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Re-EngineeringoftheDamagedBrainandSpinalCord isdedicatedtoTetsuoKanno,M. D. ProfessorofNeurosurgery Bypresenting theoriginal papers thatmakeupthis thefeaturesofthelocalmedicallandscapeinthe- third supplement we wish to make a further contri- gionswheretheyareenacted. Whatismore,progr- bution to the issue of functional rehabilitation, this sivenew?ndingsmustbealsosubjectedtoafrequent soimportantandfascinatingmodernareaofresearch revision. Ontopofthis,itshouldnotbeforgottenthat inthe?eldofneurosciences. Thecongresspaperswe even when committal therapy guidelines are c- haveselectedconstituteagoodre?ectionofthetrans- sistentlyapplied,thereareconsiderablevariationsin disciplinary objectives. The literature references are therangeofpotentialcomplicationsandintheo- designedasaguidetoleadtheinterestedreadertoa comeofprospectivecontrolledmulti-centreandmul- deeperandmoredetailedunderstandingoftheindi- nationalstudiesontheissueofqualitymanagement. vidualissues. Functionalrehabilitationhasbeenanoriginaltask The demand for "evidence-based medicine" is well ofneurosurgeryfromtheveryoutset. The1990shave justi?ed; however, it rapidly comes up against the enteredtheannalsofbrainresearchasthe"Decadeof limitsoffeasibility,especiallywherecontrolledthe- theBrain". Sincethentherehasbeenaneverstronger peuticstudiesareconcerned. TheCochrancollection growthofneuroscienti?cinterestworldwide,accom- of high-quality evidence-based healthcare databases paniedbysubstantial?nancialengagement. Thishas hasthusfarbeenofnohelptousindrawingupthe- primarily resulted in advances in basic neuro- peutic recommendations for the re-engineering of biologicalandneurophysiologicalresearchandalsoin brain and spinal-cord lesions. Today as ever, the thegrowthofneuroscienti?cknowledgeaboutbasic opinion of experts and empirically based medical mechanismsformotor control,paincontrol,aware- treatment and posttraumatic neurorehabilitation ness, cognition, learning and memory. The conse- continuetooccupyanindispensablepositionforthe quencemustbetoensurethattheadvancesmadeinthe everydayclinicalpracticeofneurosurgicalandneu- neuroscienti?cresearchareaareadequatelyexpanded traumatological therapies. Promising adjunct - intopracticalneurosurgicalcareandre-engineeringof proachesincludeneuropharmacology,forcascadesof brainandspinalcordlesionsandtoensureuponnew molecular interactions are known to be underlying approaches. Following this a fundamental path will activity-dependent plasticity and skills learning, as resultinanimprovedandmoree%ocientpreventionin many of these processes involve the major tra- thefuture,themeasuresthatstandrightatthefore- mitters. Furthermore,biologicalinterventionsby- front of all rehabilitation principles, meaning that ingendogenousneuronsandgliaaswellasexogenous conventionalconceptsmustbemodi?edtokeeppace stemcells,bone-marrowcells,macrophages,andother withthemoretask-speci?c,intensive,andprogressive types may promote the regeneration of nerve cells, demands. In this connection a series of guidelines, tissue, and neural circuitry. Class one studies have recommendations, and expert opinions and also beenmade,andnowclasstwostudieshavebeeni- algorithms have been elaborated by national and tiated, for example in connection with acute spinal international expert panels and multidisciplinary as- cord injury (SCI). The clinical application of fu- sociationsfortheacutemedicalcareofpatients.

The international interdisciplinary gathering of top of secondary brain damage in brain trauma, as ac- level clinical and laboratory scientists in Mauls, Italy knowledged from the beginning of these workshops in has developed from its beginning in 1984into a fruitful Mauls, the significance of inflammation is all but clear. tradition where worldwide experts active and knowl- Although inflammatory phenomena are seen in trauma edgeable in cerebral ischemia and trauma convene for and ischemia ofthe brain, as activation ofwhite blood update and exchanges of their most recent clinical and cells with emigration into the tissue presumably en- experimental findings and concepts. These meetings hancing damage, inflammatory cells may have benefi- have, of course, experienced shifts in emphasis from cial properties as well. Thechapter on the Janus-faceof the past until now, corresponding to the most actual inflammation isanalyzing this ambiguity. developments, which were fascinating clinicians and The exploration of novel cell-biological mechanisms laboratory scientists alike. The current Supplement of on a molecular or more systemic basis causing apop- Acta Neurochirurgica is an example in case. Its virtue totic cell death, inflammation, or regeneration, provide as before is that authors contribute articles in a review- useful objectives for therapeutical interventions ex- like manner on their own field of research, according pected to be more specific than the present treatment to the platform presentations at the meeting as indis- modalities.

The author describes in his unique style the anatomical variants of the brain and skull. This atlas is a continuation of his last work on "Neuronavigation and Neuroanatomy". Most anatomical reference volumes show a large number of common and rare variations. This atlas concentrates on well known and little known variants which are especially important for the clinicians, in particular the neurosurgeons and the radiologists. The variants have been grouped after areas of trepanation. The author presents also a number of so far unknown variants gathered from his personal theoretical and clinical experience of 50 years. Exact knowledge of anatomical variations which the surgeon may encounter helps to plan operations and to avoid unexpected complications. Variants of no clinical relevance, even rather common ones, have not been included.

In addition to surgery and radiotherapy, local treatment modalities for the management of brain tumours are increasingly being developed and clinically tested. This book describes for the first time basic tumour biology as well as all current procedures in progress at the most recent level of knowledge, presented by leading experts in the respective fields. Image guided resection procedures, fluorescence guided surgery, developments in interstitial radiosurgery are addressed, just as intracavitary chemotherapy and all current concepts and studies of interstitial targeted therapy. Owing to its topicality this book will remain for long the standard for this comprehensively treated subject.

Preoperative and intraoperative echocardiography has become an indispensable tool for guiding mitral valve surgery and has fostered the development of many innovative surgical techniques. Mitral valvuloplasty is now an established surgical method for the treatment of mitral insufficiency but the success is largely dependent on the extent of the underlying disease of the mitral valve. The book by Dr. Ng and coauthors is an extraordinary presentation of the relation between echocardiographic display of mitral valve pathology and reconstructive mitral valve surgery. The atlas provides an excellent illustrative guide to teach echocardiographic-anatomic correlations and educates the reader on the techniques of mitral valve repair. The quality of the illustrations, particularly the surgical photographs is exquisite. The book will be helpful for cardiologists and cardiac surgeons.

Anemia is a frequent complication of cancer and its treatment. A number of clinical studies shows that the impact of anemia is much greater than previously thought. Beyond clinical symptoms, anemia significantly impairs physical and metabolic functions as well as patients' activity, well-being and quality of life. Life expectancy is also affected. In this book, written by a group of outstanding international experts, the current knowledge on anemia in cancer and its treatment with rhEPO is presented and future developments are discussed. Based on a broad spectrum of topics, the book describes the scientific and clinical aspects of anemia in various fields of oncology and gives diagnostic and therapeutic recommendations on when and how to use rhEPO. The book will serve as an authentic and essential source of information for radiotherapists, oncologists, hematologists, internists, pediatricians, surgeons, specialists in transfusion or laboratory medicine and pharmacologists.

Disturbances of iron metabolism, particularly iron deficiency, are among the most commonly overlooked or misinterpreted diseases. This is due to the fact that the determination of transport iron in serum or plasma, which used to be the test in conventional diagnosis, does not allow a representative estimate of the body's total iron reserves. A proper estimate was formerly possible only by the costly and invasive determination of storage iron in the bone marrow, however, sensitive, well-standardized immuno-chemical methods for the precise determination of the iron storage protein ferritin in plasma are now available. Since the secretion of this protein correctly reflects the iron stores in the majority of cases, these methods permit fast and reliable diagnosis, particularly of iron deficiency conditions. The fact that iron deficiency is so common and is usually simple to treat ought to be well known in the medical world. Even non-iron-determined causes of anemia can now be identified rapidly by highly sensitive, well-standardized immuno-chemical methods. This book is intended to contribute to a better understanding of the main pathophysiological foundations and diagnostic principles.

Extravasation of cytotoxic drugs can lead to serious complications during tumour therapy. This volume is intended as an aid to assess the situation quickly and conclusively should this emergency occur. The substance specific section of the book provides detailed instructions for how to deal with 49 cytotoxic agents so that targeted measures can be started at once. The general section provides comprehensive information on prevention, general measures to be taken in case of extravasation, specific antidotes, and documentation. For support during everyday clinical practice, the book is accompanied by a template for an extravasation kit, tables, documentation sheets, and patient information. The book is the outcome of a consensus of an interdisciplinary working group that has collected and systematically reviewed all published literature on the topic. The practical instructions are accompanied by a review of the literature to enable readers to study source materials via the original published studies.

This atlas gives careful step-by-step guidance for endoscopic sinus surgery. In doing so, it provides exciting firsthand accounts of modern advanced endoscopic sinus procedures. In the first part of the book the surgical anatomy of the nose and sinuses and the basic surgical techniques are described. The second part deals with advanced techniques and postoperative care. The detailed, step by step narratives - integrated with many intraoperative photographs - accurately convey both surgical fundamentals and nuances. For each procedure the authors give a piece of advice ("golden rules"), making it ideal for those who want to implement well-coordinated surgical approaches to sinus disease.

In the continuous effort to further improve neurosurgery, intraoperative information on structure and function of the brain has become an important tool which potentially will result in an improved outcome of neurosurgical procedures. In this book experts from different countries and neurosurgical organizations have collected information on the state-of-the-art of intraoperative imaging, MRI, CT and ultrasound. Various contributions cover the future of neuroimaging, the impact of intraoperative imaging on glioma surgery, technical and neurosurgical aspects of the different imaging modalities and systems, and economical aspects. The present book thus provides a unique and comprehensive source of information on the complex of intraoperative imaging in modern neurosurgery.

Arteriovenous malformations (AVM) and arteriovenous fistulas (AVF) differ from all other pathology affecting the central nervous system by their high-flow arteriovenous shunts. Permanent occlusion of these shunts is the essence and the challenge of therapy. Endovascular therapy and radiosurgery became accepted alternatives or adjuncts to surgery. In many instances the choice of the primary therapeutic modality is not clear and arguments can be found for several options. However, microsurgery, endovascular therapy and radiosurgery differ very much with regard to invasiveness, length of stay at the hospital but also residual risk after therapy. The emerging treatment concepts are the object of this book. The result is a unique structured presentation of AVM and AVF therapy.

Against the background of AIDS, wars, migration, and the inadequate provision of health care, a very serious epidemic of tuberculosis is once again occurring worldwide. This profusely illustrated book, written by an author with immense personal experience in the field, documents the wide spectrum of tuberculosis encountered in the various organ systems, and correlates the images with clinical, laboratory, and histopathological findings. The value of the many different methods of imaging (radiography, ultrasound, magnetic resonance imaging, computed tomography, nuclear medicine scans) in the diagnosis, management, and follow-up of tuberculosis is discussed and illustrated. The epidemiology of tuberculosis and its relationship with AIDS are also explored. This unique book will be of great value not only to radiologists but to all who encounter tuberculosis in their clinical practice.

Morbus Dupuytren is particularly widespread among northern Europeans. However, the therapeutic success-rate often leaves much to be desired. A 50 per cent recurrence-rate after surgery indicates that the disease cannot be treated by surgery alone. This book therefore adopts two parallel approaches: emphasis is firstly placed on the systemic character of morbus Dupuytren in context with other connective tissue diseases by a description of the biochemical and molecular-biological changes in the diseased connective tissues; secondly, a diversified picture of the given anatomical facts serves to explain the employment of the various therapeutic approaches. Further, a description is given of the current surgical procedures.