William P. Cooney III, R. A. Berger, and K. N. An Orthopedic Biomechanics Laboratory Department of Orthopedic Surgery Mayo Clinic and Mayo Foundation Rochester, MN 55905, U. S. A. As surgeons struggle to find new insights into the complex diseases and deformities that involve the wrist and hand, new insights are being provided by applied anatomy, physiology and biomechanics to these important areas. Indeed, a fresh new interaction of disciplines has immersed in which anatomists, bioengineers and surgeons examine together basic functions and principles that can provide a strong foundation for future growth. Clinical interest in the hand and wrist are now at a peak on an international level. Economic implications of disability affecting the hand and wrist are recognized that have international scope crossing oceans, cultures, languages and political philosophies. As with any struggle, a common ground for understanding is essential. NATO conferences such as this symposium on Biomechanics of the Hand and Wrist provides such a basis upon which to build discernment of fundamental postulates. As a start, basic research directed at studies of anatomy, pathology and pathophysiology and mechanical modeling is essential. To take these important steps further forward, funding from government and industry are needed to consider fundamental principles within the material sciences, biomechanical disciplines, applied anatomy and physiology and concepts of engineering modeling that have been applied to other areas of the musculoskeletal system.

Anesthesia and the Central Nervous System is a textbook for a postgraduate course as well as a reference for all anesthesiologists which presents many of the latest concepts in anesthesiology within a brief formal presentation. An outstanding faculty presents topics relating to the biochemistry, physiology, and pharmacology of the nervous system, the anesthetic management of intracranial and spinal cord surgery, and the intensive care management of central nervous system disease. Each chapter is a brief but sharply focused glimpse of the interests in anesthesia. This textbook is the eleventh in a continuing series documenting the proceedings of the Postgraduate Course in Salt Lake City.

Injury of the spinal cord has been known since antiquity. There is no cure for the injury and until modern times patients died rapidly from a combination of pressure sores and urinary tract infection. Treatment consists of preventing complications until the spine has stabilised and the patient can be rehabilitated to an independent life. "History of the Treatment of Spinal Injuries" explores how this treatment developed in the Ancient World, the Middle Ages, in Europe, Great Britain and latterly in the United States. It describes how these principles of treatment were recognised and explores the relationship and rivalry of the powerful personalities of the doctors who developed this treatment against the social background at different times.

Hepatitis C Virus and Liver Transplantation is designed to provide a comprehensive and state-of-the-art overview of the major issues specific to the field of liver transplantation and hepatitis C virus infection. The sections of the book have been structured to review the overall scope of issues of recurrent hepatitis C in different complex settings, including retransplantation, HIV-coinfected patients or in the setting of suboptimal graft donors. This book provides up-to-date information on the application of new therapies to the field of liver transplantation. It provides the most recent data on their efficacy, the management of side effects, as well as the potential interactions and specific problems associated with their use in the transplant setting. Finally, an appraisal of the risks and benefits of using organs from anti-HCV positive donors is presented. This book provides concise and actual materials for several important topics that are simply not adequately covered by current available literature. Hepatitis C Virus and Liver Transplantation will provide a unique and valuable resource in the field of liver transplantation and will be of great value to Hepatologists, Transplant and Abdominal Surgeons, Oncologists, as well as Fellows and Residents training in these fields.

Written byinternationally acclaimedspecialists, "Upper Abdominal Surgery"provides pertinent and concise procedure descriptionsspanning benign and malignant problems and minimally invasive procedures. Complications are reviewed when appropriate for the organ system and problem, creating a book that is both comprehensive and accessible. Stages of operative approaches with relevant technical considerations are outlined in an easily understandable manner. The text is illustrated with photographs that depict anatomic or technical principles.

Forming part of the series, "Surgery: Complications, Risks and Consequences," this volume "Upper Abdominal Surgery"provides a valuable resource for all general surgeons and residents in training. Other healthcare providers will also find this a useful resource.

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Histotechnology and histomorphometry are the major methodologies in bone and cartila- related research. Handbook of Histology Methods for Bone and Cartilage is an outgrowth of the editors' own quest for information on bone and cartilage histology and histomorphometry. It is designed to be an experimental guide for personnel who work in the areas of basic and clinical bone and cartilage, orthopedic, or dental research. It is the first inclusive and organized reference book on histological and histomorphometrical techniques on bone and cartilage specimens. The topic has not previously been covered adequately by any existing books in the field. Handbook of Histology Methods for Bone and Cartilage has six major parts and is designed to be concise as well as inclusive, and more practical than theoretical. The text is simple and straightforward. Large numbers of tables, line drawings, and micro- or macro-photographs, are used to help readers better understand the content. Full bibliographies at the end of each chapter guide readers to more detailed information. A book of this length cannot discuss every method for bone and cartilage histology that has been used over the years, but it is hoped that major methods and their applications have been included.

"Local and Regional Flaps in Head & Neck Reconstruction: A Practical Approach "provides comprehensive, step-by-step instruction for flap raising and insetting for the head and neck region. Ideal for oral and maxillofacial surgeons, facial plastic surgeons, and head and neck surgeons, the book serves as a useful guide to planning reconstructive cases and an easily accessible reference prior to operation."Local and Regional Flaps in Head & Neck Reconstruction "is logically organized into 24 chapters, each focusing on a local or regional flap, or a special site reconstruction. Chapters focused on a particular flap will begin with a detailed description of the relevant anatomy and discuss potential applications of the flap before moving into a detailed step-by-step description of how to elevated and transfer the flap to the defect site. Potential complications will also be addressed.Well-illustrated with more than 800 clinical photographs and with a website featuring surgical procedures, this book is an ideal reference for those new to practice and experts alike.

Written entirely by surgical urologists, Surgical Management of Urolithiasis: Percutaneous, Shockwave and Ureteroscopy presents a comprehensive overview of the past, present, and future of surgical techniques, with a focus on educating urologists on the full spectrum of stone procedures. In addition to the technical issues, detailed complications are described. Basic as well as advanced techniques are presented in both a didactic and visual mode with representative endoscopic images and radiographs. Recent advancements which are not routinely a core component of surgical training programs are also covered in detail. Compact and extensively illustrated, Surgical Management of Urolithiasis: Percutaneous, Shockwave and Ureteroscopy is a unique and valuable resource in the field of surgical urolithiasis, essential both for those currently in training and for those already in clinical practice.

Laparoscopic Colorectal Surgery, Second Edition is fully revised and updated and reflects an authoritative, team-oriented approach to the latest state-of-the-art laparoscopic colorectal procedures and surgical techniques. Written by pioneers in the field, this text will supply surgeons with all the information necessary to accomplish advanced laparoscopic procedures. Comprehensive discussions of positioning, instrumentation, cannulas, surgical techniques, special considerations, and considerations in cancer surgery are featured for a wide variety of major operative procedures.

This new Second Edition includes updated information on laparoscopic colorectal procedures, including hand-assisted laparoscopic procedures and new chapters on the physiology of pneumoperitoneum, laparoscopic anatomy of the colon and rectum, and evidence-based discussion of outcomes. The text is complemented by over 200 line drawings created exclusively for the textbook.

Recent years have seen important advances in the technology and techniques available to surgeons performing gynecologic surgery as well as reconstructive of clinical pelvic procedures. These developments took place in a wide variety settings from regional teaching centers to private clinical facilities. In 1996, the leading investigators from around the world gathered to discuss the present status of pelvic surgery and adhesion prevention with a look toward the future of patient care. This volume contains the proceedings of that meeting: the Third Interna tional Congress on Pelvic Surgery and Adhesion Prevention. Each chapter in cludes the material presented at the congress as well as a timely update of the authors' latest research and clinical thinking. Presentation integrating basic and clinical science provide the basis for con sidering peritoneal repair after surgery including the interaction of growth factors and other biochemical messengers. Research has increased the understanding of mesothelial reepithelialization and has led to new surgical technologies to reduce adhesion fonnation. A state-of-the-art review of emerging surgical adjuvants for adhesion prevention is provided, including discussion of barriers, gels, and poly mers as well as "designer" drugs effective at modifying the peritoneal response to injury. Assessment of clinical outcome in a wide variety of gynecologic surgical procedures brings into focus the benefits available as a result of these new tech nologies."

This book examines British and American women's narratives of cosmetic surgery collected between 1995 and 2007, with particular attention to what those narratives say about the contemporary status of cosmetic surgery and 'local' ideas about its legitimate and illegitimate uses. The book argues that British and American women employ justificatory strategies that normalize aesthetic procedures by aligning them with nationally-specific notions of 'appropriate' medical treatment. Consumers' narratives are also informed by 'global' discourses that portray cosmetic surgery as a lifestyle choice and a tool for holding one's own in the competitive marketplace of employment or heterosexual romance. Such meanings are in turn reworked by women in their own accounting, at the same time that accounts are limited by culturally-available symbolic resources and institutional structures. Where the general and specific are incompatible - as is more often the case in the British context - women respond by stressing the power of externally-imposed appearance mandates and their entitlement to self-care.

Modern society is altering the lifestyle and longevity of its members much more quickly than evolutionary adaptation to these changes can take place. The problem of calcium deficiency in the population is compounded by the growing percentage of aged individuals with relatively fragile, less massive skeletons. Current-day civilizations are much more effective in prolonging human life in a state of relative debility than even a few decades ago. This reality is unlikely to change and mandates that we develop strategies to prevent aging-related diseases like osteoporosis before they become manifest. Osteoporosis: Genetics, Prevention and Treatment places emphasis on the (1) genetic predisposition, (2) early recognition and (3) prevention of osteoporosis. The intent is not to move the practitioner's attention away from intervention therapy of osteoporosis, but rather to expand their view of this disease as one beginning at birth and one in which susceptibility is manifest at the conclusion of adolescence, not at menopause. The book concludes with an informed view of the future in terms of the recognition, prevention and management of osteoporosis.

Today, over 500,000 patients have been treated world wide in 250 Gamma Knife Centres in 37 countries each one treating between 150 and 700 patients a year. The current book serves as a textbook, training manual and reference book for those involved in Gamma Knife practice covering the theoretical background, the practical aspects of treatment, the social side of the method and necessary information not only for users but for those who refer to the Gamma Knife. It also covers some aspects of the hospital and social administration required for optimal use of the technology, also looking at the effect of the internet on specialist medical practice. It also presents the completely new Gamma Knife (Perfexion), a new technology which extends the range of the Gamma Knife and will be the treatment standard for the future.

This book represents the proceedings from a conference that took place in Dallas in the spring of 1999 which was entitled "Pediatric Gender Assignment - A Critical Reappraisal." Some participants rightfully argued that the conference really focused on the issue of pediatric gender assignment, and that reassignment was not applied in most cases. Their comments were reflected in the title of this monograph. This multidisciplinary meeting was sponsored by a conference grant from the National Institutes of Health, and a broad inquiry into this complex topic took place from many points of view. Basic scientists offered insight into mechanisms of sexual differentiation of the gonads, physical phenotype and imprinting of the central nervous system. Endocrinologists reviewed their experience in diagnosis and management, surgeons described traditional as well as innovative approaches, and there was strong representation from the ethical and behavioral sciences. In putting together such a panel, it was essential that we identify a cast of speakers who could address their viewpoints with strong convictions, and yet not let their passions render the meeting counter productive. We were not disappointed. While many differing points of view were firmly expressed by the panelists and audience, all viewpoints were accorded the respect they deserved. The concept behind the meeting and this book really originated in 1997 shortly after Diamond and Sigmundson published their long term follow up study of the John/Joan case.

AsanadditiontotheEuropeanpostgraduatetrainingsystemforyoung neurosurgeons, we began to publish in 1974 this series of Advancesand Technical Standards in Neurosurgery which was later sponsored by the EuropeanAssociationofNeurosurgicalSocieties. This series was ?rst discussed in 1972 at a combined meeting of the Italian and German Neurosurgical Societies in Taormina, the founding fathersoftheseriesbeingJeanBrihaye,BernardPertuiset,FritzLoewand HugoKrayenbuhl. ThuswereestablishedtheprinciplesofEuropean- operationwhich havebeenbornfromthe Europeanspirit,?ourishedin theEuropeanAssociation,andhavebeenassociatedthroughoutwiththis series. ThefactthattheEnglishlanguageisnowtheinternationalmediumfor communicationatEuropeanscienti?cconferencesisagreatassetinterms ofmutualunderstanding. Thereforewehavedecidedtopublishallcont- butionsinEnglish,regardlessofthenativelanguageoftheauthors. All contributions are submitted to the entire editorial board before publicationofanyvolumeforscrutinyandsuggestionsforrevision. Ourseriesisnotintendedtocompetewiththepublicationsoforiginal scienti?cpapersinotherneurosurgicaljournals. Ourintentionis,rather,to present?eldsofneurosurgeryandrelatedareasinwhichimportantrecent advanceshavebeenmade. Thecontributionsarewrittenbyspecialistsin thegiven?eldsandconstitutethe?rstpartofeachvolume. Inthesecondpartofeachvolume,wepublishdetaileddescriptionsof standardoperativeproceduresandindepthreviewsofestablishedkno- edge in all aspects of neurosurgery, furnished by experienced clinicians. This part is intended primarily to assist young neurosurgeons in their postgraduatetraining. However,weareconvincedthatitwillalsobeu- fultoexperienced,fullytrainedneurosurgeons. We hope therefore that surgeons not only in Europe, but also throughouttheworld,willpro?tbythisseriesofAdvancesandTechnical StandardsinNeurosurgery. TheEditors Contents ListofContributors...XIII Advances .. Gene Technology Based Therapies in the Brain. T. Wirth1,4 and S. Yla- Herttuala1,2,3, 1A. I. Virtanen Institute,University of Kuopio, Kuopio,F- land, 2DepartmentofMedicine,UniversityofKuopioandGeneTherapyUnit, Kuopio, Finland, 3Gene Therapy Unit, Kuopio University Hospital, Kuopio, Finland,4ArkTherapeuticsOy,Kuopio,Finland Abstract...3 IntroductiontoGeneTherapy:ThePast,PresentandFuture...4 PotentialAreasforGeneTherapyintheBrain...6 GeneTherapyforParkinson'sDisease...7 GeneTherapyforAlzheimer'sDisease...8 GeneTherapyforVascularBrainDiseases...9 GeneTherapyforBrainTumours...11 ChallengesofGeneTherapyintheBrain...12 GeneTransferVectors...15 ViralGeneTransferVectors...17 Retroviruses...17 HerpesSimplexVirus-1(HSV-1)...17 Adenoviruses...18 Adeno-AssociatedVirus(AAV's)...18 Non-ViralVectors...19 Ethics...20 ConcludingRemarks...21 Acknowledgement...21 References...21 VIII Contents TechnicalStandards AnatomyoftheOrbitanditsSurgicalApproach. G. Hayek,Ph. Mercier,and H. D. Fournier, Laboratory of Anatomy, Faculty of Medicine, University of Angers,Angers,France Abstract...35 Introduction...36 AnatomyoftheOrbit...36 TheOrbitalCavity...36 TheOrbitalFasciaorPeriorbita...38 OrbitalContents...39 OrbitalMuscles...40 TheArteriesoftheOrbit...42 VeinsoftheOrbit...47 NervesoftheOrbit...48 LacrymalGland...55 ApproachRoutestotheOrbit...56 Incision...56 TheLateralApproachRoute...57 OsteoplasticTechniques...58 Non-OsteoplasticTechniques...58 TheSuperiorApproachRoute...60 TheHybridLateral/SuperiorRoute...63 Discussion...

There are numerous textbooks detailing almost every aspect of the different laparoscopic procedures. However, in this era of evidence-based medicine, a text focusing on the controversies from the laparoscopic as well as the general surgeon's point of view is missing.

This book is not intended to be yet another textbook of laparoscopy; instead, its main purpose is to address unsettled issues of controversy. This will significantly enhance evidence-based knowledge of this developing field, stimulate thinking and discussions in rounds and meetings, assist surgeons in their decision making and stimulate further research.

This book is not aimed only at laparoscopic surgeons with their steadily increasing number but also at general surgeons and surgical trainees. It will define and sharpen points of controversy by internationally recognized authors, and thus provide 'state of the art' quality to each topic.

Bronchiolitis Obliterans Syndrome in Lung Transplantation presents the most current and up-to-date evidence regarding the diagnosis and management of BOS. In-depth chapters provide readers with a comprehensive understanding of the definition and changing perceptions of the nature of BOS as a clinical and pathologic entity, immune and non-immune mechanisms that have been identified as risk factors for the development of BOS, and interventions that may prove to be clinically useful for the prevention or treatment of BOS. In addition to outlining the current state of knowledge, each chapter provides the reader with the most current and ongoing research in the field as well as identifies areas where future research is needed. Written by an international group of expert authors, Bronchiolitis Obliterans Syndrome in Lung Transplantation is an important new text, that is essential reading for pulmonologists, primary care practitioners, respiratory care practitioners and clinical researchers.

The possibility of treating patients with organ replacement therapy has created a new frontier in medical care. Hospitals have to deal with such vital issues as selecting potential recipients of transplants, ensuring equity in allocating organs, pre- and peri-transplantation care of patients, and post-transplantation follow-up of organ recipients. The decisions pertaining to these issues often fall to social workers, who, with their bifocal concern for individuals and society, have significant contributions to make. Here, Dhooper reviews the contributions of the few social workers in this field and suggests ways of improving their work, consolidating their professional gains, and maximizing their impact. Dhooper discusses all aspects of organ transplantation, and explores and proposes new social work roles and appropriate skills for involvement at the individual, organizational, and community levels. He deals with the larger moral, societal, economic, and technical issues, as well as the here-and-now concerns of the social worker. Recommended for social workers trained for practice in the 1990s and beyond, and particularly those specializing in health and mental health social work.