This report on Future Trends in Inflammation IV records another of the multidisciplinary meetings organized by the European Biological Research Association. The organizers wish to record their thanks to all the participants and delegates who made this such an enjoyable meeting. Our thanks are due to a number of members of the pharmaceutical industry who so kindly donated funds. These funds were used to provide grants for young research workers to attend this meeting. Many people have kindly given their time and help to make this congress possible. It is impossible to list them by name, but we are profoundly grateful. We were dubious at the outset as to whether to hold this meeting in a period when many other meetings are being organized on inflammation. The enthusiastic attendance proves that we were right in going ahead. The next international meeting will be held in France in 1983. For further details please contact: Professor J. P. Giroud Department of Pharmacology, Hopital Cochin 75014 Paris, France D. A. Willoughby J. P. Giroud xxxiii Section I Future Trends CHAIRMAN: L. Chedid CO-CHAIRMAN: Dame Honor Fell 1 The participation of mononucleur phagocytes in immune based inflammatory processes with special reference to their secretory responses P. DAVIES AND R. J.

Rheumatic inflammatory diseases represent a steadily increasing group of disorders that have considerable social impact through affected patients' worsening quality of life and require engagement in the health field. Among these, rheumatoid arthritis stands as the most frequent pathology, and the hand is the most typical affected area. The incidence of rheumatic arthritis, as indicated by recent epidemiological studies, is bound to undergo a further significant increase in the future. There is, therefore, a need for careful diagnosis of the disease, based on clinical criteria designed by the American College of Rheumatology and Diagnostic Imaging. The latter provides an objective assessment of the extent and severity of joint involvement.
Rheumatoid Hand includes 25 tables of clinical and radiological cases. The text analyses the capability of diagnostic imaging (conventional radiology, ultrasonography and magnetic resonance) to identify the early stages and the activity of disease, allowing the rheumatologist to decide on an effective therapeutic plan.

This report on Future Trends in Inflammation III is the record of what is now firmly established as a series of multidisciplinary meetings organized by the European Biological Research Association. The aim of these meetings is to provide a forum for free exchange of information between basic scien tists of many disciplines and clinicians to provide better understanding of problems of common interest. The next major meeting wi1l be held in 1980.* The European Biological Research Association promotes scientific and clinical collaboration among the member countries ofthe EEe. It encourages exchange of information between scientists and clinicians from centres all over the world. In addition to the major international meetings small work shops are organized on specific problems of common interest. Once again the Editors have attempted to capture the spirit of the meeting by publishing 'verbatim' the discussion. It can be seen that the discussions were exciting and formed an important part of the meeting. It is possible that inaccuracies have crept into the discussions; if so we apologize. It was decided that the proceedings of such a meeting had maximum value with rapid publication. We would like to thank the participants for the enthusiasm and goodwill which persisted throughout the meeting both scientifically and socially. Above all we wish to thank H.R.H. The Duchess of Kent for acting as Patron of this meeting."

Osteoporosis is a common, underdiagnosed, and undertreated condition, complicated by fractures which lead to significant mortality and morbidity. The prevalence of osteoporotic fractures in postmenopausal women exceeds the combined prevalence of breast cancer, stroke, heart failure, and myocardial infarction. Often called "the silent disease," it does not reveal itself with obvious symptoms until a fracture occurs. In the first year after sustaining a hip fracture, mortality is increased by almost 24% in women and is even higher in men. About half of those who sustain an osteoporotic hip fracture become so disabled that they are no longer able to resume their daily activities, and as many as 20% require long-term institutional care. Effective treatments for osteoporosis are now available if it is diagnosed and addressed in a timely manner. Unfortunately, this disease remains shockingly underdiagnosed and undertreated, even in patients who sustain low-trauma hip fractures. The past two decades have witnessed radical changes in the diagnosis and management of osteoporosis. The densitometric diagnosis of osteoporosis is noninvasive, quick, and relatively simple. Tools are now available to predict the patient's probability of sustaining fractures, to identify patients who are particularly vulnerable, and to determine which patients will benefit from further investigation and treatment. Various associations have developed guidelines to help clinicians reach a diagnosis and initiate treatment. Due to better understanding of the basic pathophysiology of bone turnover, potent and relatively safe medications that significantly reduce the risk of fractures are now widely available. It is of paramount importance that this disease be diagnosed and treated as early as possible in order to take advantage of these developments and reduce the enormous socioeconomic and psychological impact of osteoporosis. Given the burden of osteoporotic fractures, all clinicians should have a working knowledge of e diagnosis, treatment, and prevention of the disease. Clinicians should feel comfortable diagnosing and initiating treatment for the majority of patients with osteoporosis. Only complicated cases or patients who are unresponsive to treatment should be referred to specialists. The aim of this book is to distill the available information on osteoporosis into an easily comprehensible format that will serve as a practical guide for busy clinicians. Numerous boxes, tables, diagrams, and figures present the information in an accessible manner. This book will be of particular use to general practitioners, endocrinologists, rheumatologists, gynecologists, internists, geriatricians, and orthopedic surgeons.

The Seventh International Conference of the Inflammation Research Association, entitled "Inflammation, Mechanisms and Therapeutics" was held on September 25-29,1994 in White Haven, Pennsylvania. The major focus of this series of conferences is the multidisciplinary investigation of inflammation and the discovery of novel therapeutic approaches to inflammatory diseases. It was therefore particularly gratifying that the list of attendees included scientists of diverse backgrounds - preclinical biology, synthetic and theoretical chemistry, biotechnology and clinical research. The Conference was characterized by a very high degree of participation in the scientific debate by attendees, a large proportion of whom presented at poster sessions, poster discussions and workshops, and by the many opportunities for informal discussion provided by the organizers. This volume captures much of the excitement and enthusiasm of the Conference and should be a valuable resource for scientists in the field. Niall S. Doherty Barry M. Weichman Douglas W. Morgan Lisa A. Marshall IX Acknowledgments The manuscripts contained in this volume are based on material presented at the Seventh International Conference of the Inflammation Research Association held in White Haven, Pennsylvania, on September 25-29,1994. We would like to thank the speakers and session chairpersons for their contributions to the Conference and these Proceedings. The following individuals played indispensable roles in the organization and running of the Conference and are responsible for making it such a success: PLANNING SCHOLARSHIP Niall S. Doherty Janet Kerr, Chairperson Barry M. Weichman Richard Carlson Douglas Morgan Richard Harris Loran Killar D.

Nine years have elapsed since the second edition of this book was published. In this time the principal advances in neuromuscular diseases have been in the application of molecular genetics to understanding the aetiology and pathogenesis of this group of disorders. As a result many previously unrecognised disorders have been charac terised. Some clinical syndromes, such as the limb girdle dystrophies, have become better defined. In many such instances the new genetic information has led to major advances in knowledge of the biology of cell structures, for example, the membrane structural and channel proteins. The clinical syndromes themselves, and their patho logical and electrophysiological characteristics, however, remain as important as ever, since they constitute the clinical problem itself and, indeed, the database from which all other concepts emerge. Knowledge of the pathogenesis, genetics, and molecular biology of neuromuscular disorders is essential both in developing and applying new therapies and preventive measures, and in formulating genetic and prognostic advice. However, this informa tion does not necessarily always define clinically useful syndromes. Myotonia, for example, is an electrophysiological finding in some syndromes in which it is un detectable by clinical examination, although the phenomenon itself was originally defined as a clinical entity. The limb girdle muscular dystrophy syndromes can be defined by severity, distribution of weakness, age of onset, sex distribution and other characteristics and many of these can be better understood by study of the under lying defect in cell structural proteins.

The production of a textbook of the pathology of bone work with isotopic markers to refine their classifica- tion. tumours is a hard task to embark upon, but Andre In this book, the author takes up a firm position Mazabraud has certainly succeeded. about the difference between osteoid osteoma and oste- It is the outcome of a very long experience, provided oblastoma, about "tumoral associations" and about the initially by his hospital training, then by his collabora- so-called malignant forms of disorders described as tion with Rutishauser at the Institut de Pathologie at benign. His personal stamp is evident throughout the Geneva and with Dahlin at the Mayo Clinic. The bonds various chapters. he forged then have never been loosened. Certainly, treatment in the area is rapidly changing Subsequently, his duties as head of the department and advancing, but this book does not risk obsoles- of pathology at the Institut Curie directed him finally cence since treatment is not its focus. The extent and towards tumour pathology. At the Institute, he was not nature of the author's experience explain the essentially satisfied with routine examinations but very soon linked anatomo-pathological orientation taken by this semi- up with the research team and worked especially on nal book. It also provides valuable clinical information Ewing's sarcoma and the problems of ultrastructure, and a good radiological study.

This is an exciting era in medicine and in science. Successive waves of advance in knowledge gather, break and recede uncovering fresh challenges and new opportunities. Each plays its part in eroding the tidemark of yesterday's ignorance. Many involved in the day-to-day management of patients, ill prepared and ill-equipped by the training which they received as under graduate students, find it difficult to retain contact with the advances in medical science and feel uncomfortable on the shifting sands of uncertainty upon which we now stand. Which of the new ideas is sound ? Upon which data may we rely? How may we distinguish the real from the unreal, the true from the false, recent advances from recent retreats? These are the anxieties, often either unstated or alternatively expressed in terms of an attitude of total opposition to 'all of this research rubbish' which are widespread in medical circles today. It is for these individuals who are not themselves directly involved in the immunology of rheumatic diseases but who, nevertheless, recognize the importance of this subject to their patients and, in particular, to tomorrow's patients, that this book has been written. There are two points that I believe to be of central concern. Firstly, I think it important to recognize that the intellectual basis of most of the research work being generated today is actually extremely simple."

Rapid developments in this successful diagnostic and operative technique have called for a new edition of "Arthroscopy of the Knee Joint." This second edition has been completely revised and retains very little material from the first edition. The diagnostic section has been considerably expanded and elucidated and the operative section adapted to modern technology. The first part of the book presents the external conditions and pre-requisites for diagnostic arthroscopy. The endoscopic anatomy and pathology of the knee joint are covered in detail. Particular emphasis is placed on practical hints for accurate arthroscopic procedures. The second part then discusses operative techniques. The reader discovers step-by-step how and which pathological findings should, in the author's opinion, be treated. Here, too, the problems and possible complications of arthroscopic surgery relevant to the individual techniques are dealt with in detail. Equipped with this book, the reader will be thoroughly informed on all current arthroscopic methods and possibilities.

The question facing anyone contemplating a book on low back pain is: Why write another book? It is certainly true that there are many books on this topic addressing a wide variety of audiences. Some books are all inclusive and scholarly in nature, others are personal descriptions of diagnostic and treat ment philosophies. This book is a combination of these two extremes. It represents our views on the low back problem, supported by scientific data. Most aspects on back pain presented in this book can be found in other texts. The organization of the material is unique, however. Our approach is to start by listening to and looking at the patient. It becomes apparent, then, that patients can be classified into one of the syn dromes described in chapters 4 through 13. We believe that this syndrome classification, which is quite simple to make clinically, will allow you to diagnose and treat your patients more effectively. To set the stage for the syndrome chapters the first three chapters of the book are generic to the remaining chapters. They reviewe the epidemiology, pathology, biomechan ics, etiologic theory, diagnostic methods, and treatment modalities applicable to the low back syndromes. They should be read before the syndrome chap ters. At the end of the book you will find four chapters that are specific to disease entities."

This issue of Current Topics in Microbiology and Immunology records the proceedings of a Workshop on the Immunology of Sili cones held at the Natcher Conference Center, National Institutes of Health, Bethesda, Maryland, March 13 and 14, 1995. A large num ber of investigators from North America and Europe met to discuss available data on how the immune system responds to silicones and related materials. Some aspects of this field are controversial. Nonetheless, the meeting was marked by a civil and open ex change of scientific information and divergent interpretations, re flecting the traditions of scientific communication. Each invited participant was asked to submit an article sum marizing his/her presentation. Most of the papers are published as submitted, with only editorial changes to conform with the guide lines given to each contributor or revisions to clarify aspects of the paper. The papers should not be regarded as peer-reviewed publi cations. This preface will attempt to outline some of the immu nological areas of investigation relating to silicones."

From the basic science to potential and approved clinical applications the most recent data in the rapidly growing field of bone morphogenetic proteins (BMPs) are summarized in this topical volume. Distinguished scientists present reviews on a range of scientific topics, including biochemistry, biology, molecular biology and preclinical animal studies on spinal fusion, cartilage repair, craniofacial and dental reconstruction using BMPs, as well as approved clinical applications in human bone non-unions.

This book provides a resource not only for experts in the field, but also for undergraduate students, newcomers and clinicians worldwide, given that the use of BMPs in orthopedic reconstruction has been already approved in Europe, Australia, Canada and the USA.

Rheumatology of the Lower Limbs in Clinical Practice is a comprehensive and easy-to-use training tool for practitioners to refine their strategy for clinical investigation and differential diagnosis in regional syndromes of the lower back, hip, knee, foot and ankle. It combines instructive sections, providing anatomical information and various causes of particular symptoms. Case studies recreate the clinical setting by presenting the details of the case and giving an opportunity for the reader to make a diagnosis. The text is lavishly illustrated in full color, with detailed photos of patient examinations, complemented by radiographs and full color line illustrations. The text also benefits from the use of summaries using colored boxing to identify key points in diagnosis and management. Written by two of the biggest and most respected clinicians in the discipline, this book will be essential reading for rheumatologists in practice and training.

Rheumatology of the Upper Limbs in Clinical Practice is a comprehensive and easy-to-use training tool for practitioners to refine their strategy for clinical investigation and differential diagnosis in regional syndromes of the shoulder, elbow, forearm, wrist and hand. It combines instructive sections, providing anatomical information and various causes of particular symptoms. Case studies recreate the clinical setting by presenting the details of the case and giving an opportunity for the reader to make a diagnosis. The text is lavishly illustrated in full color, with detailed photos of patient examinations, complemented by radiographs and full color line illustrations. The text also benefits from the use of summaries using colored boxing to identify key points in diagnosis and management. Written by two of the biggest and most respected clinicians in the discipline, this book will be essential reading for rheumatologists in practice and training.

Many advances have occurred in the last 5 years especially in understanding genetic susceptibility factors, the role of immune response in chronic arthritis and the relationship between cellular processes that underlie inflammation and tissue damage. All these are dealt with in depth in the individual contributions. Genetics studies included illustrate how studies of HLA genes and genes controlling the autoantibody repertoire may be involved. Environmental factors are believed to be important and studies both in humans and in experimental models on the role of viral and bacterial agents are covered. The fascinating relationship between microbes, dysregulated immune responses and oncogenes are also examined. Since autoimmunity is the key aspect of the immunological response in rheumatoid arthritis, the role of antigens is re-examined as is the part played by immune T and B cells. New areas of clinical application of basic science is well presented in this book, forexample, in examining how markers of cartilage destruction may become important in monitoring disease activity. A chapter reviewing possible future novel therapies is included.

The most frequently requested investigation in any nuclear medicine department remains the technetium-99m (99mTc)-labelled diphosphonate bone scan. Despite rapid advances in all imaging modalities. there has been no serious challenge to the role of bone scanning in the evaluation of the skeleton. The main reason for this is the exquisite sensitivity of the bone scan for lesion detection. combined with clear visualisation of the whole skeleton. In recent years several new diphosphonate agents have become available with claims for superior imaging of the skeleton. Essentially. they all have higher affinity for bone. thus allowing the normal skeleton to be visualised all the more clearly. However. as will be dis cussed. this may occur at some cost to the principal role of bone scanning. lesion detection. The major strength of nuclear medicine is its ability to provide functional and physiological information. With bone scanning this leads to high sensitivity for focal disease if there has been any disturbance of skeletal metabolism. However. in many other clinical situations. and particularly in metabolic bone disease. more generalised alteration in skeletal turnover may occur. and quantitation of diphosphonate uptake by the skeleton can provide valuable clinical information."

Since the discovery of the bone morphogenetic proteins (BMPs) more than 15 years ago, there has been an unpredicted explosion of both basic scientific discoveries and clinical reports on their use from institutions all over the world. The potent effica cy of BMPs in almost all crucial developmental events as well as during regenera tion of various organs such as bone, kidney, brain, liver, heart etc. , has positioned BMPs at the center of scientific interest. Many of these aspects are covered in this new PIR volume. Their role in development, biology, signal transduction, kidney regeneration, eNS functions, craniofacial skeleton reconstruction, joint and carti lage repair, long bone non-unions and acute fractures, and spinal fusion is reviewed by experts in the field. For the first time, the role of BMPs in carcinogenesis has been reviewed to provide a rationale for applying their biology in patients with bone tumors. The optimism resulting from safe and successful treatment with BMPs for various skeletal malformations of more than 10,000 patients worldwide has opened new avenues for exploring other indications for their use. The next big challenge for bringing BMPs to the benefit ofmankind is in regenerating articular cartilage defects and rescuing patients with acute and chronic renal failure. The volume editors thank all authors for the rapid preparation of their chapters in order that the book remains up-to-date for readers with specific interest in the field of regenerative medicine. The important contribution of Mrs. Morana and Mr.

An overview of diagnosis and current management of ankylosing spondylitis.

Presented in a clear, concise format
High quality clinical photos and figures to enhance descriptions and aid diagnosis
Written bywell-known authors in the field"

Arachidonic acid (AA) and other 20 or 22-carbon polyunsaturated fatty acids (PUFAs) are precursors of lipid mediators of inflammation known as eicosanoids. These mediators are critical in disease processes and in regulating normal cell function. Remodeling is important in maintaining homeostasis and in regulating cell function by dictating how PUFAs are converted to lipid mediators of inflammation. Thus, PUFA remodeling is a critical process in the biosynthesis of a multitude of mediators, and understanding this process will unravel better therapeutic targets for controlling inflammatory diseases such as asthma and Alzheimer s disease.
AA metabolism is described in an integrated context linking the remodeling processes with the biosynthesis of mediators and diseases. By following the movement of the substrate (AA), the volume describes how upstream biosynthetic pathways influence the formation of lipid mediators of inflammation, showing the metabolic interrelationship between all AA-derived mediators."

High pressure in the lungs, or pulmonary hypertension, is most commonly due to smoking-related lung disease and conditions affecting the left heart, for example, high blood pressure in the arteries, faulty heart valves, and a weakened heart muscle. Pulmonary arterial hypertension (PAH), is a rare and complex disease, associated with many different medical conditions, which is caused by a growth of cells lining the inside of the lung arteries, resulting in high pressure in areas of the body. Both conditions lead to strain and potential failure of the right heart, and therefore awareness and early diagnosis of the condition is needed to lead to better outcomes: however this depends on education of all specialists and primary care clinicians about PAH. This practical handbook covers both PH and PAH, providing information required by the wide range of clinicians who will encounter these conditions, including cardiologists, respiratory physicians, rheumatologists, specialists in liver and AIDS medicine, and haematologists. It covers what it is, who it is likely to affect, how it is diagnosed, including the pitfalls of the various diagnostic tests, the different and evolving forms of treatment, long term management of this often devastating chronic disease, and the crucial role of multidisciplinary management in optimizing clinical care of these patients who usually have multi-system diseases. It also covers the up new classification for both PH and PAH, and new drugs that have recently become available.

The need for greater international collaboration is becoming increas. ingly clear. Practically every nation or people has, in addition to its own characteristics and history, its own medical tradition. Methods and ways of thinking that are successfully established in one place may not be accepted in another for some time. The medical tradition and training in different countries can take quite different forms. What would our present knowledge be - Without the creative, spontaneous ideas and contributions from the romance countries? - Without the opportunity of research, as it is practised on a large scale in the USA, where so many young Europeans took their first steps in experimental science? - Without the conscientious clinical work done in Central Europe and the valuable experience gained there? - Without, finally, the sober and critical scientific approach, as fostered in the cool heads of Northern Europe for generations? None of these qualities is sufficient without the others, but together they are a source of strength. Ultimately, we hope, through sensible con centration of efforts (while maintaining variety), to overcome the lack of an integrated approach in experimental science and to prevent repetition of painful mistakes. In this regard, the first two ESKA congresses have brought us great advances."

Cervical Spine Research Society European Branch "The Cervical Spine Research Society is an organization of individuals interested in clinical and research problems of the cervical spine. Its purpose is for the exchange and development of ideas and philosophy regarding the diagnosis and treatment of cervical spine injury and disease. The com position of the membership should reflect the varying specialities and disciplines dealing with the cervical spine; biochemical, engineering, neurology, neurosurgery, radiology, orthopedic surgery and others," wrote J. William Fielding, New York City, one of the Society'S founding members. In 1984 the membership list contained 118 names. The overwhelming majority of members came from the United States, four from Canada and 9 Europeans, amongst them Mario Boni. He was the organizer, in con junction with the members of the Cervical Spine Research Society, of a splendid "International Meeting for the updating on pathology and surgery Preface VI of the cervical spine" held in Pavia (Italy) in May 1982. It was from this meeting that the idea of a European branch of the Society first originated, with the purpose of establishing multi-disciplinary meetings in Europe. The first meeting of the European branch was organized by A. Weidner in September 1984 in Osnabriick (Federal Republic of Germany). Mario Boni was elected president. He was not only the initiator but also the drivinglorce who tirelessly promoted the development of the European branch. Mario Boni's death in 1986 at the age of 64 was a great loss to us."

Our understanding of inflammation has increased rapidly in recent years, due in large part to the impact of molecular biology and gene identification and cloning. This book brings together ideas from a number of different biochemical disciplines which are frequently not integrated. The first chapter gives a visual overview of the subject; the remaining chapters are organized into three themes: the affector molecules, the regulatory components and the processes of inflammation itself. This book is essential reading for the busy physician or pathologist who wants to be up-to-date with the latest developments in immunology as they affect the diagnosis and treatment of many conditions.

Blood Supply of Bone: Scientific Aspects provides a comprehensive description of the development and physiology of blood supply to the skeleton. Investigative techniques for different types of bone in the body are discussed and the effects of disturbed circulation and the vascular control of osteogenesis is described. This highly illustrated and authoritative volume contains much revised material and many new illustrations reflecting 25 years of advances in this research field since the publication of its well-known precursor in 1971. The wealth of information will not only be invaluable to orthopaedic surgeons, rheumatologists, and radiologists but also pathologists, sports medicine specialists and bone metabolism research workers.

With the introduction of antibiotics acute inflammatory disease has ceased to be the dominant problem in general medical practice and its place is now increasingly occupied by chronic inflamma tory disease of which the rheumatic diseases constitute the most important group. lwo aspects of these diseases need to be consid ered, their aetiology and their pathogenesis. In some respects the latter is more important since even when the aetiology is known, as for example the haemolytic streptococcus in rheumatic fever, the mechanism by which the infecting agent accomplishes the development of the lesions that characterise the disease are still largely unknown. Still more so is this the case in rheuma toid arthritis and other chronic inflammations where the aetio logical agents are unknown. In an attempt to clarify the pathogenic mechanisms involved, sev eral attempts have been made to induce comparable lesions in ex perimental animals, partly to test underlying hypotheses, and partly to provide test situations for the trial of new therapeu tic agents. In view of the deficiencies in the current drug treat ment of chronic inflammatory disease there are many who feel that this is largely due to the inadequacy of the models avail able for test purposes."