The continued high mortality (up to 70 %) in patients with necro- tizing pancreatitis and diffuse peritonitis has led to the develop- ment of various surgical strategies within the past few decades. Up to the present decisions about the management of these disea- ses have been rather difficult because of the individual courses differ considerably, even being incomparable. Today, as a result of our in creased knowledge of the pathophysiology, the impro- ved imaging procedures, and the standaridized intensive care, the rend is moving toward delayed surgical intervention. The goals in the surgical treatment of necrotizing pancreatitis and diffuse peritonitis are still surgical removal of the focus of infection, elimination of endotoxins by lavage, and optimal drainage of the peritoneal cavity. Depending on the patient's general condition this cannot always be achieved in the first surgi- cal intervention. A number of surgical methods have therefore been developed, such as postoperative dorsoventral lavage, step- by-step lavage therapy, postoperative closed continuous perito- neal lavage, and open treatment (laparostomy). The last-mentioned method ist not new; it was first described by KOR'J;E in 1894 for the treatment of necrotizing pancreatitis. However, due to the progress in intensive care medicine (long- term respiratory therapy, hemofiltration, etc.) in the last few years this method of management has become successful and gai- ned in recognition.

Fibrin plays a central role in wound healing. It has a hemostatic effect by forming a temporary wound closure and assists in neovascularization and fibroblast prolifera- tion. It therefore makes the repair of injured or severed parts of the human body by simple glueing possible, a notion that men have dreamed of since ancient times. The first modern attempts in this direction, using clotting substances derived from human blood to achieve hemostasis, were reported by Bergel (in 1909), Grey (in 1915), and Harvey (in 1916), who used fibrin powder or fibrin patches to control bleeding from parenchymatous organs. Two decades later Young and Medawar (1940) and Cronkite (1944) used blood plasma or fibrin solutions, adding thrombin to seal nerve anastomoses and to fix skin grafts in humans. Due to the poor adhesive strength of the fibrinogen the results were unsatisfactory. In 1972 a new era in fibrin sealing was initiated by Matras. By using highly concentrated fibrinogen in combination with factor XIII (fibrin-stabilizing factor) and by delaying fibrinolysis with a fibrinolysis inhibitor (aprotinin), a method was developed which after satisfactory results in animals, soon began to be applied in humans.

Das Buch gibt einen breiten Uberblick uber den derzeitigen Stand von Diagnostik und Therapie der Struma maligna aus interdisziplinarer Sicht. Dies macht es fur alle Fachgebiete zu einem aktuellen Nachschlagewerk. Die Kapitel zur Chirurgie bilden den Schwerpunkt: Es werden ausfuhrlich die chirurgischen Strategien, in Abhangigkeit vom Feinnadelpunktat oder vom klinischen Tumorstadium, sowie die aktuellen Resektionstechniken besprochen. Daneben stehen Kapitel zur Epidemiologie, nuklearmedizinischen Diagnostik und Radiotherapie der Erkrankung. Ausserdem werden neueste Techniken in der pathologischen Diagnostik beschrieben: Themen sind hier z.B.: Immunhistochemie, DNA-Messungen, molekularbiologische Techniken. Beitrage zur Diagnostik mit bildgebenden Verfahren sowie Feinnadelpunktionszytologie schliessen die praoperative Abklarung ab. Schliesslich kommen Onkologen, Nuklearmediziner, Radiotherapeuten und onkologisch tatige Chirurgen zu Wort. Wegen seiner interdisziplinaren Anlage kann das Buch als Nachschlagewerk fur Arzte unterschiedlicher Fachrichtungen dienen.

In }bersichtlicher Weise werden der derzeitige Stand der Diagnostik, Differentialdiagnostik, histopathologischen Klassifikation, Prognose bzw. die verschiedensten Therapie- formen des malignen Melanoms aufgezeigt. Offenen Fragen hin- sichtlich der Weite der Tumorexzision und der prophylakti- schen, regionalen Lymphknotendissektion werden diskutiert. Die chirurgische Therapie steht im Mittelpunkt der Behand- lung, wobei jedoch immer eine interdisziplin{re Zusammen- arbeitzwischen Dermatologen, Chirurgen, Onkologen und Ra- diotherapeuten erforderlich ist.