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.

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 The few general oncology textbooks are generally out of date.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."

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.

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.

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.

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."

"The experience of each one of us is the treasure of all. " Gerard de Nerval In 1952, J. L. Lortat-Jacob [2] reported the first programmed right hepatectomy, which had been carried out for a hepatic metastasis of colorectal origin. Today, excisional surgery of the liver has become a routine procedure, with a low mortality and morbi dity. The varieties of excision have increased and been modified in accordance with the site and number of lesions to be treated. These advances notably stem from both the work on the segmental anatomy of the liver by Couinaud [1] and that of Ton That Tung [3], which have opened the way to a simplified and segmental method of hepa tic resection that is both safe and reliable. This progress has been greatly facilitated by a better knowledge of the effects of vascular clamping of the liver, and by the intro duction of new techniques including per-operative ultrasound, the ultrasonic dissector and the argon coagulator. Improvements in anresthesia have also contributed to the safety of these procedures. The high incidence of colorectal cancer (the second commonest cause of cancer death in France) and the frequent occurrence of hepatic metastases from this tumour, more than justify the search for an effective therapeutic management pro tocol. The important place of surgical resection, the technical advances outlined above, and the prospect of new treatment modalities using adjuvant therapy, are additional reasons for preparing a report on this subject.

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.

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."

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.

This RRCR-conference-volume marks "number six" in a 20-year evolution of international conferences on the adjuvant therapy of primary breast cancer. Starting in 1978, a handful of some 80 en thusiastic breast cancer surgeons and oncologists, met in a se cluded mountain resort near st. Gallen in Eastern Switzerland, to exchange their early data of some pioneer trials on adjuvant sys temic therapy of early breast cancer, and to correlate their future research efforts to overcome the frustrating prognostic stagna tion of this dominant neoplastic disease in Western females dur ing the past decades. Repeated every 3-4 years, these St. Gallen International Conferences on Adjuvant Therapy of Primary Breast Cancer have continuously grown in numbers of partici pants and in normative, therapeutic influence by being published in major oncology journals 1-3], the last (6th) conference hav ing taken place from February 25-28, 1998 with more than 1800 attendees from over 50 countries worldwide. What is the fascination of adjuvant therapy in primary (early) breast cancer, and what has changed, during the last 3 years since March 1995, to justify another international gathering of this size, and of the world's leading experts in the field? There is no question, that providing even more effective care and designing appropriate recommendations for the multitudes of patients with so-called early breast cancer or at high risk of developing the disease, remain highly important public health goals."

The aim of computer-aided surgery (CAS) is to advance the utilization of computers in the development of new technologies for medical services. The Asian Conference on Computer Aided Surgery (ACCAS) series provides a forum for academic researchers, clinical scientists, surgeons, and industrial partners to exchange new ideas, techniques, and the latest developments in the field. The ACCAS brings together researchers from all fields related to medical activity visualization, simulation and modeling, virtual reality for CAS, image-guided diagnosis and therapies, CAS for minimally invasive intervention, medical robotics and instrumentation, surgical navigation, clinical application of CAS, telemedicine and telesurgery, and CAS education. The ACCAS is also interested in promoting collaboration among people from different disciplines and different countries in Asia and the world. This volume helps to achieve that goal and is a valuable resource for researchers and clinicians in the field.

The introduction of computed tomography in the diagnosis of pathological intracranial conditions has had considerable significance in cases of cranio cerebral injury. The decisive diagnostic advantage lies in the possibility of demonstrating both gross pathological change directly as well as secondary changes in normal brain structures. Computed tomography has proved its considerable worth, especially in evaluation of patients with craniocerebral injury and its sequelae. The capabilities of CT were quickly recognized and use of the technique spread rapidly. It is likely that CT will be available within a few years in all hospitals and clinics treating patients with craniocerebral injury. We believe it appropriate to present a detailed report on our experience with CT in 1800 cases of craniocerebral injury treated in the neurosurgical departments in Miinchen-GroBhadern and Berlin-Charlottenburg over a period of five years. Both acute posttraumatic complications and late sequelae are discussed extensively. A large number of illustrations is provided in order to facilitate the reader's introduction to CT diagnosis. The great interest in our conjoint study originally published in the German language, induced us to translate this book and to update the clinical material. We wish to thank the Stiftung Volkswagenwerk, the Senat of Berlin, the Ludwig-Maximilians-Universitat in Munich and the Freie Universitat of Berlin for the generous financial support which made this study possible."

Breast Cancer, the second volume in the MD Anderson Solid Tumor Oncology series, this book provides the general surgeon, surgical oncologist, and medical oncologist with the state-of-the art multimodality care for breast cancer. Divided into five sections, the text brings the field's recognized esperts addressing the current status of breast imaging, breast pathology, the role of breast surgery including management of in situ and early stage carcinoma, prophylatic mastectomy, axillary node dissection, sentinel node and lymphatic mapping, and outpatient mastectomy, as well as coverage of special selected topics featuring breast cancer in pregnancy, inflammatory breast cancer and breast sarcoma. An important section on future research reviews on-going studies for the use of in situ laser ablation, cryosurgery, and translational research to bring the busy practitioner up-to-date on state-of-the art advances. This book is a must-have resource on the full specturm of current and prospective treatment options for this challenging disease.

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."

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.

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."

Dr. G. M. Woerlee is well known in my department both as a clinician and teacher. Years ofexperience have taught him that the problems discussed here have as yet not been treated in this way in any single work. In my opinion there is a real need for such abook, not only for resident and specialist anaesthetists, but also among surgeons and internists, specialist and trainee. Management of a patient in the operating room is a matter of teamwork, and knowledge of the problems encountered is the basis of any mutual understanding The information which has been assembled and clearly presented in this book should prove to be of great assistance in guiding our patients though an important phase of their lives. Professor Dr. Joh. Spierdijk, Department of Anaesthesia, University Hospital of Leyden, The Netherlands. vii PREFACE Much of the literature being published in the field of anesthesiology today concerns a narrow, in-depth scrutiny of a specific area or anesthetic technique that does not provide the novice with an overview ofthe perioperativeperiod and the commoneveryday problems faced by the anesthetist. Dr G. M. Woerlee of the University of Leiden with his book, "Com mon Perioperative Problems and the Anaesthetist," has filled a void in the current anes thetic literature. Dr Woerlee reviews in a straightforward, no-frills manner problems routinely encountered during the perioperative period. Other anesthesia textbooks do not cover the material in quite the same logical, step-by-step fashion."

There has long been disagreement about various aspects of the structure and function of the "gatekeeper" (Greek pyloros, from pyle = gate and ouros = guard). In recent years the problem has often been mentioned in anatomy, physiology, gastroenterology, radiology and even in nuclear medicine. For instance, while referring to manometric and gastric emptying studies, Schu- urkes and van Nuenten (1984 ) pointed out that there was considerable contro- versy as to whether a true pyloric sphincter existed in most species, and espe- cially in man. According to Reeve (1981) many functional aspects of sphincters are poorly understood; the exact mechanism of control of the transfer of chyme from stomach to duodenum through the pylorus is still not clear. Malagelada (1983) states that controversy surrounds the motor activity and function of the antro- duodenal junction; there is disagreement as to whether the pylorus functions as or as an integral part of the distal antrum. Ehrlein et al. (1984) a separate unit reiterate that pyloric motility is poorly understood, and according to Funch- Jensen (1987) there are many unsolved questions. Malagelada (1990) states that the stomach performs multiple functions with a deceivingly simple anat- omy; this is regarded as the key to the investigator's frustration when trying to uncover its secrets. One source of the many controversies surrounding the pylorus may be species differences, according to Schulze-Delrieu et al. (1984).

Advances in breast cancer research, achieved through the progress of knowledge and development of new therapies, have been translated into improved quality of care for breast cancer patients. Clinical investigations and clinical trials have made the largest contribution to the body of knowledge that finds its way to the patient. Never before during the past decades of management of breast cancer has there been such a fruitful intellectual cross-fertilization of ideas among individuals involved in the generation of hypotheses, basic research, development of drugs and treatments, conduct of clinical trials, and statistical evaluation - the results of all of which are now translated into progress in clinical care. Even issues such as the quality of life of breast cancer patients, once the domain for few, are now being openly addressed by trials and discussed in a much broader forum. The IVth International Conference on the Adjuvant Therapy of Primary Breast Cancer, also known as the st. Gallen Conference, was again attended by more than 800 scientists and clinicians interested in this broad spectrum of breast cancer research and the interactions between such diverse fields of interest and specialties as cancer pathology, molecular biology, and psychosocial oncology. This volume collects findings and conclusions presented at the conference.

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.

Since surgery became a method of treating patients, progress in the field has been intimately associated with experimentation and serendipitous research. As in other clinical specialties advances in surgery can be considered to result from experimental attempts to increase basic knowledge and to improve technical skills. However, virtually in no other area do concepts and approaches of experimental research enter clinical routine as fast as in surgery. There are numerous examples of this. Thus, allocation of manpower and resources for surgical research can be considered particu- 1arly profitable as convincingly shown, for instance, in renal transplantation by comparison of the long-term burden of hemodialysis vs. kidney grafting, apart from the relief of suffering and misery. Surgery is a continuously spreading field, and so is surgical research. This volume is a case in point. Its spectrum reaches from basic molecular biological aspects of immune mechanisms to the current state of the art of pulmonary surgery of cancer metastases, and from the molecular processes of cell swelling in ischemic brain edema and blood-brain barrier damage to novel forms of resuscitation or of treatment of insulin-dependent diabetes mellitus. Surgical research faithfully reflects a constant reorientation of medical disciplines. Treatment of renal or gallbladder concrements was a major domain of surgery, where the introduction of extracorporeal shock wave treatment now supplies noninvasive, virtually conservative alternatives.

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.