This volume is a compilation of papers presented at the Tenth International Symposium on Brain Edema held on October 20-23, 1996, in San Diego, California. This follows the sequence of meetings that was initiated 31 years ago in the First International Symposium held in Vienna. Subsequent symposiums were held in Mainz, Montreal, Berlin, Groningen, Tokyo, Baltimore, Bern, and Tokyo CY okohama). A considerable number of papers was chosen from over 100 papers that were received. The organizers wish to thank the Advisory Committee for the excellent work done in selection of the papers. We also wish to thank all the persons who contributed to the success of the Tenth International Symposium, especially the staff who worked behind the scenes. These papers were reviewed, edited, approved or disapproved by the Editorial Board. Those manuscripts that were felt not pertinent to this publication were not accepted by the Editorial Board. Therefore, the excellent quality of those that are in the book are a reflection of the authors' dedication and work and that of those of the Editorial Board in their review process. For the reader's convenience, the papers are structured according to the various disease processes which are associated with the primary topic: hypertension, hydrocephalus, infection, ischemia, tumor, etc. We do hope that the reader will enjoy the articles and that they will provide an impetus and insight for future work.

In January 1980, the First Symposium on the Measurement of Tis sue Oxygen Pressure in Patients was held in Frankfurt. After a 4-year "rest period," the organizers of the 1984 symposium, Profes sor R. Huch of Zurich and Dr. J. Hauss of Munster, together with myself, extended another invitation to come to Frankfurt to find out what had gone on in the field of oxygen pressure measurement and its application in clinical medicine. As the following presentations will show, the application of oxygen pressure measurements has been broadened considerably. Furthermore, technological advances have been made, particularly with the increased use of computers. For various reasons, including technical ones, these methods have not been adapted as widely as one would want. Although con gresses on tissue oxygen pressure have been held in the last few years, the clinical aspect of tissue P0 measurement has not been 2 dealt with in such a concentrated and comprehensive way since 1980. It therefore seemed necessary to hold such a symposium, not only for scientific reasons, but also to enable a larger group of clini cians to gain insight into the importance of the possibilities these methods offer."

Albumin is the most abundant serum protein produced by the liver. In clinical practice the serum level of albumin continues to be used as an important marker of the presence, progress or ofthe improvement of many diseases, even though it is the complex end result of synthesis, degradation a. nd distribution between intra- and extravascular space. The clinical history of albumin began as early as in 1837, when Ancell first recognized "albumen" and noted that this protein is needed for trans port functions, for maintaining fluidity of the vascular system and for the prevention of edema. However, the important physiological properties of serum proteins and their role in the regulation ofthe oncotic pressure were demonstrated later by the physiologist E. H. Starling in 1895. In 1917 the clinician A. A. Epstein first described the edema in patients with the nephro tic syndrome as being a result of a very low level of serum albumin. Al though the determination of serum albumin concentration became more popular after Howe in 1921 introduced the technique of separation of serum globulins from albumin by sodium sulfate, the first preparations of human serum albumin were made available for clinical use in only 1941 by the development of plasma fractionation by Cohn and his coworkers at Harvard Medical School."

Are you looking for the essentials you need to learn the basics of echography for anesthesiology, intensive care and emergency medicine? This is what this book offers you! These few pages condense the essential knowledge to make getting started with echography in emergency situations easier. Ultrasounds are presented in great detail in order to facilitate and optimize the medical diagnosis process. As a doctor, you will first be placed in front of the machine in order to take the pictures that will serve to answer the questions asked. Just as the author did, you will realize that, when facing the patient with the machine, the best echographic examination is worth nothing without a good clinical examination. As a "beginner's guide", this book also offers self-training procedure that lays the foundations of the "FAST" learning method. This FAST Program of Echography allows you to learn the process by watching, feeling and talking. This training course is based on an ancient methodology that centers on the learning of a manual gesture: 'practice makes perfect'. This book will show you that you can quickly master this Program of Echography, and will in turn increase your self-confidence when taking care of your patients. Have a nice trip through the fascinating world of ultrasounds!

The fifth edition of this popular textbook continues to provide a solid foundation of pharmacological knowledge for all those working in anaesthesia and intensive care. The content has been thoroughly revised to include expanded chapters with clearer figures, ensuring readers are kept abreast of the ever-changing landscape of clinical pharmacology. Conveniently divided into four sections covering the basic principles of pharmacology, core drugs in anaesthetic practice, cardiovascular drugs, and other important drugs and complemented by new diagrams, tables and chemical formulae to facilitate learning. All four chapters on core drugs in anaesthetic practice have been updated along with others exploring applied pharmacokinetic models, antimicrobials, and drugs used in diabetes. An ideal aid to study and practice for junior and trainee anaesthetists and intensive care specialists preparing for exams. Also an invaluable resource for theatre practitioners, ICU nurses and physicians working in areas that demand a solid knowledge of pharmacology.

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

O ObivoV brac ?vV, eJ de teJcnh makrhv Life is short, the] art long -Hippocrates Pediatric Interviewing: A Practical, Relationship Based Approach by James Binder is filled with a unique blend of wisdom, experience, and evidence, which will serve as a guide and as a reminder that what comes first in the care of the patient is the language and the silences that are shared between patient and physician. The medical interview quickly establishes the type of caring relati- ship the two will share. In this age of electronic medical records, pay-forperformance, and evidence-based medicine it is easy to lose sight that medicine is fundamentally about one person who has knowledge and experience providing care for another individual who is asking for help. How the physician organizes his or her interactions has an important impact on the experience and o- comes for both the physician and for the patient. Dr. Binder presents a conceptual framework with which to approach interviewing and illustrates this framework with pr- tical examples from years of teaching and practice. Physicia- intraining will find this book filled with wisdom and much needed recommendations about how to approach the medical interview. For those of us who have been in practice a number of years, Dr. Binder's book can serve as a refreshing opportunity to reflect in detail about something many of us take for granted - the c- plexity of the medical interview."

Welcome to the City of Groningen, the center of the North of the Netherlands. Groningen is proud of the long lasting tradition of scientific symposia organised by the Sanquin Blood Bank. These Sanquin International Symposia on Blood Transfusion have become a true traditional event in Groningen, marking the early academic year and have contributed to the specific reputation of Groningen and its University in the scientific field of Transfusion Medicine. The growing tradition has also contributed to initiatives of both University, Province and the City of Groningen to bring science and industry together - BioMedCity Groningen. Such repu- tion does not just happen, but is the result of creative and scientific leadership, of vision and an open mind, to explore in a team spirit horizons. Groningen is particularly proud of this reputation thanks to its leadership, the Sanquin Blood Bank North-East. This year in particular the theme chosen some two years ago is extremely timely as it illustrates the activities and scientific interest of an integrated team which includes our regional Sanquin Blood Bank North-East and fits in the City initiatives within the concept of BioMedCity, Groningen.

lnflammatory reactions are generated in response to extemal and intemal stimuli, such as infection, trauma, clinical insult or dysregulation of the umnune system. The int1ammatory responses may bc antigen-specific or non-specific, local or systemic, chronic or rapid and severe, characterized by a massive release of mediators, often lethal. The aim of this book is to review selectcd aspects associated with the mechanism of the pathology of int1ammatory processes of ditlerent origin and to evaluate therapeutic strategies aimed at combating various inflamma- tory diseases. The introductory article describcs the inmlllnological status of patients with severe sepsis, with particular attention paid to the roJe of circulating neutrophils. Intcgrin activation and chemokine receptor expression and the roles of IL-15, prostaglandins and leukotriens in inflmmnation and immunity are the subjects of next articles. Subsequent reviews are focused on allergic diseases involving mast cells and Th2 type cytokines, in particular the mech- anisms of atopic dennatitis and signaling hy IL-13. The intlmmnatory responscs elicited by Mycobacterium tuberculosis and Mvcobacferium nviwn are also analyzed with special interest paid to the mechanisms which allow the bacteria to escape the host' s immune reactions. The thcrapeutic potential of IL- I 0 in infection and inflammation and thc possible factors contributing to the devclopment of idiopathic pulmonary fibrosis are rcvicwed in the next articles. The final report demonstrates the advantages of bacteriophage ther- apy in thc context of the aggravating problem of hactcrial resistance to antibi- otics.

Until recently, endocrinology and critical care medicine were two specialties in medicine that were rather uncomfortable with each other and hence quite i- lated. Fortunately, these two 'alien' disciplines have joined forces in successful attempts to perform high quality research in order to clarify the unknown. By integrating endocrinology in critical care medicine, or vice-versa depending on the specialty of the observer, new experimental and clinical data on the complex endocrine and metabolic derangements accompanying non-endocrine severe i- nesses came available which generated important novel insights with relevant clinical implications. In addition, the state of the art diagnosis and management of primary endocrine diseases that represent life-threatening situations leading to ICU admission has been updated. This issue of Contemporary Endocrinology aims at compiling the new ?ndings. The book indeed covers both areas of 'Acute Endocrinology' that are often taking care of at very distant sites within hospitals. The ?rst part deals with the classical life-threatening illnesses caused by primary endocrine diseases such as thyrotoxicosis, hypothyroidism, acute adrenal crisis, acute calcium disorders, pheochromocytoma, severe hyper- and hypoglycemia . The second part looks at endocrinology from the ICU side, starting with a g- eral overview of the dynamic neuroendocrine and metabolic stress responses in the condition of intensive care-dependent, non-endocrine critical illness.

Sepsis is an important public health problem around the world. Severe sepsis carries significant morbidity, mortality and high costs. The incidence of sepsis is increasing because of the aging population, the growing number of immunocompromised hosts, the increasing use of invasive procedures, and, to a lesser extent, antibiotic resistance among pathogens. Despite recent advances in the pathogenesis, diagnosis, and therapeutic approaches the mortality rate associated with this condition remains high. Therefore, the goal of Sepsis: New Strategies is to review novel targets to be considered in patients with severe sepsis and to assess new developments for patients with sepsis originating in the respiratory tract.

Sepsis is a very important public health problem. It is widely acknowledged that the severe inflammatory response syndrome/severe sepsis paradigm fails to stratify sepsis patients adequately. This book reviews in detail how sepsis should be managed on the basis of a novel approach to staging. The PIRO (predisposing factors, infection, response, organ dysfunction) model was first proposed at the start of the decade on a theoretical basis and has now been translated into a practical approach for use at the bedside. It is loosely based on the TNM staging system for cancers, with points being allocated to each of the four aforementioned key characteristics of the septic process. The proposed PIRO framework facilitates evaluation of factors that are important in the pathogenesis of severe sepsis and in the development of treatment strategies. This book clearly explains the advantages of the PIRO approach in different settings and will be of value to all practitioners concerned with the management of sepsis.

88 short papers originating from the 12th International Symposium on Intracranial Pressure and Brain Monitoring held in August 2004 in Hong Kong present experimental as well as clinical research data on invasive and non-invasive intracranial pressure and brain biochemistry monitoring. The papers have undergone a peer-reviewing and are organized in nine sections: ICP management in head injury, neurochemical monitoring, intracranial hypertension, neuroimaging, hydrocephalus, clinical trails, experimental studies, brain compliance and biophysics.

Critical Care Surgery provides an illustrative, instructive, and comprehensive review that depicts the rationale of basic operative principles essential to surgical therapy in the critically ill patient.The chapters provide pertinent and concise, summaries of how to deal with various types of critical illness, including acute renal failure, coma and altered mental status, multiple organ dysfunction and hepatic failure. Stages of operative approaches with relevant technical considerations are outlined in a straightforward manner, and complications are reviewed when appropriate for the organ system and problem. The text is illustrated throughout by line drawings and photographs that depict anatomic or technical principles.A concise, handbook-sized reference work, this book is a valuable resource for all general surgeons and residents in training.

Therapeutic Hypothermia will provide a review of the subject, in particular, resuscitative hypothermia and include known mechanisms of action and results from both mechanistic and outcome laboratory studies and clinical trials. Cooling methods and potential side effects of hypothermia will be addressed as well as recommendations for future laboratory and clinical research.

This volume will be of interest to both the researcher interested in therapeutic hypothermia as well as the clinician interested in the potential use of therapeutic hypothermia in their patient population.

Effective drug administration is a crucial skill for any practitioner working in the critical care unit. This book, in providing a concise account of the fundamental principles of pharmacology and pharmacokinetics, equips the critical care physician for such a task. In addition to the principles of pharmacology and pharmacokinetics, this volume alerts the reader to factors that affect drug action such as disease, pregnancy and age, and advises on how to adjust drug dosages accordingly. The specialist therapeutics covered comprise drugs targeting the gastro-intestinal tract, sedation, non-opioid analgesia and opiates. A quick and easy reference, this volume will prove a valuable asset for both trainees and fully qualified practitioners in critical care.

The ? eld of critical care medicine is in the midst of a dramatic change. Technological and s- enti? c advances during the last decade have resulted in a fundamental change in the way we view disease processes, such as sepsis, shock, acute lung injury, and traumatic brain injury. Pediatric intensivists have been both witness to and active participants in bringing about these changes. As the understanding of the pathogenesis of these diseases reaches the cellular and molecular levels, the gap between critical care medicine and molecular biology will disappear. It is imperative that all physicians caring for critically ill children in this new era have a th- ough understanding of the applicability of molecular biology to the care of these patients at the bedside in order to keep up with the rapidly evolving ? eld of critical care medicine. To the same extent, the practice of critical care medicine is in the midst of fundamental change. In keeping with the Institute of Medicine's report "Crossing the Quality Chasm," the care of critically ill and injured children needs to be safe, evidence-based, equitable, ef? cient, timely, and fami- centered [1,2]. In the following pages, these changes in our specialty are discussed in greater scope and detail, offering the reader fresh insight into not only where we came from, but also where we are going as a specialty.

Demand for neuromonitoring in neonatal, pediatric and cardiac intensive care units continues to grow, motivated by increased awareness of the high prevalence of seizures among critically ill neonates and children, and emerging evidence that these seizures can contribute to brain injury. This book provides physicians, nurses and trainees caring for critically ill newborns and children with a practical overview of how to use and interpret continuous neuromonitoring to enhance patient care. Authored by international experts from diverse institutions and professional backgrounds, this is a practical guide that is accessible to intensive care specialists, but also comprehensive enough to serve as a reference book for neurologists and neurophysiologists. Concise enough to be read cover-to-cover and illustrated with over thirty case-based examples, this authoritative reference will guide readers in accurate neuromonitoring interpretation and optimal use of conventional EEG, amplitude-integrated EEG and other quantitative EEG techniques.

Recent Advances in Anaesthesia and Intensive Care, volume 23 is the latest volume in this very successful and long-established series (previously entitled Recent Advances in Anaesthesia and Analgesia) to present a collection of cutting-edge topics for anaesthetists. It has been compiled by some of the world's leading authorities in their subjects and builds on the successful formula of the previous volumes. As the title suggests, these latest volumes have increased input from the field of intensive care, and the emphasis remains on producing articles of high quality and interest to the reader while providing exceptional value for money. This volume is recommended reading for trainee and practising anaesthetists and intensivists at all levels of experience.

More than 20 years ago it was recognized by Stoutenbeek and colleagues that patients in the intensive care unit suffered from infections developed whilst being treated. Moreover, the majority of these infections appeared to originate from bacteria that were acquired in the intensive care leading to pathologic colonisation and overgrowth in the gut, subsequently leading to organ site infections. Selective decontamination of the digestive tract (SDD) is an antibiotic strategy which aims to prevent secondary infections in critically ill patients. This book provides both the scientific rationale and the practical approach to nurses, physicians, pharmacists and microbiologists to design a SDD treatment strategy tailored to each individual patient and the local hospital situation.

The care of the critically ill or injured child begins with timely, prompt, and aggressive res- citation and stabilization. Ideally, stabilization should occur before the onset of organ failure in order to achieve the best possible outcomes. In the following pages, an international panel of experts provides an in-depth discussion of the early recognition, resuscitation, and stabilization of the critically ill or injured child. Once again, we would like to dedicate this textbook to our families and to the physicians and nurses who provide steadfast care every day in pediatric intensive care units across the globe. Derek S. Wheeler Hector R. Wong Thomas P. Shanley V Preface to Pediatric Critical Care Medicine: Basic Science and Clinical Evidence The ? eld of critical care medicine is growing at a tremendous pace, and tremendous advances in the understanding of critical illness have been realized in the last decade. My family has directly bene? ted from some of the technological and scienti? c advances made in the care of critically ill children. My son Ryan was born during my third year of medical school. By some peculiar happenstance, I was nearing completion of a 4-week rotation in the newborn intensive care unit (NICU). The head of the pediatrics clerkship was kind enough to let me have a few days off around the time of the delivery-my wife, Cathy, was 2 weeks past her due date and had been scheduled for elective induction.

Mastering Emergency Medicine is a concise, revision-focused textbook that covers everything that candidates need to know in order to pass the College of Emergency Medicine's (CEM) membership examination (MCEM) to enter training, and to the pass fellowship examination (FCEM) to complete the Certificate of Specialist Training. With over 100 OSCE scenarios designed to stimulate everyday emergency department clinical encounters, Mastering Emergency Medicine covers all the key areas of the CEM syllabus, including: clinical examinations and practical skills, communication skills, teaching and management. This book takes a practical approach to the subject - core facts are presented and common scenarios are explored using an OSCE style, as used in the Part C MCEM and the FCEM examinations - which makes it an invaluable blueprint for management of cases. Closely linked to the current CEM syllabus, each chapter comprises three parts: Core topics that supplement revision for Part A and B. Clinical scenarios, including data and relevant practical skills that can be used to prepare for Parts B and C. Mock 'Scoring Scenarios' that give specific guidance on how to perform in OSCEs. Mastering Emergency Medicine is a highly detailed revision guide for the OSCE examinations and an essential study guide for all those who are preparing for the MCEM or FCEM examinations. It will also be useful to those who are wishing to pursue a career in Acute Medicine.

Improving standards of care is a real challenge in Intensive Care Medicine. Bettering clinical performance, patient safety, risk management and audit represents the cornerstone for raising the quality of care in ICU patients. Communication is the platform from where to start to reach a consensus in an extremely crowded area, a unique multidisciplinary and multiprofessional environment in which quality of care and, ultimately, patient survival need to be ameliorated.

Core Cases in Critical Care describes the clinical management of some of the most common problems seen in the critically ill patient. Twenty detailed, illustrative case histories are presented and for each, descriptions of the problem, its underlying pathophysiology and the key principles of principles of patient management are given. Each 'case' is written by experts in the field, and all contributors are practising anaesthetists and critical care specialists of many years' experience. Core Case in Critical Care is essential reading for all trainees in critical care, and will also prove a valuable addition to the libraries of other groups such as critical care nurses, surgical trainees and practising critical care physicians and anaesthetists, both as a useful summary of key topics in critical care in an easily-digested format, and as a stimulus for discussion and analysis of current practice.

In modern medicine the most functional methodologies are taking an increasing importance in spreading informations, rendering it credible while at the same time using reliable data to focus interaction between basic science and clinical medicine. Critical care medicine embraces these needs and more than any other discipline thrives and develops thanks to interdisciplinary contact.

APICE 2004 has been organised to provide precise answers to these issues. In particular, considerable emphasis has been given to the reviews regarding the most important aspects - or the most significant clinical developments - in the sectors involving variety of functions: neurological, respiratory and cardiovascular, gastrointestinal, metabolism and perfusion; trauma infections, sepsis and organ failure; perioperative medicine and life support techniques; information technology dedicated to clinical medicine, but also as a means of information and education. The contributing authors are all part of leading research groups at the international level in the various sectors presented in the volume.