This volume contains the proceedings of a symposium held in Marseille on April 6, 1992, on the topic "Heterogeneity of Alzheimer's disease. " This was the eighth of a continuing and very successful series of meetings related to Alzheimer's disease organized by the Fondation Ipsen pour la Recherche Therapeutique. These symposia, known as "Colloques medecine et recherche," started in 1987 and have dealt with widely different aspects of the disease such as immunology, genetics, neuronal grafting, biological markers, imaging, growth factors, and last year's less conventional topic of Neurophilo- sophy and Alzheimer's disease. The next IPSEN symposium dedicatet to Alz- heimer's disease will take place in Lyon on June 21, 1993, and will deal with "Amyloid protein precursors in development, aging, and alzheimer's disease. " It is being organized by Konrad Beyreuther, Colin Masters, Marc Trillet, and Yves Christen. Until a few years ago, several names were used to refer to the most common cause of dementia in the elderly. They included such terms as "senile psycho- sis," "organic brain syndrome," and "senile dementia. " Following Kraepelin, the term "Alzheimer's disease" was often restricted to an uncommon condition starting at a younger age (before 60 or 65 years of age).

It is a great pleasure for me to introduce and to recommend this much needed text on double contrast examination of the colon. It is aimed both at clinicians who request X-ray examinations of the colon and at radiologists who must per form and interpret these studies. Over the past decade there has been renewed interest in X-ray examination of the colon despite the tremendous advances in endoscopy and imaging tech nology. This renewed interest is evidenced by the proliferation of new books on radiology of the colon. However, previous discussions of double contrast ex amination have concentrated primarily on the technique with too little attention to the understanding and interpretation of the radiologic images. This volume is unique in its emphasis on the basics of image formation and interpretation. It emphasizes the importance of the anteroposterior relation ships of the colon in determining the distribution of barium and air. It also rec ognizes the influence oflocation on the radiologic appearance of the lesion. The authors demonstrate a profound understanding of the principles of double contrast diagnosis as applied to the colon. They also have a good grasp of the gross pathologic changes underlying the radiologic images. The material is presented in a logical and analytical method which should be particularly useful to the beginner in this field. There are many helpful diagrams and the ra diographic illustrations are of excellent quality."

The many advances in breast cancer research, as well as the large quantity of published material, make it very difficult to gain insight into the global aspects of cancer management. To follow and understand all the new developments is becoming a major challenge. For this reason, the editors decided to bring together a group of top researchers in breast cancer to provide a comprehensive, yet readable conceptual review of the state of the art of breast cancer diagnosis and therapy. The proposal to focus the review on the quantitative assessment of the risk at diagnosis, the determination of which may permit selective therapies for individual patients, was met with enthusiastic approval, resulting in the present volume with contributions by the leading investigators in the field. While the volume relating to diagnosis, published re cently, focused on efforts leading to refinement at diagnosis of risk criteria sensitive enough to reliably distinguish the low- and high-risk categories, the second volume, by provid ing a review of the main problems and results of therapy given to high-risk patients, can be considered as a continua tion of the first book. A refined risk assessment at diagnosis and the application of the most suitable treatments to well selected individuals are the most important steps towards avoiding the present worrisome reality of overtreating the low risk and undertreating the high-risk patients. The first few chapters of the present volume offer an insight into the general management of early breast cancer.

Numerous diseases in the areas of orthopaedics, rheumatology, and radiology can only be completely diagnosed if the corresponding conditions of the skin and mucous membranes are included in the diagnostic work-up (skin-bone). Conversely, dermatologic assessment of skin symptoms in isolation may lead to serious delays and errors in the diagnosis and treatment of associated changes in the musculoskeletal system. This monograph gives an interdisciplinary synopsis, from a dermatologic and clinical radiologic perspective, of 85 disease entities which in practice are likley to present. For orientation purposes the main dermatologic and radiologic symptoms are presented in table form at the beginning of the book.

Abundantly illustrated with more than 1,850 figures, this comprehensive monograph describes the experience gained through the treatment of patients with spinal tumors over a 25-year period. It covers clinical presentations and neuroradiological features of intramedullary, extramedullary, and extradural spinal tumors. Coverage provides step-by-step intraoperative photographs to describe surgical strategies. In addition, the book offers techniques and gives detailed statistical analyses on postoperative outcomes by focusing on postoperative complications as well as short-term and long-term results.

Progress in traumatology of the vertebral spine has been restrained for a long time by two hindering factors. The first obstacle is presented by the differences in approach and a conflict of competences. The neurosurgeons, considering only the spinal chord, have confined themselves to indications for laminectomy, an insufficient and usually ineffective intervention. The orthopedic surgeons, on the other hand, obsessed by the fear of medullary lesions, have long hesitated to apply the fundamental rules for the treatment of fractures, namely precise reduction followed by strict immobilization, thus depriving themselves of the efficacy of radiculomedul lar decompression and of the protection this procedure affords to these structures when they are themselves involved in the trauma. Taking these facts into account, together with the rather poor results of laminectomy, the specialists have wisely and successfully recommended that one should abstain from treating the initial lesion, but rather attenuate the damage by appropiate nursing care and adequate reeducation. The second hindering factor was the insufficient knowledge of the extreme complexity of the anatomic lesions. This explains the orthopedists' relative caution; one only treats well what one knows well. More precise analysis of the lesions, not only of the bones but also of the joints, i. e., the osteofibrous involvement, is mainly based on strict radiologic semiology, which is rendered difficult because these structures are simultaneously affected. We are greatly indebted to Dr. DOSCH, radiologist at our Center, for having untertaken this difficult task, using all available conventional radiologic techniques."

Die Rontgendiagnostik cerebraler und spinaler Erkrankungen - die Neuroradiologie - hat in den letzten Jahren so groBe Fortschritte gezeigt, daB ihr 3 Bande dieses Handbuches zur Verfligung gestellt wurden. Die einzelnen Kapitel umfassen die spezielle Diagnostik der Hirntumoren, der cerebralen GefaB- erkrankungen, des Schadel-Hirn-Traumas, die Diagnostik der Orbita und die Diagnostik des Spinalkanals. Besonderer Wert wurde auf die neueste Untersuchungsmethode, auf die cerebrale Computer- Tomographie, gelegt, die in ihrer Aussagekraft eine flihrende Stelle in der Neuroradiologie ein- nimmt. Eine ausflihrliche Darstellung der angiographischen und luftencephalographischen Technik und der Untersuchungsbefunde bei raumfordernden intracraniellen Prozessen mit diesen Methoden war jedoch auch erforderlich, da die Neuroradiologie nicht nur aus der Computer-Tomographie besteht, die als alleinige Untersuchungsmethode nicht immer ausreicht. Ferner ist es auch he ute noch nicht moglich, daB uberall in der Welt ein CT-Gerat zur Ver- fligung steht. Den Indikationen zu jeder Untersuchung ist in allen Kapiteln ein groBer Raum gewidmet; die Normalbefunde, die Physiologie, Pathophysiologie und die Neuropathologie werden in speziellen Kapiteln abgehandelt. Das Gebiet "Neuroradiologie" ist damit von Spezialisten in allen Abschnitten umfassend dar- gestellt. S. WENDE Preface So much progress has been made in the past years in neuroradiology ~ X-ray investigation of neurological disorders in the cranial and spinal regions ~ that three volumes of this Handbook are now devoted to it.

Der Umfang der Erkenntnisse uber das Mammakarzinom in Theorie, Klinik und Praxis ist in den vergangenen drei lahrzehnten so groB geworden, daB ein eigener Band zur Abhandlung dieses Themas erforderlich wurde. 1m Rahmen dieses Werkes ist es naheliegend, daB die radiologischen Disziplinen sowohl in der Diagnostik als auch in der Therapie besonders zu Wort kommen. Die Atiologie, die entsprechende Ethnologie, die Stochastik der Zellentartung, die Experimen- talmedizin, die Immunologie und die ausfUhrliche Chirurgie werden nicht abgehandelt, weil dadurch der Umfang des Buches wahrscheinlich mehr als verdoppelt werden wurde. Die Diagnose des Mammakarzinoms wurde zum einen durch die Mammographie und Thermographie erweitert und zum anderen durch die gezielte pditherapeutische Gewebsentnahme mit einer entscheidenden Histopathologie betrachtlich verbessert. Die fruhe Entdeckung eines Carcinoma in situ und die Differenzierung in ein lobulares, intraduktales oder infiltrierendes Karzinom bestimmen entscheidend das Schicksal der Frau. Die Frage nach der radikalen Mastektomie mit postoperativer Bestrahlung und der einfachen Mastektomie mit Bestrahlung konnen nur nach sorgfaltigen statistischen Unter- suchungen auf breiter Basis unter Berucksichtigung alterer und neuerer klinischer Erfah- rungen entschieden werden. Zur Vermeidung der oft sehr verstiimmelnden Operation sind die Kombinationsthera- pien, wie einfache Ablation des fortgeschrittenen Karzinoms oder Tumorektomie bei fruhen Karzinomen zusammen mit der Bestrahlung, in den Vordergrund getreten. Die Bedeutung der immer wieder diskutierten pdioperativen Bestrahlung und die Indikation dazu werden sorgfaltig besprochen. Eine ganz besondere Beachtung verdienen die jahrelangen sorgfaltigen Untersuchun- gen uber die alleinige Strahlentherapie mit Megavoltstrahlen, weil sie sowohl kosmetisch als auch statistisch ausgezeichnete Ergebnisse aufweisen konnen.

The second common meeting of the European Section and the Cervical Spine Research Society took place in Marseille (France) from June 12 to 15, 1988 and was organized by Rene Louis. More than 130 specialists from every part of Europe, from America and Asia participated, representing, among others, the fields of Orthopedics, Neurosurgery, Traumatology, Neurology, Anatomy, Rheumatology and Radiology. This meeting again was convincing proof of the growing interest which exists in Europe in research into injuries and diseases of the cervical spine. The main topics of this meeting were the subluxation of the lower cervical spine (chapter 1) and the infectious diseases of the cervical spine (chapter 2). Chapters 3 and 4 of this volume deal with degenerative lesions and the upper cervical spine. In chapter 5 experimental reports are presented, so that a good synopsis is provided of our present state of knowledge of diseases of the cervical spine. The European Section of the Cervical Spine Research Society was founded by Mario Boni in 1984, who unfortunately died in 1986 and was proclaimed Honory President of the European Section. There is a European meeting every summer and one every three years with our colleagues from the United States of America, Canada and Japan organized in Europe. The first combined meeting was organized by Pierre Kehr in Strasbourg (France) in 1985 and the presented papers were published in Cervical Spine I (Springer, Wien-New York, 1987).

During the past decade there has been a burgeoning of interest in arthritis and related rheumatic diseases. The spe ciality of rheumatology, once regarded as a "Cinderella" speciality, is now one of the leading specialties in internal medicine. Indeed, just as infant mortality is a good index of the general health of a community, so a University Med ical School can be similarly judged by the quality of its Department of Rheumatology. Perhaps no other specialty has helped to advance knowledge in medicine as has rheu matology One might have thought that little could be added to the clinical and radiologic description of one of the most studied diseases in rheumatology rheumatoid arthritis. There are several excellent large radiology textbooks on bones and joints, and it is surprising that yet another book has been published. However, the reader will soon appreciate on reading this superb radiologic text on rheumatoid arthritis that here is something new and quite different from what has been published in the past. The combination of clinician and radiologist has produced a textbook which will become a standard reference on the subject. The authors are both well known in their respective fields and they have concentrated on the early changes in the disease-not only those in the articular surfaces but also those in the soft tissues. In 1948 the late Dr Philip Ellman coined the term "rheumatoid disease," to indicate the systemic nature of rheumatoid arthritis."

With the advent of CT we entered a new area of radiological imaging. Structures which rarely if ever were seen became apparent. In no part of the body was the impact of CT as profound as it was in the retroperitoneum. In the pre-CT area this region of the body could not be directly studied and only when gross abnormalities were present could they be appreciated. The best we could do was to try to identify a suspected process by studying its effect on surrounding organs whose position might have been affected by the growth. Urography, barium studies or angiography were employed in the hope that variation in the position of the vessels, ureter or bowel would lead us to the correct diagnosis. With computed tomography all this changed. Modern scanners, available to all today, permit us to appreciate details undreamed of only few years ago. The abundance of fat in this region helps to clearly show even the smallest of structures. We now have the ability to recognize small vessels, lymph nodes and fascial planes. We had a tool which permitted us to study structures which hitherto were only seen by the anatomist or during surgical dissection.

Fast neutron therapy was introduced in London in 1970. The book gives an overview of the developments of the past 28 years, assesses the results of fast neutron treatment, and reviews the compiled clinical data worldwide. The authors describe the radiobiological profile of the neutron beams and evaluate the neutron RBE for secondary cancer induction, they introduce heavy-ion therapy, which combines high physical selectivity with the biological advantages of high-LET radiation for some tumor types, and finally they describe the very recent developments in Boron Neutron Capture Therapy (BNCT).

'Samii's Essentials in Neurosurgery' contains selected papers written by internationally recognized contributors who were trained by Professor Madjid Samii in Hannover, Germany. The main topics deal with cutting-edge technology in neurosurgery, skull-base surgery, and specific peripheral nerve, spine, and vascular surgeries. The texts and a wealth of illustrations review and reinforce guidelines on the diagnosis and management of situations that readers are likely to encounter in everyday practice. This book will be of great interest to neurosurgeons, neurologists, ENT surgeons, neuroradiologists, and neurophysiotherapists."

In 1992 the Editors published the first volume of Minimally Invasive Neurosurgery (MIN I) which described the current state of the art in this rapidly developing field of neurosurgery and reported first clinical experiences with these new technologies. The subject of MIN II is limited to endoscopic anatomy, technical devices and surgical management of disorders suitable for endoscopic procedures. The indications and approaches in different diseases are still highly preliminary and longterm results are not yet available. The clinical value and the benefit to the patients treated with these new techniques must still be proven against the well established standards of microsurgery. This volume presents a critical update of neuroendoscopy.

Many different opinions exist as to the appropriate diagnostic workup and therapy for spinal tumors. With the advent of new imaging techniques and therapeutic regimens, an up-to-date reference work has become an urgent requirement. This book is designed to meet this need, and is the first of its kind to offer an overview of the opinions of internationally renowned specialists in the field. By addressing in detail all of the relevant topics and areas of contention, it should prove of great value in establishing rational imaging and therapeutic protocols for spinal tumors.

The biennial symposium 'Radiology Today' continues its original mission to bring together European and American radiologists to discuss advances in the field. This volume presents material by well-known experts in cardiovascular and skeletal radiology. Its aim is to provide an overview of each major topic, trends in clinical development, and current interests in research. The future holds much promise for cardiovascular and skeletal radiology, primarily because of new techniques and procedures, but also because of the development of imaginative approaches to clinical problems. Ideas are born on both sides of the Atlantic, and we believe that it is important to ensure a rapid exchange of new information and to determine how it fits into today's medical care, keeping in mind the quality of patients' care, their safety and comfort, as well as cost. The traditional role of radiologists as consultants has increased greatly over time, with new responsibilities being continuously added. We radiologists are challenged to determine the diagnostic pathway appropriate to each patient. To arrive at the diagnosis quickly, safely, and at the lowest possible cost is as important as our participation in determining the patient's management. Some therapeutic procedures are even carried out by diagnostic radiol ogists themselves, employing ultrasound, computed tomography, or fluoroscopy and intracavitary catheters. Abscesses can be drained, and blood vessels dilated or blocked. In diagnosis and therapy, events are moving quickly, and advances are made at a rapid pace."

Throughout the twentieth century, interest in sport has evidenced a major increase worldwide and a new field of sports medicine has emerged. Sport spectators hip has been stimulated in part by the increased ease of international travel and the intro duction of new means of communication. Interest in professional sports and in such events as the World Cup and the Olympic Garnes has never been higher and the general popularity of sports has drawn increasingly greater numbers of young people to sports participation. Interest in sports participation has been strength ened both by the provision of numerous sports facilities to populations throughout the world and the accumulating information base that relates regular participation in programs of sport and exercise to health enhancement. Along with in creases in interest and participation has corne a need for a better understanding of the physiological changes accompanying muscular activity and of the trauma that can result from both competitive sport and recreational exercise.

We are in the midst of major advances in medical imaging, converting static pre sentation of anatomic information into near real-time interactive imaging and displays capable of depicting both structure and function. This will have pro found impact on diagnosis and image-guided therapies. These advances have been most notable in the modalities of computed tomog raphy and magnetic resonance. These technologies have become capable of ac quiring volumetric images in short periods of time. Speed gains in MRI were very significant in the early 1990s with the development of clinically usable pulse se quences for gradient-recalled and echo-planar imaging. It appears that further speed gains in MRI will be difficult to achieve. The development of spiral CT has ushered in an era in which major speed gains in CT are also possible. This has enabled creation of new types of applica tions such as CT angiography, which has already come to replace catheter angio graphy at many medical centers throughout the world. We are very pleased that the results from industrial and academic laboratories have been transferred to the bedside to improve patient care at a speed that may be faster than in any other area of medicine. Concurrent with advances in CT technology there have been dramatic strides in the performance characteristics and costs of computer hardware and software.

Percutaneous lumbar discectomy is a new surgical method for treating lumbar disc diseases. The goal of the procedure is decompression of the spinal nerve root by percutaneous removal of the nucleus pulposus under local anesthesia. Probably 20 % of all patients requiring lumbar disc surgery can be successfully treated by this method. During the past two years, percutaneous discectomy has spread rapidly, and it is now performed in most clinical departments engaged in spinal surgery. The first International Symposium on Percutaneous Lumbar Discectomy, held in Berlin in August 1988, covered all current procedures known as "percutaneous discectomy" and the entire range of percutaneous techniques, both clinical and experimental. Its publication is important because of the recency of this new surgical procedure, the outstanding experience of the speakers - including the Japanese, American, and European "pioneers" of the technique - and last but not least the gaps in the knowledge of physicians concerning this topic. This procedure opens up new perspectives in the surgical treatment of degenerative diseases of the lumbar spine.

A comprehensive review of current endovascular techniques for the treatment of cerebral aneurysms, this is a practical manual for those practicing, or intending to practice, this rapidly expanding branch of minimally invasive surgery. The authors provide descriptions based on an extensive combined experience of clinical management, technical problems, complications and recent results, and discuss the limitations and role of combined extravasular/endovascular techniques.

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).

This book deals with all aspects of surgery of the pancreas. The leading authorities from all over the world have contributed to this volume. Surgery of acute pancreatitis, chronic pancreatitis and pancreatic malignancies is demonstrated. This book defines standards for pancreaticand general surgeons. In addition all aspects of diagnostics, pathophysiology and basic scientific data with regard to pancreatic disease are presented.

The decision of Harvey Cushing to leave general surgery and concentrate on the infant field of central nervous system surgery was in retrospect a landmark in the history of neurosurgery. His concentrated work, and also that of his colleague Walter Dandy, originated with the desires of both pioneers to understand surgical anatomy and neurophysiology. The fundamental knowledge and surgical techni ques that they provided became the standard of excellence for several generations of neurosurgeons; so much so that the general belief was that the surgical techniques could not be improved upon. Twenty-five to thirty years ago microtechniques began to appear in a few surgical research centers, they were then gradually applied to clinical neurosurgery and have contributed to a new level of understanding in surgical anatomy and neurophysiology. We are now fortunate to have a new standard of morbidity and mortality in the surgical treatment of intrathecal aneurysms, angiomas, and tumors. It has been said that microneurosurgery was reaching its limits, especially when treating lesions in and around the cavernous sinus and skull base; those lesions notorious for involvement of the dural and extradural compartments, with a tendency to infiltrate adjacent nerves and blood vessels. The dangers of uncontrollable hemorrhage from the basal sinuses and post-operative CSF rhinorrhea appeared unsurmountable. The lateral aspects of the petro-clival region have been of interest to a few pioneering ENT surgeons and neurosurgeons but the cavernous sinus in most respects has remained the final unconquered summit."

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."

In 1932 there appeared the work of SCHMORL and JUNGHANNS, Die gesunde und kranke Wirbelsiiule im Rontgenbild, which laid the foundations of diagnostic radiology of the spine. Since that time the discipline has been extended and refined in a systematic manner and our knowledge has been greatly enriched by the large number of monographs in which leading experts have assembled additional data. An encyclopedic treatment of all that is currently known requires not only that reference be made to all work published since 1932 in order to reveal the problems that remain but also that a serious attempt be made to contribute to the solution of such problems. For this reason, Professor TONDURY and Professor THEILER of Zurich, who know more than anyone else about the ontogeny of the spine, have been invited to display their erudition in this field. Should contra dictions or divergent opinions on certain points be revealed through this confrontation with radiologically obtained findings, so much the better; the effect of this could only be to spur workers in both disciplines on to more advanced research. We have only to recall how in Goethe's time the premaxilla was still the subject of controversy, yet this great man pursuing his studies in comparative anatomy and anthropology was able to prove its existence beyond all doubt. Mainz, May 1974 L. DIETHELM Inhaltsverzeichnis - Contents A. Die normale Wirbelsliule . . . . . . . . . . . . . . . . . . . . 1 1 I. Phylogenetische Entwicklung des Achsenskelets. Von K. THEILER 1 1. Die Bogenelemente. . . . . . . . . . . . . . . 2. Die Chorda dorsalis . . . . . . . . . . . . . ."