This is a carefully illustrated volume of surgical procedures. Well-known standard as well as alternative procedures in surgery of the stomach and the proximal duodenum are depicted with anatomical exactness. Possible complications, errors, and dangers and how to avoid them are discussed in detail. Each operative step is illustrated superbly and accompanied by a short, precise text. Both illustrations and text stem from the practical experience in the operating theater of the many renowned surgeons who have contributed to this volume. The book serves as an indispensable reference for surgeons; likewise, gastroenterologists, radiologists, pathologists, and anatomists will find this volume of immeasurable value in their daily work.

and refinement that exists within the necessarily strict rules of the internal fixation method. In this way we seek to contribute to as weIl as to stimulate the search for rational solutions to surgical problems. It is assumed throughout that the reader is fa miliar with the technical fundamentals of internal fixation, and so these details are omitted. Instead, special indications and technical refinements are presented on the basis of case examples. Because an endless variety of situations can arise in orthopedic surgery (a circumstance that is attracting more and more surgeons to the field), we have taken ca re that our examples can readily be applied to novel situations. We now credit, in alphabetic order, those who contributed most to the techniques presented: R. BLATTER, A. BOITZY, C. BRUNNER, O. CECH, A. DEBRUNNER, F. MAGERL, G. SEGMUELLER, G. STUEHMER, and B.G. WEBER. We thus express thanks to those colleagues in our clinic who agreed to having their ideas published. But we are also grateful to our illustrators, H. and K. SCHUMACHER, our photographer, M. SCHAFFNER, and our chief secretary, U. OETLIKER, who contributed so much to the preparation of the manuscript. Finally, we thank Springer-Verlag for their patience with us and especiaUy for their efficient work in bringing the book to press. St. GaU, Fall 1981 CH.F. BRUNNER B.G. WEBER Contents Lag Screws ............. .

Surgeons confronted with acute trauma are frequently under great pressure to act quickly. Only a few have an infallible three-dimensional memory as regards the different approaches necessary for treating fractures by inter nal fixation. Thus there is a real need for a reference book on the approaches to the shoulder, arm, pelvis, and leg which is instructive and based on clinical practice. This is true both for the emergency situation and for the "evening before" with the imperative preoperative planning. THOMAS RUEDI, himself a surgeon as well as a gifted illustrator, in coopera tion with ARTHUR VON HOCHSTETTER, a clinical anatomist, and excellently interpreted by the artist ROBERT SCHLUMPF, has created a novel and impres sive atlas. The surgical approaches are depicted in a manner which is ana tomically correct, limited to the essentials, and realistic. In addition, the attractive, black-and-white illustrations of the anatomy are successfully sup plemented by color schematic drawings. This luxuriously prepared edition may become a daily advisor to surgeons dealing with trauma. It deserves a widespread distribution in surgical depart ments and reference libraries.

The introduction of lasers into operative medicine and advances in fiberoptic technology have made a significant contribution to minimally invasive surgery. This book was written to raise awareness of the capabilities and advant ages of lasers in urological surgery and to make this tech nology more widely accessible. The book reflects the cumulative experience of 25 years of laser research and clinical application, starting in 1972 with studies on laser tissue interactions, endoscopic studies with fiberoptic "sutures;' and the first clinical use of lasers in 1975 and 1976. These early efforts were followed by the develop ment oflaser lithotripsy in the early 1980 s and a Lubeck based research program leading to the development of a "smart" laser lithotriptor (Lithognost) in the late 1980s. There have been recent advances in the field of photo dynamic diagnosis based on the use of locally adminis tered photo sensitizers, a development that will redefine the role of the Nd:YAG laser in the treatment of bladder cancer. Perhaps the most interesting concept is the inter stitiallaser therapy of prostatic hyperplasia and, perhaps one day, certain forms of prostatic cancer. We have also developed a technique, first described in 1986, for the laser treatment of schistosomal bladder lesions. I dedicate this book to the many pioneers oflaser medi cine and to all the colleagues and research assistants who accompanied me on this journey. I cannot name them all; their names can be found in more than 300 publications.

More than a century ago, Cripps successfully employed the direct and complete division of the anal sphincters as a means of approaching the lower rectum and anal canal, and reported on a series of 36 patients who had been treated in that fashion. Cripps was pleasantly surprised to find good fecal continence in over two-thirds of the patients during later follow-ups, despite the fact that the divided sphincters had not been repaired. The transsphincteric procedure was largely forgotten in subsequent years, however, and only the parasacral proctotomy of Kraske, which spared the anal sphincters, can be said to have gained an established place in the" surgical armamentarium. " It remained for York Mason to redirect the attention of the surgical community to the great potential of the trans sphincteric approach and the excellent continence that can be achieved through adequate repair of the divided sphincters. Having recognized the outstanding practical value of this procedure, we felt it necessary to define more precisely the anatomical prerequisites that would ensure minimum operative bleeding, and to bring the procedure more in line with current knowledge of normal continence and defecation. Dr. A. Huber, in consultation with the director of the Institute for Clinical Anatomy of our surgical department, Prof. A. von Hochstetter, did many months of dissection work on fresh anatomic preparations in an effort to explore and refine the various aspects of the trans sphincteric ap proach."

In response to the great demand for an English edition of the standard German handbook, Systematic Musculoskeletal Examination will soon be available. This comprehensive book contains up-to-date information for the orthopedic examination of the locomotor apparatus. In addition to the well-known techniques of the musculoskeletal examination, it also describes in detail the diagnostic techniques used in manual medicine. The numerous examinations are carried out according to five clearly defined examination stages which are the same for each joint and allow a systematic examination of the individual joint structures for functional disorders or disruptive effects (functional structural analysis). The examination is thus logically organized according to an outline, and the indications for each stage are based on the results of the previous stage and the summary of the functionally related body regions. The functions tests take into account the state of the art in biomechanics, and the symptoms requiring radiologic functional diagnosis are depicted. The systematized and streamlined examination procedure makes it possible to obtain and document results in a uniform manner. The all-inclusive nature of the text, guided by a well-designed systematic and methodical approach, will make it attractive to anyone dealing with the musculoskeletal system.

3.2 Technique ............. '. . . . . . . 123 3.3 Drainage Catheters: Materials and Selection . 139 3.4 The Loop Catheter . . . . . . . . . . 141 4 Aspiration of Pancreatic Pseudocysts 145 E. Concluding Remarks 149 151 References " Subject Index . 158 VII List of Contributors BURGER, H. R, Dr. med., Oberarzt, Institut fur Pathologie, Univer sitiit Zurich, SchmelzbergstraBe 12, CH-8091 Zurich EINIGHAMMER, H.J., Dipl. Phys., Dr. rer. nat., Neurologische Uni versitatsklinik, MoorenstraBe 5, 0-4000 Dusseldorf HAUKE, R, Dipl., Phys., Dr. rer. nat., Gesellschaft fur Medizin. Techn. Informationssysteme, MarienstraBe 2,0-7910 Neu-Ulm PEmo, G., Professor Dr. med., Leitender Arzt, Abteilung fUr Zytolo gie, Institut fur Pathologie, Universitatsspital, CH-8091 Zurich " ... so it is not good for men to fear all that is not already known and settled, and thus feel that it is bad and harmful to strive for a greater perfection than already exists." Holderlin to his mother, 16. November 1799 A. Introduction 1 General The modem cross-sectional imaging methods of sonography and computed to mography, developed in the early 1970s, have contributed greatly to noninva sive studies of the parenchymatous organs and permit the evaluation of patho logic changes in areas that were previously accessible only to invasive, indirect, or inadequate examination."

It will be a long time before the quality of this profusely illustrated book is overtaken and the present spate of books on the subject of obstetric ultrasound may, as a result, suffer a numerical set-back - especially with translation into English which will "deliver the milk on everyone's doorstep". Two of the authors studied in our department in Glasgow and worked like If there are any rewards for teaching, then we humble Scots who demons. have had the privilege have had more than our share as a result of the pride with which we regard our pupils. In my own old age and looking back over the last thirty years, the innumer able difficulties, set-backs and disappointments have been more than compen sated for by those who have turned the subject from a laughable eccentricity (as I have at one time experienced) into a science of increasing exactitude. This transformation has come about, not by any efforts of mine, but by the enthusiasm and ingenuity of those who would probably have achieved as much on their own if given the encouragement which I ultimately received in Glasgow University life. Limbo must be the expected lot of most of us ordinary mortals but the work lives on. And so, in this reminiscent and philosophical mood I beg leave to quote a little poem which I wrote at an age when young men do that sort of thing.

This book is the product of long years of close collaboration between two physicians, a pediatric endocrinologist and a pediatric surgeon, who are interested in the complex field of human malformations. Their efforts have set a new standard in the treatment of children with intersexual or mal formed female genitalia. It is impossible to convey the details of complex surgical procedures without the help of meticulous illustrations. It is fortunate that happened to meet an academically trained artist, Mrs. Siri Mills, M.A., while visiting in the United States. Her excellent knowledge of anatomy, her remarkable skills as an artist and technical illustrator, and her readiness to include all details of interest to the surgeon have found their fruitful expression in the illustrations of this book. We express our thanks to Springer-Verlag and especially to Prof. Diet rich Goetze, at whose suggestion this book was written, for their amiable compliance with all our wishes, and particularly for their willingness to retain Mrs. Mills as our illustrator. Munich, May 1985 WALDEMAR HECKER Contents In trod ucti on 1 Part 1: Endocrinologic Diagnosis in Pediatric Patients with Genital Anomalies General Rules . . . . . . . . . . . 4 Endocrinology of Antenatal Sex Differentiation 6 Male Differentiation 6 Female Differentiation 7 Specific Endocrinologic Diagnosis and Therapy 8 Virilization of the Female External Genitalia 8 Congenital Adrenogenital Syndrome with a Defect of 21-Hydr- ylase . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Intersexual Genitals Due to Deficient Androgenization of the Male 11 Defects of Testosterone Biosynthesis 11 Androgen Receptor Defects . . ."

If a consecutive series of patients with lung cancer is followed up until the decision is made about therapy, it emerges that the role of surgery is quite small. Only a very limited proportion will ultimate ly qualify for rationally conceived surgical therapy; most patients are inoperable. In a series of 397 patients investigated at our hospi tal, 78% were inoperable on the basis of preoperative evaluation and a further 3% proved nonresectable at thoracotomy; therefore, only 19% were suitable for resection. On the other hand, surgery is still thought to offer the best, if not the only realistic chance of cure. The question "operable or not?" is therefore of vital importance for the individual patient. The answer to this crucial question must be based on valid guidelines for pa tient selection and preoperative evaluation, and it should be clearly defined what extent of resection is necessary in order to realize any curative intention. In 1972 a thorough analysis of the literature revealed that re section of bronchial carcinoma - although 40 years old - was being undertaken with very variable indications. There was hardly any systematic staging, and assessment of results was hampered by the fact that most communications in the literature were based on retrospective analysis.

ARCHIVE COpy DO NOT REMOVE The public in industrialized countries shows a mounting concern about biological effects of electrical and magnetic fields. As a result, experimental studies on this subject are being published in increasing numbers throughout the world. Prof. H. L. Konig, of the Technical University of Munich, West Germany, a leading expert and pioneer in this field, has written an authoritative text in a lucid style which makes the material also accessible to lay readers. The book describes the effects of natural as well as artificial electromagnetic energies covering the en tire measurable frequency range from the highest frequencies, x-rays, through microwaves, radio waves, and finally extremely low frequency (ELF) waves. Cit ing the evidence from scientific studies in various countries, Konig also appraises the biologic effects of microwaves and high tension power lines, which have become controversial issues in recent years. Other contributions to the book have been made by Prof. Albert P. Krueger, University of California, Berkeley, on air ionization effects and by the mete orologist Walter Sonning on biometeorology, documenting the influence of atmo spheric electrical currents on health and disease. Moreover, the late Dr. Siegnot Lang, a former coworker of Dr. Konig, has contributed to this book."

This new treatise is the most outstanding piece of work on the knee and its associated ligaments currently available. Never before have I seen such an extensive study of the biomechanics of the knee with such a comprehensive review of the literature. The first section of the book, which deals with the functional anatomy (structure and biomechanics), immediately alerts the reader to the necessity of understanding the natural develop ment and action of the related structures, clearly emphasizing that successful diagnosis and treatment cannot otherwise be expected; the many who want an easy standard approach to each classic problem may find this hard to accept. Study what Werner Muller has written and compare it with your own findings from repeated dissection of anatomical specimens. The author goes on to stress that to have a real grasp of reconstructive surgery of the ligaments, one must be properly acquainted with the pathology and the repair of acute lesions. In no other way can one learn to recognize chronic problems. Once this step has been mastered it can be seen that the reconstructive procedures that Muller advocates do, for the most part, follow the laws of Nature rather than create the kind of abnormalities which often disrupt natural anatomical func tion.

This volume presents an overview of the pathophysiology, clinical features, and treatment of disseminated intravascular coagulation with regard to those conditions encountered most often during intensive medical care. The excellent organization of the book enables the reader to easily find answers to specific, individual questions.

Every bone fracture must be held rigid and, because of the long healing process, infringes on the individual's life-style. Treatment with ultrasound, however, may reduce the healing time 30-50% since the piezoelectric effect of ultrasound acts as a callus stimulator. This book documents more than twenty years of clinical experience with ultrasound treatment of fractures. The authors give statistical evidence and show numerous X-rays to document their success. They also include a summary of experimental studies. The method is described in detail so that the practicing physician can easily learn how to apply it.

Progress in medical science, and the deeping of physician experience in general, make continuing education a fundamental obligation on the part of the practicing physician. Besides academies of advanced medical training, we feel that medical schools and uni versities offer a particularly good setting for continuing medical education. When the Hannover Medical School established West Germany's fIrst Department of Trauma Surgery in 1970, we committed ourselves to this goal and instituted the Hannover Trauma Seminars as a regional forum for continuing physician education. Made up almost entirely of our colleagues at the Trauma Surgery Clinic, the basic goal of the seminars is to review new discoveries and techniques in the fIeld of traumatology and assess their practical relevance to the physician who treats trauma victims. In addition to research, the experience ofthe Hannover School of Trauma Surgery form an important basis for seminar activities. The fIrst Trauma Seminar was held on February 2, 1972. Initially, copies ofthe proceed ings were simply distributed to all interested participants. But as attendance grew and demand for the proceedings increased, it became necessary to seek a broader form of publication. Henceforth, the Hannover Trauma Seminars will be published as part of the Topics in Traumatology series. For this we are grateful to Springer Verlag and to series editors Jorg Re and Leonhard Schweiberer."

During the past 3 years, little has been added to our funda mental knowledge of hormonal disorders in gynecology. Diagnostically, however, there has been an almost com plete departure from traditional chemical methods in favor of radioimmunoassay techniques. As a result, diagnostic capabilities which previously were restricted to large cen ters have now been extended to the office and small clinic. Accordingly, the chapters dealing with these techniques have been revised and updated. There is also new material on advances in the hormonal treatment of endometriosis and hyperprolactinemic states. Finally, the bibliography has been extensively revised to include a number of recently published books and survey articles of general interest. Paul J. Keller v Preface to the First German Edition Menstrual disorders and sterility are among the most com mon complaints noted by both the specialist and general practitioner. For many patients they are far more distress ful than is generally assumed. Recent years have brought our knowledge. While this has led to great advances in major improvements in the results of treatment, it has made it difficult for the nonspecialist to keep abreast of developments in the field of gynecologic endocrinology.

This is an "old-fashioned" book in the best sense of the term: It is written by one man, and it is scholarly, complete, thorough, and thoughtful. It is, in fact, a magnum opus wherein every aspect is not only touched, but handled to perfec- tion. This is a treatise that deserves careful reading by that increasing cadre of medical specialists who understand the many ways in which mycoses threaten human health and happiness, viz, the veterinarian, pharmaceutical chemist, general practitioner, pharmacologist, and entire consortium of researchers who study the biology, epidemiology, pathogenesis, and treatment of fungus infec- tions. Mycoses encompass a vast spectrum of diseases from trivial superficial skin infections (tinea versicolor), troublesome ringworm infections (the tineas of skin, hair, and nails), yeast infections (candidosis), the systemic mycosis (cryptococcosis, histoplasmosis), and even the deep-seated infections due to molds and saprophytic fungi (aspergillosis). It is precisely because of the great variety of causative organisms that the imidazoles deserve a special treatise. They provide the first class of drugs with therapeutic activity against all the important fungi which infect humans and animals. Accordingly, their medical significance is great and the possibilities endless. Morever, the imidazoles are the first effective drugs whose antimicro- bial activities extend beyond the usual designation of "broad-spectrum. " Broad-spectrum antibiotics, for example, are either antifungal or antibacterial, not both as the imidazoles are. To be sure, there have been other chemothera- peutic compounds which inhibit bacteria and fungi.

Intended for nuclear medicine specialists in training, it is equally an invaluable reference for other professionals and students. The richly illustrated chapters are devoted to individual organs and systems, with each chapter depicting the findings in selected pathological cases and in healthy individuals, with a comparison of nuclear medicine with other diagnostic imaging modalities. The full potential and also the limitations of modern nuclear medicine are described and sources of error are elucidated. The author is a well-versed nuclear medicine specialist with experience in research, teaching and clinical practice.

All practitioners and pharmacists interested in treatment with herbal remedies should have this book at their disposal. It is the definitive practice-oriented introduction - now in its fifth edition - to phytotherapy. Methodically classified by organic systems and fields of application, the text provides a quick insight into dosage, form of application and effects of the most important herbal remedies. Only those herbal remedies that are of pharmacological and clinical efficiency have been considered. The authors are highly experienced in the field of postgraduate medical education, and, with this work, present an indispensable reference book for the medical practice.

The significant strides made during the past decade in neonatal medicine are based largely upon the provision of intensive perinatal care to the parturient, her fetus, and the newborn. In addition to technologic advances in the bioelec- tronic monitoring of the fetus and newborn, the introduction of noninvasive methods to monitor oxygenation, the pharma- cologic manipulation ofthe ductus arteriosus and pulmonary vasculature, and the use of ultrasonographic diagnosis of congenital heart defects and other lesions, intensive efforts by neonatal specialists throughout the world have also contri- buted to the decline in neonatal and infant mortality. Professors Wille and Obladen have provided an authoritative manual outlining intensive care of newborns and the ways in which the science of neonatal medicine, the technology of the 1980 s, and the art of application have resulted in the practice of neonatal intensive care at the Kinderklinik of the University of Heidelberg. The English translation resulted from the success of the German edition and will serve well the needs of the English-speaking student and practitioner of neonatal intensive care. T. Allen Merrit, M. D.

All practitioners and pharmacists interested in treatment with herbal remedies should have this book at their disposal. It is the definitive practice-oriented introduction - now in its fifth edition - to phytotherapy. Methodically classified by organic systems and fields of application, the text provides a quick insight into dosage, form of application and effects of the most important herbal remedies. Only those herbal remedies that are of pharmacological and clinical efficiency have been considered. The authors are highly experienced in the field of postgraduate medical education, and, with this work, present an indispensable reference book for the medical practice.