Over the past ten years, cardiac transplantation has evolved from an exper imental procedure performed in a handful of university centers to a viable therapeutic modality now performed in more than 150 centers worldwide. The complexity of the procedure, the changing immunosuppressive re gimes, and the follow-up care have necessitated a multidisciplinary ap proach involving a variety of medical, nursing, and social sciences special ties and subspecialties. In addition, health care trainees and referring physicians are increasingly becoming involved in the care of the cardiac transplant recipient. This book does not attempt to be a comprehensive treatise on cardiac transplantation; rather, we hope that it will serve as a manual and guideline for all health professionals involved in cardiac trans plantation. JEFFREY D. HOSENPUD, M.D. Contents Preface v Contributors IX 1. Cardiac Transplantation: An Overview JEFFREY D. HOSENPUD AND ALBERT STARR Immunogenetics and Immunologic Mechanisms of 2. Rejection 15 DOUGLAS J. NORMAN 3. Medical Therapy Tailored for Advanced Heart Failure 33 LYNNE WARNER STEVENSON 4. Ventricular Assistance as a Bridge to Cardiac Transplantation 53 D. GLENN PENNINGTON AND MARC T. SWARTZ Recipient Selection for Cardiac Transplantation 71 5. GEORGE A. PANTELY 6. Donor Selection and Management for Cardiac Transplantation 85 JEFFREY SWANSON AND ADNAN COBANOGLU 7. Operative Techniques and Early Postoperative Care in Cardiac Transplantation 95 ADNAN COBANOGLU Endomyocardial Biopsy: Techniques and Interpretation of 8."

After yet another decade of leaming, experimenting, and inves tigating since my first book, Arterial System Dynamics, the many new medical breakthroughs and technological advances have inspired me to write this book to bridge the gap between basic research and clinical applications. The application of physical principles and quantitative approaches to the understanding of the arterial circulation and its interactions with the heart in normal and diseased conditions form the basis of The Arterial Circulation. Knowledge of the physiology and rheology of arteries, as well as all of their structural-functional corre lates, is a necessary prerequisite to the proper hemodynamic interpretatiqn of pressure-flow relations and the pulsatile transmis sion characteristics in different arteries. The natural coupling and interactions of the heart, the coronary circulation, and the arterial system necessitate analysis of alterations to global functioning. Modeling provides a tool for isolating and predicting parameter changes and is employed throughout the book. Experimental data are provided for model validations, and also for more realistic interpretations. Techniques and new methods for clinical hemo dynamic measurement and diagnosis are included to help the reader un derstand the physical principles underlying such abnormal cardiovascular functions as hypertension, stenosis, and myocardial ischemia. The progressive changes in vascular properties during aging are also discussed. Modem approaches utilizing computer mode ling and allomery are presented with selected examples, such as combined hypertension and aortic valve stenosis, and ventricular hypertrophy."

"Duplex Sonography" is the first comprehensive text written about this modality. The book offers the reader detailed information about all major uses of duplex and is introduced by a brief chapter on the physical principles of doppler ultrasound as it relates to duplex scanning. "Duplex " "Sonography" is intended to provide relevant information on all aspects of the technique, ranging from the basics of performing the examination to the features of sometimes complex pathological states. The book is intended for anyone interested in non-invasive vascular diagnosis including radiologists, vascular surgeons and ultrasound/peripheral vascular technologists. Other groups may find individual chapters appealing: carotid/cardiac sonography for cardiologists, fetal sonography for obstetricians or carotid sonography for neurologists. Each chapter is not only a guide to duplex evaluation, but also provides valuable information about vascular dynamics of the organ system under discussion. Physicians or technologists reading this book should come away with a well-rounded background in state-of-the-art duplex sonography and will undoubtedly discover new possibilities for using this non-invasive vascular technique.

What we now call 'deep venous thrombosis' (DVT) has been elucidated by a diversity of investigative approaches during the past four centuries. The authors of this book survey the history of the field and ask: why has one of these perspectives - the haematological/biochemical - come to dominate research into the causation of DVT during the past 50 years and to exclude alternatives? In answering this question, the authors show that the current consensus model is conceptually flawed.

Only comprehensive reference book on pressure ulcers and their management

Only book in its field endorsed by the European Pressure Ulcer Advisory Panel, the leading European authority on pressure ulcers

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

This book provides detailed guidelines to any physician treating patients with emergency vascular disorders. These might include ruptured abdominal aortic aneurysms, acute limb ischemia, vascular trauma, iatrogenic vascular injuries and complications to vascular surgery. The book provides an introduction to vascular surgical operations and focuses on how to manage patients. Numerous figures illustrate the particular points in vascular techniques and diagnostic problems in the emergency situation. This is an indispensable guide for all surgeons dealing with vascular emergencies.

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.

Fundamentals of Frontline Surgery is an easy to read text, written by world class faculty, that provides clinicians with succinct and didactic information about what to do in high intensity, resource limited situations.With global conflicts and humanitarian emergencies on the rise, there has been a dramatic uptake in the number of volunteers for both military and humanitarian operations. This manual aids best practice and fast decision making in the field.

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.

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.

Following the popular and accessible at a Glance format, Vascular and Endovascular Surgery at a Glance demystifies the important concepts of vascular disease and vascular surgery. Featuring in- depth details of common vascular topics, to rarer presentations, this is an ideal guide for those interested in a variety of subjects relating to this rapidly expanding area. This is a must- read for any specialist at all levels who has an on-going commitment to vascular disease management and medical education. Vascular and Endovascular Surgery at a Glance: Comprehensively covers the key concepts and core practical procedures with superb illustrations Is a brilliant companion to the emerging curriculum for specialist vascular training Is an excellent source of information and management guidelines for interdisciplinary specialties Includes a companion website at www.ataglanceseries.com/vascular featuring a wide range of interactive multiple choice questions This title forms a succinct overview of vascular disease management, giving salient points relevant to general surgery examinations, for those requiring an in-depth yet manageable introduction to vascular diseases, and for those entering this prevalent field as a stand-alone specialty.

This new, comprehensive analysis of human cardiovascular control explains the control of pressure, vascular volume and blood flow during orthostatis and exercise. Analysis of the physical properties of the vascular system and their modification by mechanical, neural, and humoural factors is highlighted by novel graphical representations of basic concepts. Interactive effects of the vasculature on cardiac performance and factors that both control and limit oxygen transfer from lungs to cells are stressed. This complete account will prove invaluable for all medical students, physiologists and clinicians who wish to better understand the reflex and hormonal control of the human cardiovascular system.

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.

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.

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.

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.

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."

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.