l. A. STURM In modern society, trauma remains the number one cause of death in people under 50 years, but, despite this, very little attention has been paid to trauma care compared with other diseases such as malignancy or myocardial infarction (Table 1). The efforts that have been made in medical care, however, have showed some success; for example although the frequency of traffic accidents in the Federal Republic of Germany has remained constant over the years, the number of deaths resulting from them has decreased (Fig. 1). The results of improvements in rescue systems, surgical techniques, and intensive care are evident, as shown by a review of the statistics of about 3000 multiple trauma patients treated in the last 15 years at the trauma de partment of Hannover Medical School which reflects the progress that has been made in medical care. After the problem posed by posttraumatic kidney failure had been solved in the 1960s and 1970s, the adult respiratory distress syndrome (ARDS) became the biggest problem in the 1970s and 1980s (Fig. 2). ARDS as a single entity disappeared in the literature in the early 1980s and was replaced by the so-called multiple organ failure (MOF) syndrome. Between 1985 and 1990 35% of the patients in our intensive care unit developed MOF, and 70% of them died. Overall MOF mortality has remained constant since 1985 at about 20% (Fig. 3)."

Lung function assessment is the central pillar of modern respiratory diagnosis, providing invaluable information to assist in clinical decision making and management strategies.Interpreting Lung Function Tests: A Step-by Step Guide is a practical "how-to" training manual, which provides the reader with the necessary skills to interpret lung function test results, and to write a concise and informative report on the outcome. Interpreting Lung Function Tests: A Step-by Step Guide provides unique guidance on the reporting of pulmonary function tests, including illustrative cases and sample reports. utilizes the many references available on interpretation of lung function and provides a teaching/reference tool for report writing of lung function results routinely performed in clinical practice. provides the reader with the skill to interpret and write a concise, yet informative report provides examples of results and written reports (with commentary where necessary as further explanation). focuses primarily on tests performed as part of routine clinical testing: spirometry, static lung volumes, gas transfer, bronchial provocation tests, and maximal respiratory pressures. Interpreting Lung Function Tests: A Step-by Step Guideis a superb new resource to educate medical students, junior doctors, family physicians, as well as advanced trainee physicians specializing in respiratory medicine, respiratory scientists, and respiratory physicians

This welcome addition to the series Update in Intensive Care and Emergency Medicine emerges from the most recent of a series of meetings organized by Alvar Net and Salvador Benito of Barcelona. This gathering provided a forum for European intensive care specialists to exchange ideas, knowledge and experience on, the measurements feasible in mechanically ventilated patients. The scope was ambitious, ranging from basics like the measurement of airway pressure and blood gases to topics such as CT, MRI and the multiple inert gas elimination technique. The success of the meeting made publication a logical consequence. The book is unique in its breadth. The contributors, from numerous centers in Europe and North America, cover all tech niques employed in intensive care units, describing indications, contraindications, procedures, biases and complications. This volume will be an invaluable source for intensive care specialists and other clinicians. Alongside practical descriptions of procedures they employ routinely (spirometry, measurement of sys temic vascular oxygen pressure, Swan-Ganz catheterization, BOPA etc.), they will find accounts of such sophisticated techniques as on line measurement offunctional residual capacity, isotope determina tion of ventilation/perfusion ratios, diaphragmatic metabolism and peripheral oxygen exchange. I am especially happy to see the book published by Springer-Verlag, which has distinguished itself in the field of intensive care medicine.

Chest radiography is the most commonly perfonned diagnostic radiological exam- ination in the United States. More than 80 million chest radiographs are perfonned annually in the United States and this type of radiograph accounts for 30%-50% of the total volume of diagnostic studies. Standard chest radiographic examinations are difficult to optimize, primarily because of the seven-to tenfold greater attenuation of the mediastinum and heart than of the lungs. In order to obtain the best results, we must be able to see with distinct clarity the vascular markings of the lungs, particularly when these are superimposed on the rib cage, the bony structures, and the air-soft tissue interfaces of the mediastinum. The large variation in attenuation caused by the mediastinal structures cannot be recorded routinely on a radiograph with maximum image contrast. The lungs are shaped like a truncated cone. The apices are volumetrically smaller than the bases and are crisscrossed by bony structures (the upper ribs, clavicle, and sometimes the scapula and manubrium of sternum). Often in women, the density of the breasts overlaps the lung bases, and X-rays must therefore traverse more tissue. Despite the cephalocaudal increase in tissue volume, it is possible in most in- stances to obtain a balanced density and contrast from the apices to the bases using the high kilovoltage peak (kVp) technique. Optimal image quality demands appro- priate resolution and contrast that will pennit the detection of pulmonary opacities and lucencies and of mediastinal and chest wall abnonnalities.

The "Europe against Cancer" programme has, from its inception, emphasised the key role which general practitioners must play in the actions necessary to achieve its aim of reduc ing the incidence and the mortality from cancer in the European Community. General practitioners, because of their day-to-day direct and continuing contact with patients, playa role not only in primary prevention and education of patients, but also in motivating their patients to accept secondary prevention and screening, some of it carried out by general practitioners themselves. These preventive activities are in addition to their traditional role in the care and management of patients with cancer at home, and increas ingly, their role in active treatment. In view of the importance of the general practitioner in the "Europe against Cancer" pro gramme, the European Commission, with a view to providing general practitioners with up-to-date useful information, has sponsored the production of this series of publications on organ based cancers, especially written for general practitioners. MICHEL RICHONNIER Coordinator ofthe "Europe against Cancer" programme, Commission ofthe European Communities, Brussels Preface To decrease the death rate of lung cancer is today one of the major challenges of medical doctors all over the world. In Europe alone, one person is dying of lung cancer every two minutes. Accordingly, most physicians will regularly in their career be confronted with a patient being either suspect of or having a lung cancer.

In this issue of Emergency Medicine linics, guest editors Drs. Haney Mallemat and Terren Trott bring their considerable expertise to the topic of Respiratory and Airway Emergencies. Respiratory emergencies may range from "shortness of breath," or dyspnea, to complete respiratory arrest, or apnea, in which the patient is no longer breathing. In this issue, top experts in the field address topics such as pulmonary hypertension; COPD and asthma; pulmonary embolism; special procedures; procedures for the challenging airway; physiologically difficult intubation; and more. Contains 13 relevant, practice-oriented topics including intubating special populations; ARDS; basic modes of ventilation; advanced modes of ventilation (APRV); infectious pulmonary disease; and more. Provides in-depth clinical reviews on respiratory and airway emergencies, offering actionable insights for clinical practice. Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize and distill the latest research and practice guidelines to create clinically significant, topic-based reviews.

All aspects of oxygen transport and tissue oxygenation that are relevant in clinical medicine are covered in this monograph. Experts from basic science as well as clinical research provide information that improves understanding of how to treat O2-transport disturbances in daily practice. Special interest is focussed on the question of supply dependency of O2-uptake and its role in multi-organ failure in the critically ill. Other topics are the clinical monitoring of O2-transport and O2-utilisation, oxygen toxicity, and the role of O2-radicals and the reperfusion syndrome in organ transplantation and cardiopulmonary resuscitation.

"Respiratory Disease," the latest volume in the "Treatment in Clinical Medicine" series, is in two parts: the first reviews the background to each of the main respiratory diseases with particular emphasis on management and treatment. The second reviews the main drugs used in respiratory practice in more detail and combines a pharmacological appraisal with a more personal assessment of their role and value in treatment. Practical aspects of management are emphasised. Where uncertainty exists the authors have described their own practice. The book aims to fill the gap which exists between textbooks of respiratory medicine, where there is often insufficient space to cover treatment in detail, and pharmacological textbooks, which are not concerned with practical management problems. It is intended for respiratory physicians, general physicians and senior medical students, and will provide useful background information for researchers entering the the field.

The anesthetist-computer interface tends to be a problem for the utilization of computer systems for anesthesia. Ergonomic interface design with an emphasis on the coherency of the interface's static and dynamic structure may improve this situation. To investigate this proposition we developed an Anesthesia Information System (AIS) with a touch-sensitive monitor as the hardware-user interface. Basic data input and system control techniques were defined and implemented. Record keeping is integrated into the user interface. Ventilator control from the same interface is an additional feature for laboratory simulations. The system is being evaluated using a technique that simulates live operations. References Anthony J (1982) BAS - A major change coming in delivery. IEEE EMB 1 (1): 36-42 Apple HP, Schneider AJL, Fadel J (1982) Design and evaluation of a semiautomatic anesthesia record system. Med lnstrum 16 (1): 69-71 Arnell WJ, Schultz DG (1983) Computers in anesthesiology - a look ahead. Med Instrum 17 (6): 393-395 Bender HJ, Osswald PM, Hartung HJ, Lutz H (1983) On line - Erfassung haemodynamischer und respiratorischer GraBen in der Anaesthesie. Anaesth Intensivther Notfallmed 18: 37-40 Cooper JB et al. (1982) A graphics-tablet for data entry in computer assisted recordkeeping Proc.

In this issue, guest editors bring their considerable expertise to this important topic. Provides in-depth reviews on the latest updates in the field, providing actionable insights for clinical practice. Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize and distill the latest research and practice guidelines to create these timely topic-based reviews.

Cystic fibrosis is the most common life-threatening inherited disease in the UK and Europe. It affects around 1 in 2500 live births in the UK. There have been enormous advances in the treatment of CF over the last 40 years, with life expectancy increasing from just 5 years in 1964 to mid 30s today, and it now affects as many adults as children. The burden of care for CF patients is, however, considerable, and with the increase in life expectancy the impact of CF on respiratory medicine has increased considerably.
Part of the Oxford Respiratory Medicine Library series, this pocketbook aims to be a concise companion for all health care professionals who manage, or come across, patients with CF. The book covers all aspects of care, including both paediatric and adult-specific issues. The book will appeal to a wide variety of health professionals in respiratory medicine, paediatrics, and primary care.

In this issue of Thoracic Surgery Clinics, guest editors Drs. Jasleen Kukreja and Aida Venado bring their considerable expertise to the topic of Lung Transplantation. Top experts in the field cover key topics such as inpatient management of the acutely decompensating lung transplant candidate, lung allograft rejection, management of the potential lung donor, postoperative management of lung transplant recipients, and more. Contains a variety of relevant, practice-oriented topics including donation after circulatory death; lung transplant for ARDS; centralized organ recovery and reconditioning centers; infectious complications in lung transplantation; anesthetic management during lung transplantation; and more. Provides in-depth clinical reviews on lung transplantation, offering actionable insights for clinical practice. Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize and distill the latest research and practice guidelines to create clinically significant, topic-based reviews.

Gain realistic National Board of Respiratory Care (NBRC) Exam experience to help eliminate exam day surprises! The Comprehensive Respiratory Therapist's Exam Review, 7th Edition covers every topic listed on the 2020 NBRC Detailed Content Outline - and presents every item listed as testable on the Therapist Multiple Choice (TMC) Exam and Clinical Simulation Exam (CSE). It provides study hints, in-depth content review, and self-assessment questions with rationales to help you retain more information. Two practice exams on an accompanying Evolve website prepare you for the TMC Exam. In addition, twenty-two updated practice clinical simulation scenarios on Evolve offer invaluable CSE prep. Updated content reflects 2020 NBRC Detailed Content Outline and examination matrix so that you know exactly what to expect on the exams and can review each of the areas covered on the matrix. Exam Hints point out commonly tested items to help you determine what to study, how to plan your time, and improve test-taking skills. Special NBRC coding of topics corresponds to every topic covered on the NBRC Detailed Content Outline (DCO) so that you know exactly what to expect on the exams and can easily review each of the areas covered on the DCO. Self-study questions at the end of each chapter include an answer key with rationales to help you analyze areas of strengths and weaknesses in content learned. Additional analysis-type questions account for changes in the testing matrix. Rationales for each question provide feedback for correct and incorrect answers to help you understand why an answer is correct or incorrect and retain information better. Difficulty level codes (recall, application, analysis) for each question included with each NBRC topic to help you prepare for questions in a way that is most appropriate for that type of question (e.g., memorization for recall or synthesis for analysis). Twenty-two clinical simulations align in content and structure with the new 2020 NBRC Clinical Simulation Exam in both study mode and exam mode. In the untimed study mode you can select each scenario individually and choose to receive detailed feedback on the items that were selected, or on all possible items, upon completion. In the exam mode you take all 22 scenarios with a 4-hour time limit and receive feedback after completion. The clinical simulations can be found on the secured Evolve website and accessed by a pin code (access code in book). The software mimics that used on the actual NBRC CSE. Two 160-question versions of the Therapist Multiple Choice (TMC) Exam align in content and structure with the new 2020 NBRC TMC Exam. The untimed study (pretest) version provides immediate feedback on each question with a rationale about the correct and incorrect answers. The timed exam (posttest) version has a 3-hour limit. Feedback, including the correct answer and a rationale for the correct and the incorrect answers, is provided on each question upon completion. Final scores are given in the pretest and posttest versions, and the software for both versions mimics that used on the actual NBRC TMC Exam. The question sequence mixes with each repeated attempt, giving you a unique exam experience each time. This content can be found on the secured Evolve website and accessed by a pin code (access code in book). NEW! Every item listed as testable on the 2020 National Board for Respiratory Care (NBRC) Therapist Multiple Choice (TMC) Exam and Clinical Simulation Exam (CSE) presented to get you exam-ready. UPDATED! Two TMC practice exams on Evolve. UPDATED! Twenty-two updated practice clinical simulation scenarios on the practice CSE (on Evolve). NEW! Updated artwork enhances comprehension.

Die Behandlung der aktuten respiratorischen Insuffizienz steht hiiufig im Mittelpunkt therapeutischer Bemiihungen warnend der postoperativen Phase sowie in der Intensivmedizin. Entsprechend lag und liegt das wissenschaftliche Hauptinteresse zahlreicher Arbeitsgruppen verschiedenster medizinischer Fachrichtunge- von der Physiologie liber die Pathologie, Rontgenologie, Chirurgie, Innere Medizin bis hin zur Aniisthesiologie und Intensivmedizi- im Bemiihen, den Pathomechanismus der akuten respiratorischen Insuffizienz aufzukliiren und hieraus therapeutische Konsequenzen zu entwickeln. Das vorliegende Heft beinhaltet Vortriige, die auf einem inter- nationalen Symposium, veranstaltet yom Institut flir Aniisthesiolo- gie der Universitiit MUnchen, gehalten worden sind. Die themati- sche Palette reicht von der Darstellung der normalen Lungenfunk- tion bis hin zur Diskussion detaillierter Fragen der Beeinflussung von PEEP auf die Hamodynamik. Es wird die pathologische Anato- mie der akuten respiratorischen Insuffizienz dargestellt, das rontge- nologische Substrat bei dieser Erkrankung diskutiert und die ver- schiedensten therapeutischen Verfahren werden angesprochen. Von besonderem Interesse wird flir Experten die Diskussion der Frage nach der Bedeutung des !lerzens, insbesondere des rechten Ven- trikels unter den Bedingungen der respiratorischen Insuffizienz sein. Es ist das liel der Zusammenstellung der verschiedenen Sympo- siumsbeitrlige, fdr Studenten wie auch fUr Arzte, die an Fragen der Intensivmedizin interessiert sind, eine lesenswerte Arbeitsgrundlage zu schaffen. Mein Dank gilt deshalb den Autoren sowie dem Springer-Verlag.

This book presents the proceedings of a satellite symposium of the XXVllth International Congress of IUPS held in Berlin, July 12-15, 1977 the latest of a series of meetings dealing with the organization of the autonomic nervous system, especially its central nervous control (Warsaw 1971, Tokyo 1974, Heidelberg 1976). This was an occasion for the discussion of the rapidly increasing experience of laboratories and research groups in a number of countries. Interest is growing in the organization of the sympathetic and parasympathetic nerve supplies, and there is much new material derived largely from single unit re cordings within both central and peripheral nervous structures. It has long been known that various rhythms originating in central ner vous structures, including the respiratory rhythm, are reflected in autonomic outflows. Moreover, the autonomic responses themselves rarely appear in isolation, and are usually seen as part of patterns of change involving a number of organs and systems. These facts alone imply com plex interactions within the central nervous system, which indicate that studies of relationships between the relevant inputs, intrinsic central nervous activity and autonomic outputs constitute a special branch of neurophysiology which needs to be developed in order to gain insights into the forms of central nervous organization which are in volved."

This atlas is designed as an easy-to-use reference guide that identifies and illustrates the key patterns of diffuse lung diseases observed on high-resolution computed tomography (HRCT) and then documents in more detail the characteristics and appearances of the individual diseases, grouped on the basis of their prevalent pattern. A further feature of the book is its interdisciplinary nature: contributions from experts in various specialties are tightly interwoven throughout and many pathologic correlations are included. Less experienced readers will find that this atlas, with its wealth of figures and helpful color coding, steers them towards correct interpretation when confronted by the multiplicity and complexity of these diseases; those who are already experts, on the other hand, will benefit from the detailed coverage of individual diseases, which will deepen their understanding. At the end of the book, a graphically appealing and practice-oriented illustrated glossary with tips and tricks offers a further highly effective educational tool. Given the clinical spectrum of diseases covered, this atlas will prove invaluable for a wide range of healthcare workers, especially radiologists, pulmonologists, and pathologists.

Respiratory conditions are a leading cause of death and disability and account for a massive proportion of hospital admissions. This comprehensive text provides a detailed overview and discussion of respiratory care, with chapters on assessment, investigations, treatments and a wide range of conditions, as well as anatomy and physiology. Taking an inter-professional and patient-focused approach, Respiratory Care is evidence-based and linked to key practice guidelines to enable postgraduate students and professionals to provide the most effective care. Each chapter includes learning outcomes and makes use of case studies to provide an explicit and practical application of the topic to patient care. Respiratory Care is essential reading for all nurses and healthcare professionals in respiratory care in hospital or community settings. Vanessa Gibson is a Teaching Fellow, and Learning and Teaching Lead at the Department of Healthcare at Northumbria University, UK. David Waters is Head of Academic Department, Faculty of Society and Health, Buckinghamshire New University, UK.

"Analyzes the role of peptides in promoting or suppressing inflammation. Thoroughly examines the therapeutic potential of key peptides, analogs, agonists, and antagonists that influence cell injury and repair."

A review of the publications, dealing with the morphology of the cartilages of the tracheo-bronchial tree, shows how scarce they are and how fragmentary the contributions based on research. Isolated parts only of the bronchial tree have been investigated, mostly in single specimens or small series. Anatomical textbooks merely state that the trachea and main bronchi are supported by rings and the more distal branches by irregular, circumferentially placed plates which become smaller towards the periphery, until they disappear in the bronchioli. It is at once obvious that this old-time view is not only superficial, but it leaves one completely ignorant about the site where rings cease and plates begin. No information is available about the arrangement of cartilages around the bifurcations of the main bronchi and contradictory descriptions are given about the cartilaginous architecture of the lobar bronchi. A more searching study reveals that cartilages are hardly mentioned in the huge amount of literature on bronchial anatomy which has accumulated since 1880. It is therefore not exagerated to say that the study of this subject has been grossly neglected.

As the series title implies each Clinician's Desk Reference is a practical resource and a daily aid for physicians in the hospital setting and in primary care. Asthma is one of the most important chronic disorders in the developed world. Evidence from around the world shows the prevalence of asthma has increased considerably since 1975, and now affects around 7.2% of the world population (about 100 million individuals). In the UK asthma is now the most common chronic disease affecting all age groups with approximately 11% of the population being diagnosed as having asthma at some time in their lives. Understanding of the basic mechanisms involved in the pathogenesis of asthma has improved dramatically over the past 20 years. Along with this increase in basic scientific knowledge, randomized clinical trials have produced evidence to guide clinicians in how to manage patients with asthma. The book covers epidemiology, diagnosis and management, and takes a look at future developments. The authors highlight the under diagnosis of occupational asthma and emphasize the importance of effective patient education, particularly asthma action plans. There are ten clinical cases dealing with common diagnostic and management problems, frequently asked questions and appendices containing resources for patients and clinicians including useful websites, information leaflets and major references.

Incidence of invasive fungal sinusitis has been increasing over the years. The understanding of its pathophysiology has improved with newer serological tests and diagnostic methods helping in earlier diagnosis and reducing patient morbidity. It was believed earlier that invasive fungal sinusitis is seen only in immune compromised patients but clinical reports suggest otherwise. More anti-fungal drugs are being added to improve incidence of patient survival. This book aims to compile all practical information about invasive fungal sinusitis into a single volume. Therefore, busy clinicians would not have to perform exhaustive literature studies to diagnose invasive fungal sinusitis. The book aims to provide an overview of diseases which could be mistaken for invasive fungal sinusitis and discuss how the management is different.

Book sections consist of clinical, microbiological, serological, pathological, radiological and pharmacological features of the disease and its management. Each section is important in today s context as it dynamically alters the management of the patient. Early clinical suspicion and rapid microbiological, pathological and radiological diagnosis with aggressive treatment with surgical debridement and medical therapy leads to favorable outcomes.

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In this issue of Thoracic Surgery Clinics, Guest Editor Farid Shamji brings considerable expertise to the topic of Lung Cancer in this second issue covering this topic. Top experts in the field cover key topics such as biological treatments, improving anesthesia safety in pulmonary resection for lung cancer, history of surgical instruments in thoracic surgery, The Hemithorax - the empty chest syndrome, and more. Provides in-depth, clinical reviews on lung cancer, providing actionable insights for clinical practice. Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field; Authors synthesize and distill the latest research and practice guidelines to create these timely topic-based reviews. Contains 16 relevant, practice-oriented topics including Assessment of Operability and Resectability in Lung Cancer; Complications of chest wall resection in conjunction with pulmonary resection; Sepsis in the postpneumonectomy space: pathogenesis, recognition and management; Neuroendocrine cancers of the lung: natural history, pathological classification, biological behaviour and treatment; and more.