The ultimate "consumer" of the data presented at conferences on the primary treatment of operable breast cancer is the patient, and when, as in this disease, the benefits of therapy are relatively mod est, the availability and interpretation of the data from trials be comes an issue of primary importance. The effects of present treat ment are in fact such that more patients relapse despite therapy than are estimated to benefit from it. It is, therefore, extremely dif ficult for the physician to recommend unequivocally one particular adjuvant treatment modality for the vast population of women with breast cancer. The interpretation of results from clinical research-oriented pro grams is constantly applied, however, in the treatment of breast cancer patients outside of clinical trials. From presented or publish ed data, many physicians extrapolate indications for the use of a given treatment regimen for their patients, perceiving it as the "best available therapy. " It is essential that the "best available therapy" be selected individually for each patient. However, considering the modest effect of treatment upon outcome, it is imperative that those who provide the data - those who are involved in both pa tient care and clinical research - make it known that the best cur rent treatment for the population of breast cancer patients is avail able within the framework of clinical trials. In this way not only present-day patients but also future ones will derive the greatest benefit.

After a practical description of the endoscopic anatomy, the first part of the book deals with such topics as preparing and positioning the patient, anaesthesia, operation theatre layout and operating team, inducing pneumothorax, general operative steps, after-care in the hospital, prevention of thrombosis, prophylactic antibiotics, dangers and risks of the method, and the use of documentation. General operative steps such as thoracoscopic exploration and palpation intervention haemostasis andparenchymal leaks are described in a separate section. A special part isdevoted to the diagnostic possibilities and current indications for thoroscopy including: spontaneous pneumothorax, haemothorax, chylothorax; pleural empyema, bronchopleural fistula, extrathoracic and intrapulmonary cysts and tumours, pericardial fenestration, treatment of malignant effusions, and thoracal sympathectomy.

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."

After the Second World War the number of biliary diseases has abruptly risen and lithiasis has become in many regions the most frequent surgical disease of the abdomen. At present, though there are perspectives of rational conservative treat ment and though endoscopic techniques permit removing some of its complications even without laparotomy, the basic treatment method still remains, and probably shall remain for long the classical surgical intervention. On the contrary, the indications for such intervention are always widening, as its risks become always smaller and the requirements for prevention higher. Many books have been written on the surgery of biliary ducts, but recent knowledge is growing so rapidly that it forces within short periods its new integration and critical assessment. Attention is mostly paid to interventions on the biliary ducts with their wide scope of problems and to the prevention and treatment of postoperative disturbances. New and more perfect diagnostic possibilities and some more suitable technical procedures as well require comparison and verification, introduce new aspects on old problems, and even change some established rules."

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."

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."

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."

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.

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.

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...

An authoritative panel of researchers and clinicians critically reviews the entire field to provide a comprehensive guide to modern brain tumor immunotherapy and thereby enhance future research in this area. The contributors detail many of the key laboratory experiments and clinical protocols that are currently being investigated, integrate the available information from previous and ongoing research, and help define the current status of the field. Topics range from adoptive cellular and antibody-mediated immunotherapy of brain tumors to tumor vaccines and related strategies, and include many vanguard experimental strategies and immunological techniques for studying brain tumor immunotherapy. Cutting-edge and comprehensive, Brain Tumor Immunotherapy brings together all the important recent advances in our understanding of central nervous system tumor immunology and illustrates in powerful detail the many new applications now harnessing the immune response for brain tumor therapeutics.

Mr. Chairman, ladies and gentlemen, with great pleasure I like to welcome you in the cityofGroningen and hope that you will have an enriching and enlighten ing discussion on the conference theme on risk management in blood trans fusion. The organisation of this symposium aims at scientific networking by discussing in an international forum the most important themes of current interest in relation to the state of the art in transfusion medicine. Dr. Cees Smit Sibinga took the initiative in 1976 to start organising the blood bank symposia as they were named in the beginning. Without doubt these symposia have contributed considerably to the development of transfusion medicine. To illustrate the fact that these symposia came to my attention I recollect that I have attended the symposium in 1978, chaired by Dr. Leo Vroman, in my capacity in those days of alderman deputy mayor of the city. So, it has been a long time since. After having been away from Groningen for 18 years I have been inaugurated last week as a mayor and it is a plcasure to be again in your midst. The scries of annual symposia on blood transfusion have contributed to mark the city of Groningen on the map of the international scientific world. A great number of prestigious institutes all over the world involved in the development of transfusion medicine have linked to Groningen and we are proud of that."

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."

Advances of cardiovascular engineering prompt one to consider innovative device technology - that is, the development of new replacement heart valves or engineering of a totally implantable energy source for an artificial heart. However, these kinds of advances have often proved unable to achieve a long-lasting benefit as the cardiovascular field has matured so fast. Cardiovascular engineering has matured to the point where a major innovation must not only function, but must continuously function better than existing devices. This is difficult to accomplish in the complex cardiovasculature system, in which energy source, biocompatibility, compliance, and functionality all must be considered. The maturation of the field is evident from the fact that many engineered prosthetic systems perform well - for example, heart valves function for long periods of time, large-vessel vascular grafts are quite adequate, extracorporeal membrane oxygenation has significantly prolonged the feasible length of heart bypass and other surgical operations, and total artificial hearts can be used as a bridge to transplant without serious complications, yet none of these systems is as good as the natural ones it replaces. The reasons for this are many and incompletely understood. The next stage of progress must be better to alterations understandings of the various components of vasculature and their response by our devices, be they at the micro- or macro-circulatory levels, in the blood, or associated with the vascular wall.

An invaluable work that will help dentists and oral surgeons to recognize and diagnose gross dental abnormalities. This book provides practically applicable knowledge on histology and histopathology of the changes that are seen in diseases of the dental and periodontal tissues. It includes the disturbances in tooth formation, acquired dental diseases including caries and its sequelae for the tooth-surrounding tissues, periodontal disease and odontogenic tumours. Also, attention is paid to the histological alterations induced by dental treatment.

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."

Presents both current and future aspects of diagnosis and treatment.

Presents evidence-based knowledge of pressure ulcer aetiology.

Contains over 90 illustrations.

Explores the possiblities of tissue repair using new tissue engineering strategies.

This book addresses the contemporary multidisciplinary management of liver metastases. Throughout the text, experience from the paradigms of colorectal cancer metastases treatment strategies are used to point to new directions in the management of liver metastases from other cancers. The book will be invaluable for surgeons in general surgery, hepatobiliary surgery, upper GI surgery, colorectal surgery, medical and clinical oncologists with an interest in liver tumours, and radiologists with an interest in liver disease.

Epidermolysis bullosa (EB) is a heterogenous group of genodermatoses characterized by the formation of blisters and erosions on skin and mucous membrans from birth on. The cause are mutations in the genes of structural proteins of the junction between epidermis and dermis. This book deals with the treatment of this skin disease itself and its many extracutaneous complications. There is no previous book which has been focused on the therapy and it will be based on evidence-based data derived from the world?'s largest cohort of inherited EB-patients, the American EB Registry. An important chapter will discuss gene therapy in hereditary EB which has been recently successfully performed within a localized skin site on a single EB patient as a proof-of-principle test. Given its unique collective contents, the monograph will provide the primary source for clinical informations of this oftentimes severe multiorgan disease.

This book covers a wide range of topics in oral surgery with detailed, step-by-step analysis of surgical techniques, with many examples. Various aspects of surgical techniques are analyzed. These include the instruments and materials used in oral surgery, types of flaps and suturing techniques, radiographic techniques, complications and treatment, and odontogenic infections. Also covered is the latest scientific information concerning preventive and therapeutic use of antibiotics in dentistry. The abundant photographic material, together with figures which are of excellent quality, make this book a must in every dental library.

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.

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.

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."