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Increasingly, pathologists are being confronted with the effects of
a number of complex devices on the body. Cardiac pace-makers are
becoming increasingly sophisticated, ventricular support systems
for the heart are well established, and vascular and other
protheses are being used in increasing numbers. New joint systems,
contraceptive devices used as drug delivery systems, and the use of
new cement materials all provide challenges in terms of their
pathology. The articles in this text collectively form a body of
information on these devices not available elsewhere and with an
up-to-date bibliography.
Increasing specialisation in pathology reflects the progressive
changes in medical practise. The advent of a specialist with a new
interest in a hospital or clinic may present the pathologist with a
need to extend his or her knowledge to be able to work closely with
the clinical practi tioner in order to provide adequate clinical
care. Some sub-specialisations are long established, such a one is
neu ropathology. However, an exclusive specialist practise is
generally con fined to neurosurgical centres and much
neuropathology is of necessity, executed by geneni.l pathologists.
The areas covered by this volume are those which are commonly
managed by the generalist. Professor Adams' account of how the
skull and brain should be examined here will give confidence to
many by defining a good technique and the careful description of
various kinds of vascular injury lesions resulting from raised
intracranial pressure will help to clarify repeated difficulty.
More subtle forms of damage are also considered in detail.
Professor Weller provides a detailed account of how the central
nervous system may be examined in a way which permits all of us to
prepare material which will allow adequate investigation of central
nervous system disease and the proper examination of peripheral
nerves. This chapter will become a "handbook" and will be of
interest to those in training and established practitioners. Muscle
biopsy is also dealt with; this is an area of investigative concern
for many gener alists. The role of that singular neuropathological
technique is very clearly emphasized.
La pathologie vasculaire a ete tres marquee par les progres
biologiques de ces vingt demieres annees. Le systeme arteriel est
main tenant considere comme un organe a part entiere. Modelee au
cours de l'organogenese par les facteurs hemodynamiques, Ie paroi
arterielle maintient une structure hautement organisee et des
proprietes mecaniques qui dependent directement des conditions de
pression et de debit. La monocouche endotheliale developpe 2 une
surface de plusieurs centaines de m a l'interface sang-tissu; elle
est a la fois un organe endocrine complexe synthetisant de
nombreuses proteines qui participent a l'hemostase, une surface
thromboresistante et hemocompatible, une barriere de permeabilite
contr6lant les echanges sang-tissus. Les cellules musculaires
lisses constituent un tissu multifonctionnel, contractile, assurant
la synthese des composants structuraux responsables des proprietes
mecaniques de la paroi arterielle, la transmission de la force
contractile, et une etonnante activite reparatrice en reponse aux
agressions. Tout ceci est soumis a un ensemble complexe de
communications cellulaires qui font de l'endothelium un veritable
systeme recepteur pour la paroi vasculaire. Parallelement, ou a la
suite de ces progres, l'angeiologie s'est progressivement affirmee
comme une specialite clinique. Debordant Ie cadre de la chirurgie
vasculaire, elle integre les concepts physiopathologiques au
diagnostic et au traitement des maladies arterielles. De cet effort
d'integration est ne cet ouvrage, cherchant a concilier les
connaissances fondamentales es plus recentes et la demarche
clinique.
It is easy to be confident that an appropriate body of advice is
available to candidates about the content of an examination once
you have passed it. Prospectively, the Primary and Final
Examinations of the Royal College of Pathologists will appear to
most to involve the assimilation of what seems at the time an
inexhaustible volume of data, and the recent change in the College
examination system has not diminished this concern for the majority
of candidates. The guidelines for training for the new Part I
examination state that this is the "major hurdle of the MRCPath"
and it is clear that it will determine whether candidates are
suitable for training which will permit them to practise
independently as consultants after Part II. These general aims and
objectives do not answer questions such as "How much do I need to
know about glomerulonephritis?" or "Where do I stop with the
lymphomas?" This text attempts to resolve the difficulty of knowing
what standard to aim at, using College questions as its starting
point. It concentrates on the essential basis of any single answer;
many candidates for the new three-year examination will know more
about individual topics than is stated here. However, it is the
breadth of information required which is a feature of College
examinations and this text should help with this problem.
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