When John Thompson and I first began talking about finding a way to measure and cost the output of hospitals in the 1960s. we really had no concept of the need for this kind of result. In fact. if we had listened to others in the health services research community. we would rrever have begun or persisted in the task. But it seemed important to us to begin to understand what up until then seemed unexplainable - the rather strange cost behavior of hospitals. We had the benefit of Professor Martin Feld stein's observation that case-mix was certainly an important factor. but we had literally no guidance on how to make some sense out of the very large number of illnesses that beset the human race. and the very large number of different processes that obtain in our hospitals as they attempt to cope with those illnesses. We were fortunate to find a small number of curious and capable graduate students to join us in this effort. for without them we would not have had a chance of success. While many contrib uted to the ultimate outcome. it is important to single out Ronald E. Mills. Richard F. Averill. Youngsoo Shin. and Jean L. Freeman for their efforts over many years. The diagnosis-related groups (DRGs) constitute a way of identifying the normal output of hospitals in a consistent and exhaustive manner."

The first edition of Histological Typing of Soft Tissue Tumours, pub- lished in 1969, represented a major step in the standardization of nomen- clature in this specialty area. Accompanied by a glass slide set of more than a hundred common and exotic tumours, this book resulted in the rapid assimilation of a universal set of guidelines and diagnostic defini- tions by pathologists in many countries. In the intervening two decades numerous changes have occurred, and our committee has been chal- lenged by the desire to incorporate new and exciting findings from the areas of immunohistochemistry and molecular biology into the classifi- cation with the need to develop a simple reproducible classification for practising pathologists. The current system, while based principally on standard microscopic observations, acknowledges and cites the use of di- agnostically valuable ancillary techniques. Changes in the Classification Although the original classification utilized the concept of "histogene- sis" or tissue of origin in defining tumours, we have departed from that point of view, acknowledging the impossibility of determining histogen- esis by morphologic means alone. This classification is based on the "line of differentiation", or stated simply, by comparing tumours to the nor- mal cell they most closely resemble without necessarily implying origin therefrom. As in the old classification we have interpreted the term "tu- mours" in the broadest sense of the word and have, therefore, included neoplastic and non-neoplastic conditions.

The fourth edition of the TNM Classification was published in 1987,1 and a revision in 1992.2 It was the result of efforts by all national TNM Committees towards a worldwide uniform classification. The classifica tion criteria are identical with the fourth edition of the Manual for 3 Staging of Cancer of the American Joint Committee on Cancer (AJCC). Although the classification has found wide acceptance, some workers have pointed out that individual definitions and rules for staging are not sufficiently detailed. This can lead to inconsistent application of the clas sification. the antithesis of standardization. This source of differences in interpretation applies not only to the classification of individual organs but also to the general rules of the system, especially to the definitions of the requirements for the pathological classification (pT, pN). These are specified only for carcinoma of the breast; for other sites, reference must be made back to the general rules. which can lead to variable interpreta tions. The TNM Project Committee of the UICC has addressed this prob lem and collected and considered the criticisms and suggestions from the national TNM Committees as well as from cancer registries, oncolo gical associations and individual users. The result was the decision to complement the 4th edition of the TN M Classification 1.2. 3 with the publi cation of a TNM Supplement containing recommendations for the uni form use of TNM."

This text describes a system of reporting breast fine needle aspiration biopsy that uses five clearly defined categories, each described by a specific term and each with a specific risk of malignancy. The five categories are insufficient/inadequate, benign, atypical, suspicious of malignancy and malignant. Each category has a risk of malignancy and is linked to management recommendations, which include several options because it is recognized that diagnostic infrastructure, such as the availability of core needle biopsy and ultrasound guidance, vary between developed and low and middle income countries. This text includes key diagnostic cytological criteria for each of the many lesions and tumors found in the breast. The cytopathology of specific lesions is illustrated with high quality photomicrographs with clear figure descriptions. Chapters also discuss current and potential future ancillary tests, liquid based cytology, nipple cytology and management. An additional chapter provides an overview of an approach to the diagnosis of direct smears of breast fine needle aspiration biopsies. The International Academy of Cytology Yokohama System for Reporting Breast Fine Needle Aspiration Biopsy Cytopathology provides a clear logical approach to the diagnosis and categorization of breast lesions by FNAB cytology, and aims to facilitate communication with breast clinicians, further research into breast cytopathology and related molecular pathology, and improve patient care.

In recent years, the boundaries of the neurological fields have blurred, and students and scientists in all subdivisions of neuroscience now must be familiar not only with the terminology of their own specialty but also with that of the related disciplines. In response to these developments, the author has written this revised and expanded edition of her Desk Reference for Neuroanatomy (Springer-Verlag 1977), entitled Desk Reference for Neuroscience, Second Edition. The dictionary has been amplified to include terms from neurophysiology, neuropathology, and neuropharmacology, in addition to neuroanatomy. Illustrations have been added and the references and bibliographythoroughly updated. Students and scientists will find the second edition of the Desk Reference for Neuroscience an accessible and practical guide to essential terms and definitions in all branches of the neurosciences.

CT scanning is now an integral part of everyday diagnostic procedure, yet the imaging technique must be good if the diagnosis is to be accurated. Here is the book that shows how to guarantee good CT scans Patient preparation, slice thickness, IV contrast and other pieces to the puzzle of successful scanning are fully described. The consistent format allows easy cross referencing throughout the book. The sequences and protocols in this simple guidebook provide a sound basis which can be altered and adapted to suit individual needs. Practical CT Techniques has been written especially for radiographers, but junior radiologists working with CT for the first time will find it to be a useful introduction, too.

Dementia of Alzheimer type (DAT), multiinfarct dementia (MID) and dementia occurring in the course of Parkinson's disease (PD +D) now make up one of the largest categories of chronic diseases in the elderly. In addition to the burden those illnesses impose on the affected individuals and their families they consume large socio-economic re- sources. In the light of all the above mentioned features, it seemed to us that a Symposium on behalf of the 125th Anniversary of Birth of Aloys Alzheimer was particularly well-suited to help to advance research on Alzheimer's disease and other dementias. This International Symposium combined with a Satellite Symposium about "Clinical Aspects of Alz- heimer Dementias" took place in June 1989 in Wiirzburg and has been organized by the Psychiatric Departments of the Universities of Wiirzburg and Munich (H. Beckmann, K. Maurer, P. Riederer, H. Hippius and H. Lauter) and the Department of Pathochemistry and General Neurochemistry of the University of Heidelberg (S. Hoyer). In the chapters which follow, thorough reviews of recognized authorities in the field of dementia are given in the four main fields of epidemiology, neuropathology, neurochemistry and clinics. This Symposium and the edition of this book would not have been possible without the generous support of E. Merck, Darmstadt. In particular we gratefully acknowledge the efforts undertaken by Mr. Hernandez-Meyer to organizing this symposium and to publish this book. Furthermore we are grateful to the secretarial help by Mrs. Moeslein, Miss Philipp and Miss Grabner.

Until recently, innate immunity was regarded as a relatively nonspecific system designed to engulf and destroy pathogens. However, new studies show that the innate immune system is highly developed in its ability to discriminate between self and foreign entities. Understanding this mechanism can lead to therapeutic strategies based on manipulation of this previously unexploited branch of the immune system. Drawing on the research of leading experts, Nucleic Acids in Innate Immunity provides insight in this new area of immunology. The book begins by explaining the roles of nucleic acids in immunity, describing the mechanism of discrimination based on pattern-recognition receptors (PRRs), including Toll-like receptors (TLRs), Nod-like receptors (NLR), and RIG-I-like receptors (RLR). Chapters discuss how these PRRs recognize and respond to pathogen-associated molecular patterns (PAMPs) by activating specific signaling pathways. The second section focuses on the therapeutic applications of immunomodulatory DNA by manipulating released pathogenic nucleic acids as immune system stimulants. The book introduces novel therapeutics developed to prevent or treat infectious diseases, allergic disorders, and cancer, as well as clearing unnecessary or abnormal host molecules. The final section addresses how the immune system discriminates self and non-self RNA. Recent findings that host (self) nucleic acids are not inert in the immune system beg the question of exactly what elements within DNA or RNA are recognized by the innate immune system. Contributions review recent advances to understand innate immune recognition of nucleic acids and describe the resulting immune modulation. Providing a comprehensive review of nucleic acid recognition and regulation by the innate immune system, this seminal work reveals new directions for future research in immune modulation.

Experimental results reached by the authors as well as various hypotheses previously advanced by other research workers are examined in this volume. The authors' study of the course of bloodstreams in the ventricular outflow tract and in the 6th and 4th branchial arterial arches points to 13 hemodynamic patterns and 13 changes in the direction of the endocardial septal ridges. They describe the hemodynamic processes of development of several well-known malformations of the great arteries and of other vascular anomalies that have not been identified morphologically. The authors conclude that it is possible in this way to correctly explain the cardiovascular malformations that have been obtained experimentally.

This classification is based primarily on the microscopic characteris- tics of tumours. It is therefore concemed with the identification of cell types and histological pattems as seen by conventional light mi- croscopy. In general, time-honoured terms have been retained. Syn- onyms are listed only if they have been widely used, or if they are considered to be important for understanding the disease process. In such cases the preferred term is given first, followed by the synonym in parentheses. The individuality of the tumour manifests itself principally in its histological appearance and the extent of spread at the time of diag- nosis. This volume is concemed only with the histological classifica- tion of tumours. Anatomieal extent or staging is covered in the TNM 1 Classification. The histological classification of a tumour depends on two main parameters, typing and grading, and a number of additional parame- ters which may apply to selected examples.

This book is written for hospital doctors, nurses, biochemists, medi cal laboratory scientific officers and phlebotomists involved with the biochemical investigation of patients. It is hoped, also, that general practitioners and medical students will find it of help. Whilst the vast majority of biochemical tests assess the level of constituents in blood and urine at a given point in time, an impor tant additional parameter is the assessment of physiological reserve function by means of loading tests, prOlonged fasting, exercise and clearance studies. The protocol and interpretation of response of each of these stress tests form the main basis of the text. An attempt has been made to be reasonably comprehensive in the range of tests described; hence, not only have some rather older ones been re tained, but also some very recently introduced ones included. It is appreciated that practice varies widely from laboratory to labora tory with respect to protocol, sample collection, methodology and quotation of reference ranges, and no doubt also from clinician to clinician, particularly regarding interpretation of results. In paedi atric work, micromethods will demand much smaller volumes of blood than those stated here, which relate generally to adult medi cine. The account, therefore, must be seen as a guide to practice rather than as a recipe; it is in no wayan attempt to standardise procedures, which depend on the local requirements."

There is an increasing demand for high-standard fetal and infant neuropathology examinations. Novel imaging techniques, development of new diagnostic methods and advances in genetics have stimulated the interest in gaining additional knowledge on developmental, perinatal and neonatal neuropathology. Approaching the subject from a practical standpoint, diagnostic templates for reports are provided in this essential guide to aid clinicians with different areas of expertise. Each chapter will includes numerous high-quality images, accompanied by explanatory legends from the authors' own experiences. Covering autopsy and tissue processing techniques, the authors discuss a range of disorders such as neural tube defects, brain tumours, storage disorders and many others. This book provides access to an online version on Cambridge Core, which can be accessed via the code printed on the inside of the cover. Compiling the latest advances in fetal and infant diagnostics and care, this book is a highly valuable educational resource.

For scientists in physics, chemistry, biology, engineering, medicine, and other disciplines

Two research centers joined to study the development of numerous malformations of the vertebral column in 30 mutants of the laboratory mouse: the Department of Anatomy of the University of Zurich, that has long been a center of research in vertebral anatomy and pathology, and the Jackson Laboratory in Bar Harbor, Maine, the largest center of research in mouse genetics. This volume describes the normal and abnormal morphogenesis of vertebrae and summarizes the data presently available in order to give better insight into the developmental mechanics of the vertebral column.

Dismemberments: Perspectives in Forensic Anthropology and Legal Medicine is the only volume in the field to address the complexities of interpreting dismemberment trauma, the different tools used, and the sociocultural motives behind dismemberments. The book's goal is to provide the reader with a comprehensive assessment that covers all aspects of dismemberment, from means and motive, to toolmark and instrument identification, to disarticulation and re-association of body parts. Each chapter is written by internationally known, expert contributors from around the world. Users will find this to be is a great resource for those involved in the analysis of recovered human remains.

Imaging now plays an integral part in most diagnostic pathways. A familiarity with plain-film abnormalities and the more specialised modalities such as computerised tomography, ultrasound, nuclear medicine and magnetic resonance is an important part of the clinician's "medical knowledge," and a sound grasp of the subject is expected in postgraduate examinations. This book is primarily intended as a study guide for film interpretation in postgraduate examinations, especially the MRCP and FRCR exams. The layout of the questions follows the format of the examination of the Royal College of Radiologists. On right-hand pages brief clinical details and one or more imaging examples are presented for the candidate to analyse and report. In each case specimen answers with comments and, where necessary, further illustrations, are shown on the following left-hand page. This text cannot be comprehensive, but it should form a foundation for future study. Finally, we are very grateful to our many colleagues who have provided additional material for this book. London, 1987 Patric Nisbet Wladyslaw Gedroyc Sheila Rankin Introduction Guidance for FRCR Candidates Since April 1984 the Final Fellowship examination of the Royal College of Radiologists has included a new section: the Film Viewing Session. One hour is allotted to this session, with eight candidates being examined at one time using identical sets of cases. Each candidate is given eight packets of films and each packet may contain up to three films. Relevant clinical data is included with each individual case.

Preface to the Second Edition Since publication of the first edition, continuing developments in histopathology have motivated the inclusion of four new chapters: cytology, immunohistology, quality control and assessment, and the autopsy. The increasing use of cytology in clinical practice and advances in techniques and diagnostic interpretation justify the devotion of more space than formerly to this important topic. Immunohistology now merits a separate chapter because it has a status beyond that of being just another "special stain" and there are certain aspects of technique and interpretation that are peculiar to it. Quality control and assessment in histopathology are very topical and important now that greater attention is being paid to cost effectiveness and the auditing of many aspects of clinical practice. The autopsy is an integral part of the professional life of a histopathologist and, though it lacks the immediate clinical impact of the biopsy diagnosis, it nevertheless constitutes an important activity in all hospitals; without detailing dissection techniques I have provided some information and guidance about the autopsy which I believe will be useful to trainees and of interest to others. The remainder of the book has been thoroughly revised and updated, and illustrations and tables added where experience has shown that the text is insufficient. Sheffield, October 1986 J. C. E. Underwood Preface to the First Edition This book is primarily addressed to the needs of the trainee histopathologist.

This supplement to "Acta Neurochirurgica" contains a selection of papers which were presented at the 9th Scientific Meeting of the European Society for Paediatric Neurosurgery on Space Occupying Lesions of the Cerebral Midline in Vienna, October 10-13,1984. This meeting was arranged at the same location where the ESPN was founded exactly seventeen years ago. Although the presentations in this meeting dealt with numerous important problems encountered in paediatric neurosurgery, the main emphasis was on that special problem which exemplifies the extraordinary advances in paediatric neurosurgery and its related fields. Therefore the main topic of this scientific meeting was dedicated to the subject of "Space Occupying Lesions of the Cerebral Midline." Recent diagnostic procedures, such as computerized axial tomography and magnetic resonance imaging, now enable the neurosurgeon preoperatively, to obtain precise data on the location, and in many cases also on the nature of a lesion deep within the brain. Fundamental new knowledge in neuroanatomy and neurotopography has now transformed previous high-risk procedures into routine ones for the neurosurgeon, and an abundance of new surgical techniques has improved the success rate in the treatment of many patients. The scientific meetings of the ESPN have proved to be a successful forum for the exchange of experiences, opinions and even critical discussions. The present selection of papers will undoubtedly support this endeavour. Wolfgang T. Koos Gerhard Pendl Contents A. Statistics Koos, Wo To, Horaczek, Ao: Statistics of Intracranial Midline Tumors in Children 0 1 B.

The General Council of the International Society of Neuro pathology enthusiastically and unanimously endorsed the sug gestion made by the Executive Committee----chaired by Professor Dr. Franz Seitelberger, Vienna-for the IXth International Congress of Neuropathology that one of the major symposia at that Congress should be on Trauma and Regeneration of the Central Nervous System. The reasons for this are not difficult to understand: non-missile head injury and its sequelae-often a permanently brain damaged young adult-is one of the major problems that has faced society for many decades, and is continuing to do so since relatively little progress appears to ha ve been roade in its prevention; and the hope is that experimentalists may be able to shed some light at least on the potential for regeneration in the central nervous system. These proceedings are the outcome of that very successful symposium held in Vienna in September 1982. The Society is most grateful to Allgemeine Unfallversicherungsanstalt (AUVA), Vienna, for their sponsorship. Ofthe faur major presentations, two were on the subject of non missile head injury in man and experimental animals, and two dealt with recent developments in the field of regeneration. The former review the clinical features and their structural hasis and establish that all of the major types ofbrain damage seen in man as a result of a non-missile head injury ha ve now been reproduced by controlled angular acceleration of the head in subhuman primates without anything striking the head."

"Diagnostic Electron Microscopy: A Practical Guide to Interpretation and Technique "summarises the current interpretational applications of TEM in diagnostic pathology. This concise and accessible volume provides a working guide to the main, or most useful, applications of the technique including practical topics of concern to laboratory scientists, brief guides to traditional tissue and microbiological preparation techniques, microwave processing, digital imaging and measurement uncertainty.

The text features both a screening and interpretational guide for TEM diagnostic applications and current TEM diagnostic tissue preparation methods pertinent to all clinical electron microscope units worldwide. Containing high-quality representative images, this up-to-date text includes detailed information on the most important diagnostic applications of transmission electron microscopy as well as instructions for specific tissues and current basic preparative techniques.The book is relevant to trainee pathologists and practising pathologists who are expected to understand and evaluate/screen tissues by TEM. In addition, technical and scientific staff involved in tissue preparation and diagnostic tissue evaluation/screening by TEM will find this text useful.

The present report, compares two murine models of virus induced chronic relapsing demyelination. MHV-induced demyelination in the BALB/c mouse results from the direct virus mediated cytolysis of oligodendrocytes. Extensive remyelination by oligodendrocytes is noted. Recurrent demyel- ination occurs in small areas. Infectious virus persists and 34 Fig. 2: Demyelination in SJL/J mice infected with TMEV. A) Multifocal areas of perivascular demyelination in the spinal cord (110 days post infection). Para- phenylene diamine stain. X 250. B) Perivascular inflammatory infiltration within the white matter of the spinal cord (22 days post infec- tion). Paraphenylene diamine stain. X600. C) Localization of TMEV associated antigen in the cytoplasm of oligodendrocytes (45 days post infec- tion). Vibratome section stained with the peroxidase-anti peroxidase technique. X 400. D) Immunoperoxidase staining of viral antigen within inner and outer loops of an oligodendrocyte (45 days post infectin) X 60,000. E) Longitudinal section showing viral antigen within Schmidt-Lanterman incisures (80 days post infection). X 49,000. viral antigens are localized within oligodendrocytes and their processes. TMEV-induced demyelination in SJL/J mice is asso- ciated with perivascular inflammatory infilrates and is dimin- ished by immunosuppressive measures. Remyelination by oligo- dendrocytes is delayed and incomplete. Chronic demyelination is widespread and associated with perivascular inflammatory infiltrates. The virus persists and viral antigen is local- ized within oligodendrocytes.