Ischemic brain damage represents a major source of morbidity and mortality in westernized society and poses a significant financial burden on the health care system. To date, few effective therapies have been realized. Recent evidence, however, suggests that channels, pumps, and ionic exchangers are involved in CNS ischemia and ischemic stroke, but the potential contribution of these channels for curing stroke is far less understood than for many other normal and pathological conditions. New Strategies in Stroke Intervention: Ionic Channels, Pumps, and Transporters, analyzes the roles played by targets in stroke development and the potential action of drugs modulating these proteins. This book provides a groundbreaking review of these ionic channels, pumps, and transporters as regulators of neuronal ionic homeostasis, providing a better understanding of ischemic brain disorders and the new pharmacological avenues for a cure.

The first international symposium on brain edema was held in Vienna/ Austria in 1965 followed by altogether eight meetings since. The most recent was organized in Y okohama by the Department of Neurosurgery of the Musashino Red Cross Hospital, Tokyo. The continuing interest of both, clinicians and experimental scientists alike may be attributable to the fact that brain edema is a common denominator of many cerebral disorders, which under acute conditions threatens life and weIl-being of afflicted patients. Although progress in understanding as weIl as treatment can be recognized since 1965 many problems remain, particularly concerning the control of brain edema under acute conditions, as in trauma or ischemia. A quantum leap was the distinction of the cytotoxic and vasogenic brain edema prototypes as advanced by Igor Klatzo, providing for transition from a morphological to functional understanding now. The recent brain edema meetings were certainly benefiting from developments of both, molecular neurobiology on the one hand side and functional brain imaging at an ever-increasing resolution on the other, such as magnetic resonance imaging orpositron emission tomography. The international symposium in San Diego 1996 may witness further breakthroughs, hopefully also of effective treatment modalities. The symposium in Y okohama was dedicated to the "Legacy of 28 Years of Brain Edema Research" as a reminder of accomplishments as weIl as remaining challenges.

Until recently, monitoring of cerebral blood flow and metabolism was an unattained goal. Determination of cerebral blood flow was limited to intermittent measurements and particularly difficult to perform in critically ill patients. Meanwhile there are techniques available, however, to monitor cerebral blood flow and cerebral oxygenation, both globally and regionally. Therefore we thought it worthwhile to discuss these new continuous techniques and to compare them with well-known techniques which discontinuously measure CBF. For that purpose, an international workshop with some leading experts in the field was held in October 1992 in Berlin. The workshop consisted of about 20 lectures, either reviews on a special topic, or latest results. These contributions were given by invitation and were extensively discussed. Unfortunately it is impossible to reproduce the discussions. On the other hand, all speakers delivered a manuscript promptly after the meeting so that we were able to edit them within a short time. Since monitoring of cerebral blood flow in intensive care is a rapidly growing and changing topic, the written contributions should be quickly available. Authors, editors and publishers have tried to come close to this ideal. As editors we would like to thank the authors and the publishers who enabled us to come out with this volume of the proceedings as early as possible.

The publication of the Vth International Symposium 1995 on "Mechanisms of Secondary Brain Damage" in Mauls/ltaly is a collection of focused reviews reaching from novel molecular- and cell biological findings to aspects of clinical management in head injury and cerebral ischemia. A specific purpose of these series of meetings introduced in 1984 is for an exchange on problems of mutual interest by international high ranking experts from the basic sciences and related clinical disciplines, such as intensive care medicine, neurology, or neurosurgery. The present volume covers three major areas: (a) Molecular and cell biological mechanisms including inflammation (b) Novel findings on mechanisms and treatment in cerebral ischemia (c) Secondary processes in head injury, regeneration and treatment Molecular-and cell biology is currently attracting attention towards activation of genomic processes associated with the demise of cells referred to as "programmed cell death" and "apoptosis" which, actually, might be distinguished from each other. Thus, the phenomenon of delayed neuronal death in selectively vulnerable brain areas following brief interruption of blood flow is scrutinized as to the contribution of the activation of suicide genes. The physiological role of such a response, among others, is removal of surplus neurons during ontogenesis of the brain. Yet, evidence is accumulating that similar mechanisms playa role in cerebral ischemia, probably also trauma, where nerve-and other cells demonstrate features of apoptosis. Observations on protection of neurons by administration of protein synthesis inhibitors in cerebral ischemia provide more direct support.

Every so often a gathering of minds and experience occurs that results in an all encompassing overview in depth of such a vast subject as Cerebro-Vascular Malformations, as occurred in Verona in June 1992 and which warrants publication. Professors Da Pian and Pasqualin deserve high compliment and it is a measure of the respect in which they are held that virtually all those most knowledgeable around the world attended, presented their work and thoughts and contributed to intense discussion. Ljunggren's opening historical survey set the stage and must be the most comprehensive yet published. Subarachnoid hemorrhage from aneurysm rupture still constitutes, I dare say, the most difficult problem for neurosurgeons, in relief of the brain injury and arterial reaction and the technical perfection of aneurysm obliteration, even for small, as well as large and giant sacs. Very large high flow A VMs can be as demanding too. The bulk of the conference was devoted to subarachnoid hemorrhage, aneurysms and A VMs which were discussed under about 14 headings each. But vein of Galen malformations, dural A VMs, cavernous angiomas and venous angiomas (renamed developmental venous anomalies) came under scrutiny, not always with consensus. Trends are perceptible such as fibrinolysis of subarachnoid clot, non surgery for Galenic and dural malforma tions, the benignity of venous angioma, but there is still much variation in approach, pharmacologically, technically and with such as the evolving endovascular and radiosurgical stories, used alone or in conjunction."

25 years have passed since a small group met for the First International Symposia on Brain Edema in Vienna. Subsequent Symposia were held in Mainz, Montreal, Berlin, Groningen, Tokyo and Baltimore. During this time we have witnessed a virtual explosion of the number of publications in this field and our basic and clinical understanding of this disease process has increased tremendously. Our meetings have always been a landmark to take stock of our experience so far and to provide perspectives toward future developments. In addition, it always was a good opportunity to renew old friendship and to make new friends. This volume is a compilation of papers presented at the Eighth International Symposium on Brain Edema held on June 17-20, 1990 in Bern, Switzerland. During this Symposium 158 papers were presented as oral or poster presentations. This considerable number of papers was chosen from more than 230 abstracts that were received. The organizers wish to thank the Advisory Committee for the work done in paper selection and focus on the Symposium. Appreciation is also given to all persons, who have contributed to the success of this meeting, the Chairmen, the participants and last but not least all the staff who worked behind the scene.

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.

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

Great progress has been made in the understanding and prevention of secondary brain damage from acute cerebral disorders, such as trauma and ischemia. Advances may be concerned in particular with better organization and logistics of preclinical emergency care, including rapid arrival of well-trained medical staff on the scene of an accident and of transportation to a competent hospital. Nevertheless, it is a safe assumption that development of secondary brain damage from both intra- and extracranial causes still represents a major factor for the final outcome in severe head injury. Thus, exchanges of experiences and information between various disciplines involved with this important clinical problem - trauma still assumes the number one position as a cause of morbidity and mortality up to an age of 45 years - may provide a basis for in-depth analysis of remaining problems as well as of methods of their solution. This exactly is the purpose of the present publication on concepts and findings pertinent for the general subject of secondary brain damage from various experimental as well as clinical viewpoints. An internationally high-ranking group of experts has been contributing to this collection of reviews on cerebral trauma and ischemia and its adverse sequelae, including cerebral exploration by most modern technologies, such as NMR spectroscopy or PET scanning, among others.

by E.K. ZSIGMOND, M.D. Department of Anesthesiology University of Illinois Chicago U.S.A. It is, indeed, a distinct honor and privilege to be invited by the authors to write a preface to this monumental monograph, Regional Opioid Analgesia. Regional Opioid Analgesia is a colossal undertaking by Drs. De Castro, Meynadier and Zenz shortly after the introduction of this revolutionary approach to pain relief which opened a new epoch in analgesiology. This is, indeed, the first authentic and comprehensive textbook encompassing the current knowl edge on this novel approach to pain relief. We are indebted to the authors for introducing the new opioids to regional analgesia with the scientists, who de veloped the potent short and ultrashort acting opioids with high therapeutic indices, which many researchers dreamt about but never before materialized. The side effect liabilities of these new opioids are minute as compared to morphine and meperidine. Regional Opioid Analgesia could not have been more authentically written than by Drs. De Castro, Zenz and Meynadier, who have conducted daily clinical investigations on all known opioids for regional analgesia as well as for neurolept analgesia. Therein lies the great value of this monograph: it is the most authentic work on this topic."

New findings involving the brain in traumatic and septic shock and after brain injury are reported in this book, including pathophysiological and pathohistological results. An experimental and clinical approach to treatment is presented together with specific results obtained from the encephalogram and from histopathological study with regard to the immunohistochemistry of toxic lipid peroxidant products. The latest results of clinical and experimental pathophysiology in inflammatory processes after traumatic brain injury and the therapeutic effects of hypertonic fluid therapy are also discussed.

This book reviews the most recent developments in the patho- physiology and therapy of ventilatory failure. It contains contributions by twenty-five internationally recognized aut- horities on respiratory muscle function and investigators actively contributing to our knowledge of the cause, diagno- sis and therapy of ventilatory failure. Of particular inter- estare the descriptions of new modalities of partial and complete ventilatory assistance as well as new knowledge re- garding ventilatory control and fatigue during stressful breathing. The reader will find here a state-of-the-art re- view of the latest research and practical applications in this most critical area of intensive care medicine.

Over the last 10 years the syndrome of severe acute renal failure has progressively changed in its epidemiology. It is now most frequently seen in critically ill patients, typically in the context of sepsis and multiorgan failure. This epidemiologic change has meant that intensive care physicians and nephrologists must now work in close cooperation at all times and must take many com plex issues of prevention, pathogenesis, and management into account that they did not previously have to tackle. Simultaneously, the last 10 years have seen the development of major technical and conceptual changes in the field of renal replacement therapy. There are now previously unavailable therapeutic options that provide physicians with a flexible and rapidly evolving armamentarium. The nutrition of these patients, previously limited by the par tial efficacy of renal replacement therapies, has also become more aggressive and more in tune with the needs of critically ill patients. Increased understanding of the pathogenesis of the multi organ failure syndrome has focused on the role of many soluble "mediators of injury" (cytokines, leukotrienes, prostanoids etc.). These molecules are likely to participate in the pathogenesis of acute renal failure. Their generation and disposal is also affected by different techniques of artificial renal support."

During the last decade a multitude of studies concerning the dynamic changes in cerebral blood flow (CBF), cerebral metabolic rate of oxygen (CMRO2), and intracranial pressure (ICP) in the acute phase after head injury have been published. These studies have been supplemented with studies of cerebral autoregulation, CO2 reactivity and barbiturate reactivity. Other investigations include studies of cerebrospinal fluid pH, bicarbonate, lactate and pyruvate. In this book experimental and clinical studies of the dynamic changes in CBF, CMRO2, CO2 reactivity and barbiturate reactivity are reviewed. The author's own clinical studies of the dynamic changes in CBF and cerebral metabolism are summarized and discussed, and the therapeutical implication as regards the use of artificial hyperventilation, sedation with barbiturate and mannitol treatment are discussed.

This book deals with the methods and scientific basis of inhalation toxicology. It describes devices and facilities needed to expose animals to inhaled particles and gases as well as approaches to estimating or measuring the fraction of the inhaled material that is retained in the respiratory tract. The book then reviews the evergrowing repertoire of techniques that can be used to measure the responses elicited by the exposure. Quantitative and qualitative anatomical, physiological, and biochemical strategies are discussed in detail. We believe that the toxicology of inhaled materials is an important and timely topic for several'reasons. During the past decade, morbidity and mortality attributable to cardiovascular disease have significantly decreased. Progress in combatting cancer, the second most important cause of death, has been slower, and lung cancer actually became the leading cause of death in men and the second leading cause of cancer death in women. In addition, the incidence of non-neo plastic respiratory diseases such as emphysema, fibrosis, and chronic bronchitis has increased the past decade. In the United States, the National Institutes of Health (NIH) has recently reported that chronic obstructive pulmonary disease affects nearly 10 miliion persons and accounts for 59,000 deaths yearly; indeed, it ranks as the fifth leading cause of death. Because the incidence is increasing, the NIH estimates that it may become the nation's fourth or even third leading cause of death by the year 2000."

Neurological, neurovegetative, and psychic changes following surgery or in tensive care indicate alterations in cerebral function. When these changes are analyzed exactly, they are found to be by no means rare; at the same time, they present a wide spectrum of clinical manifestations. While optimal circulatory monitoring - including continuous EEG recording during anes thesia or intensive care - is today regarded as routine, the problem of objec tive and continuous monitoring of cerebral function under various forms of anesthesia, surgery, and intensive care has not been solved. Considerable improvements in clinical neurophysiology, mainly through visual and spectral analytic evaluations of the EEG, show func tional neurophysiological changes to be equivalent to, or the cause of, clinical, neurological, and psychic changes. The question of current interest, therefore, is whether anesthesiological EEG monitoring is able, both theo retically and practically, to detect and adequately interpret cerebral altera tions following perioperative measures such that these alterations can be treated or avoided accordingly. In the long run, the basic questions are to what extent can anesthesiological measures be guided by the EEG pattern and managed effectively, and can EEG analysis be significant both for the individual patient and in the general interpretation of the effect of anes thesiological procedures? Questions of the relevance and practicability of anesthesiological EEG monitoring are dealt with in this book. This study is based on an analysis of more than 1500 EEGs of patients who underwent anesthesia during surgery."

An engaging and effective way to learn all the essential anesthesia procedures

More than any other text, "Anesthesia Unplugged," 2e disarmingly demystifies anesthesiology. Featuring an easy-to-navigate atlas-style design, this skill-sharpening book delivers step-by-step instruction on the entire spectrum of perioperative, ambulatory, regional, and general procedures.

Essential for anesthesiology residents, student registered nurse anesthetists, medical students with an interest in anesthesiology, and Intensive Care Unit personnel, "Anesthesia Unplugged," 2e features: Authoritative, complete coverage of all relevant anesthesia procedures, from the IV and laryngoscopy, to the combined spinal-epidural and transesophageal echocardiography An efficient organization featuring one procedure per chapter Critical information broken down into manageable chunks and templates - ideal for busy residents and clinicians 600 high-quality photographs and illustrations that put key anesthesia procedures into proper clinical perspective Amusing insights you won't get anywhere else with chapters that include: The Mask of Zorro: Mask Ventilation; Whiz-Bang Intubation Gizmos; PICC Lines - Just Really, Really Long IVs; Goodnight, Sleep Tight: Setup and Mask Induction for Pediatric Patients; The Lung's Not Down, You Idiot - Lung Isolation; Thoracic Epidurals--What's the Big Deal?; Stand By Me: The Femoral Arterial Line

This book records the presentations given at a workshop held in Bonn in May 1994. The aim of the meeting was to bring together scientists from various disciplines and clinicians to discuss within a group of experts the theoretical, medical, engineering, and regulatory aspects of automated control of therapeutic interventions in. anaesthesiology. The meeting was considered a continuation of a preceding work shop on "Quantitation, Modelling and Control in Anaesthesia" 1], which was held also in Bonn 10 years ago in May 1984. That workshop dealt with problems of how to quantitate concepts like anaesthetic depth, how to model anaesthetic drug disposition, how to link phar macokinetics and pharmacodynamics, and how to use such concepts for the control of anaesthetic drug delivery. With respect to these topics the current proceedings have simultaneously both a broadened and a narrowed perspective. It is broadened in so far as the topics of the workshop did not focus exclusively on anaesthetic drugs and the control of their delivery, but did also discuss anaesthesia machine monitoring and patients therapeutic monitoring as well as control of blood pressure and artificial ventilation. The proceedings have nar rowed the perspective insofar as they do not intensively discuss the processes of quantitation and modelling but presuppose them and give more room to control, especially automated control. During the past 10 years informatics has tremendously expanded its knowledge and methods applicable to control problems."

This book concentrates on problems generated by acute care in severely traumatized patients during the first 24 hours after injury. During this hectic period, highly complicated problems have to be solved at the site of the accident, during transport to hospital, and in hospital. Multiple medical and paramedical disciplines are involved in providing care to the severely injured. This book endeavors to present a problem-oriented approach to the diagnostic, therapeutic, and organizational aspects that may be encountered.

Every specialist, at present, is confronted with the fact that it is continually becoming more difficult to remain 'up to date'. The areas in which he must read are expanding while the individual publications are becoming greater in number, larger in content and appear more frequently. The choice of the subject was not easy. This time we have selected the pharmacological aspects of anaesthesiology as our main topic, as a continu ation of the Boerhaave course in 1971. Although we know that a drug works, the mechanism behind this action is of great importance. The pharmacokinetics and side effects of the drugs we administer affect not only our patients, but also ourselves, our children, and the personnel under our care. In a special section we draw attention to this subject. We fervently hope that this symposium will further enrich your knowledge of anaesthesia and that through this enrichment you will derive more pleasure from the profession you have chosen and that in the end this will lead to even better care and treatment of the patients entrusted to us. We wish to express our thanks to Prof. C. M. Conway, Dr. D. T. Popescu, and Prof. D. M. E. Vermeulen-Cranch for their assistance in the editing of some of the chapters in this book."

Intensive Care Medicine has been continuously growing and expanding, culturally, technically and geographically. Monitoring and instrumentation are continuously improving and more and more hospitals are getting Intensive Care facilities. The costs have proportionally increased over the years, so that ICUs represent today a major cost for health structures. Since the available resources are limited, a real need is emerging to set the limits and indications of Intensive Care. It is understood that the problem not only involves medical considerations, but also ethical and economical aspects of the utmost importance. For the first time in Europe, this book edited by Reis Miranda and his colleagues tackles systematically the many structural aspects of the European Intensive Care. The organisation and financing of health care in the Old Continent is deeply different from the American one, and the results and consequent proposals obtained in the USA cannot simply be transferred to this side of the Atlantic Ocean. Weare extremely pleased to welcome this first European attempt to discuss the Intensive Care problem. It lays no claims to giving definite replies in a continuously developing field, but it will surely become the basis for future discussions and proposals. I am particularly happy that this work has mainly developed within the European Society of Intensive Care, whose final target is to ensure a common standard of therapy in our old Europe, beyond national differences. We warmly congratulate the authors, and I am sure that their work will find wide diffusion and consent.

Nitric Oxide (NO) is a free radical, a gas, and a pluripotent product of mammalian cells. Only a few years ago, scientific discussions of NO were largely held in the context of the chemistry of air pollution. Now, however, the great significance of NO as a signalling and cytotoxic molecule has captured the attention of the biomedical community. This book provides a very up-to-date review of the role of NO in sepsis and ARDS. Consideration is given to NO both as a pathophysiologic mediator as well as a therapeutic agent. An internationally recognized group of scientists and clinicians have contributed chapters dealing with cutting-edge science and practical clinical strategies. Numerous tables and charts have been included to aid the reader in understanding this fascinating and important subject.

The book is based on papers presented at the recently held international meeting on central-nervous-system monitoring in Hamburg, Germany. Experts inthe fields of neurophysiology, experimental and clincial anesthesia and intensive care discussed the state of the art in noninvasive central-nervous-system monitoring. Starting with the principles of CNS monitoring in humans, the topics covered include pharmacokinetic pharmacodynamic interactions, the usefulness of spontaneous and evoked brain electrical activity as an overall-control for afferent systems andfor the assessment of analgesic drug treatment, perioperative anesthesiological monitoring, and intraoperative awareness. Recently developed specific EEG and EP indices such as spectral edge frequency, median frequency, auditory and somatosensory evoked responses for the assessment of depth of anesthesia are evaluated for intraoperative monitoring. The surgical and anesthesiological perspective in intraoperativemonitoring during vascular surgery are presented, as is the state of theart in the monitoring of afferent central-nervous-system pathways by monitoring transcranial motor evoked potentials. Bispectral EEG analysis forthe assessment of anesthetic adequacy represents the future trend in intraoperative monitoring. In addition to neurophysiological methods, assessment of jugular bulb venous oxygen saturation and transcranial Doppler sonography may give additional information for the interpretation of brain fuction. In the field of intensive care, topics in multimodal long-term monitoring of brain function are presented. The application of an expert system supporting the diagnosis of brain death is also included.

The primary mission of the medical school is to create new doctors. Once the medical student has received his or her doctorate, the medical school's interest in, and acceptance of, responsibility for the continued professional development of the physician ceases almost entirely. Yet, with scientific advances in medicine increasing exponentially and the inevitable erosion of memory with time, teachings from our schools of medicine become increasingly irrelevant, forgotten, or both. To maintain competence, the physician must continuously re-educate him- or herself. CME-Continuing Medical Education-will probably never attain the status of the medical school's degree-granting undergraduate program, but medical schools and their faculties must recognize their responsibility, not creating competent physicians but also for maintaining that com only for petence. is the product of a Continuing Medical Education program This volume initiated by the Department of Anesthesiology at the Albert Einstein Col lege of Medicine/Montefiore Medical Center. Our Department of Anes thesiology has historically been, and continues to be, unusually active in post-doctoral education through regional and national conferences and symposia. We recognized, however, that programs that bring physicians together in one location for a limited menu of lectures, questions, and discussion reach only a fraction of the potential audience of anesthesiolo gists. Such programs, as valuable as they are, by their very structure exclude more anesthesiologists than they include."

Perinatal medicine, which is concerned with the problems of the fetus and newborn, has rapidly developed in the last two decades as an important and challenging specialty. Rapid advances in the field, coupled with tech nological advances, now are making survival of infants with weights as low as 500 grams possible. Ventilator care for severe respiratory problems is on the verge of being replaced by surfactant replacement therapy; on the other hand, development of such technologies as extracorporeal mem brane oxygenation and jet ventilation has revolutionized the care of these sick infants. The advances taking place today in the field of perinatal medicine make periodic updates, like the one provided by this volume, a virtual necessity for clinicians and paramedical personnel alike. A distinguished group of specialists in various aspects of perinatal medicine has contributed to this book. Their wide-ranging experience and points of view should make this book a valuable reference for all physicians and allied health personnel involved in the care of the high-risk fetus and newborn. MANOHAR RATHI, M.D. Acknowledgements. I am grateful to the contributors for their cooperation in preparing the manuscripts, to my associates for their help and support, and to the publishers for their continued interest in this work. Above all, I thank Ms. Rose Aiello-Lech and Ms. MaryAnn Cichowski for their hard work in making this publication possible."