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!

This book builds on the success of previous editions, once again providing hepatologists the most current clinical guide on how to best treat the liver transplant recipient. With an international mix of experienced contributors, this new edition highlights initial indication and selection of the potential recipient, management of the donor organ, post-operative complications in the patient through to acute recovery, long-term follow-up, and continued health. This provides the user a complete guide to the correct clinical management of both the recipient and the donor organ through all stages of transplantation.

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 . . . . . . . . . . . . . ."

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.

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

The small neck of the aneurysm afforded an easy surgical attack. An ordinary flat silver clip was placed over the sac and tightly compressed obliterated it completely. The clip was flush with the wall of the carotid artery. The sac, lateral to the silver clip, was then picked up with the forceps and thrombosed by the electocautery. Walter Dandy reporting his successful operation of a posterior communicating aneurysm on March 23, 1937. Walter Dandy's patient left the hospital in good health 2 weeks later, and from his report one may gain the impression that the operation was an easy task. Despite continuous developments during the following decades, it was not until the introduction of the operating microscope and microsurgical techniques that surgical treatment was generally accepted. During the microsurgical era surgical results have continued to improve due to diagnostical, neuroanaesthesi ological, and microsurgical refinements, and improved neurointensive care. Endovascular obliteration has become an important treatment alternative but this has not been included in this particular volume. The purpose of the present supplement of the ACTA NEUROCHIRURGICA is to review some of the elements in the neurosurgical management of patients with aneurysmal subarachnoid haemorrhage that are important for a successful outcome. Professor Helge Nornes has been a major force in the development of new techniques and research strategies in this area for a number of years and has recently retired from the National Hospital in Oslo."

This volume of "Advances and Technical Standards in Neurosurgery" is devoted entirely to the spine. Like other volumes in the series, it presents important recent progress in the field and offers detailed descriptions of standard procedures to assist young neurosurgeons. Among the advances considered are approaches to spinal navigation, including intraoperative imaging based navigation, and concepts of spinal robotics. The value of sagittal balance as a parameter for the neurosurgeon is examined, and a novel surgical approach to longitudinal pathologies within the spinal canal is presented. Developments in surgery for kyphosis are also discussed, with a focus on pedicle subtraction osteotomy. The technical standards section critically reviews the latest evidence regarding cervical disc arthroplasty and pedicle-based non-fusion stabilization devices. The book concludes by discussing the treatment of craniovertebral junction instability as a result of juvenile chronic arthritis.

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.

Leading clinicians and scientists in solid organ transplantation review the current status of the field and describe cutting-edge techniques for detecting the immune response to the allografted organ. The authors present the latest techniques for HLA typing, detecting HLA antibodies, and monitoring T-cell response, and examine more specialized methods utilizing proteomics, laser dissection microscopy, and real-time polymerase chain reaction. The area of tolerance induction and reprogramming of the immune system is also covered, along with a discussion of up-to-date methods of organ preservation, of today's optimal immunosuppressive drug regimens, as well as the difficulty of mimicking chronic rejection in experimental models. Introductory chapters provide a theoretical update on current practices in renal, liver, islet, and lung transplantation and on the pathways of antigen presentation and chronic rejection.

Cardiac surgery is performed on hundreds of thousands of patients a year, and can have an important beneficial impact on the outcomes of patients with coronary and valvular heart diseases. Despite the favorable recovery of most patients, some will have their post-operative period interrupted by the development of atrial fibrillation, with a host of potential complications including stroke. High risk subgroups may develop atrial fibrillation in more than half of cases, and often despite aggressive prophylactic measures. Treatment of atrial fibrillation and its aftermath can also add days to the hospital stay of the cardiac surgical patient. In an era of aggressive cost cutting and optimization of utilization of health care resources, the financial impact of this arrhythmic complication may be enormous. Experimental studies have led to a greater understanding of the mechanism of atrial fibrillation and potential precipitating factors in the cardiac surgical patient. Prophylactic efforts with beta-blockers, antiarrhythmic drugs and atrial pacing are being used, or are being investigated in clinical trials. New methods of achieving prompt cardioversion with minimal disruption of patient care, and prevention of the thromboembolic complications of atrial fibrillation, are also important therapeutic initiatives. This text is designed to aid health care professionals in the treatment of their patients in the recovery period after cardiac surgery, and to instigate additional research efforts to limit the occurrence of, and the complications following, this tenacious postoperative arrhythmia.

Percutaneous cardiac and endovascular procedures performed by a variety of interventional physicians continue to evolve and expand. One of the most important steps in performing these procedures is vascular access and their Achilles heel is vascular access site complications. This volume is here to help the clinician, providing a practical overview of the techniques and technologies used in top catheterization laboratories to access the arterial and venous beds. Dr. Mazen Abu-Fadel and his contributors, part of the renowned cardiovascular team at the University of Oklahoma College of Medicine, carefully walk the reader through the various techniques used to obtain vascular access into most arterial and venous sites. They thoroughly describe current data, techniques, advantages, risks, and benefits of each vascular access site. Covering everything from anatomic landmarks to closures devices, Arterial and Venous Access in the Cardiac Catheterization Lab offers a complete overview of each procedure. In addition, it provides an up-to-date guide to the best medical technologies and equipment used when performing these procedures. Arterial and Venous Access in the Cardiac Catheterization Lab is an invaluable resource for a wide range of clinical personnel, from attending physicians and trainees to nursing staff and vascular technicians. Written by experienced leaders in the field, it demonstrates how to perform complex, risky procedures while providing patients with expert care.

Cochlear implants are currently the standard treatment for profound sensorineural hearing loss. In the last decade, advances in auditory science and technology have not only greatly expanded the utility of electric stimulation to other parts of the auditory nervous system in addition to the cochlea, but have also demonstrated drastic changes in the brain in responses to electric stimulation, including changes in language development and music perception. Volume 20 of SHAR focused on basic science and technology underlying the cochlear implant. However, due to the newness of the ideas and technology, the volume did not cover any emerging applications such as bilateral cochlear implants, combined acoustic-electric stimulation, and other types of auditory prostheses, nor did it review brain plasticity in responses to electric stimulation and its perceptual and language consequences. This proposed volume takes off from Volume 20, and expands the examination of implants into new and highly exciting areas. This edited book starts with an overview and introduction by Dr. Fan-Gang Zeng. Chapters 2-9 cover technological development and the advances in treating the full spectrum of ear disorders in the last ten years. Chapters 10-15 discuss brain responses to electric stimulation and their perceptual impact. This volume is particularly exciting because there have been quantum leap from the traditional technology discussed in Volume 20. Thus, this volume is timely and will be of real importance to the SHAR audience.