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."

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.

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.

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.

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.

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."

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.

Essential Pathophysiology for Nursing and Healthcare Students is the perfect quick reference and study guide for students covering pathophysiology, disease and therapeutics as part of a nursing or other healthcare course. It clearly and simply explains the underpinning processes of disease, covering cellular physiology, genetics, fluids, electrolytes and the immune system, and the main diseases and conditions that can occur within each.Each chapter is written in a quick reference format so it can be used for study, exam preparation or use on student placement. The book covers body systems including: CardiovascularRespiratoryImmuneLymphaticNervousDigestiveEndocrineReproductive Developed with the reader in mind, each chapter includes clinical tips, case studies, diagrams, and self-assessment questions to make pathophysiology accessible and digestible - this is a must-have book for students of nursing and healthcare."Essential Pathophysiology for Nursing and Healthcare Students is a book that should be kept no further than an arm's reach away. The book is easy to navigate and easy to understand. Nursing and healthcare students will find that this book is essential in helping them comprehend and learn about the systems and mechanisms of the human body in health and ill health. This book would also be a good read for anybody working with or teaching students as a refresher on pathophysiology." Rebecca Bailey-McHale, Lecturer, Faculty of Health and Social Care, University of Chester, UK "This detailed but accessible book covers this subject in sufficient depth to give a good understanding of the topic without becoming overwhelming. As well as giving the evidence behind the text, this is a good resource if more in-depth reading is required. The authors have succeeded in writing a quick reference book that is remarkably in-depth and easy to read. This book would be suitable for any healthcare student who needs an understanding of the concept of pathophysiology however it would also be relevant for those seeking a general overview of the subject or more senior staff who wish to consolidate or refresh their knowledge." Rebecca Myatt, Guy's and St Thomas' NHS Foundation Trust, UK

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.

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.

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."

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.

The topic "Cerebrovascular Transport Mechanisms" was chosen by the General Couneil of the International Society of Neuropathology as one of the four main symposia at the IX International Congress of Neuropathology, September 1982 in Vienna. The chairmen of the symposium were asked to structure a program which would cover the reeent devel- opments in this field and which could serve as a background for free communications, relevant to this topic, submitted by the participants of the Congress. Cerebrovascular transport mechanisms refleet the main function of the blood-brain barrier in providing optimaI, homeostatically regulated, biochemical environment for the brain. It is obvious that disturbanees of this function may play a significant role in patho- physiology of various brain disorders. Since the elucidation of the complex blood-brain barrier phenomenon, consisting of various "barrier systems", necessarily requires applica- tion of multidisciplinary approaches, the program of this symposium was structured by evaluation of ultrastructural, cytochemical, physiological, biochemical, pathophysiological and therapeutic aspects of the blood-brain barrier by invited, recognized experts in respec- tive areas. As aresult, this volume of the proceedings of the symposium attempts to summarize much of today's knowledge on cerebrovascular transport mechanisms in health and disease, and is supplemented by the abstracts of free communications dealing with the most reeent research in this field. We hope that this volume wil1 serve both as an introduction and a reference book, and that it wil1 stimulate further research.

Die Ovarialtumoren gehoren heute mit zu den haufigsten Tumoren des weiblichen Genitale. Ihre morphologische Differentialdiagnostik und die sich darauf aufbauende gezielte Therapie ist aufgrund der Vielfalt dieser Tumoren ungleich viel komplizierter als in anderen Organen. Dement- sprechend liegt der Schwerpunkt dieses Buches auf dem Gebiet der Histo- pathologie. Spezialkenntnisse insbesondere tiber die selteneren Formen der Ovarialtumoren hangen von groBen Fallzahlen abo Hier ist der inter- nationale Erfahrungsaustausch von vorrangiger Bedeutung. Die derzeit weltweit anerkannte histogenetische Klassifikation der WHO erfahrt an- hand der Erfahrungen an drei deutschen Frauenkliniken kleine Erganzun- gen und Variationen. Einige Lander, Z. B. Israel verfUgen tiber groBe epi- demiologische Untersuchungen, deren Ergebnisse korrelierend aufgenom- men sind. Zur klinischen Diagnostik wurden in den letzten lahren mo- dernste Untersuchungsmt;thoden neu eingefUhrt; ihre Anwendung setzt jedoch individuell anzupassende kritische Indikationsstellungen voraus. AbschlieBend werden die sich sehr differenziert auf der histologischen Diagnostik aufbauenden modernen Moglichkeiten einer gezielten Thera- pie der Ovarialtumoren ausfUhrlich diskutiert. Hier steht die Chemothera- pie im Vordergrund. 1m Hinblick auf die Frage einer Hormonbehandlung kommt neuerdings auch dem Rezeptornachweis im Tumorgewebe Bedeu- tung zu. Diese Zusammenstellung spricht somit gleichermaBen Pathologen, Onkologen und Gynakologen an und will versuchen, gegenseitige Infor- mationslticken der Fachexperten auf dem Gesamtgebiet der Problematik der Ovarialtumoren in zumutbarer Klirze zu schlieJ3en. Daher nehmen ge- rade die selteneren und bisher weniger bekannten Tumoren in Bild und Text einen verhaltnismaBig breiten Raum ein auf Kosten der hinlanglich bekannten haufigeren Formen, bei denen Spezia1fragen der Differenti- diagnostik aufgrund neuester Erkenntnisse im Vordergrund stehen.

Now in its second edition, the best-selling Color Atlas of Forensic Medicine and Pathology is an easy-to-read reference covering forensic pathology principles, from basic to advanced concepts relating to all manners of death. Featuring over 1600 full-color images, including 400 more photographs than the first edition, this book provides unparalleled photographic illustration to enhance understanding for medical and non-medically trained personnel. Providing thorough visual demonstrations of postmortem changes of the human body, the book presents the different kinds of patterns produced in deaths resulting from Natural causes Diagnostic procedures Therapeutic procedures Substance abuse Poisoning Child abuse Firearms Blunt instruments Sharp instruments Burns Asphyxia The book also includes an entirely new section on histopathology. The text uses specific, detailed language to describe what is represented in each photo and to make side-by-side comparisons of similar but distinct pathologies. The Color Atlas of Forensic Medicine and Pathology, Second Edition is an invaluable professional reference for death investigators, medical examiners, and forensic pathologists.

No one has counted the enzymes in the human organism, and probably their profuse number can only be estimated from the restrictions the finite mass of genetic material imposes. Still, nu merous catalytic activities have been identified and investigated for their clinical relevance. After one century of such research, surprisingly, only a handful of enzymes has survived the stern trial of clinical application to find regular medical use. Dis regarding genetic defects, most of the diagnostically used en zymes participate in metabolic conversions fundamental to life: the utilization, transfer or fixation of vital nutrients or of cheJ,llical energy. Creatine kinase is central to the function of the mitochond rion, the cellular power generator. The wider distribution of this enzyme is linked to tissues whose physiology crucially relies on an adaptable supply of energy, notably skeletal muscle, the brain, and the heart. Just as these three tissues vary in their pre ference for different energy sources, each produces a different isoenzyme of creatine kinase. Accordingly, the finding of elevat ed creatine kinase activity in blood can lead to a variety of interpretations, but in practice the diagnosis of acute myocardial infarction is the major consideration.