Radiologists who already use the SOMATOM PLUS computed tomography system discuss their experiences in this report of a User Conference in March, 1990. The distinct advantage of this system in which the whole measuring system rotates continuously is emphasized. More than fifty participants from nine European countries present scientific papers, discuss clinical experience and consider future prospects.

This work has true international scope, being a unique European/American joint venture that focuses on the state of the art in both diagnostic and therapeutic radionuclide methodology. Pertinent clinical applications are emphasized rather than attempting to cover everything included in the several large comprehensive texts available in our field. This "practical" approach should make it an essential guide to nuclear medicine physicians, technologists, students and interested clinicians alike.

Radiation safety and risk management, a critical issue in the nuclear age, is an ongoing concern in the field of radiation health risk sciences. It is the particular mission and task of the Nagasaki University Global COE program to explore human health risks from radiation on a global scale and to come up with measures for overcoming its negative legacies. Ionizing radiation is a well-documented human cancer risk factor, and long-term health consequences in individuals exposed at a young age to such events as the Hiroshima and Nagasaki atomic bombing are now being followed up. Unique and comprehensive, this book introduces updated radiation health-related issues, including the proper collection and analysis of biological samples, cancer research, psychological effects, fair disclosure, and the effects of low-dose exposure as they apply to future public health policy. Also addressed is the need for emergency radiation medicine in case of accidents.

Although in the last few years more experience in the field of epilepsy surgery with amygdalo-hippocampectomies was gained in several hos- pitals, a detailed microanatomical and microsurgical description meet- ing the requirements of the modern neurosurgeon has not been achieved so far. Recently the allocortex - the so-called "limbic system" - has doubtlessly received more attention, as can be gathered from the recently published monography by Duvernoy, which however only considers anatomical points of view. Lately not only epilepsies but also tumorsurgical operations on the border between temporal lobe and basal ganglia can be - thanks to modern MR-examinations - carried out more exactly. Here the tumor-conditioned deformations of the temporo-medial area and its connections with the adjacent basal gang- lia as well as their blood supply are of great importance. Using conven- tional techniques the postoperative morbidity was especially high until recently. The author has at the suggestion of his teacher G. M. Ya argil approached the problem first of all morphologically by developing his own techniques of brain dissection. After some developmental and topographic-anatomical descriptions he has described the vessel-supply by using injection-preparations. Particular aspects of A. chorioidea ant. with her lateral, medial and Tractus opticus penetrating perforat- ing arteries to the basal ganglia and Capsula into have never been described in such a convincing manner before. It is of great importance in the operative removal of the amygdalo- hippocampal area to realize that it is not sufficient to preserve the A.

Key Features * Shows how to select the best thermal imager for your clinical practice, care for it, and use it correctly. * Explains how to take medical quality thermal images and scale them for maximum visual effect using the guidelines detailed in this book. * Details the myriad ways that thermography can aid in medical diagnosis and improve surgical outcomes.

Medical Management of Heart Failure brings together the current knowledge on the medical management of heart failure into one cohesive volume. It includes copious illustrations and photographic material that will explain the techniques and medical management of patients with heart failure in an effective modern format.

Plain radiography is still alive. In many institutions, including ours, conventional radiography has been replaced by digital systems including imaging-plate-based computed radiography and fat-panel detector-based digital radiography. Even for the education of radiation technologists, conventional flm-screen radiography has been de-- phasized, and their education is concentrated on digital systems. Spatial resolution of a conventional system is still far better than the current digital systems, although the dynamic range is wider in the latter system. Industrial flm radiography with small grain size and direct exposure has an even higher resolution, and such hi- resolution systems are something we lost in the transition from the conventional system to the current PACS-friendly system. I am pleased to know that Giuseppe Guglielmi and Wilfred Peh have published this textbook of high-resolution hand radiographs that cannot be obtained with any other techniques. Radiography has always been the most important modality in the evaluation of the hand, and, moreover, high-resolution industrial flms are extremely efective in the evaluation of the hand, particularly for assessing subtle erosions. Hands are not just one of the peripheries of the human body. Tey refect conditions of the whole human body. Not only the metabolic status, but also many congenital disorders are manifested in the hand. Radiographic fndings of the hand are ofen specifc, and contribute to the diagnoses a great deal. Tere have been several publications concerning the radiology of the hand, and they have been well accepted.

This is an atlas on contemporary MR imaging of the reer in neuroradiology she has continuously gathered pediatric central nervous system. We have concen- interesting cases. When Dr. Ketonen moved from trated on brain imaging,but have an extensive chap- Massachusetts General Hospital in Boston to the U- ter on the spine and a smaller chapter on the head versity of Rochester it was quite obvious,looking into and neck. her new of?ce, that she had a very extensive collec- The book starts with a chapter on the normal tion of such cases. She would have needed a much myelinization and normal variance. We are including larger of?ce than the one we were able to offer her chapters on malformations,inherited conditions,in- just to store her enormous teaching ?le. Seeing her fection,tumors,trauma,vascular abnormalities,and phenomenal collection of cases and pairing that with spine abnormalities. The last chapter of the book is a our positive experience writing our previous book, miscellaneous chapter that includes all those cases Diffusion-Weighted MR Imaging of the Brain, it was that did not ?t well in other categories. The chapter obvious that we had both an idea and the material for on trauma and brain damage includes an extensive another neuro-imaging book. We decided on the t- section on CNS manifestations of nonaccidental pe- ic of pediatric neuro-imaging with Dr. Ketonen as the diatric trauma. There is an also an exciting chapter lead author.

The sober explanation for this book is a call by the Springer-Verlag, London, to edit a publication on 'The functional relevance of the collateral circulation' of the heart. Alternatively, it could be 'sold' as the result of my intention to reduce entropy of 18 years of scientific work on the topic of the coronary circulation, which was itself meant to diminish the amount of 'useless' energy. Such a process of reducing disarray in a system with the aim of grasping it better is related to simplification, which carries the risk of introducing error. This can be exemplified by the historic view of angina pectoris, which used to be simplified as being always fatal, thus obscuring for nearly two centuries the view of a 'self-healing' mechanism such as the collateral circulation of the heart. It would be na?]ve, to assume the present work to be free of erroneous oversimplification, because the very nature of scientific work is related to generating (simple) hypotheses with their subsequent falsification. In that context and bluntly, my primary interest in the field of the collateral circulation was not initiated with a vision of eradicating the consequences of coronary artery disease (CAD) by promoting the growth of natural bypasses. The time for such sizeable ideas had passed in the 1970s with the start of the work by Wolfgang Schaper."

Endovascular Neurosurgery represents a unique collaboration between contributors from a number of specialties, all of whom are concerned with the management of cerebrovascular disease. This provides a balanced account of the efficacy of interventional endovascular techniques in this group of conditions. As a result, Endovascular Neurosurgery will prove an invaluable account of a relatively new specialty and will be essential reading for neurosurgeons, neurologists, neuroradiologists, neurophysiologists and neuroanaesthetists.

This is the first book to cover minimal-invasive treatment of osteoporotic, tumorous and traumatic vertebral fractures in the English language. In addition to detailed descriptions of the techniques, including tips and tricks from experts, the book contains a chapter about the medical treatment of osteoporosis, which is indispensable in the interdisciplinary approach to osteoporosis. This acclaimed innovative concept unites several treatment aspects. More conservative treatment methods are also presented in this work.

All chapters reflect new developments and clinical findings in the field of orthopaedics, surgery, traumatology and neurosurgery.

Imaging procedures have been used for many years and are becoming increasingly important in a number of medical disciplines. This is due to recent technological advances, primarily computerization. The meth ods employed in CNS diagnostics are collectively referred to as "neu roimaging" and include procedures for investigating both cerebral morphology and cerebral function, such as computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomogra phy (PET), and single-photon emission computed tomography (SPECT). Topographic mapping of electroencephalograms (EEG) and evoked potentials represents one of the functional procedures and per mits topographic imaging of EEG, evoked potentials, and magnetic fields. The latter application includes not only magnetic fields evoked by stimuli relating to different sensory modalities, but also endogenous and motor fields resulting from spontaneous brain magnetic activity, as recorded by magnetoencephalograms (MEG), the magnetic comple ment of the EEG. The advantage of recording electric and magnetic fields over other neuroimaging procedures is that these techniques are completely noninvasive and have extremely short analysis times (in the millisecond range). The aim of this book is to clarify the current state of this emerging technology, to assess its potential for substantive contributions to brain research, to delineate areas for further research and, over all, to envis age clinical applications in disciplines such as psychiatry, neurology, and neuropsychology."

Malignant growth of cells is often characterized by disorganization of tissue structure, abnormal blood vessel development, and insuffi cient vascular supply. As a consequence, the cancer cells grow in a three-dimensional pattern in atypical microenvironments which include physical, chemical, and nutritional stresses. Necrosis often develops some distance away from the blood vessels. In association with an inherent instability in malignant cell populations, and also because of the changing micromilieu, significant cellular heteroge neity emerges with regard to various phenotypic characteristics. Both biological behavior and responses to therapeutic agents can be affected. A variety of in vitro and in vivo experimental models exist for research on properties of cancer cells during growth. The multicell spheroid model was developed as a system of intermediate complexity in which three dimensional growth of cells enhances cell-cell interactions and creates micro environments that simulate the conditions in intervascular microregions of tumors or microme tastatic foci. Spheroids may change their cellular characteristics with changing environments during growth. These can be studied under controlled conditions in vitro. Interest in details of experimental methods for this model system stimulated the organization of the First International Conference in Rochester, NY in 1980, the Proceedings of which were summarized in Cancer Research in 1981. Since then there has been a rapid increase in the use of this model system, and increased research on the significance of cell-cell and cell-microenvironment interactions in biology in general."

Since the small bowel except the duodenum and (1961), Pygott et al. (1960), Gianturco (1967) terminal ileum is largely inaccessible during en- and Bilbao et al. (1967). doscopic examination, radiology of the small Sellink, however, was really responsible for bowel attains special significance as a diagnostic the widespread recognition of enteroclysis method. Owing to the length and position of (1971, 1974, 1976). In spite of the increasing this organ, good images are difficult to obtain. popularity of this method, the necessity for sub- Furthermore, the considerable variation oftran- stituting this apparently viable method for the sit time, unpredictable response of the contrast peroral examination is still equivocal (Rabe medium, and superimposition with the filled etal. 1981; Fried etal. 1981; Maglinte etal. loops make small bowel radiology difficult. As 1982; Ott et al. 1985). Comparisons of both methods, however, (Fleckenstein and Pedersen a result, few radiologists specialize in this field. With the exception of Crohn's disease, disorders 1975; Sanders and Ho 1976; Ekberg 1977; Val- lance 1980) have confirmed the superiority of of the small bowel are relatively rare. Thus, not many clinicians and radiologists are interested enteroclysis. It achieves a high accuracy (Antes in the small intestine. and Lissner 1983).

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.

The purpose of this series of volumes is to present a comprehensive view of the complications that result from the use of acceptable diagnostic and thera peutic procedures. Individual volumes will deal with iatrogenic complications involving (1) the alimentary system, (2) the urinary system, (3) the respiratory and cardiac systems, (4) the skeletal system and (5) the pediatric patient. The term iatrogenic, derived from two Greek words, means physician-in duced. Originally, it applied only to psychiatric disorders generated in the patient by autosuggestion, based on misinterpretation of the doctor's attitude and comments. As clinically used, it now pertains to the inadvertent side effects and complications created in the course of diagnosis and treatment. The classic categories of disease have included: (1) congenital and developmen tal, (2) traumatic, (3) infectious and inflammatory, (4) metabolic, (5) neoplastic, and (6) degenerative. To these must be added, however, iatrogenic disorders a major, although generally unacknowledged, source of illness. While great advances in medical care in both diagnosis and therapy have been accomplished in the past few decades, many are at times associated with certain side-effects and risks which may result in distress equal to or greater than the basic condi tion. Iatrogenic complications, which may be referred to as "diseases of medical progress," have become a new dimension in the causation of human disease."

In Videofluorscopic Studies of Speech in Patients with Cleft Palate, Drs. M.L. Skolnick and E.R. Cohn present multiview videofluoroscopy as a technique for the radiological evaluation of speech defects in patients with cleft palate. Dr. Skolnick's invaluable contributions as both the originator and leading authority on the subject are discussed in a concise, clinical fashion. Topics examined include the anatomy and imaging of the velopharyngeal portal; the equipment and techniques of multiview videofluoroscopy; the interpretation of results and various patterns of velopharyngeal closure; Passavant's Ridge and patterns of velopharyngeal closure; normal and abnormal speech production; and the evaluation of test results. This book is the only source which concisely and completely describes the technique and its interpretations for those who need a description of the clinical procedure.

The diagnosis of osteoporosis and the determination of fracture risk has always been a challenge for radiologists, epidemiologists, and clinicians as well as oth er researchers and health care professionals working in the field. It is bone min eral density that is closely related to bone fragility, and the advent of techniques to quantitatively assess bone density has been welcomed. It has reduced the sub jectivity inherent to conventional radiologic assessment of osteoporosis. The on going technical process has made various techJ)iques to assess bone density wide ly available. However, these measurement techniques have also incurred some crit icism because bone densitometry has sometimes been applied without specific indications and without appropriate clinical ramifications. The purpose of this text is to provide a perspective on the current status of bone densitometry and ist relevance to osteoporosis diagnosis and management. Therefore, this book will give the reader an introduction to the nature of osteo porosis, its pathophysiology and epidemiology, and the clinical consequences of performing bone densitometry. Aside from standard bone densitometry, newer technologies such as quantitative ultrasound techniques, magnetic resonance imaging and bone structure analysis are discussed in the context of diagnosing osteoporosis."

Advanced Renal Cell Carcinoma (RCC) cannot be cured by surgery alone. Its resillience to irradiation and chemotherapy demands a new approach to the management of this disease. This book provides an overview of the scientific and clinical developments of RCC, and clarifies the fields ofimmunotherapy and immunobiology. The book contains a compilation of approaches that will enhance the effectiveness of the management of advancedRCC, even in the absence of definitive pre-clinical data. These require additional study and will stimulate the reassessment of preliminary results.Furthermore, preliminary results of already implemented clinical trials withbiological modifiers are presented. Of special interest are the current achievements in the field of immunotherapy using topically and subcutaneously low dosage combinations of cytokines. This concise volume will benefit those seeking a thorough review of the research and the clinical aspects of RCC simultaneously.

There has long been disagreement about various aspects of the structure and function of the "gatekeeper" (Greek pyloros, from pyle = gate and ouros = guard). In recent years the problem has often been mentioned in anatomy, physiology, gastroenterology, radiology and even in nuclear medicine. For instance, while referring to manometric and gastric emptying studies, Schu- urkes and van Nuenten (1984 ) pointed out that there was considerable contro- versy as to whether a true pyloric sphincter existed in most species, and espe- cially in man. According to Reeve (1981) many functional aspects of sphincters are poorly understood; the exact mechanism of control of the transfer of chyme from stomach to duodenum through the pylorus is still not clear. Malagelada (1983) states that controversy surrounds the motor activity and function of the antro- duodenal junction; there is disagreement as to whether the pylorus functions as or as an integral part of the distal antrum. Ehrlein et al. (1984) a separate unit reiterate that pyloric motility is poorly understood, and according to Funch- Jensen (1987) there are many unsolved questions. Malagelada (1990) states that the stomach performs multiple functions with a deceivingly simple anat- omy; this is regarded as the key to the investigator's frustration when trying to uncover its secrets. One source of the many controversies surrounding the pylorus may be species differences, according to Schulze-Delrieu et al. (1984).

The contributions in this book were originally presented at the workshop "Research and Clinical Application of Isolated Liver Perfusion for Hepatic Tumors" held on 28 February to 1 March 1997 in Hanover, Germany. The workshop was planned to bring together groups working with isolated liver perfusion techniques worldwide. Experts from various countries were invited to pre sent and discuss their experimental data and clinical results. USA par Groups from Japan, The Netherlands, Sweden and the ticipated. At the beginning, oncologists, surgeons and patholo gists presented possible indications and the oncological back ground for therapeutic isolated liver perfusion from their points of view. Based on data from previous studies about loco regional chemotherapy and based on the pathology of metastasis, it could be concluded that there is a place for isolated liver perfusion in the therapy of liver cancer. Second, different surgical techniques of isolated liver perfusion were presented. These techniques var ied from a percutaneous approach with extracorporeal chemofil tration to extended open abdominal surgery. Perfusion of the liv er without a considerable amount of drug reaching the systemic circulation proved to be possible. The complex procedure with complicated extracorporeal perfusion technique represented a disadvantage of the methods presented. Further studies should simplify the technical and surgical aspects. Intraoperative and postoperative management of . patients undergoing isolated liver perfusion were also discussed. Coagulopathy was one important aspect which can occur during isolated liver perfusion. The per centage of leakage determined systemic side effects."

As an addition to the European postgraduate training system for young neurosurgeons we began to publish in 1974 this series devoted to Advances and Technical Standards in Neurosurgery which was later sponsored by the European Association of Neurosurgical Societies. The fact that the English language is well on the way to becoming the international medium at European scientific conferences is a great asset in terms of mutual understanding. Therefore we have decided to publish all contributions in English, regardless of the native language of the authors. All contributions are submitted to the entire editorial board before publication of any volume. Our series is not intended to compete with the publications of original scientific papers in other neurosurgical journals. Our intention is, rather, to present fields of neurosurgery and related areas in which important recent advances have been made. The contributions are written by specialists in the given fields and constitute the first part of each volume. In the second part of each volume, we publish detailed descriptions Of standard operative procedures, furnished by experienced clinicians; in these articles the authors describe the techniques they employ and explain the advantages, difficulties and risks involved in the various procedures. This part is intended primarily to assist young neurosurgeons in their post graduate training. However, we are convinced that it will also be useful to experienced, fully trained neurosurgeons."

2 Diagnostic Use of Radiographic Methods in Coronary Disease. . . . . . . . . . . . . . . . . . . . . . . . . . 56 3 Material. . . . . . . . . . . . . . . . . . . . . . . . . 58 4 Mode of Operation . . . . . . . . . . . . . 62 5 Radiological Projections. . . . . . . . . . . . . . . . . 63 6 Monitoring of Cardiac Parameters . . . . . . . . . . . . 64 7 Pharmacological Tests . . . . . . . . . . . . . . . . 66 7. 1 Coronary Arteries . . . . . . . . . . . . . . . . . . . . . 66 7. 2 Left Ventricle. . . . . . . . . . . . . . . . . . . . . . . . 67 8 Accidents and Risks of Coronary Arteriography . . . . . 67 References . . . . . . . . . . . . . . . . . . . . . . . . . 68 III Angiographic Explorations: Normal Results . . . 71 1 Left Ventricle and Left Ventricular Function 71 1. 1 Radiological Anatomy. . . . . . . . . . . . 71 1. 2 Normal Kinetics. . . . . . . . . . . . . . . 77 1. 3 Analysis of Wall Contraction . . . . . . 78 1. 4 Volumes and Function Indexes. . . . . . . 81 2 Coronary Arteries and Veins . . . . . . . . 84 2. 1 Origin, Calibre and Preponderance of the Coronary Arteries . . . . . . . . . . . . . . . . . . . . . . . . 84 2. 2 Nomenclature and Segmentation of the Coronary Arteries . . . . . . . . . . . . . . . . . . . . . . 87 2. 3 A Reminder About the Physiology of Coronary Circulation . . . . . . . . . . . 93 2. 4 Angiographic Anatomy . . . . . . . . . . 94 2. 4. 1 Left Coronary Artery . . . . . . . . . . . 94 2. 4. 2 Right Coronary Artery. . . . . . . . . . . . . 95 2. 4. 3 Vascularization of Nodes and the Conduction System . . 96 2. 4. 4 Interconnecting Anastomoses . . . . . . . . . . . . . . . 97 2. 5 Coronary Veins . . . . . . . . . . . . . . . . . . . 97 References . . . . . . . . . . . . . . . . . . . . . . . . . 98 IV Angiographic Explorations: Congenital Anomalies of the Coronary Arteries. . . . . . . . . . . . . . . . . . . . . . . . 100 1 Anomalies of the Origin, Course and Distribution of Coronary Arteries Arising from the Aorta . . . . . . . . 100 2 Abnormal Origin of a Coronary Artery from the Pulmonary Artery . . . . . . . . . . . . . . . . . . . . . 101 3 Anomalies in the Diameter of Coronary Arteries . . . . . 104 4 Coronary Fistulae . . . . . . . . . . . 109 References . . . . . . . . . . . . . . . . . . . . . . . . . 113 VII V Angiographic Explorations: Coronary Atheroma. . . . . . . . 114 1 Left Ventricle . . . . . . . . . . . . . . . . . . . . . . . . 114 1. 1 Morphological Anomalies: Bulging and Lacuna-Like Aspects . . . . . . . . . . . . . . . . . . . . . . . . . . .

The concept of the ISS was developed in 1972 by three Internationally renowned radio logists; Harold G. Jacobson M. D. , Ronald O. Murray M. D. , and Jack Edeiken M. D. Their hard work and dedication allowed their vision to become a reality when the first meeting of the Society was held in 1974. The ISS is an interdisciplinary society dedicated to the learning, understanding, and teaching of musculoskeletal disorders. From the beginning, the Society established itself as a premier society, and its members, all experts in their respective fields, continue to make significant contributions to the field of medicine. The sharing of knowledge and a feeling of camaraderie by the members has made this truly a unique society. The Book of Members is in part a historical compilation of information about the Society. The first edition was compiled by Friedrich W. Heuck, Dr. med. , and spanned the first fifteen years of the Society. Dr. Heuck's contribution to the first edition is immeasurable". In the book, Harold Jacobson M. D. presented his historical perspective of the beginnings of the Society and Dr. Heuck presented information of the years that followed. I have brought that information up to date in this edition, and have added new facts about the Society and its membership. The amount of information about each member of the Society is purposefully less than that which was presented in the first edition, as the Society has grown to 427 members and 20 Honorary members .

Percutaneous transluminal angioscopy is opening up exciting possibilities for the interventional radiologist, since it can picture vascular features with an accuracy and clarity that previously has not been possible. Dr. Beck paves the way for the use of this new tool in clinical diagnosis; he details the technical prerequisites, gives step-by-step instructions for applying the technique and discusses how to interprete the resulting images. The amazing results of percutaneous angioscopy are compared with the results of conventional angioscopy. This approach introduces the new and unknown in perspective with the tried and trusted of the past. Major advantages become obvious: unclear or uncertain angiographical findings can be cleared up, interventional procedures can be supported, and the effects of interventional radiology can be seen before and after vascular treatment. The author's unique insight and systematic approach to the vascular system make this atlas a truly pioneering work.