Neurosurgery o/the Future: Computers and Robots in Clinical Neurosurgical Practice and in Training - a Philosophical Journey into the Future Many present day neurosurgeons believe that they already obtain good results in operative surgery with the benefit of the operating microscope and other aids which have become available in the last three decades and that the introduction of computers and robots to the operating theatre is superfluous. However, it is clear from analogy with the function of the airline pilot, another profession where there are great demands on manual skill and on spatial awareness, that these devices do have much to offer neurosurgery. Classical neurosurgery, in the time of Cushing, Dandy and Scarff, was based on a three dimensional picture of the patient's brain formed in the surgeon's mind and often illustrated in elegant drawings. Such pictures were based on neuroradiological studies by pneumoencephalography, ventriculography or by angiography. Generally these stud ies showed the presence and position of a lesion by displacement of normal brain structures and the picture was built up by interference. This was then converted by the experienced neurosurgeon into a plan for the craniotomy site and the trajectory of the surgical approach. Once the brain was exposed further pre-operative information was obtained by visual inspection and by palpation with the brain needle. These classical forms ofneuroradiology have largely been superseded by computerised tomography and by magnetic resonance imaging."

Alcohol and other drugs of abuse are major contributing factors to liver disease and its pathology. Alcoholic cirrhosis causes thousands of deaths each year in the United States, and encourages liver replacement. A better understanding of the mechanisms of liver pathology will significantly aid basic researchers and physicians in treating and preventing liver damage. This book is designed especially for those researchers wishing to understand alcoholic liver disease. Therefore the role of alcohol in changing nutrition and its nutritional effects on liver disease are reviewed. The generation of free radicals during alcohol use has been found to be an important cause of membrane changes, of cancer development, and of lipid alterations-and thus of liver pathology. In addition to alcohol, other drugs of abuse, including morphine, cocaine, marijuana, and caffeine have also been shown to be significant contributors to liver pathology. The prevalence of drug and alcohol use and abuse today means that liver disease will continue as a major social and medical problem. The explanation of its biological origins cannot fail to help us better understand and treat the disease in the years to come.

It is a great honor and pleasure for cerebral infarction have been carried me to have Springer-Verlag publish out. Dr. Yoshimoto hoped that the this volume entitled "Treatment of results of research done in our depart Cerebral Infarction." I am much in ment over the last sixteen years con debted to my colleagues for my success cerning cerebral infarction could be in publishing this book. published. Moved by his enthusiasm, I have engaged in clinical work in my colleagues took their share in writ the field of neurosurgery for these few ing each article. I suggested to them decades and I have performed more that this volume should cover primarily than 5,000 major operations of intra the results of our own research, but that cranial surgery. Throughout this time, at the same time it should also include it has been my privilege to conduct a 2- the results of related work done by neurosurgical experts throughout the hour-morning research seminar in our department every Wednesday and to world. Therefore, I hope that this book supervise a great deal of research. At will interest many investigators who these seminars my fellow research have devoted themselves to research in workers and I have exchanged many the field of neuroscience. ideas about the study of neurosurgery My colleagues acknowledge that and we have designed many animal our research has been stimulated and experiments."

Mohs surgery is a highly effective treatment for certain cutaneous and oral pharyngeal cancers. The procedure allows for the precise and complete removal of cancers while preserving significant amounts of normal tissue. Through the presentation and orientation of the specimens' complete surgical margin on pathology slides, the location of tumor foci and other relevant findings can be correlated with their locations on the surgical wound. The ability to create perfect slides for histological examination lies at the core of effective Mohs surgery. These procedures have a 99 per cent cure rate for certain cancers when implemented correctly. This book describes the methods the dermatologist, pathologist, or technician can use to optimize the Mohs technique and produce the highest-quality slides and highest cure rates possible.

Increasing specialisation in pathology reflects the progressive changes in medical practise. The advent of a specialist with a new interest in a hospital or clinic may present the pathologist with a need to extend his or her knowledge to be able to work closely with the clinical practi tioner in order to provide adequate clinical care. Some sub-specialisations are long established, such a one is neu ropathology. However, an exclusive specialist practise is generally con fined to neurosurgical centres and much neuropathology is of necessity, executed by geneni.l pathologists. The areas covered by this volume are those which are commonly managed by the generalist. Professor Adams' account of how the skull and brain should be examined here will give confidence to many by defining a good technique and the careful description of various kinds of vascular injury lesions resulting from raised intracranial pressure will help to clarify repeated difficulty. More subtle forms of damage are also considered in detail. Professor Weller provides a detailed account of how the central nervous system may be examined in a way which permits all of us to prepare material which will allow adequate investigation of central nervous system disease and the proper examination of peripheral nerves. This chapter will become a "handbook" and will be of interest to those in training and established practitioners. Muscle biopsy is also dealt with; this is an area of investigative concern for many gener alists. The role of that singular neuropathological technique is very clearly emphasized.

If you want practical information on how to use this book please refer to "Note to the Readers" p. VII. Histochemistry and cytochemistry are essential tools in biomedical research and routine service laboratories. Most texts on histochemistry fall into one of two categories: 1. Encyclopaedic texts covering all or nearly all information available on the whole or selected parts of histochemistry. 2. Reviews or surveys of methods found to be useful by the author(s). While the former category often appeals to the more philosophically inclined reader, direct guidance on the selection of technique may be difficult to find. In contrast, the latter category are often excellent sources for details on how to perform a particular method with a reasonable chance of success. Consideration of the exact mechanism of staining, of possible reasons for failure, and of alternative techniques are, however, frequently lacking. This book is an introduction to the scientific basis of histochemistry and is intended to provide a background for the selection and development of appro priate methods. It is not a "cook book" and readers expecting exhaustive methodological descriptions will be disappointed. Although most ofthe contributors to this book would not describe themselves as histochemists, they have all at some time found it essential to develop a basic understanding of histochemistry. This book contains the information they would have greatly appreciated ready access to at that time."

More than a quarter century has passed since the initial descriptions of tardive dyskinesia (Schonecker, 1957; Sigwald et aI., 1959). The earliest epidemiologic study of this disorder was carried out in Roskilde, Denmark, by Uhrbrand and Faurbye (1960); the term tardive dyskinesia was first used a few years later in a subsequent paper (Faurbye et aI., 1964). Despite 25 years of intensive investiga- tive scrutiny, the syndrome persists, and approaches to its prevention and treat- ment continue to have limited efficacy. It is thus fitting to evaluate what has already been learned and consider future directions for research. . Tardive dyskinesia is generally dermed as an involuntary movement disorder, mainly involving the mouth, which attends long-term neuroleptic exposure. Beyond these simple facts, however, there has been relatively little consensus about this disorder. A desire to address the controversies associated with tardive dyskinesia prompted the organization of an international symposium at Kolle- kolle, just outside Copenhagen. This publication comprises all 26 presentations.

The enormous importance of the diseases of the locomotor system in all populations and the large component of general clinical practice which they represent have not, in the past, been matched by an appropriate pathological effort. Increasing expectation of an active and long life has resulted in a great increase in specialisation in Rheumatology and rehabilitation of those with crippling diseases. This volume presents many of the pathological advances that have followed this clini cal interest, beginning with reviews of changes in biological materials obtained by in vasive investigation of joints, continuing with an account of therapy Goint replace ment) and also describing a "new" hazard - hyperbaric injury. Experimental models of joint disease are also described as are other entities such as crystal deposition dis ease. A detailed consideration of the electron microscopy of bone tumours is included since this data is not widely available in current texts. Finally, the role of the HLA system in rheumatic disease is included, indicating the value of close co-operation between clinician and pathologist in defining and link ing the various rheumatic syndromes. London Contents Examination of Synovial Fluid. With 9 Figures P.A. Revell ........................................... . The Synovial Biopsy. With 20 Figures F. Eulderink. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 25 Tissue Reactions to Joint Prostheses and the Products of Wear and Corrosion. With 20 Figures P.A. Revell. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 73 Bone and Joint Diseases in Workers Exposed to Hyperbaric Conditions."

Blood Supply of Bone: Scientific Aspects provides a comprehensive description of the development and physiology of blood supply to the skeleton. Investigative techniques for different types of bone in the body are discussed and the effects of disturbed circulation and the vascular control of osteogenesis is described. This highly illustrated and authoritative volume contains much revised material and many new illustrations reflecting 25 years of advances in this research field since the publication of its well-known precursor in 1971. The wealth of information will not only be invaluable to orthopaedic surgeons, rheumatologists, and radiologists but also pathologists, sports medicine specialists and bone metabolism research workers.

This volume covers, in a logical sequence, the brain neuroscience which underpins current management of malignant brain tumours. Cellular and molecular studies are considered, as well as current concepts of histopathological classification and grading. The clinical manifestations and natural history of these tumours is set in context by a discussion of the pathophysiology of intracranial mass lesions. Special attention is given to low-grade and childhood tumours. The more common cerebral gliomas and cerebral metastases are also examined. Diagnostic imaging methods are described and the differential diagnosis of benign and malignant tumours is explored. The final chapters are devoted to conventional and innovative methods, along with the results, of treatment by surgery, radiation, chemotherapy and immunotherapy.

Over recent years, much renal research has focused on the pathology of the glomerulus, where many primary renal insults occur. However, nearly thirty years have passed since Risdon's study made the apparently anomalous observation that the extent of damage to the tubulointerstitial compartment is the major determinant of renal outcome in a variety of human glomerular diseases. This volume covers various aspects of tubulointerstitial disease, and starts with an update on cystic disease of the kidney, by Drs. WILSON and FALKENSTEIN, which includes recent experimental data on the altered properties of cystic epithelium. My own chapter gives an overview of the mechanisms of tubulo interstitial damage in progressive renal disease and includes a dis cussion of the possible role of cytokines, vasoactive peptides and peptide growth factors found over the last few years to be secreted by renal tubular cells. These comments are expanded in the contribution by Dr. WOLF and Professor NEILSON, who provide a detailed account of the cellular biology of tubulointerstitial growth. The earliest studies from the 19608 attempted to correlate histo morphometry of the tubulointerstitium with renal outcome. Dr. KHAN and Professor SINNIAH provide us with an update on mor phometric methods as applied to the kidney using new techniques. Similar techniques are employed by Dr. IVANYI and Professor OLSEN who give a detailed stereomorphological account of tubulitis both in acute allograft rejection, where its- recognition is central to the diagnosis, and in other forms of tubulointerstitial disease."

Close cooperation between those involved in clinical treatment and pathology is imperative in head and neck surgery, as in all surgical fields. The degree of cooperation depends, on the one hand, on the knowledge that the head and neck surgeon has about the possibilities and limits that confront the pathologist, and on the other hand, on the knowledge that the pathologist has about the special problems of head and neck pathology and their management by the surgeon. Within the last 15 years, the knowledge of larynx growths and their treatment has changed rapidly. Parallel to this increase in knowledge, the technical possibilities in histopathology have also increased. For this reason, the authors of this volume present an up-to-date view of the whole scope of the pathology and clinical treatment of larynx tumours.

The early development of the mammalian embryo belongs to a period which, for the student, provides the particularly deep fascination connected with the processes of germination of the fIrst tender buds of life. Moreover, developmental biology encompasses a very large part of biology; if broadly dermed - almost all of it. The same is true for the fIeld of pathology if the manifold possibilities of disorders of the orderly arranged pathways of developmental processes are considered. Normal development in its earliest steps - and it would be diffI cult to see it otherwise - means the functioning of very intricate systems of complex inter dependent cycles controlled by structural, genetic, physiological and biochemical determi nants. However, disturbances interfering with them in their very different ways, can lead to fetal death, disorders of growth and differentiation, malformation and disease, sometimes as late as in the next generation or later. This is, indeed, the concern of the pathologist to whom and to whose interest in developmental pathology, this book is dedicated. The outlines of the present volume were conceived at a symposium on "Control of early em bryogenesis and factors responsible for failure of embryonic development" held May 1-4, 1974 in Travemtinde and sponsored by the Deutsche Forschungsgemeinschaft. Almost fIfty active participants attended this conference. At the time and in keeping with the purpose of the conference, publication of the proceedings was not envisaged."

First published in 1992, this volume provides a systematic survey of the dibenzanthracenes and of their chemical, physiochemical and biological properties. The carcinogenic potential of the dibenzanthracenes - an important subclass of polycyclic aromatic hydrocarbons - has been extensively studied and documented since their identification as animal skin carcinogens was first demonstrated in the 1930s. the volume treats the nomenclature, the chemical and physical properties and the synthesis and preparation of the five principal isomers of the dibenzanthracenes series: dibenz (a, h), - dibenz (a, c), -dibenz (aj) anthracene, benzo(a)naphthacene and pentacene. Other chapters are devoted to their occurrence and analysis in the environment, in industrial processes and effluents, and in foodstuffs. The second part addresses their biological activity and reviews the metabolism, cellular interactions, toxicology mutagenicity and carcinogenicity of the dibenzanthracenes. The final chapter is devoted to structure-activity relationships in this class of aromatic compounds. This is the first comprehensive account of this important group of environmental pollutants and carcinogens. It will be of interest to all scientists studying carcinogenesis, and the mutagenicity and toxicology of environmental pollutants.

First published in 1988, this volume surveys the chemical synthesis and biological activity of the benz a]anthracenes. These compounds occur in smoke and mineral oils and a few have been shown to be potent carcinogens. This volume was the first to review, systematically and in depth, the organic synthesis of these compounds as well as their metablolism, interactions with nucleic acids and protein, mutagenicity and carcinogenicity. Such studies have important implications in determining mechanism and specificity of chemically induced carcinogenesis.

Advances in biochemistry, cell biology, genome-wide mutagenesis - coupled with molecular technology, including gene microarray and transgenic and knock-out animals - have been instrumental in understanding the cellular processes and molecular pathways of self-tolerance and autoimmune diseases. The molecular definition of these pathways and processes has led to novel treatments for certain auto-immune diseases that are based on the pathogenesis of diseases rather than on broad-spectrum immunosuppression. This book reviews many of these current developments and proposes future novel approaches for understanding the pathogenesis of auto-immune diseases and designing novel therapy. This book covers three major areas of auto-immunity: the basic mechanisms of immunological tolerance, pathogenesis of auto-immune diseases, and some novel therapies. This book should be useful for immunologists, molecular biologists, rheumatologists, and clinical scientists.

The origins of this book go back to the first electron microscopic studies of the central nervous system. The cerebellar cortex was from the first an object of close study in the electron microscope, repeating in modern cytology and neuroanatomy the role it had in the hands of RAMON y CAJAL at the end of the nineteenth century. The senior author vividly remembers a day early in 1953 when GEORGE PALADE, with whom he was then working, showed him an electron micrograph of a cerebellar glomerulus, saying "That is what the synapse should look like. " It is true that the tissue was swollen and the mitochondria were exploded, but all of the essentials of synaptic structure were visible. At that time small fragments of tissue, fixed by immersion in osmium tetroxide and embedded in methacrylate, were laboriously sectioned with glass knives without any predetermined orientation and then examined in the electron microscope. After much searching, favorably preserved areas' were studied at the cytological level in order to recognize the parts of neurons and characterize them. Such procedures, dependent upon random sections and uncontrollable selection by a highly erratic technique of preservation, precluded any systematic investigation of the organization of a particular nucleus or region of the central nervous system. It was difficult enough to distinguish neurons from the neuroglia.

Although most textbooks of neurology contain a certain amount of pathological informa tion, neuropathology has often been treated in isolation. However, neuropathology has a close relationship to clinical neurology, neurosurgery and neuroradiology. Thus, advances in the rapidity and accuracy of pathological diagnosis have often led to changes in clinical management and, recently, improvements in clinical diagnosis, particularly CT scanning, have brought about a change in emphasis in the practice of neuropathology. In this textbook we have sought to present a widely based account of neuropathology in combination with information from clinical experience. We chose this approach in order to emphasize the close interrelation between clinician and pathologist. The book grew out of a course organised jointly by two neurologists and two neuropathologists from the Depart ments of Neuropathology and Neurology of The London Hospital and The University of Southampton. It is hoped that the book will be useful not only to pathologists, neurologists, neurosurgeons, and neuroradiologists, but also to general physicians. In a period of rapid advance in knowledge it is important to recognise how changes in the clinical and laboratory disciplines overlap. In order to make the most of consultations with pathologist colleagues the clinician must know what skills and techniques are available in the laboratory, and similarly, the pathologist must keep abreast of changes in clinical practice. In the past the clinician and pathologist have often been slow to appreciate advances in each other's fields."

During the past years a considerable number of books have been published on atherosclerosis research. Much attention has been focused on the biochemical properties of lipoproteins and the involvement of lipoprotein metabolism in the atherogenic process. The monograph presented here focuses on morphologic studies of atherosclerotic plaque. One chapter deals with the pathobiochemical changes in the arterial wall at the inception of atherosclerosis. Recently the specific role of macro phages in atherogenesis has been the object of much interest. A morphological study of their role and differentiation is the topic of another chapter. This is complemented by a study of lipoprotein receptors on macrophages and smooth muscle cells both in cell culture and in situ, based on electron microscopic investiga- tions. An immunohistological study on the in situ localization promotes our understanding oflipoprotein metabolism in the arterial wall. The morphologic aspects of more advanced lesions are present- ed in studies of collagens and angiogenic processes in the athero- sclerotic vessel wall. Experimental investigations have also been useful for understanding the pathogenetic aspects of atherosclerosis; one crrapter concentrates on the metabolism of fibromuscular and atheromatous plaques in an experimental model. A final chapter deals with transplant arteriopathy and its possible parallels with conventional atherosclerosis. The widespread discussion of athero- genesis is focused on the arterial wall and its morphological alter- ations, emphasizing once again the importance of morphological research for understanding the pathological basis of disease. Borstel and Magdeburg E. VOLLMER and A.

With the introduction of antibiotics acute inflammatory disease has ceased to be the dominant problem in general medical practice and its place is now increasingly occupied by chronic inflamma tory disease of which the rheumatic diseases constitute the most important group. lwo aspects of these diseases need to be consid ered, their aetiology and their pathogenesis. In some respects the latter is more important since even when the aetiology is known, as for example the haemolytic streptococcus in rheumatic fever, the mechanism by which the infecting agent accomplishes the development of the lesions that characterise the disease are still largely unknown. Still more so is this the case in rheuma toid arthritis and other chronic inflammations where the aetio logical agents are unknown. In an attempt to clarify the pathogenic mechanisms involved, sev eral attempts have been made to induce comparable lesions in ex perimental animals, partly to test underlying hypotheses, and partly to provide test situations for the trial of new therapeu tic agents. In view of the deficiencies in the current drug treat ment of chronic inflammatory disease there are many who feel that this is largely due to the inadequacy of the models avail able for test purposes."

La pathologie vasculaire a ete tres marquee par les progres biologiques de ces vingt demieres annees. Le systeme arteriel est main tenant considere comme un organe a part entiere. Modelee au cours de l'organogenese par les facteurs hemodynamiques, Ie paroi arterielle maintient une structure hautement organisee et des proprietes mecaniques qui dependent directement des conditions de pression et de debit. La monocouche endotheliale developpe 2 une surface de plusieurs centaines de m a l'interface sang-tissu; elle est a la fois un organe endocrine complexe synthetisant de nombreuses proteines qui participent a l'hemostase, une surface thromboresistante et hemocompatible, une barriere de permeabilite contr6lant les echanges sang-tissus. Les cellules musculaires lisses constituent un tissu multifonctionnel, contractile, assurant la synthese des composants structuraux responsables des proprietes mecaniques de la paroi arterielle, la transmission de la force contractile, et une etonnante activite reparatrice en reponse aux agressions. Tout ceci est soumis a un ensemble complexe de communications cellulaires qui font de l'endothelium un veritable systeme recepteur pour la paroi vasculaire. Parallelement, ou a la suite de ces progres, l'angeiologie s'est progressivement affirmee comme une specialite clinique. Debordant Ie cadre de la chirurgie vasculaire, elle integre les concepts physiopathologiques au diagnostic et au traitement des maladies arterielles. De cet effort d'integration est ne cet ouvrage, cherchant a concilier les connaissances fondamentales es plus recentes et la demarche clinique.

Immunology, in all its facets of immunochemistry, humoral immunity, cellular immunity, immunodiagnosis, and immunotherapy, is currently the most rapidly advancing discipline of clinical and experimental oncology. But as in most developing subjects, it is continually beset with problems of methodology and nomenclature, both of which are often intertwined. Indicative of this problem are our circular definitions of antigen and antibody. Another fre quent problem is the use of the words "specific" and "associated" when characterizing re actions to tumors or the antigenic properties of neoplasms. When applied to cancer, these terms are obviously very dependent upon the methods used to demonstrate these qualities. Indeed, the very diverse nature and multitude of types of cancer preclude our making gen eralizations or categorical statements regarding tumor "specificity. " Similar problems arise when one considers that many antigens found in malignant tumors share certain properties with embryonic or fetal tissues. First, these observations emphasize a lack of true tumor specificity, for which reason the category of oncofetal antigens has been established. Second, whether or not such antigens are truly oncofetal depends upon the method of detection used, and it has been found that here too specificity decreases as the antigen assay increases in sen sitivity. Thus, whether substances can be truly oncofetal in nature still remains a matter of debate, and such terms must therefore be used in an operational sense.

The aim of this book is to expand the clinical information given by computed tomograms (CTs) of cerebral infarcts. Anatomical sections are displayed parallel to the CT correlate in the hope that the interpretation of pathogenesis will provide valuable clinical data at a time when the number of angiographies performed in cerebrovascular cases has diminished rapidly. For better understanding of pathogenesis our concepts concerning the process of infarction have been summarized on the basis of schematic draw ings. K.-J. ZULCH KOln Acknowledgments I am most grateful to Professor Hoeffk: en for permission to use computed tomograms from his institution, to Herr GOldner and Frau Miihlhover for their technical assistance, and to Frau Goldner for help during the editorial work. My particular thanks go to my friend Professor W.S. Fields, Houston, who undertook the great burden of styling the English text. My gratitude is expressed to Dr. Dr. h.c. multo Heinz Gotze and Springer Verlag for the excellent layout and quality of this book."

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."

Battle is a practical and sometimes lasting way of solving man's problems. It relies on the strength of the combatants and ignores the truth of the dispute. Discussion face to face can dissolve attitudes which have incorrectly determined judgements. The most striking example of this that I know is a Battle in Ireland in the eleventh century, where the king of Leinster fought a Viking prince. The Icelanders had raided Ireland for several generations in search of women, which they lacked since most of the population of Iceland were men who had arrived there by rowing long-boats from Norway. The prince was leading such a raid for the first time. Standing in the prow of the leading boat he saw Irish cavalry galloping along the beach to meet them. As they approached the shore the Irish king rode out of the band to challenge single combat. The Icelander jumped into the surf to meet him. As they raised their swords each realized that the other's face was like his own. When the Irish king spoke the other recognized the language. It had been spoken in Iceland by his grandmother who had been captured and taken there from Ireland. Swords were dropped and replaced by drinking horns. It was soon established that they were cousins. The battle gave way to a life-time of close co-operation.