This volume of proceedings contains in their entirety the reports submitted at the 6th International Congress of Minimally Invasive Surgery and the 3rd World Congress of the Academy for Multidisciplinary Neurotraumatology, held concurrently in Nagoya, Japan, in March 2005, and provides valuable insights into the latest innovations in clinical neurosurgery for practitioners from a broad range of disciplines.

As an addition to the European postgraduate training system for young neurosurgeons we began to publish in 1974 this series of Advances and Technical Standards in Neurosurgery which was later sponsored by the European Association of Neurosurgical Societies. This series was first discussed in 1972 at a combined meeting of the Italian and German Neurosurgical Societies in Taormina, the founding fathers of the series being Jean Brihaye, Bernard Pertuiset, Fritz Loew and Hugo Krayenbiihl. Thus were established the principles of European co operation which have been born from the European spirit, flourished in the European Association, and have throughout been associated with this series. The fact that the English language is well on the way to becoming the international medium at European scientific conferences is a great asset in terms of mutual understanding. Therefore we have decided to publish all contributions in English, regardless of the native language of the authors. All contributions are submitted to the entire editorial board before publi cation of any volume. Our series is not intended to compete with the publications of original scientific papers in other neurosurgical journals. Our intention is, rather, to present fields of neurosurgery and related areas in which important recent advances have been made. The contributions are written by specialists in the given fields and constitute the first part of each volume.

Cell-Cycle Mechanisms and Neuronal Cell Death examines the role of cell cycle activation in the molecular mechanisms leading to neuronal degeneration. Leading Authors discuss this topic in relation to the major neurological disorders, including Alzheimer 's disease, stroke and epilepsy. This book serves to gain new insights into the molecular determinants of neuronal death and to establish new targets for therapeutic intervention.

This book is an up-to-date reference on all aspects of anticoagulation and hemostasis in neurosurgery. After an opening section on basic principles and drug classes in current use, detailed consideration is given to coagulation issues relevant to all patients, not just neurosurgical ones. The coverage includes, for example, deep vein thrombosis, pulmonary embolism, and disseminated intravascular coagulation. A variety of important issues specific to neurosurgical practice are then addressed, and a summary of current guidelines and best practices is provided. By bringing together the latest knowledge from across the discipline, this book will serve as a sound basis for informed decision making in surgical practice. It will be of daily value for neurosurgeons and trainees worldwide and will also be of interest to emergency room physicians, surgeons in general, critical care physicians, neurologists, and hospital medicine specialists.

Transferring hematopoietic stem cells and immune cells has continued to be a promising therapeutic alternative and a fascinating area of cell biology as well as a field of persistent procedural problems. This explains why substantial parts of basic research on cell growth and differentiation, immune tolerance and antitumor effects, gene transfer, minimal residual disease and supportive care have settled around clinical transplantation in hematology and oncology. This second volume updates the current role of allogeneic and autologous transplantation in leukemias, lymphomas and solid cancers, including controversial strategies and novel experimental approaches. Outstanding representatives of leading groups guarantee first-hand information and indicate how we can work and cooperate more effectively to the benefit of our patients.

A comprehensive description of macroscopic, microscopic, and radiological methods for the diagnosis of bone diseases. The book presents all the procedures involved in diagnosis, using not only radiological and histological techniques, but also modern immunohistochemical and scintigraphic methods. Succinct and well-structured therapeutic recommendations are provided for an array of bone diseases, making this a practice-oriented reference work for pathologists, radiologists, rheumatologists, and orthopedists.

Re-EngineeringoftheDamagedBrainandSpinalCord isdedicatedtoTetsuoKanno,M. D. ProfessorofNeurosurgery Bypresenting theoriginal papers thatmakeupthis thefeaturesofthelocalmedicallandscapeinthe- third supplement we wish to make a further contri- gionswheretheyareenacted. Whatismore,progr- bution to the issue of functional rehabilitation, this sivenew?ndingsmustbealsosubjectedtoafrequent soimportantandfascinatingmodernareaofresearch revision. Ontopofthis,itshouldnotbeforgottenthat inthe?eldofneurosciences. Thecongresspaperswe even when committal therapy guidelines are c- haveselectedconstituteagoodre?ectionofthetrans- sistentlyapplied,thereareconsiderablevariationsin disciplinary objectives. The literature references are therangeofpotentialcomplicationsandintheo- designedasaguidetoleadtheinterestedreadertoa comeofprospectivecontrolledmulti-centreandmul- deeperandmoredetailedunderstandingoftheindi- nationalstudiesontheissueofqualitymanagement. vidualissues. Functionalrehabilitationhasbeenanoriginaltask The demand for "evidence-based medicine" is well ofneurosurgeryfromtheveryoutset. The1990shave justi?ed; however, it rapidly comes up against the enteredtheannalsofbrainresearchasthe"Decadeof limitsoffeasibility,especiallywherecontrolledthe- theBrain". Sincethentherehasbeenaneverstronger peuticstudiesareconcerned. TheCochrancollection growthofneuroscienti?cinterestworldwide,accom- of high-quality evidence-based healthcare databases paniedbysubstantial?nancialengagement. Thishas hasthusfarbeenofnohelptousindrawingupthe- primarily resulted in advances in basic neuro- peutic recommendations for the re-engineering of biologicalandneurophysiologicalresearchandalsoin brain and spinal-cord lesions. Today as ever, the thegrowthofneuroscienti?cknowledgeaboutbasic opinion of experts and empirically based medical mechanismsformotor control,paincontrol,aware- treatment and posttraumatic neurorehabilitation ness, cognition, learning and memory. The conse- continuetooccupyanindispensablepositionforthe quencemustbetoensurethattheadvancesmadeinthe everydayclinicalpracticeofneurosurgicalandneu- neuroscienti?cresearchareaareadequatelyexpanded traumatological therapies. Promising adjunct - intopracticalneurosurgicalcareandre-engineeringof proachesincludeneuropharmacology,forcascadesof brainandspinalcordlesionsandtoensureuponnew molecular interactions are known to be underlying approaches. Following this a fundamental path will activity-dependent plasticity and skills learning, as resultinanimprovedandmoree%ocientpreventionin many of these processes involve the major tra- thefuture,themeasuresthatstandrightatthefore- mitters. Furthermore,biologicalinterventionsby- front of all rehabilitation principles, meaning that ingendogenousneuronsandgliaaswellasexogenous conventionalconceptsmustbemodi?edtokeeppace stemcells,bone-marrowcells,macrophages,andother withthemoretask-speci?c,intensive,andprogressive types may promote the regeneration of nerve cells, demands. In this connection a series of guidelines, tissue, and neural circuitry. Class one studies have recommendations, and expert opinions and also beenmade,andnowclasstwostudieshavebeeni- algorithms have been elaborated by national and tiated, for example in connection with acute spinal international expert panels and multidisciplinary as- cord injury (SCI). The clinical application of fu- sociationsfortheacutemedicalcareofpatients.

This issue of Thoracic Surgery Clinics, guest edited by Dr. Bryan M. Burt, is devoted to Malignant Pleural Mesothelioma. Dr. Burt has assembled expert authors to review the following topics: Biomarkers for the Diagnosis and Monitoring of Malignant Pleural Mesothelioma; Taken Together: Effective Multimodal Approaches for Malignant Pleural Mesothelioma; Pleurectomy/Decortication for Malignant Pleural Mesothelioma; Preoperative Identification of Benefit from Surgery for Malignant Pleural Mesothelioma; The Role of Extrapleural Pneumonectomy in Malignant Pleural Mesothelioma; The Molecular Basis of Malignant Pleural Mesothelioma; Radiation Therapy for Malignant Pleural Mesothelioma; The Staging of Malignant Pleural Mesothelioma; Intraoperative Adjuncts for Malignant Pleural Mesothelioma: The Fourth Dimension; The Pathology of Malignant Pleural Mesothelioma; and more!

Quantitative coronary angiography has become an invaluable tool for the interventional cardiologist, providing objective and reproducible measurements of coronary artery dimensions, which can be used to study progression or regression of coronary atherosclerosis, as well as the immediate and long term effects of percutaneous interventions. Until recently, this powerful imaging technology was confined to a small number of so-called high level institutions. Fortunately, with the development of digital cardiac imaging equipment and adaptation of cine-angiographically based computer software for on-line use in the catheterization room, quantitative coronary angiography is now available to all interventionalists. This book is a timely guide for the impending QCA user, providing practical as well as theoretical and scientific information. A comprehensive evaluation of the clinical usefulness of QCA is covered, from the fundamental principles through experimental validation studies, application to clinical trials of a wide range of pharmacological and interventional therapies in the full spectrum of clinical presentation of coronary disease syndromes, evaluation of the therapeutic efficacy of various new devices for coronary intervention, together with extensive presentation of its physiological, functional and anatomical correlations, by comparison with other intracoronary measurement and imaging techniques. In addition, evolving theories and concepts in the ever topical restenosis phenomenon' after percutaneous intervention, based on serial QCA studies, are presented and discussed and a potentially unifying methodological approach to further study of this ubiquitous problem is offered. Thisbook, thanks to the collaboration of many experts in the field of intracoronary imaging and measurement, provides stimulating, interesting and practical information, both for the academic scientist and practising clinician.

The scope and importance of hip fractures is almost incomprehensible. With a world wide incidence of close to 2 million cases per year, these fractures pose a daunting challenge to our ability to affect and treat this epidemic. The incidence of these fractures is predicted to grow to 6 million in 2050 including a near term baby boom spike. Add the hospital mortality rate of up to 4% and the one mortality of from 8% to 20% and the life ending effect of these fractures becomes a glaring reality. Of those who initially survive their fracture, about 50% never walk the same again. The social problem in the care of these elderly people is enormous. Of course, any real solution to this problem will include education, prevention, surgical and hospital treatment protocols, long term rehabilitative efforts, social - justments and a generous contribution of money. This publication is primarily directed to the amplification of a new treatment modality that addresses only a fraction of the problem. It is, however, a quantum leap in the evolution of fixation with compression hip screws which are still the gold standard for surgical stabilization of pertrochanteric hip fractures. The Dynamic Martin Screw (DMS) addresses the issue of adjustability of the fixation angle with appropriate mechanical strength characteristics that were la- ing in its historical predecessors.

This manual reviews the definitions and typical approach to quality assurance in healthcare and includes a review of the most prominent quality studies. A program for quality management in surgery is presented with chapters reviewing patient safety and external reporting requirements. An introduction to medical malpractice and risk management is also provided and followed by a chapter on how to implement the necessary behavioral changes to improve quality practices. The appendix includes useful protocols, forms and order sets.

The second congress of the Paci?c Asian Society of Minimally Invasive Spine Surgery (PASMISS) held in Phuket,Thailand,August 5-6,2002,was highly s- cessful. Dr.Akira Dezawa, the president, had worked hard in organizing the congress,which was well attended.All scienti?c papers presented were of the highest standard and were worthy of publication in book form.This scienti?c meeting brought to light the practice of this modern surgical technique as it is being performed by spine surgeons in the Asia-Paci?c region.Dr.Dezawa has made a great effort to collect the papers from the congress,and to have them edited and published as a text that covers all aspects of the minimally invasive spine surgical approach. Minimally invasive spinal surgery will be a highlight of operative approaches in the twenty-?rst century and already has been popularized worldwide.This procedure will provide surgical options that address several pathological conditions in the spinal column without producing the types of morbidity commonly seen in open surgical procedures. The contents of this book provide highly relevant and detailed information. I certainly believe that it will be a great bene?t to all orthopedic surgeons who are interested in performing minimally invasive spine surgery. Charoen Chotigavanich,M.D. Chairman,Spinal Section The Royal College of Orthopedic Surgeons of Thailand V Preface Recent decades have been characterized by revolutionary changes in spinal surgery. Concurrent progress in implant technology and functional en- scopes and the improvement of less invasive surgical techniques has opened a new dimension for spine surgery.

This manual reviews the important critical functions of a department of surgery which are synthesized into specific departmental roles. A departmental organizational structure and the required personnel is presented along with the appropriate job descriptions and the role of hospital committees for a department of surgery. To help with process management, a listing of policies, protocols and communications are provided. To ease the access to external oversight, the conditions of participation from CMS related to surgery are reproduced and this is followed by a chapter on change management and program development. The appendix includes useful forms and templates.

The motivation for this book was the recognition by two of us (RL and TL) that, despite our training as cardiologists, we had a limited understand ing of many aspects of the surgical management of our patients. Conversa tions with other cardiologists at our own institution and at other medical centers around the country convinced us that many of our colleagues shared our uncertainty about the details of surgical procedures and the factors that determine decisions in the perioperative period. As surgical techniques continue to evolve, this knowledge gap can become only more severe. We therefore compiled information about cardiac surgery that might be useful for cardiologists and other nonsurgeons. We asked cardiologists what questions they would like to ask their surgical colleagues and provided these questions to the authors of the chapters. Thus, the goal of these chapters is to help nonsurgeons answer their own questions about common cardiac procedures, and to help prepare these physicians to address the questions raised by their patients. In addition, we hope that insight into these issues will improve communication between surgeons and their col leagues-and, ultimately, lead to better patient care. Contents Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi 1 Chapter 1. Anesthesia for Cardiac Surgery JONATHAN B. MARK Chapter 2. Cardiopulmonary Bypass . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 DANIEL FITZGERALD Chapter 3. Myocardial Protection in Cardiac Surgery . . . . . . . . . . . . . . . . . . 23 JEFFREY SELL Chapter 4. Coronary Artery Bypass Grafting . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 HENDRICK B. BARNER Chapter 5. Surgery for Left Ventricular Outflow Obstruction: Aortic Valve Replacement and Myomectomy . . . . . . . . . . . . . ."

Reoperation is one of surgery's greatest challenges. This book provides a practical reference on how to prevent, identify and treat all abdominal complications. Organised primarily by body system Reoperative Abdominal Surgery covers the spectrum of conditions and complications faced by the general surgeon. Separate chapters also cover safety issues, and specific issues related to diagnosis, surgical technique and patient presentation. Combining the expertise and advice of leading international surgeons the book offers a clinical instructive manual for trainee and practising surgeons. Focus on abdominal surgery the key province of the general surgeon Expert guidance on the prevention, identification and management of post-operative complications Key reference on difficult surgical area for residents and young surgeons Experience and advice from best surgeons around the world Covers entire spectrum of reoperative abdominal surgery

Key Clinical Topics in Critical Care offers an indispensable and practical guide for exam revision and clinical practice. Written and edited by specialists with a wealth of clinical experience, this book provides rapid access to core topics in critical care. Each topic is written in a concise and easy-to-digest format, making this book the essential resource for exam revision and quick reference at the point of care. * Over 100 topics presented in alpha order, from acute coronary syndrome to weaning from ventilation * Succinct coverage of clinical features, diagnosis, treatment and complications * Effective exam revision for FRCA, FFICM and EDIC candidates * Includes clinical photos and diagrams to improve understanding of key concepts * Contributions from experienced specialists to ensure authoritative, accurate content

Pancreatic islets make up the endocrine pancreas and they contain the only source of insulin in the body, beta cells. Hence, access to high quality preparations of pancreatic islets is fundamental for in vitro studies and to test pre-clinical applications in animal models in vivo. Access to healthy human islets is also crucial to improve transplantation procedures for diabetes. Given the susceptibility of pancreatic islets to the enzymatic digestion and mechanical stress required to obtain them, the isolation of islets is often considered as the delicate "work of a craftsman". This book, which is aimed at beginners and experts alike, is a survey of the current state-of-the-art in this field and it centres on the challenges, pitfalls and peculiarities of pancreatic islet isolation in the different species used in pre-clinical and clinical applications. It explores the similarities and differences between human islets and those from other relevant species (rodents, pigs and non-human primates), and how these influence islet isolation. The ultimate goal of this book is to improve the outcome of islet isolation and transplantation in pre-clinical and clinical applications.

Osteoarthritis (OA), the most common form of arthritis, is generally characterized by a slowly progressive degeneration of articular cartilage, particularly in the weight-bearing joints. It has a stronger prevalence in women, and its incidence increases with age. OA is a major and growing health concern in developed countries, owing to steadily increasing life expectancy and the demand for better quality of life. Because of its chronic nature and nonfatal outcome, OA affects the growing population of the elderly over an increasing time span. Moreover, despite its relatively benign character, OA is one of the most disabling diseases; it is responsible for increasing financial and social burdens in terms of medical treatments, forced inactivity, loss of mobility, and dependence. Despite a growing awareness of OA as a medical problem that has yet to reach its maximum impact on society, there is a surprising absence of effective medical treatments beyond pain control and surgery. So far, only symptom-modifying drugs are available, while there remains a major demand for disease-modifying treatments of proven clinical efficacy. This demand will hopefully be met in the future by some of the drugs that have been pressed into development and are now at different stages of clinical investigation. Nevertheless, the current lack of effective treatments reflects a still insufficient knowledge of cartilage with respect to its metabolism, interactions with other joint tissues, and causes and mechanisms (possibly of very different nature) leading to failure of its turnover.

Leading basic and clinical investigators from around the world summarize the most recent research on the molecular and cellular origins of lupus. Their cutting-edge articles review the mechanisms underlying abnormal immunity and introduce the powerful new concept that a disorder of multiple genes underlies the abnormal immune response, leading directly to the development of lupus. This pathophysiology is shown to involve a wide variety of cell types, including T cells, B cells, natural killer cells, macrophages/monocytes, and endothelial cells. Over time, the resulting long-term inflammation causes irreversible cell destruction and, ultimately, organ failure. Lupus: Molecular and Cellular Pathogenesis is a masterful new synthesis of all the new knowledge emerging today about lupus. Its new perspectives will sharpen the focus of research and ultimately lead to better and more effective treatment.

This collection of articles by leading orthopedic and craniofacial surgeons and researchers comprehensively reviews the biology of bone formation and repair, the basic science of autologous bone graft, allograft, bone substitutes, and growth factors, and explore their clinical application in patients with bone repair problems.