In patients with coronary artery disease, surgical revascu- larization with arterial or venous bypass grafts not only relieves symptoms, but also prolongs life. The result of such interventions, however, is frequently impaired by graft dysfunction and occlusion. This monograph highlights the clinical importance of coronary artery bypass graft disease and, in particular, the use of modern diagnostic techniques to assess graft structure and function. The molecular and cellular mechanisms of coronary bypass graft disease are ex- tensively discussed with several chapters devoted to prophy- lactic medical therapy. The indication, technique and results of reinterventions with balloon angioplasty, reope- ration or transplantation in patients with graft failure are also reviewed.

Originally published in 1980-1981 as a two-volume set, the Manual of Cardiac Surgery has been completely revised and now includes new full-color illustrations in a single convenient volume. This new edition maintains the high standards established in the first edition: insightful descriptions of various cardiac surgical procedures illuminated by clear, brilliant illustrations.

Varicose veins are a very common problem. The precise aetiology of primary varicose veins remains unclear. It seems likely from the available evidence that inherited structural weakness combined with haemodynamic or microcirculatory abnormalities eventually lead to reduced vein wall elasticity, dilatation and the formation of varicosities. Increasing age, female gender, parity and occupation may all promote the development of varicose veins in susceptible individuals. Further clinical and experimental studies are necessary if the relative contribution of each of these factors is to be fully elucidated. References 1. Editorial. The treatment of varicose veins. Lancet 1975;ii:311. 2. Prerovsky I. Diseases of the veins. World Health Organisation, internal communication, MHO-PA 10964. 3. Weddell JM. Varicose veins: pilot study. Br J Surg 1969;23:179-186. 4. Hobsley M. Pathways in surgical management. 2nd ed. London: Edward Arnold, 1986. 5. Browse NL, Burnand KG, Lea Thomas M. Diseases of the veins. London: Edward Arnold, 1988. 6. Logan WPD, Brooke EM. The survey of sickness. Studies on medical and population subjects no. 12. London: General Register Office, 1957. 7. The committee on the Danish national morbidity survey. The sickness survey of Denmark. Copenhagen, 1960. 8. US Department of Health. Education and welfare: national health survey 1935-1936. Washington, DC, 1938. 9. The Department of National Health and Welfare and the Dominion Bureau of Statistics. Illness and health care in Canada. Canadian Sickness Survey 1950-1951. Ottawa, 1960.

Molecular biology has revolutionized research into vascular disease. Over the past 20 years molecular techniques have enabled us to both elucidate - lecular mechanisms in vascular disease and identify appropriate therapies. The vast explosion in technical knowledge and the array of protocols that become more advanced and intricate by the day lead us into new and exciting areas of research that were previously unobtainable. Vascular Disease: Molecular Biology and Gene Transfer Protocols - scribes today's most powerful molecular methods for the investigation of the pathogenesis of vascular disease. The protocols are highly detailed, allowing beginners who have little experience in either vascular biology or molecular biology to embark on new molecular projects. This book is also suited to more experienced molecular biologists who wish to grasp new methods for stu- ing the involvement of genes in normal vascular physiology and in diseased states. It is well established that cardiovascular disease progression has a s- stantial genetic influence. Part I describes three methods that have been used successfully to identify specific mutations in candidate genes involved in c- diovascular disorders. These mutations include both single-stranded conf- mational polymorphism analysis and heteroduplex detection methods. In addition, technology to map new genes to specific regions of chromosomes by high-resolution mapping is described.

Among the many intense light sources, excimer lasers have a unique set of properties that place them at the forefront of tooling for material processing. Their extreme versatility means that they can be used in many areas of materials science and medicine. But three conditions need to be fulfilled in order that their versatility be truly appreciated and exploited: the characteristics and limitations of the sources must be known; the basic excimer laser processes should become reasonably widely known; and problems in search of a solution should be clearly identified. Excimer Lasers covers all three of these points in an instructive and logical way. Probably for the first time, both instrumental and fundamental aspects of excimer laser interaction with matter are presented side-by-side, with examples drawn from the widest range of materials. The articles gathered here are tutorial in their nature, thus making them suitable for a wide readership, from recent graduates and postgraduate students to those established scientists entering the field, all of whom could not find a better, nor more authoritative work with which to start their reading.

ABC of Arterial and Venous Disease provides a structured, practical approach to clinical assessment, investigation and management of the most commonly presenting arterial and venous disorders. Structural and functional abnormalities of arteries and veins manifest clinically in a broad spectrum of disorders, including cerebrovascular and carotid artery disease, abdominal aortic aneurysms, acute and chronic limb ischaemia, vasculitis and varicose veins. This revised edition incorporates new chapters on coronary artery disease and acute coronary syndrome, visceral artery stenosis and mesenteric ischaemia, and arteriovenous malformations. Many of these common or chronic conditions first present for initial assessment by primary health care professionals. Case vignettes have been added to relevant chapters to aid understanding and decision making. Fully up to date and from an expert editor and contributor team, ABC of Arterial and Venous Disease remains a useful resource for non-specialist doctors such as general practitioners, family physicians and junior doctors in training. It is also a relevant guide for all other primary health care professionals working within the multidisciplinary teams responsible for patients with chronic arterial and venous disorders.

Essential for Board Exam Candidates

Unique US/UK collaboration, with commentaries on approaches used in each region

Easily formatted, higlighting the essential learning points

Practical advice from renowned experts

The second half of the twentieth century saw vascu- agree or disagree, but will be stimulated to question lar surgery develop from a necessity for hemostasis their surgical management and explore possible - to a mature reconstructive art. However, this was ac- ternatives. companied by increasing patient expectations and The only certainty of the future is that it will bring the introduction of the alternative techniques of dila- change. An essential requirement for facing that tation and stenting. These factors have helped sur- change is multidisciplinary teamwork, and within geons to focus attention on the need for clinical audit that framework to define the roles of endovascular and to define clearly the limitations and standards of and invasive procedures, as well as the place of m- excellence that should be achieved in the specialty. ical management in the prevention and modification Vascular disease remains an extensive problem in of vascular disease.

With an invaluable selection of color images, this guide authoritatively covers the identification, assessment, pathophysiology, epidemiology, and treatment of disorders affecting the venous and lymphatic anatomy. Written by experts from several fields, this source considers topics including the management of deep venous thrombosis, chronic venous insufficiency, venous trauma, and surgical and pharmacologic therapies for these conditions.

Der Dialyseshunt als moderne Form des permanenten Gefazugangs ist grundlegender Bestandteil der Betreuung des chronisch niereninsuffizienten Patienten.

In diesem Band wird das komplette Spektrum der Fragestellungen rund um Dialyseshunts fachkundig und umfassend abgehandelt: von der interdisziplinaren Vorbereitung der Gefauntersuchung durch Nephrologen und Gefachirurgen, uber die Diskussion unterschiedlicher chirurgischer Moglichkeiten der direkten Gefazugange bis hin zur Shuntpflege und Shuntpunktion. Daruber hinaus werden Diagnostik und Therapie bei Komplikationen sowie alternative Dialysezugange detailliert dargestellt.

Mit der 1. Auflage dieses Buches wurde vor 10 Jahren erstmals eine interdisziplinare, gefachirurgisch und nephrologisch angelegte Darstellung des groen Gebietes der Dialyseshunts in deutscher Sprache vorgelegt. Diese 2. Auflage belegt die weitere rasche Entwicklung dieses immens wichtigen Gebietes.

Since major prospective randomized multicenter studies (NASCET, ECST, ACAS) have assured the significant effect of the carotid reconstruction on stroke prevention, the main interest in carotid surgery focuses on modern radiologic procedures, new aspects in surgical technique, and perioperative region, paricularly of the carotid artery is, therefore, also best treated in an interdisciplinary way involving the neurologist, angioradiologist, and vascular surgeon. These current themes need to be discussed and constantly revised with new developing aspects.

Infolge verbesserter diagnostischer und therapeutischer Moglichkeiten und der Zunahme der durchschnittlichen Lebenserwartung steigt die Zahl der Patienten mit terminaler Herzinsuffizienz weltweit dramatisch an. Die Herztransplantation als etablierte Therapie allein ist nicht in der Lage, dies zu kompensieren. Daher besteht die dringende Notwendigkeit, neue Behandlungsstrategien zu entwickeln.

Mit den heute zur Verfugung stehenden Unterstutzungssystemen stehen wir an der Grenze zwischen "bridge-to-transplant" und "chronical support." Das vorliegende Buch bietet einen Uberblick uber die etablierten Systeme zur Behandlung der Herzinsuffizienz, aber auch eine erste Orientierungshilfe bei alternativen Verfahren, die sich noch in einem experimentellen Stadium befinden."

Periphere DurchblutungsstArungen sind eine Volkskrankheit moderner Industrienationen. Sie sind mit einer hohen MorbiditAt und MortalitAt verbunden. Insbesondere diabetische Angiopathien fA1/4hren nicht selten zu invalidisierenden GliedmaAenamputationen. PrAventive und therapeutische Zielsetzungen gehAren deshalb zu den vordringlichsten Aufgaben der heutigen GefAAmedizin.

Bei der Behandlung der pAVK haben angiologische Therapien die gleiche Bedeutung wie die Fibrinolyse, die endovaskulAre Kathetertherapie oder die offene GefAArekonstruktion. FA1/4r die Auswahl und die Kombination der Verfahren ist eine optimale GefAAdiagnostik entscheidend. Der Therapieerfolg aber hAngt ausschlieAlich von der Versorgung der ExtremitAt mit Sauerstoff und NAhrstoffen, also der Wiederdurchblutung ab. Deshalb haben auch QualitAtskontrollen der Behandlungsverfahren eine wachsende Bedeutung.

Dieses Buch zeigt die MAglichkeiten und Grenzen der modernen GefAAmedizin auf und bietet hilfreiche AnsAtze zur Behandlung gefAAkranker Patienten.

Safe surgery is founded upon careful dissection and clear identification of vital structures. Knowledge of the appropriate anatomy and anatomical relations is therefore essential, not only during surgical training, but as the cornerstone of surgical practice. The aim of this book is to describe the essential anatomical basis of a range of common procedures in general and vascular surgery. The large-format multi-volume texts on operative surgery, despite their undoubted excellence, are now too expensive for individual purchase. Single-volume books on operative surgery have been unable to devote sufficient attention to anatomical detail and the surgeon is left ploughing through anatomy texts, often failing to find illustrations which demonstrate clearly the features that are important in an operative dissection. The present text highlights features of the operations which are important anatomically while not attempting to give a complete description of the operative procedure. A combination of line diagrams and cross sections has been used to provide the topographical detail. The volume is aimed mainly at surgeons in training, to help them on a day-to day basis and to provide a text which will be useful in revising for post graduate examinations in surgery. It is also hoped that the book will be of use to practising surgeons, providing an easy means of highlighting important anatomical aspects of the procedures they perform relatively infrequently. 1989 S.J.S."

Attempts to reconstruct various parts of the heart started even before the beginning of open cardiac surgery. By the late 1950s and early 1960 s several closed and open procedures had already been described. In that era, several surgeons in Europe and the Americas were particularly prompted to develop various techniques of valve re construction because of the lack of acceptable valve prostheses and conduits which have become available subsequently. At that time, several congenital lesions still defied definitive correction, and clinical attempts at left ventricular wall replacement had not yet got under way. A renaissance in different cardiac reconstructive procedures started at the beginning of the 1980s. As the problems relating to valve prostheses became more generally appreciated and the importance of chamber volumes and geometry (atrial or ventricular) was accorded due importance in the long-term follow-up, there was a resurgence of surgical attempts at reconstruction in congenital and acquired cardiac lesions so as to approximate the natural state. At the same time several characteristics of this reconstructive "discipline" became apparent. First, cardiac reconstructive surgery has remained a surgical "art" with a gradually increasing number of interested cardiac surgeons."

Effective treatment of acute myocardial infarction remains one of the major issues in cardiology and internal medicine. The present monograph summarizes the relevant experimental data and the results of major clinical trials in the treatment of myocardial infarction. There are contributions of fundamental anatomical and physiological concepts of vascular occlusion and myocardial damage due to ischemia as well as discussions of therapeutic strategies involving thrombolytic agents, adjuvant drug therapy for limitation of myocardial damage, improvement in myocardial tolerance to ischemia and prevention of coronary reocclusion. In this regard, there is an extensive discussion of the role of coronary angioplasty and bypass surgery in the setting of acute myocardial infarction.

Written by internationally acclaimed specialists, Cardio-Thoracic, Vascular, Renal and Transplant Surgery provides pertinent and concise procedure descriptions spanning 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. Forming part of the series, Surgery: Complications, Risks and Consequences, this volume Cardio-Thoracic, Vascular, Renal and Transplant Surgery provides a valuable resource for all general surgeons and residents in training. Other healthcare providers will also find this a useful resource.

Die chirurgische Therapie von Erkrankungen des arteriellen und venosen Gefasssystems einschliesslich der thorakalen und abdominalen Therapie von Aneurysmen ist der Schwerpunkt dieses Buches. Die haufigsten Operationen werden mit vielen Tipps und Details zum praktischen Vorgehen und anhand zahlreicher Abbildungen dargestellt. Grundlagen der Gefassdiagnostik und Wissenswertes zur medikamentosen Therapie runden das Werk ab. Das Buch profitiert von der grossen Erfahrung des Autors in Gefasssprechstunde und Ultraschalldiagnostik sowie seiner langjahrigen operativen Tatigkeit. Zielgruppe sind junge Assistenzarzte und das medizinische Personal im Operationsbereich, aber auch Schwestern und Pfleger auf den Stationen, deren haufige Fragen zu Grundbegriffen und speziellen Techniken in der Gefassmedizin beantwortet werden."

In recent years, major social forces such as: ageing populations, social trends, migration patterns, and the globalization of economies, have reshaped social welfare policies and practices across the globe. Multinational corporations, NGOs, and other international organizations have begun to influence social policy at a national and local level. Among the many ramifications of these changes is that globalizing influences may hinder the ability of individual nation-states to effect policies that are beneficial to them on a local level. With contributions from thirteen countries worldwide, this collected work represents the first major comparative analysis on the effect of globalization on the international welfare state.

The Welfare State in Post-Industrial Society is divided into two major sections: the first draws from a number of leading social welfare researchers from diverse countries who point to the nation-state as case studies; highlighting how it goes about establishing and revising social welfare provisions. The second portion of the volume then moves to a more global perspective in its analysis and questioning of the impact of globalisation on citizenship, ageing and marketization.

With its integrative analyses of policy and practice in countries struggling to provide social welfare support for their needy populations, The Welfare State in Post-Industrial Society will become an important voice in the debate on social welfare.

Since the last meeting "Myocardial Biopsy - Diagnostic Signifi cance" was held under the auspices of the International Society and Federation of Cardiology (ISFC) in Munich, many new data and new aspects have been developed in the field of myocardial dis eases. Most importantly, the classification of cardiomyopathies and specific heart muscle diseases, as described in the report of the WHO-ISFC task force (see reference 1 in the Introduction), is now widely accepted as a basis for clinical practice and scientific work. Investigators from all over the world have again assembled un der the auspices of the ISFC at an international workshop on viral heart disease and its implications with regard to congestive cardio myopathy, which was held in Munich January 1983. This book con tains the significant results of the workshop. For practical use, the authors have incorporated important points made in the discussions into their contributions and a subject index has been provided. First of all I should like to thank Professor Riecker, Director of the Medizinische Klinik, Klinikum Grol3hadern, University of Mu nich, West Germany. Without his friendly support in many aspects, this meeting would not have been possible. I should like to thank Professor Goodwin and Dr. Olsen from the ISFC for their active participation and advice in organizing the meeting. Last but not least, I am particularely grateful to all the contributors, whose co operation has made this book possible."

The joint workshop between the European Society of Cardiology and the European Society ofCardiovascular Surgery, held October 14-15, 1983 in Innsbruck, Austria, was a unique event. The idea originated in Atlanta, 1982, with C. Hahn and was supported by V. Bjork and N. Browse. H. Denolin and F. Loogen brought added impact from the European Society of Cardiology. The joint workshop specifically emphasized new trends and controversies in coronary artery surgery. The contri- butions appearing in this edition were selected by a scientific committee: H. Deno- lin, H. Kraft-Kinz, F. Unger, F. Loop, L. Cohn, F. Loogen, P. Lichtlen, T. Killip, and F.Kaindl. The specific aim was to evaluate controversial review points in coronary artery surgery. These were covered in six discussions and in nine forums with slide presen- tations. The topics were: 1. Indications for coronary artery surgery 2. Graft patency and long-term results 3. New operative techniques 4. Myocardial preservation and anesthetic management 5. Combined procedures 6. Long-term follow-up Coronary artery surgery is a model for comprehensive cardiology, whereby sur- gery serves as a link between diagnosis and rehabilitation. Because coronary artery surgery has become a routine procedure with standardized techniques, the demand is increasing dramatically as reflected by enormous waiting lists. Hospital mortality can be kept under 1 %, so that the value of this operation can also be discussed with regard to its social and economic aspects. In the majority of cases, patients improve and finally retum to work, finding life most enjoyable again.

Despite the exponential growth in the use of peripheral CTA in the diagnosis and follow-up of vascular disease patients, practical sources from which to gain valuable expertise in this field remain scarce. There is becoming a great need for experts in the field of peripheral CTA, yet learning this imaging modality may be intimidating and time consuming. Very few if any, small, concise and portable books exist to ease training in this field and current books in this field are overwhelming, difficult to manage, text books that often combine CTA and MRI. A so called " how to manual" and reference guide to explain this technique from beginning to end, which compiles valuable, and difficult to obtain clinical pearls and descriptions of disease processes will be of tremendous value. The Peripheral CT Angiography Manual aims to make learning this intimidating technique and the diseases for which it applies simple and fun.

Mankind in the second half of the twentieth century has encountered a number of social and economic problems, which, as never before, determine its future. Among the main problems facing medicine, meriting distinction is organization of the struggle against the increase of cardiovascular and oncological diseases which, with the birthrate, are the main demographic indices of our planet. According to the World Health-Organization, the deathrate from diseases of the cardiovascular system has risen by 60% in recent years, and there has been a sharp increase of myocardial infarctions and cases of sudden death in young people aged 25-30. The "geography" of heart and blood vessel diseases has changed: a dramatic increase of morbidity has been recorded in rural regions, and in districts where 10-20 years ago the native population was practically unaffected by atherosclerosis. Diseases of the cardiovascular system have become widespread among women as well as men. Cardiovascular diseases tax the national economy: they are responsible for over half the mortality among people at the prime of their productive life. More than 50% of temporary disability is also accounted for by ischemic heart disease, hypertension, stroke, etc.