At the Sixth Wiggers Bernard Conference, a group of scientists from various disciplines discussed new findings relating to nitric oxide synthase inhibitor in shock, sepsis, and organ failure. Dedicated to the presentation and discussion of both positive and negative findings related to the use of NOS inhibitors, the meeting served as a forum for issues relating to specific and non-specific inhibitors, as well as the role of nitric oxide-oxygen radical interactions. Both experimental and clinical data were presented in the trauma and sepsis field.

At the Sixth Wiggers Bernard Conference, a group of scientists from various disciplines discussed new findings relating to nitric oxide synthase inhibitor in shock, sepsis, and organ failure. Dedicated to the presentation and discussion of both positive and negative findings related to the use of NOS inhibitors, the meeting served as a forum for issues relating to specific and non-specific inhibitors, as well as the role of nitric oxide-oxygen radical interactions. Both experimental and clinical data were presented in the trauma and sepsis field.

International experts examine the role of nitric oxide in various metabolic events such as septic shock, cardiovascular dysfunction, and trauma and hemorrhagic shock. The nitric oxide pathway and nitric oxide synthesis regulation are also discussed.

New findings involving the brain in traumatic and septic shock and after brain injury are reported in this book, including pathophysiological and pathohistological results. An experimental and clinical approach to treatment is presented together with specific results obtained from the encephalogram and from histopathological study with regard to the immunohistochemistry of toxic lipid peroxidant products. The latest results of clinical and experimental pathophysiology in inflammatory processes after traumatic brain injury and the therapeutic effects of hypertonic fluid therapy are also discussed.

The decisive factor in trauma is that many processes first occur at the cellular level before they can be determined in laboratory tests, and recognition of them has only recently found its way into intensive care practice. Yet knowledge of the pathophysiology of these processes is essential for an early diagnosis of multiple organ failure and the implementation of adequate therapy, which ultimately make the patient's survival possible. Professor Schlag, an internationally renowned scientist and clinician, has been concerned with the basic pathophysiological principles of shock for many years. In this book he has brought together for the first time an international team of authors primarily from the USA and Europe, who present their collective findings of trauma, shock, development of the organ in shock and early failure and of sepsis-like syndrome, and development of septic multiple organ failure. Patienten mit Multiorganversagen haben immer noch eine schlechte Prognose in der intensivmedizinischen Behandlung, insbesondere wenn sie noch zusatzlich in einen septischen Schock geraten. Hier hilft auch oft eine breite Abdeckung mit modernsten Antibiotika nicht weiter. Neue Ansatze fur eine Therapie dieser problempatienten haben sich in den letzten Jahren durch Erkenntnisse der pathophysiologischeen Vorgange die zum Schock fuhren ergeben. Herr Professor Schlag hat als anerkannte Kapazitat auf dem Gebiet der Traumatologie und Schockforschung fur dieses erste umfassende Werk zu den Grundlagen des Multiorganversagens eine beeindruckende Liste von mehr als 50 international renommierten Autoren zusammenbekommen. Das Buch ist nicht nur eine Aufarbeitung aller Grundlagen des Schocks und Multiorganversagens sondern zudem ein ausgezeichnetes Nachschlagewerk fur jeden intensivmedizinisch tatigen Klinikarzt, egal ob er aus der Anasthesie, der Inneren Medizin oder der Unfallchirurgie kommt."

These eight volumes, which developed out of the international congress "Update and Future Trends in Fibrin Sealing in Surgical and Nonsurgical Fields" held in November 1992, present the state of the art in fibrin sealing. Initially, fibrin sealant played an important role in surgery. During the past few years, it has been increasingly applied nonsurgically and we can now say that it has become an integral component of medical treatment. The doubts which have been raised by nonusers about the efficacy of fibrin sealant are no longer valid. The correct indication and technique continue to be basic prerequisites for effective treatment. Even today - 20 years after fibrin sealant was first used - the three most prominent effects of fibrin sealant are still hemostasis, sealing of the wound, and support of wound healing. The problems posed by the transmission of viral infections have gained substantially in importance because of the potential transmission of AIDS via fibrin sealant. Fortunately, this is so unlikely today that it no longer represents a cause for concern, which does not mean, however, that research in this field can be discontinued.

These eight volumes, which developed out of the international congress "Update and Future Trends in Fibrin Sealing in Surgical and Nonsurgical Fields" held in November 1992, present the state of the art in fibrin sealing. Initially, fibrin sealant played an important role in surgery. During the past few years, it has been increasingly applied nonsurgically and we can now say that it has become an integral component of medical treatment. The doubts which have been raised by nonusers about the efficacy of fibrin sealant are no longer valid. The correct indication and technique continue to be basic prerequisites for effective treatment. Even today - 20 years after fibrin sealant was first used - the three most prominent effects of fibrin sealant are still hemostasis, sealing of the wound, and support of wound healing. The problems posed by the transmission of viral infections have gained sub stantially in importance because of the potential transmission of AIDS via fi brin sealant. Fortunately, this is so unlikely today that it no longer represents a cause for concern, which does not mean, however, that research in this field can be discontinued.

The last volume in the series Fibrin Sealing in Surgical and Nonsurgical Fields discusses various uses of fibrin glue in endoscopic surgery. During the last years fibrin sealant has been established in the treatment of gastrointestinal ulcers and esophageal fistulae.

Fibrin sealant is used for numerous indications in gynecology, especially for the McIndoe Operation and Cohn biopsy, the Marshall-Marchetti-Krantz-Hirsch-Stoll-Operation, urethrocysopexy, or in vitro fertilization for embryo transfer. The use of fibrin sealant in urology has also been extended, especially in operations of the spermatic cord, reconstruction of the urethra and closing of nephrotomies.

These eight volumes, which developed out of the international congress "Update and Future Trends in Fibrin Sealing in Surgical and Nonsurgical Fields" held in November 1992, present the state of the art in fibrin sealing. In itially, fibrin sealant played an important role in surgery. During the past few years, it has been increasingly applied nonsurgically, and we can now say that it has become an integral component of medical treatment. The doubts which have been raised by nonusers about the efficacy of fibrin sealant are no longer valid. The correct indication and technique continue to be basic prerequisites for effective treatment. Even today - 20 years after fibrin sealant was first used - the three most prominent effects of fibrin sealant are still hemostasis, sealing of the wound, and support of wound healing. The problems posed by the transmission of viral infections have gained sub stantially in importance because of the potential transmission of AIDS via fi brin sealant. Fortunately, this is so unlikely today that it no longer represents a cause for concern, which does not mean, however, that research in this field can be discontinued.

In the field of orthopedic surgery, additional areas of application and new indications have been discovered for fibrin glue treatment, for example, hemostasis in pseudotumors in hemophilic patients or in torn ligaments, and in spongiosa transplantation, primarily when nonautologous bone material is being used, or to fill large defects. In maxillofacial surgery fibrin glue is mainly used for osseous contouring of the facial and frontal bones, for alveolar ridge augmentations in preprosthetic surgery, and for soft tissue reconstructions.

These eight volumes, which developed out of the international con gress "Update and Future Trends in Fibrin Sealing in Surgical and Nonsurgical Fields" held in November 1992, present the state of the art in fibrin sealing. Initially, fibrin sealant played an important role in surgery. During the past few years, it has been increasingly applied in nonsurgical applications and we can now say that it has become an integral component of medical treatment. The doubts which have been raised by nonusers about the efficacy of fibrin sealant are no longer valid. The correct indication and technique continue to be basic prerequisites for effective treatment. Even today - 20 years after fibrin sealant was first used - the three most prominent effects of fibrin sealant are still hemostasis, sealing of the wound, and support of wound healing. The problems posed by the transmission of viral infections have gained substantially in importance because of the potential transmission of AIDS via fibrin sealant. Fortunately, this is so unlikely today that it no longer represents a cause for concern, which does not mean, however, that research in this field can be discontinued.

These eight volumes, which developed out of the international con gress "Update and Future Trends in Fibrin Sealing in Surgical and Nonsurgical Fields" held in November 1992, attempt to present the state of the art concerning fibrin sealing. Initially fibrin sealant played an important role in surgery. During the past few years, however, it has been increasingly used in nonsurgical applications, and we can now say that it has become a component of medicine in general. The doubts about the efficacy of fibrin sealant, which had been raised by nonusers, are no longer valid. The correct indication and method ology continue to be basic prerequisites, and even today - after 20 years of fibrin sealant renaissance - the three most prominent effects of fibrin sealant still retain their validity: hemostasis, sealing and sup port of wound healing. The problems posed by the transmission of viral infections have gained substantially in importance because of the potential transmission of AIDS via fibrin sealant. Fortunately the transmission of AIDS via fi brin sealant is today so unlikely that it no longer poses a cause for con cern. This does not mean, however, that research in this field can be discontinued.

This book is the result of the 3rd Wiggers Bernard Conference. The Wiggers Bernard Conferences, named after two great physiologists of the past, are biannual gatherings of the leaders in the field of shock. The meetings focus on specific areas of interest, where a lot of new informations is available, but needs to be focused. There are informal presentations during which the seminarian can be intenupted in order to clarify a pat1icular point; formal discussions follow each presentation; these are followed by infOlmal gatherings in which these discussion continue in a very relaxed environment. The 1992 meeting took place in Obermayerhofen, a small but charming castle in the soft green hills of Eastern Styria in the South-Eastern part of Austria. The castle was built in 1130, restored and turned into a hotel in 1977. The renaissance court yard and the generous and exclusive decors make it one of the most beautiful castles in Austria. The frank beauty and hospitality of this area acted as a catalyst to crystalize the thoughts of this interdisciplinary group of scientists as they discussed new findings in the cytokine area.

The Wiggers Bernard Conferences, named after two great physiologists of the past, are an nual gatherings of the leaders in the field of shock. The meetings focus on specific areas of which appears to be showing the most advancement during the previous year. There are se veral types of sessions; informal presentations during which the seminarian can be intenup ted in order to clarify a particular point; formal discussions follow each presentation; these are followed by informal gatherings in which these discussions continue during meals and libation in a very relaxed environment. The 1990 meeting took place in Durnstein, Austria. A small hamlet in the wine growing area of the Wachau valley, on the Danube above Vien na. This was the site of a former citadel where the English King Richard the Lion-Heart (Coeur de Uon) was held for ransom during the middle ages. The frank beauty and hospi tality of this area in addition to the ancient Roman adage "in vino veritas" acted as a catalyst to crystalize the thoughts of this interdisciplinary group of scientists as they discussed the following areas: 1. Gut as a Source of Organ Failure 2. Metabolic Aspects of the Liver in Sepsis 3. Endothelium as a Target'in Sepsis We would like to thank the participants of the conference for taking time away from their very productive and busy schedules to participate in the conference and for the prompt pre sentation of their manuscripts and editions of their discussions.

The First Wiggers Bernard Conference on Shock, Sepsis, and Organ Failure was envisaged as a meeting of American and European Scientists. It was named after two researchers, one from the "Old" and one from the "New World," who are wellknown for their outstanding achievements in shock research and experimental medicine. This meeting was a point of de parture for a series of workshops that will focus on two to three main topics dealt with in detail by experts in their respective fields. The First Wiggers Bernard Conference addressed three main questions: 1. Multi-organ-failure - is it a sequence of organ failures or a systemic disease? 2. Cellular events in trauma and sepsis - are they due to suppression, activation or both? 3. Mediators of organ failure - are LPS or sepsis necessary? Although many answers were given in this first session, numerous issues remain to be clarified due to the enormous complexity of the subject. How ever, the stage was set for encounters between clinicians and basic medical researchers, since theoretical knowledge will be useful to the clinician ex ploring new approaches to diagnosis, prophylaxis, and therapy. The conference could not have been organized without the generous sup port of the Immuno Company, Vienna, Austria. May we express our special thanks to Dr. Eibl, managing director and head of the research division of Immuno AG, not only for granting financial support but also for his valuable advice, encouragement, and scientific expertise."