Aims and approach In order to chart the way for long-tenn policies in the field of public health, the Dutch government needs to have the best possible insight into potential future trends and the problems to which these could give rise. It was with a view to compiling a number of long-range studies that the independent Steering Committee on Future Health Scenarios was set up in 1983. In 1988 this body appointed a board of experts to sUivey the future of Chronic Diseases. Three chronic diseases have been selected: diabetes mellitus, CNSLD (chronic non-specific lung disease) and rheumatoid arthritis (a chronic disorder of the joints). In close consultation with this board, the study has been conducted by the Department of Epidemiology of the National Institute of Public Health and Environmental Protection in Bilthoven. This report contains the results of the research into CNSLD. The report on diabetes mellitus was published in March 1990, while that on rheumatoid arthritis followed shortly (1991). The series has been concluded with a fmal report (spring 1992), in which, among other things, the results of the three reports have been brought together with a view to arriving at an overall picture of chronic diseases. The research had two main objectives: 1.

Birth is a sudden, traumatic transition of environments. Once the placental oxygen supply ceases, the foetus has only minutes to establish pulmonary oxygen transport, which requires not only inflation of the lungs, but also sudden and sustained changes in the lung circulation. Not long ago, research in this field was largely restricted to morphology and physiology. Now the powerful new tools of cellular and molecular biology have begun to
shed light on the physiological processes in the developing lung and its supporting vasculature.

In 22 chapters, three main sections explore lung growth and development, vascular cell growth and differentiation, and the mechanisms of hemodynamic control in the neonate; extensive illustrations give a comprehensive picture of pulmonary circulatory development. Factors controlling vasculogenesis and angiogenesis are described by the scientists who pioneered the field. Similarly, the intracellular signaling cascades that determine proliferation or growth inhibition of fibroblasts, smooth muscle cells, and endothelial cells are also presented in an understandable manner. Finally, the role of
substances, such as nitric oxide and endothelin, that control the hemodynamics of the fetal and neonatal circulations are discussed in detail, particularly in relation to the changes occurring at birth.

This book will inform basic scientists as well as the clinician and student, and should be of particular interest to pediatric cardiologists, pulmonary medicine physicians, and vascular biologists.

The Austrian Pneumological Society held its 33th Workshop on "Clinical Respiratory Physiology" at Graz, November 1st - 3rd, 1990. Sleep related breathing disorders have been known for many years to be an important cause of daytime disability I a huge amount of literature about this topic has been written in the last ten or fifteen years. Because of the practical relevance owing to the high competence of the authors we hope that the lectures and discussions we had at Graz will enjoy and inform the interested reader. I want to express my deep gratitude to all the authors for providing us with the manuscripts and graphs. I am especially grateful to Mrs. H. Weber for her secreterial work and to Mrs. Mag. A. Lahrmann-Ramharter for correcting the written version of the speeches and preparing a manuscript that was ready for the press. Prim. Dr. Hartmut Zwick Contents Douglas J. N.: Breathing During Sleep................... 1 Krieger J.: Pulmonary Hemodynamics in Sleep Apnea .................................16 Peter J. H.: Epidemiology of Sleep Related Breathing Disorders with Obstruction of the Upper Airways.....................

The Austrian Pneumological Society held its 33th Workshop on "Clinical Respiratory Physiology" at Graz, November 1 st -3rd, 1990. Bronchial hyperresponsiveness has been known nearly as long as asthma bronchia Ie itself. During the last two decades while exploring the inflammatory nature of asthma bronchiale we have learned a lot about measuring and modifying this phenomenon. Because of the practical relevance and owing to the high competence of the authors we hope that the lectures and discussions we had at Graz will inform and enjoy the interested reader. I want to express my deep gratitude to all the authors for providing us with the manuscripts and graphs. Finally I am especially grateful to Mrs. H. Weber for her secreterial work and to Mrs. Mag. A. Lahrmann-Ramharter for correcting the written version of the speeches and preparing a manuscript that was ready for the press. Prim. Dr. Hartmut Zwick Contents Barnes P. : Cellular and Biochemical Aspects of Airway Hyperresponsiveness. . . . . . . . . . 1 Hargreave F. E. : Airway Hyperresponsiveness and Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Ingram R. H. : Physiologic Correlates of Increased Airway Responsiveness . . . . . . . . . . . . . . . . 36 K errebijn K F. : Bronchial Provocation Testing in Children -Methods and Clinical Relevance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Tattersfield A. E. : Bronchial Provocation Testing in Adults -Is There Clinical Relevance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Kummer F. : Principles and Approaches in Asthma Therapy. . . . . . . . . . . . . . . . . . . . . . . . . .

It is often said that we live in a violent world. Traumatic injuries are commonplace; every hospital, large or small, sees scores of such patients daily. Appropriate diagnosis and management of the trauma patient are necessary not only to save lives but also to minimize the morbidity which follows injury. It is not surprising, therefore, that several books covering various aspects of trauma diagnosis and treatment are published annually. They are, however, seldom redundant because of the continuing rapid evolution of knowledge relating to the diagnosis and management of the traumatized patient. This volume, restricted to the consideration of thoracic trauma, represents a comprehensive and authoritative study of chest injury. Dr. Groskin is exceptionally well qualified to discuss his subject, being Board Certified in Internal Medicine, in Pulmonary Diseases, and in Diagnostic Radiology. He has practiced and taught in these disciplines in several prestigious institutions. The author has used his multidisciplinary background to develop a book which is unique among others of its kind. The reader will quickly appreciate that it is unusual in its correlation of clinical information with radiological diagnosis. Unlike any other book on traumatology with which I am familiar, this volume discusses extensively the mechanisms of injury which make both clinical and radiological findings easier to understand and to remember. It also presents a meticulous approach to the diagnosis of the many forms of thoracic trauma in which all clinical and radiological diagnostic modalities are thoughtfully integrated.

While specialists often guide the care to lung cancer patients, it is often a general radiologist who is left to interpret studies that impact patient care and management. Lung Cancer Imaging provides a comprehensive guide to the diagnosis, staging and overview of the management of lung cancer relevant to practicing radiologists so that they can better understand the decision making issues and provide more directed and useful communication to the treating physicians. It Primary Care physicians will also find this book valuable to understand the relevant issues that they face when one of their patients is being treated for lung cancer.

Only very few therapeutic modalities are used as extensively as mechanical ventilation in intensive care units, during anaesthesia and in emergency situations. Hence theoretical and practical knowledge in this technique had to be made available to workers in a number of medical specialities. In addition to anaesthetists, who are most familiar with artificial ventilation for historical and practical reasons, surgeons, internists, paediatricians and emergency physicians also need a foundation. Furthermore, the widespread application of this life-supporting method requires that paramedical personnel such as nurses and respiratory therapists be trained to use mechanical ventilation, to understand how it works and to be aware of specific side effects and dangers. This book, edited by Fran ois Lemaire, is a well-designed present ation of a number of the relevant aspects, types and problems of mechanical ventilation which are important for physicians and paramedical personnel who use it. After a description of the technical principles and maintenance of an artificial ventilator, the main part of the book is devoted to the most frequently used types of mechanical respiratory support, with their specific indications, the pathophysiology of their effects on pulmonary gas exchange and the specific choice and regulation ofthe mechanical variables involved. Older and new types of ventilatory support are discussed; there is a good balance of enough specific information for the inexperienced as well as a critical analysis of the indications for more exotic techniques, such as mandatory minute ventilation, independent lung ventilation and airway pressure release."

This volume provides a comprehensive and multi-disciplinary overview of the aging lung, written by the main researchers in the field. Current physiological, cellular and molecular understanding of how the lungs age and the relationship to age-associated lung diseases will be presented. The contents are aimed at a broad audience of scientists and clinicians with an interest in the respiratory system, pathogenesis of age-associated lung diseases and clinical implications.

Pleural diseases are very common and of increasing prevalence. This brand new title in the ABC series covers a wide range of conditions including pneumothorax, pleural effusions, pleural infections, chylothorax and mesothelioma.

Written by a team of specialists this overview of pleural diseases is a practical guide for the management of pleural diseases including general practitioners, junior doctors, specialist nurses, radiologists and all healthcare professionals working within chest medicine.

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)."

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.

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.

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.

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.

Find critical respiratory care information fast! Comprehensive and precise, this portable guide provides rapid access to vital respiratory procedures, facts, and formulas with an emphasis on critical care. It fits easily into your pocket, and the spiral binding allows it to lie flat on any given page. Whether you use it as a clinical resource, a study tool, or a quick refresher, this full-color resource offers quick access to just the right amount of practical, must-know information - essential for boosting your confidence at the point of care. A quick-reference format provides all of the key information you need with fast-access to respiratory care guidelines, including assessment, arterial blood gases, EKGs, medications, and PFTs. You'll also find essential information on pulmonary diseases, equipment disinfection, and neonatal and pediatric care. Waterproof and stain-resistant pages keep your PDQ reference guide performing like new in any clinical setting. Color coded tabs feature a table of contents with page references, making it easy to quickly locate key information within each section. Full color design includes illustrations and clarifies important facts to help you easily find what you need. Commonly used and updated clinical information, including tables, formulas, equations, algorithms, and lab values - all necessary to deliver safe and efficient care. AARC Clinical Practice Guidelines content has been redesigned into easy-to-use, compact algorithms. The latest asthma guidelines Increased coverage of neonatal and pediatric care Expanded BLS and ACLS protocols; updated medications, therapies, and therapeutic devices; and updated ventilator modes More formulas and facts than in the previous edition

"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 ?Understanding Asthma chart takes a look at the causes, symptoms, risk factors and treatments for asthma. The anatomy of airways and gas exchange is graphically depicted, along with a peak flow chart. Images of normal and asthmatic bronchioles are shown for comparison in the asthma attack section. Heavy gauge 3ml lamination with sealed edges and two metal eyelets for hanging makes chart highly durable. Write-on/wipe-off with dry erase marker (not included).

Gain a foundational understanding of respiratory physiology and how the respiratory system functions in health and disease. Respiratory Physiology, a volume in the Mosby Physiology Series, explains the fundamentals of this complex subject in a clear and concise manner, while helping you bridge the gap between normal function and disease with pathophysiology content throughout the book. Helps you easily master the material in a systems-based curriculum with learning objectives, Clinical Concept boxes, highlighted key words and concepts, chapter summaries, self-study questions, and a comprehensive exam. Keeps you current with recent advances in respiratory physiology, and includes a new chapter on new and emerging aspects of the lung. Includes nearly 150 clear, 2-color diagrams that simplify complex concepts. Features clinical commentaries that show you how to apply what you've learned to real-life clinical situations. Enhanced eBook version included with purchase. Your enhanced eBook allows you to access all of the text, figures, and references from the book on a variety of devices. Complete the Mosby Physiology Series! Systems-based and portable, these titles are ideal for integrated programs. Blaustein, Kao, & Matteson: Cellular Physiology and Neurophysiology Johnson: Gastrointestinal Physiology Koeppen & Stanton: Renal Physiology Pappano & Weir: Cardiovascular Physiology White, Harrison, & Mehlmann: Endocrine and Reproductive Physiology Hudnall: Hematology: A Pathophysiologic Approach

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.

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.

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."

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