It gives me great pleasure to have this opportunity to write a Foreword for this new book. In the past two decades we have witnessed very significant advances in the management of the very ill patient. The great success in this field of medical endeavour is largely due to the establishment of intensive care units, but a great deal of progress can also be attributed to the major developments in technology, which affect patient management and care as well as the many sophisticated techniques of diagnosis and patient monitoring. Imaging and Labelling Techniques in the Critically III covers this new important and difficult field of diagnosis and visual monitoring. By establishing the criteria and algorhythms for the choice of the different methods available for this purpose, defining the diagnostic signs on images and resolving some of the mis conceptions and pitfalls, this book will go a long way to help the reader, particularly those involved in the care of patients in the intensive care units. This book brings together many different methods of investigation and discusses the advantages and limitations of these techniques in different clinical circumstances. Some of the techniques are well established and their usefulness in the intensive care unit is in no doubt. Some of the newer techniques such as PET scanning or NMR imaging have not yet found a defined position of usage in the critically ill patient. There is, however, little doubt that in due course this situation will change.

The interrelated syndromes of shock and the adult respiratory distress to attract the attention of both clinical and syndrome (ARDS) continue laboratory scientists. This reflects both the size of the problem and its unresponsiveness to current lines of treatment. Doubtless, a greater appreciation of the underlying pathophysiological disturbances during the past two decades has led to appropriate action and increased survival in the early stages but once established these syndromes have remained remarkably immune to a wide spectrum of therapeutic modalities. This observation stresses the importance of prevention but also indicates the need for continued research into the nature of the established syndromes and the means whereby they may be reversed. Drs Kox and Bihari are to be congratulated on bringing together within the covers of this volume many of the acknowledged European experts in these two fields of investigation. Each author has provided an up-to-date account of his current experimental and clinical research, and their com bined contributions makes fascinating reading. Undoubtedly, these are exciting times in the development of understanding of shock and ARDS. Inevitably, more questions are raised than answers provided, but the accumulated knowledge presented here adds significantly to our under standing of this complex biological jigsaw. From this corporate endeavour will come the clinically useful developments of the future and with them the ultimate hope that the term 'refractory' shock may be finally removed from our vocabulary.