore not surprising to find that its colourful past has induced quite a few authors to take up their pens. The truth of this in the Netherlands is witnessed by a number of dissertations and monographs and especially by the numerous articles related to the history of surgery which have appeared in the medical weekly Nederlands Tijdschrift voor Geneeskunde, particularly during the two decades preceding the Second World War. The memorial volume, published in 1977 by the 'Nederlandse Vereniging voor Heelkunde' (Association of Surgeons of the Netherlands) has thoroughly covered the history of Dutch surgery since the tum of the century, but a chronological survey of the earlier events which led to these modem achievements is still wanting. This book has been written with a view to meeting this need. In it, Dutch surgery has by no means been taken as an isolated phenomenon, but considered in its context with European surgery as a whole. Foreign influences on the on surgery abroad are discussed Netherlands and, conversely, Dutch influences whilst contemporary medical thinking is set against a cultural and political back ground. It is hoped that this approach will allow the book to exceed the narrow boundaries of'campanilismo' and make it of interest to non-Dutch readers as well."

The present volume is concerned with bone surgery in the area of the facial skeleton. We find this branch of maxillofacial surgery espe- cially challenging because in our work within the Surgical Depart- ment of the University of Basle, we are constantly being confronted with the principles of internal fixation - in the care of poly- 1 traumatized patients, in organizing joint AO-ASIF courses or dur- ing trauma conferences. The problems of fracture disease and the unpleasant sequelae of unanatomical healing are by no means alien to maxillofacial surgery. Our main aim is to broaden our experience of the basic principles of stable anatomical fixation and early function in this branch of trauma and corrective surgery. It soon became apparent that pri- mary healing of fractures and osteotomies, as well as undisturbed re- vascularization of bone transplants and long-term tolerance of inert implants and joint prostheses depend on the stability of fixation un- der preload.

The Fourth International Copenhagen Symposium on Detec tion of Breast Cancer, which took place in Copenhagen August 1988, made it possible once again for scientists from all over the world to come together to present the latest advances in the fight against breast cancer. This book forms a synthesis of important contributions, with special reference to follow-up screening trials, stereotactic X-ray guided fine-needle aspira tion biopsy procedures, and new and important contributions to our knowledge concerning nonpalpable breast tumors. It is our fervent hope that the reader of this book will be encouraged to join in the struggle against breast cancer, especially screening programs, in order to detect the disease as early as possible, bearing in mind that breast cancer, in spite of recent advances, still is a dreadful strain on women throughout the world. S. Brunner B. Langfeldt Contents E. L. Kitts, Jr., J. Beutel, R. S. Holland, and B. Blank Relative Doses in Mammography: The Future Development of Film/Screen Mammography Systems . . . . '. . . . . . . . . . . . . . . . . . . . . 1 R. McLelland . Earlier Detection of Breast Cancer: An Overview 10 J. Leveque, e. O. Lorino, and J. J. Ferrara Inflammatory Disease of the Breast. . . . . 18 R. McLelland Stellate Lesions of the Breast 24 R. McLelland Screening for Breast Cancer: Opportunities, Status and Challenges . . . . . . . . . . . . . . . . . . . . . . . . . . 29 S. A. Feig Follow-up Studies of the Health Insurance Plan Study and the Breast Cancer Detection Demonstration Project Screening Trials in the USA. . . . . . . . . . . . . . . . 39 R."

Hemorheologic therapy has gained considerably in importance in recent years. This detailed and comprehensive book enumerates, discusses, and critically evaluates those treatment methods in which therapeutic success rests essentially on achieving an improvement in hemodynamics. After a general account of clinical hemorheology, fundamental aspects of hemorheologic methods and the eval- uation and assessment of hemorheologic parameters are discussed and the pathophysiology is described in detail. The treatment methods and substances that bring about improvement of the hemodynamics are described in chronologic order of first publication, and in each case all known later publications are also discussed in the order in which they appeared. This topical account of hemorheologic therapy - the results reported to date and the spectrum of applications - will be a valuable addition to the library both of the specialist and of all interested doctors in hospital and general practice.

Boston University School of Medicine has established a series of Medical Education Programs in Nutrition held each summer since 1975. These deal with controversies in human clinical nutrition. The subjects have covered various topics, including those dealing with the relation ships between diet and heart disease, diet and cancer, breast. versus bottle-feeding, and dietary fiber and disease. Other noncontroversial topics were also covered at these conferences; they were discussed simply to bring to the attention of the health professional new happenings in nutritional research. These topics dealt with the relationships of nutrition to immune function, to neurotransmitters, to infection, to obesity, and to chemotherapy. This text is a compilation of selected manuscripts of interest to the health professional in the area of human clinical nutrition. Whatever success this text enjoys is in no small way due to the ad ministrative and editorial efforts of our administrative assistant, Mrs Geraldine Rankin - our sincere thanks."

by Dr. Nathaniel R. Bronson, 11 This volume serves a two-fold purpose very nieely. For the ophthalmologist there is a presentation of the teehniques and results of ultrasonie examination of the eye and orbit. For the radiologist or general ultrasonographer the essential oeular anat- omy and pathology are deseribed with these findings. Unlike eon- ventional x-rays or statie general body ultrasonograms, the exami- nation of the eye by real-time ultrasonography must be done by an examiner with extensive personal knowledge of the eye and the orbit, both anatomieally and pathologieally. The student must realize that the Polaroid photographs ean only show an example of what was transiently seen, such as spot films taken during fturo- seopy. This is further eomplieated by the poor reproduetion by Polaroid films of the aetual gray sc ale seen during the examination. Considerable work has been done to prepare this text. The author has done elinieal ultrasonography of many eyes and presents the findings of his experienee. As in most fields of medieal diagnostie work this experienee is essential to aehieve the best results. The beginner in ophthalmie ultrasonography is eneouraged to work with known pathology. Fortunately, pathologie ehanges in the eye vii FOREWORD can frequently be seen with a slit lamp or an compared our ultrasonic diagnosis of orbital ophthalmoscope. For example, a known retinal masses with those of the same patient done on a detachment is an ideal case with which to start. CAT scanner.

The Nd: YAG laser has finally become the multidisciplinary and muitispeciaity tool of the 1980s. Primarily developed for gastrointestinal applications for controlling bleeding, at present it is also used for endoscopic treatment of gastrointestinal tumors, endobronchial cancer, and bladder and gynecological lesions and finding applications in otorhinolaryngology and neurosurgery. De velopment of laser scalpels and focusing head-pieces has now allowed the Nd: YAG laser to be used for open surgical procedures in general and plastic surgery, head and neck surgery, urology, gynecology, dermatology, and neu rosurgery. The rapid development in ceramic technology has led to contact surgery allowing physicians a choice of excision, vaporization, coagulation, incision, or combinations thereof by easily changing probes rather than having to select new laser wavelengths. This technology is rapidly replacing the carbon dioxide laser which currently has no adequate flexible waveguide for fiberoptic en doscopy, cannot be used in a water medium (e.g., bladder), and has poor coagulation properties when compared to the Nd: YAG laser. Future developments may see the Nd: YAG laser even replacing electro cautery in the operating room due to its greater safety and efficacy. Local hyperthermia (laserthermia) with computer control, photodynamic therapy, and ophthalmic applications make the Nd: YAG laser the most exciting tech nological advancement in medicine and surgery for the 1980s."

The "shoulder-hand syndrome" or pain in the shoulder or arm is an extremely vital subject for the multi-disciplinary approach and usually re quires more than one speciality for complete evaluation. The proceedings of this symposium - organized by the department of general surgery of the University of Limburg - cover the field thoroughly with contributions from outstanding specialists from all over the world. Rheumatological, neuro surgical, orthopedic, and traumatological aspects are covered. Vascular surgeons considering both venous and arterial problems entwine with thoracic surgeons to review the thoracic outlet problem. Establishing a diagnosis in this multi-disciplinary field is extremely important and encom passes a combination of disciplines including neurology, orthopedics, sur gery, and physical medicine. Likewise, the role of each contributing factor must be assessed when multiple sources were responsible for pain. In addition to adequate diagnosis, it is important to institute the appropriate therapy and to establish the proper priority and timing of such therapies. The follow-up techniques particularly regarding thoracic outlet syndrome are extremely important to provide an objective basis for evaluation. Although many advances have been made in the field of objective diagnosis and therapy, there still is a great deal of overlap and confusion which has to be clarified. Professor Greep and his organizing committee have done a wonderful job in composing a program covering all aspects of this field. They are to be congratulated on bringing us a "timely current status" report on pain in the shoulder and arm."

It was not too many years ago that the role of chemotherapy for head and neck cancer consisted of single-agent methotrexate for selected patients with recurrent disease. In the past decade, multiple new agents, high-dose chemotherapy, combinations, and intra-arterial approaches have been used for the patient with recurrent disease. Wheeler critically assesses the current status of these approaches. When oncologists began testing chemotherapy in the combined modality approach, trials consisted of induction chemotherapy and use of single agents as radiosensitizers. Although a great deal has been learned from these trials, benefit in terms of survival has been marginal. Even more promising may be the concomitant use of combination chemo therapy and radiation. Taylor describes the encouraging results as well as the potential. Induction chemotherapy may have a second important goal in addition to improving curability-it could be used for organ preservation. Dimery et al., present the background for this approach in the patient with laryngeal cancer as well as a description of their randomized trial for voice preservation. Head and neck squamous cancers are a heterogeneous group of diseases, and surgeons have long sought parameters that will help predict outcome."

Dear colleagues, Promotion of the development of ENT is one of the most important tasks of IFOS (International Federation of Otorhinolaryngology). Apart from organizing the World Congresses it supports different international and regional meetings, organizes symposiums on well determined subjects, etc. Since the last World Congress in 1981, in addition to the Danube Symposium in 1982 and the Congress of ENT Societies in Asia Oceania in 1983, an international symposium was organized in Antwerp by the Belgian ENT Society on evaluation problems of middle ear surgery. This is a very controversial question on which there is no concensus. During a four-day meeting many anatomical and pathological aspects, operative methods, possibilities of the evaluation of the results with computers, were widely discussed. You will find all the lectures presented in this book. I am convinced that these papers will prove to be a good basis for further discussion and hope that finally we shall achieve an international agreement on the evaluation of our results in middle ear surgery. My thanks go to Professor Marquet for organizing the meeting and for publishing the papers. Professor Dr. L. Surjan President of IFOS 10 WELCOME Dear colleagues and especially dear Professor Marquet, In my function as pro-rector of the University of Antwerp I am very proud of welcoming you to the opening of the International Conference on "The Postoperative Evaluation in Middle Ear Surgery." It gives me the opportunity to stress the importance of this congress and to honour Prof. Marquet."