Biopsy of the gastrointestinal tract has been revolution less busy) teaching hospital. These sort of techniques, which I confess interest me greatly because of the ized by the introduction of fibreoptics; the proximal additional information which they can yield when rightly reaches, as far as the second part of the duodenum, and chosen, are naturally linked with improved methods of the whole large bowel back to the caecum can now be tissue preservation in general, bearing in mind that the sampled under direct vision and multiple small biopsies need for special techniques often becomes apparent can be obtained. Only in the jejunum and ileum are there only when the biopsy has been conventionally still limitations on the sampling of localized as opposed to generalized conditions. The sheer volume of gastro processed and examined. However, I have firmly intestinal material passing through our own laboratories stabled this hobbyhorse and have included little that has risen steeply over the last years to form some 25% cannot be done in a district general hospital and nothing that I am not prepared to do myself. I have tried to of the total current work load and the rise continues; stress, particularly, common lesions which can cause nearly all of it is in biopsy form rather than as resected specimens."

Various textbooks on stereotactic neurosurgery have been published during the last few years (Riechert 1980, Schaltenbrand and Walker 1982, Spiegel 1982), all of them dealing with functional stereo tactics as the major subject in the field. Diagnostic and therapeutic stereotactic interventions are only briefly described, whereas localization techniques are not yet mentioned. Since 1980, however, an increasing number of reports has been published on CT guided and computer monitored stereotactic performances which enable the surgeon to combine diagnostic and therapeutic efforts in one session. With recent progress in scanning techniques, including high resolution CT, NMR, and PET imaging of the brain, it has become possible to study and localize any brain area of interest. With the concomitant advances in computer technology, 3-dimensional reconstruction of deep seated lesions in stereotactic space is possible and the way is open for combined surgery with stereotactic precision and computer guided open resection. This type of open surgery in stereotactic space is already being developed in some centers with the aid of microsurgical, fiberoptic, and laser beam instrumentation. With these advances stereotactic techniques will rapidly become in tegrated into clinical neurosurgery. Stereotactics has become a metho dology which enables the surgeon to attack deep seated and subcortical small tumors. Neurosurgeons may abandon therapeutic nihilism, still frequently seen in glioma treatment, in the near future when stereotactic resection will be feasible and remaining tumor cells may be killed by adjuvant treatment modalities still in development."

The purpose of this work is to review the current knowledge of laryngeal pathology in the light of my experience at the Institute of Laryngology and Otology, London. The role of histopathological investigations in the care of patients with diseases of the larynx is given special consideration. Radiologi cal study of the larynx has become more refined in recent years with the introduction of computerised tomography. Microlaryngoscopy with biopsy of the interior of the larynx is now a frequent procedure in the diagnosis of laryngeal disease. In the effort to interpret the findings resulting from these methods, the need for a monograph outlining the pathological basis of laryngeal disorders has arisen. To the best of my knowledge, such a work, devoted to the pathology of the larynx only, has never been written; a modern study in this field is certainly not available. I have aimed the text towards the practising pathologist in order to give it the broadest scope. It was necessary, therefore, to include an account of the basic anatomy of the larynx. For this purpose (and in subsequent descriptions throughout the book) I have not used the formal anatomical terminology for the two folds on either side of the ventricle of the larynx. There is some variation in the use of these terms, and they are not yet completely in general use."

One out of every two men over eigthy suffers from carcinoma of the prostate.It is discovered incidentally in many patients with an alleged benign prostatic hyperplasia. In treating patients, the authors make clear that primary radical prostatectomy is preferred over transurethral resection due to the lower complication rate.

Almost all known tumors and tumor-like conditions of the fe- male lower genital tract are classified in this complete mo- nograph on the subject. Clinical features, treatment and prognosis ar included, making this book a practical refe- rence for the busy clinician.

John R. Petersen and Amin A. Mohammad, along with a panel of leading basic and clinical investigators, review those CE methods that are now replacing many routine serum and blood tests in clinical and forensic laboratories. Major areas reviewed include the coating of columns; the analysis of serum, urine, and CSF proteins and paraproteins; abnormal hemoglobins and hemoglobin Alc; peptides, amino and organic acids; therapeutic drugs; drugs of abuse; viral load; and short tandem repeats (STR). The methods discussed include capillary zone, micellar, electrokinetic, capillary gel, and non-aqueous electrophoresis. Innovative and highly practical, Clinical and Forensic Applications of Capillary Electrophoresis demonstrates the power and versatility of CE-not only to develop new assays, but also to markedly simplify today's clinical and forensic laboratory methodology.

Larry L. Hench June Wilson OBJECTIVE Millions of people presently enjoy an improved quality of life due to prostheses which repair, augment or replace parts of their skeletal system: bones, joints, teeth, etc. However, all replacement parts have a finite probability of survival. The goal of this book is to compare the survivability data for various skeletal prosthesis systems. All data derive from previously published clinical studies. Where possible statistical comparisons are made and the reasons for failure are discussed. THE NEED FOR SKELETAL PROSTHESES We are an aging population with more than 100 million people in the U. S. and Europe over the age of 50 years. An unfortunate consequence of aging is a progressive deterioration of the quality of skeletal tissues. From the age of 30 years there is a decrease in bone mass for both men and women (Fig. 1. 1). However, for women it is much greater and between 40 and 60 years of age the rate of deterioration of long bones and vertebrae of women is especially severe due to hormonal changes. By the age of 70 most women will have lost from 35 to 60% of their bone mass. The loss of volume of cancellous or trabecular bone leads to a large decrease in mechanical compressive strength (Fig. 1. 2). The clinical consequence is an increasing incidence of vertebral collapse. Cortical bone decreases in tensile strength with age (Fig. 1.

This book represents the fourth ina series of international conferences related to Alzheimer's (AD) and Parkinson's (PO) diseases. The first one took place in EHat, Israel in 1985; the second in Kyoto, Japan, in 1989; and the third in Chicago, IL, USA in 1993. This book incorporates the proceedings of the Fourth International Conference on Pro gress in Alzheimer's and Parkinson's Diseases, held in EHat, Israel, on May 18-23, 1997. This Conference was the 41st in the series of annual OHOLO Conferences sponsored by the Israel Institute for Biological Research (IIBR). It was also conducted under the aus pices of the Alzheimer's Association Ronald and Nancy Reagan Research Institute, USA. The Conference was attended by 550 participants from 28 countries, representing a broad spectrum of research interests; and included a well-balanced representation from aca demia, clinical institutions and pharmaceutical industry. The four-and-one-half day meeting served as an excellent medium for surveying the current preclinical and clinical develop ments in AD, PO, and other related disorders. The scientific program was divided into 24 oral sessions and daily poster sessions. The conference culminated in a round table discus sion. There were 122 talks and 161 posters. This book incorporates a combination of both.

New methods in immunocytochemistry and hybridization techniques enable the pathologist active in diagnosis to clarify more effectively problems in the classification and prognosis of tumors. By adopting these methods into his diagnostic repertoire it will be possible to create a closer, more productive connection between morphological diagnosis and clinical work. This volume gives the reader an up-to-date general survey from international experts of the method, technique and practical application of these new procedures.

MOTOOMI NAKAMURA As we approach the 21st century, ischemic heart disease is the major cause of death in most of the developed nations of the world. Since the 1970s, much effort and expense have led to designs of coronary thrombolytic therapy, percutaneous coronary angioplasty (PTCA), coronary artery bypass grafting, heart transplantation, automatic defibrillators, as well as to the formation of beta blockers and com pounds which block the calcium channel. Socio-educational programs directed at exercise, diet, instruction in the risk factors of smoking, hyperlipidemia and hypertension have contributed to the decrease in the rate of morbidity and mortality of patients with ischemic heart disease. However, the first clinical event of ischemic heart disease, the so-called "heart attack" and sudden cardiac death continues to present problems, as the mechanisms involved in these events are poorly understood. It has long been thought that ischemic heart disease is the sequence of an organic fixed atherosclerotic obstruction of the epicardial coronary arteries and the role of coronary vasomotion has been given much less attention. Recent clinical and laboratory animal studies revealed that increased tonus and spasm of the large epicardial coronary arteries are the cause of various stages of ischemic heart disease. The role of coronary vasospasm in the development of un stable angina, sudden cardiac death and acute myocardial infarction remains open to debate. Pharmacophysiological studies showed that the epicardial large coronary artery contributes only 5% to regulation of normal coronary flow."

Contents: Intracranial Pressure and Mass Displacements of the Intracranial Contents. - Special Neuropathology - Morphology and Biology of the Space-Occupying and Atrophic Processes with Their Related Neuroradiological Changes of Diagnostic Significance. - Cerebral Angiography. - Pneumoencephalography. - Myelography. - Spinal Angiography. - Discography. - Ossovenography and Epidural Venography. - References. - Subject Index.

Changing approaches to diagnosis and clinical management of the uterus are comprehensively examined in this book. It gives a concise update of new concepts in physiology and pathology and their application in clinical practice. The book is designed especially for the gynecologist actively involved in patient care. Topics discussed include the pathophysiology of diethylstilbestrol (DES) changes, the immunology of the uterus, papillomaviruses and cervical neoplasia, endocervical carcinoma, mesenchymal tumors and diagnostic procedures such as colposcopy of the cervix, hysterosalpingography, and magnetic resonance imaging. The status of contemporary management is presented for hysteroscopy and hysteroscopic surgery, the congenital absence of the uterus and vagina, anovulatory dysfunctional uterine bleeding of the adolescent, uterine leiomyomata, genital prolapse, endometrial adenocarcinoma and childhood rhabdomyosarcoma of the vagina and uterus.

Imaging of Gastrointestinal Tract Tumors describes current imaging practice for the most commonly encountered benign and malignant digestive tract tumors and gives a review of the literature for less frequent tumors. General features (anatomic data, frequency, clinical and biologic signs, treatment) are discussed for all pathologies prior to description of imaging techniques, which include barium studies, ultrasonography and angiography, and above all CT. MRI appears particularly indicated for esophageal carcinoma and pelvic recurrences of colorectal cancers. The book is divided into three main section - benign tumors, malignant tumors, and tumors with an indeterminate prognosis - reflecting the value of different imaging strategies as a function of a tumor's natural history. The thorough analysis of literature for both frequent and less common tumors allows global evaluation of the diagnostic possibilities of imaging techniques, making Imaging of Gastrointestinal Tract Tumors a reference work for all specialists concerned with digestive tract pathologies.

Malignant melanoma is the focus of investigations which range from basic re search to clinical trials with conventional therapy and with biological response modifiers. The involvement of investigators with different backgrounds in combi nation with recent progress in biotechnology has facilitated the characterization of the antigenic profile of melanoma cells, the analysis of the structural and function al properties of melanoma-associated antigens, and the application of immuno diagnostic and immunotherapeutic approaches to melanoma. As a result, a large body of information about various aspects of melanoma has been rapidly accumu lated during the past few years. In organizing this book I aimed at providing a readily available source of infor mation on the current research in melanoma. To this end I invited investigators with active research programs to contribute chapters describing and discussing the significance of their most recent results. To facilitate the preparation of the manu scripts and to avoid duplicating other recently published books on melanoma, I discouraged the contributors from providing extensive reviews of the literature on the various topics. Although I made every effort to be as complete as possible in the selection of the contributors, while writing this preface I realized that I had overlooked at least three investigators whose work should have been included.

Few subjects in gynecology, let alone in medicine in general, have provoked such inter est or study as cervical cancer. Although the wealth of monographs and books publish ed on the subject would seem to obviate the need for more, the great advances made in the medical sciences and in gynecological experience and techniques in recent years call for, if not require, a new book on cervical cancer to bring together the latest ideas and trends in its methods of study, diagnosis, and treatment. Although precancerous lesions have become more common, the number of women developing invasive cervical carcinomas has not increased, owing in part to programs of patient education, in part to screening examinations sponsored by the government. The gynecologist is now able to detect with well-tried and proved techniques precan cerous states of the cervix, and to treat these effectively before they become invasive cancer. Accordingly, recent interests in cervical cancer have shifted from the classic descrip tion of invasive carcinoma to newer studies of cause, diagnosis, therapy, and terminol ogy of its precursors. As the reader will learn, epidemiological studies as guides for the future account for, and justifiably so, an important part of this book. New knowledge about changes in the morphology of cervical carcinoma confirms its dependency on hormonal stimulation. Furthermore, modem experiences serve to explain which therapy is best. Overlapping of concepts and opinions between some chapters could not be avoided."

This second volume reports on the reaction patterns of lymph nodes in neoplastic and immunodeficient diseases. Based on the contents of volume 1, it presents a detailed survey of lymph node structures and their cellular components under these conditions. The patterns of nodal reactions to the development and spread of cancer have recently been investigated and discussed by several authors. Here, the immediate interactions between tumor tissue and the regional nodes have been assessed in experimental models and in human material. Using modern morphological methods such as im munohistochemistry on the light and electron microscopic level, new insights have been gained into the stepwise process of lymphogenous metastasis. Macrophages/reticulum cells were found to playa signifi cant role in this process, which is duly emphasized. Based on appro priate animal models, one chapter focuses on various subtypes of these cellular elements and their role in the two separate phases of tumor spread and the development of true metastases. The induction of fibronectin in lymph nodes is effected by tumor cells forming a special part of the extracellular matrix. The multifunctional fibronec tin molecule serves as a mediator between tumor cells and fibroblasts, furthering the formation of tumor stroma. This volume also contains a comprehensive survey of primary im munodeficiency syndromes and their nodal manifestations, reference being made to the most recent immunological knowledge."

Dr Taylor's book analyses the disease concept as it developed in medical history and seeks to clarify it with the help of concepts largely derived from logical class theories. A solution is proposed to the problem of how to distinguish between the class of 'patients' and the class of 'healthy persons' which corresponds to the actual diagnostic practices of doctors. The earliest theories of disease postulated concrete entities which exist independently of the body. The notion of disease entity has lost its original ontological connotations and instead its important feature has become the possession of a unitary and self-contained character. Dr Taylor describes the modern theories as essentially 'reactive' in character, that is the symptoms of a disease are the bodily reactions to the 'noxae'. After seeing the subject in its historical content, Dr Taylor goes on to discuss in detail the notion of the classification of diseases, making extensive use of modern views on the logic of classes.

This book was conceived with the object of presenting to doctors and medical students with a potential interest in the disciplines of orthopaedic surgery, diagnostic radiology and orthopaedic pathology, a volume which would contain basic and essential information concerning those disorders of the skeleton in which a common interest exists. Diagnosis in such conditions is dependent on close collaboration between specialists in these subjects. As medical knowledge has advanced, so the necessity for detailed specialisation has increased. As a result co-operation in a combined approach has become of great importance. The method of presentation, in the form of Exercises, is designed to permit readers to test their own diagnostic ability. The book consists of ninety-four problems of diagnosis which might be encountered in any orthopaedic unit. The case material has been chosen to emphasise those conditions in which appreciation and integration of the clinical, radiological and pathological features are required in order to establish the diagnosis.

The European School of Oncology came into existence to respond to a need for information, education and training in the field of the diagnosis and treatment of cancer. There are two main reasons }Vhy such an initiative was considered necessary. Firstly, the teaching of oncology requires a rigorously multidisciplinary approach which is difficult for the Universities to put into practice since their system is mainly disciplinary orientated. Secondly, the rate of technological development that impinges on the diagnosis and treatment of cancer has been so rapid that it is not an easy task for medical faculties to adapt their curricula flexibly. With its residential courses for organ pathologies and the seminars on new techniques (laser, monoclonal antibodies, imaging techniques etc.) or on the principal therapeutic controversies (conservative or mutilating surgery, primary or adjuvant chemotherapy, radiotherapy alone or integrated), it is the ambition of the European School of Oncology to fill a cultural and scientific gap and, thereby, create a bridge between the University and Industry and between these two and daily medical practice. One of the more recent initiatives of ESO has been the institution of permanent study groups, also called task forces, where a limited number of leading experts are invited to meet once a year with the aim of defining the state of the art and possibly reaching a consensus on future developments in specific fields of oncology.

Continuing progress has been made since the first edition of Artificial Liver Support was published. Liver transplantation has however become an estab lished therapy for a relatively small number of patients who remain patients for life. There therefore continues to be a great need for the development of other forms of artificial liver support. Improved intensive care utilizing improved plasma exchange, dialysis, sclerotherapy, and intracranial pressure monitoring have improved survival in fulminant hepatic failure. Progress has also been made in lipid membrane detoxification, in cell cultures, and in cell transplantation, and the isolation of various liver cell growth factors has led to deep insight into the mechanisms of liver regeneration. This book gives the clinician and the researcher detailed information about established new methods of clinic work and laboratory research, and describes new experimental approaches indicating the direction of future research. G. BRUNNER M. Mno Preface to the First Edition The regenerative capacity of the liver cell is almost unlimited. Therefore after acute liver damage, be it viral, toxic, hypoxic, or surgical in origin, restitutio ad integrum is the usual outcome. In two forms of liver disease, however, this is not the case: in fulminant hepatic failure, liver regeneration often is not fast enough to keep the organism alive; in end-stage cirrhosis, regeneration is disturbed by a hypertrophic architecture of fibrotic tissue. For these extreme forms of liver disease and for critical situations before and after liver surgery, artificial liver support is needed.

The region of the skull base was long considered a surgical barrier because of its complex anatomy. With few exceptions, the region immediately beyond the dura or bony skull base constituted a "no man's land" for the surgeon working from the other direction. A major reason for this was the high morbidity associated with operative procedures in that area using traditional dissection techniques. This situation changed with the advent of the operating microscope. Used initially by ear, nose and throat specialists for resective and reconstructive surgery of the petrous bone and parana sal sinuses, the operating microscope was later introduced in other areas, and neurosurgeons began using it in the mid-1960s. With technical equality thus established, the groundwork was laid for taking a new, systematic, and interdisciplinary approach to surgical problems of the skull base. Intensive and systematic cooperation between ear, nose and throat surgeons and neurologic surgeons had its origins in the departments of the University of Mainz bindly supported by our chairmen Prof. Dr. Dr. hc Kurt Schiirmann (Department of Neurosurgery) and Prof. Dr. W. Kley (Depart ment of Ear, Nose and Throat Diseases, Head and Neck Surgery). The experience gained from this cooperation was taught in workshops held in Hannover from 1979 to 1986, acquiring a broader interdisciplinary base through the participation of specialists from the fields of anatomy, patholo gy, neuroradiology, ophthalmology, and maxillofacial surgery.

Oral Pathology as part of the Head and Neck Pathology is an interdisciplinary field of science. The oral mucosa and the saliva are reflectors of many systemic diseases of the organism and therefore valuable parameters of the diagnosis and prognosis of pathological processes. In the last years many new methods have been integrated in the diagnostic repertoire. Proliferation markers are of predicitive value and characterize the biological behavior of a tumor. Markers are such as oncogenes, growth factor receptors or genetic aberrations. The importance of these new markers shall be discussed concerning the different types of oral cancers and salivary gland tumours.

Society is showing increasing concern for disorders related to aging that lead to a loss of brain function. In view of the enormous proportion of elderly people in our society today, brain aging is more than ever subject to challenge to us all, not only politicians and health authorities, but every individual who is confronted with the difficult situation of watching the mental powers of apparently healthy elderly friends, neighbours, or relatives fail, often with alarming rapidity. This challenge is directed especially toward us scientists. As one of our colleagues succinctly put it 2 years ago at the close of our First International Symposium on Brain Aging: "Do something. We are not dealing here with just another disease; we are concerned with human dignity. " More than any statistics, these words convinced me that Tropon's decision to leave the field of classic CNS pharmacology and move into the field of gerontopsychopharmacology was the right one, even though we knew that success would be uncertain and that, even if it finally comes it will be many years hence. At this point, let me add a personal comment: each one of us is judged by his or her own success. We live in a competitive society where success counts. This applies not only to the businessman, but also to the scientist, in particular, to those in industry.

I am honored to have been invited to write a foreword for this book, because tumors of the yolk sac have been a preoccupation of mine since the days of my residency, now more than 3 decades ago. At that time, a 3-year-old boy died of a testicular cancer of unknown histo genesis. It was bad enough that the child died, but it bothered me even more that medical science did not know the histogenesis of the tumor that destroyed him, and I decided to study testicular cancer. For re search training I sought out F. J. Dixon, who had written the Armed Forces Fascicle on testicular tumors. Dr. Dixon and I showed that embryonal carcinoma was a multipoten tial malignant stem cell that differentiated into the three embryonic germ layers of murine teratocarcinoma. This led to the idea that the normal counterpart of embryonal carcinoma must also be multi potent, and we focused on the preimplantation embryo for the histo genesis of the tumor. This idea was strengthened by the discovery that embryonal carcinoma cells made embryoid bodies in the ascites and it was possible to observe the development of these bodies in vitro. These observations led to the idea that embryonal carcinoma was a caricature (gross misrepresentation) of early development, and car cinomas in general were a caricature of the process of renewal of their normal counterpart."

Competitive binding techniques such as radioimmunoassay (RIA) are widely used to measure an enormous variety of compounds in biological fluids. Current methods have 1 2 arisen from the pioneering work ofYalow and Berson in the U. S. A. and Ekins in the u. K. Much of the early development was concerned with the analysis of protein hormones, and nearly a decade passed before attention focussed also on small molecules such as steroids and drugs. The potential of immunoassay methods for drug monitoring in clinical and forensic laboratories and in addict treatment programmes resulted in the commercial production of immunoassays for various therapeutic and abused drugs, making the technique available to laboratories lacking the facilities to raise their own antisera and synthesise labelled compounds. However, commercial assays are not only expensive but are restricted in range, and so it is advantageous for a forensic laboratory to have the capability to devise "in-house" immunoassays suited to its particular requirements. This chapter describes the theory and practice of RIA in forensic drug analysis. Much of the theory and some of the practice are applicable to immunoassays in which non isotopic labels are used, but such assays are not described in detail since, to date, the versatility and sensitivity of RIA have made it the immunoassay technique of choice in forensic toxicology. The particular advantages of RIA are its sensitivity and the fact that samples such as haemolysed blood can be assayed with little or no prior preparation."