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This book offers a comprehensive overview of the basic physiology of the cardiac and pulmonary systems, tools for cardiopulmonary monitoring, and related issues in the management of specific conditions. The volume is divided into three main parts. The first part examines the functional basis of normal and abnormal physiology, organized into cardiac and pulmonary units and followed by a “combined” interactive component. The next section discusses cardiopulmonary monitoring tools and variables and is also divided into cardiac (e.g, echocardiography, heart rate, cardiac output), pulmonary (e.g, lung volume, pleural pressure, electrical impedance tomography), and combined tools such as radiology/MRI and tissue perfusion tests. The third section concerns the management and application of specific clinical problems such as pulmonary hypertension, cardiac shunts, cardiogenic shock, and ECMO with an emphasis on the physiological basics. Cardiopulmonary Monitoring: Basic Physiology, Tools, and Bedside Management for the Critically Ill is an essential resource for physicians, residents, fellows, medical students, and researchers in cardiology, critical care, emergency medicine, anesthesiology, and radiology.

Covering every problem encountered in today's intensive care unit, this leading critical care textbook presents the knowledge and expertise of more than 350 global experts in this fast-changing field. Beginning with the social aspects of medicine, it then discusses monitoring and organ system pathobiology followed by specific diseases states/syndromes. Each chapter begins with immediate concerns and proceeds to broader-based discussions of relevant pathophysiologic and clinical issues.

Principles and Practice of Clinical Research, Fourth Edition has been thoroughly revised to provide a comprehensive look at both the fundamental principles and expanding practice of clinical research. New to this edition of this highly regarded reference, authors have focused on examples that broadly reflect clinical research on a global scale while including a discussion of international regulations, studies, and implications. In addition to key topics such as bioethics, clinical outcome data, cultural diversity, protocol guidelines, and'omic platforms, this edition contains new chapters devoted to electronic health records and information resources for clinical researchers, as well as the many opportunities associated with big data. Covering a vast number of topics and practical advice for both novice and advanced clinical investigators, this book is a highly relevant and essential resource for all those involved in conducting research. - Features input from experts in the field dedicated to translating scientific research from bench to bedside and back - Provides expanded coverage of global clinical research - Contains hands-on, practical suggestions, illustrations, and examples throughout - Includes new chapters on the international regulation of drugs and biologics, the emergence of the important role of comparative effectiveness research and how to identify clinical risks and manage patient safety in a clinical research setting

Advanced Perioperative Crisis Management is a high-yield, clinically-relevant resource for understanding the epidemiology, pathophysiology, assessment, and management of a wide variety of perioperative emergencies. Three introductory chapters review a critical thinking approach to the unstable or pulseless patient, crisis resource management principles to improve team performance and the importance of cognitive aids in adhering to guidelines during perioperative crises. The remaining sections cover six major areas of patient instability: cardiac, pulmonary, neurologic, metabolic/endocrine, and toxin-related disorders, and shock states, as well as specific emergencies for obstetrical and pediatric patients. Each chapter opens with a clinical case, followed by a discussion of the relevant evidence. Case-based learning discussion questions, which can be used for self-assessment or in the classroom, round out each chapter. Advanced Perioperative Crisis Management is an ideal resource for trainees, clinicians, and nurses who work in the perioperative arena, from the operating room to the postoperative surgical ward.

Frontiers in Myocardia is an eBook series which compiles information about the structure and function of myocardial muscles (the heart muscles) and includes updated reviews on the recent developments in the treatment of associated diseases such as angina, cardiac arrhythmias and myocardial infarction. Advances in research on clinical sepsis in the last few decades have lead to the use of new concepts and treatment paradigms that have been tested and implemented in the clinical setting of Intensive Care Units around the world. An integrative approach towards understanding the pathophysiology of cardiac dysfunction in septic patients can, therefore, lead to better patient outcomes. The first volume of this series, Septic Cardiomyopathy: from bench-to-bedside, integrates new and old information about the molecular mechanisms, histopathological and electrophysiological alterations with novel findings for diagnosing and treating septic cardiomyopathy. This eBook attempts to bridge the gap between basic and clinical scientists and presents new data on different aspects of cardiac physiology during critical illness in a single volume. Chapters in this volume also cover cardiovascular changes that occur as a consequence of sepsis including metabolic, mitochondrial arrhythmic changes. This eBook is of significant value to medical students, cardiac physicians and medical scientists engaged in the field of critical care medicine

Feigin and Cherry's Textbook of Pediatric Infectious Diseases helps you put the very latest knowledge to work for your young patients with unparalleled coverage of everything from epidemiology, public health, and preventive medicine through clinical manifestations, diagnosis, treatment, and much more. Ideal for all physicians, whether in an office or hospital setting, Feigin and Cherry's equips you with trusted answers to your most challenging clinical infectious disease questions.Meet your most difficult clinical challenges in pediatric infectious disease, including today's more aggressive infectious and resistant strains as well as emerging and re-emerging diseases, with unmatched, comprehensive coverage of immunology, epidemiology, public health, preventive medicine, clinical manifestations, diagnosis, treatment, and much more.Find the answers you need quickly thanks to an organization both by organ system and by etiologic microorganism, allowing you to easily approach any topic from either direction.

This book provides a detailed review of state of the art knowledge on critical care topics as well as the latest research findings. It covers the core aspects in excellent detail, but is not so comprehensive as to make its daily use unfeasible. For each condition considered, discussion of the pathophysiology is integrated with observations on diagnosis and treatment in order to allow a deeper understanding. The book is scientifically based, with extensive references to published research. This will allow readers to investigate their individual interests further and will enable physicians to justify measures by providing a coherent, evidence-based strategy and relevant citations where needed. Core Knowledge in Critical Care Medicine will appeal to experienced practitioners as an aide-mémoire, but will also be of great value to a wide range of more junior staff wishing to complement their background knowledge with important facts applicable to everyday practice.

Here's the most clinically oriented critical care text focusing on the adult patient. In full-color and superbly illustrated with clinical photographs, imaging studies, and management algorithms, and with a broad multidisciplinary focus, this text will help you enhance your skills at any level of training.Stands alone as a clinically oriented comprehensive reference. Completely updated and authorship expanded to reflect the evolution in critical care practice. In color for the first time, with new color schematics and treatment algorithms for greater ease of reference. Utilizes key points lists at the end of chapter, to help you make decisions rapidly and easily. Delivers key references that list other useful resources for information.Learn from the best ICU specialists worldwide with contributions from an increased number of international authorities. Effectively manage common complications in the ICU with updated coverage of severe sepsis, septic shock, surgical infections, neurogenic and anaphylactic shock, severe heart failure, acute coronary syndromes, and Acute Respiratory Distress Syndrome. Access the complete contents online at Expert Consult, along with an image bank and instructional videos!

The Yearbook compiles the most recent, widespread developments of experimental and clinical research and practice in one comprehensive reference book. The chapters are written by well recognized experts in their field of intensive care and emergency medicine. It is addressed to everyone involved in internal medicine, anesthesia, surgery, pediattrics, intensive care and emergency medicine. (With approximately 90 contributions.)

The Yearbook compiles the most recent, widespread developments of experimental and clinical research and practice in one comprehensive reference book. The chapters are written by well recognized experts in the field of intensive care and emergency medicine. It is addressed to everyone involved in internal medicine, anesthesia, surgery, pediatrics, intensive care and emergeny medicine.

Die 3. Auflage wird von Prof. Schuster erstmals mit Prof. Werdan als Mitherausgeber verfaßt und lehnt sich an das Konzept der Vorauflagen an. Im 1. Teil werden die klinischen Grundlagen, die Definition, Diagnose, Pathophysiologie und Therapie von Sepsis und Multiorganversagen kurzgefaßt, aber vollständig beschrieben, während im 2.Teil auf die speziellen Therapiemöglichkeiten der Intensivmedizin eingegangen wird. Die speziellen Therapieformen werden detailliert und kritisch beleuchtet dargetellt. Somit richtet sich dieses Buch sowohl an die in der Ausbildung stehenden Intensivmediziner, die einen Überblick über Komplexität der Pathogenese der Sepsis als Ausgangspunkt für die Therapie erhalten als auch an erfahrene Intensivmediziner, die über aktuelle wissenschaftliche Ergebnisse informiert werden.

Literally thousands of papers have been published on nitric oxide over the past ten years. But there is no single monograph available that has previously attempted to summarize the important features of the roles of nitric oxide in inflammation. The voluminous literature regarding the incredible range of chemical and biological effects of nitric oxide and reactive nitrogen oxide species, RNOS, may present a tangle of confusing information to the researcher. This volume brings together experts from nitric oxide and inflammation research and presents a concise up-to-date overview as well as future aspects of this rapidly growing field.

Die vorliegende Habilitationsschrift untersucht die Hypothese, daß die Pumpstörung des Herzens bei Herzinsuffizienz, extrakorporaler Zirkulation und früh nach Herztransplantation eine gemeinsame immunologische Komponente umfaßt. Die direkten Beziehungen zwischen dem Immunsystem und den klassischen Determinanten der kardialen Pumpfunktion, d.h. der Vorlast, Nachlast, Kontraktilität und Herzfrequenz, werden kritisch diskutiert. Sie werden als mögliche gemeinsame biologische Endstrecke verschiedener pathophysiologischer Konstellationen, von der asymptomatischen linksventrikulären Dysfunktion bis hin zum Sepsis-Syndrom und Multi-Organ-Versagen, interpretiert. Die vorliegende Arbeit, die im interdisziplinären Konzept des Herzzentrums Münster entstand, stellt einen originellen fachübergreifenden Denkansatz dar. Dieser ist für Kardiologen, Herzchirurgen, Anästhesiologen und Intensivmediziner gleichermaßen von Bedeutung. Er wird in Zukunft im ärztlichen Alltag zu einem verbesserten Verständnis der kardialen Pumpstörung unterschiedlicher Genese sowie zur Entwicklung von neuen Möglichkeiten der Erkennung und Behandlung beitragen.

GEORGE A. PORTER information is an international commodity whose The field of clinical nephrotoxicity involves toxins of interpretation and application are strongly influenced diverse origin and exposure. A significant contribution by both the cultural and ethnic background of the to this problem arises from registered and non-regis­ observer. The opportunity to share in the rich diversity tered drugs either prescribed or purchased over the of the international scientific community was a fun­ counter. Another major contributor comes from occu­ pational or industrial exposures. Each situation pre­ damental goal of this endeavor. To participate as sents the nephrologist with unique challenges con­ equals leads to mutual respect and peer appreciation. cerning diagnosis, confirrnation, and treatment includ­ The sharing of intellectual resources which such an ing limitation from future exposure. In selecting drugs effort fosters, should facilitate the advancement of for inclusions in this book the editors were guided by sound science. both frequency and current knowledge. For occupa­ Our approach to the field of nephrotoxicity is from tionall environmental exposures similar guidelines the perspective of a book which will be of value to the were applied. As one reviews the world's literature clinician. In this respect we have chosen compounds concerning nephrotoxicity two types of investigation wh ich are of current importance to the nephrologist and his/her patient rather than of historical interest.

This book has a distinguished legacy, having begun as the first major American textbook specifically to address complications of pregnancy. Its first edition (Medical, Surgical and Gynecologic Complications of Pregnancy, 1960) was a bellwether that focused attention on what were then nascent interfaces emerging among medicine, surgery, and obstetrics. The 6th edition concentrates on practical issues of clinical management and addresses both common and uncommon medical and surgical problems encountered during pregnancy. The book s title has varied in its previous editions, but the 6th edition has been renamed Obstetric Medicine. The change reflects the book s content more accurately and acknowledges the evolution of an emerging special interest domain. Increasingly, physicians are caring for pregnant women with acute and chronic medical conditions that require complex assessment and sophisticated care. We have tried to provide a text to help the practitioner clarify and organize some of the intricacies of such cases. The editors are an obstetrician with a longstanding interest in the management of surgical and medical complications of pregnancy and an internist-nephrologist with extensive experience in the management of medical diseases during gestation. They have assembled a group of contributors with an exceptionally broad range of backgrounds and interests, who in turn have emphasized clinical management approaches that are grounded in our understanding of pathophysiology and are functional in their attention to practical detail. KEY FEATURES New chapters addressing management of trauma, burns, liver disease, and obesity in the pregnant patient. Comprehensive coverage of common as well as uncommon conditions encountered during pregnancy. Use of logic trees and inclusion of a brief list of clinical pearls at the end of each chapter.

The third edition of this innovative work again provides a unique perspective on the clinical discovery process by providing input from experts within the NIH on the principles and practice of clinical research. Molecular medicine, genomics, and proteomics have opened vast opportunities for translation of basic science observations to the bedside through clinical research. As an introductory reference it gives clinical investigators in all fields an awareness of the tools required to ensure research protocols are well designed and comply with the rigorous regulatory requirements necessary to maximize the safety of research subjects. Complete with sections on the history of clinical research and ethics, copious figures and charts, and sample documents it serves as an excellent companion text for any course on clinical research and as a must-have reference for seasoned researchers. - Incorporates new chapters on Managing Conflicts of Interest in Human Subjects Research, Clinical Research from the Patient's Perspective, The Clinical Researcher and the Media, Data Management in Clinical Research, Evaluation of a Protocol Budget, Clinical Research from the Industry Perspective, and Genetics in Clinical Research - Addresses the vast opportunities for translation of basic science observations to the bedside through clinical research - Delves into data management and addresses how to collect data and use it for discovery - Contains valuable, up-to-date information on how to obtain funding from the federal government

Over recent years, much renal research has focused on the pathology of the glomerulus, where many primary renal insults occur. However, nearly thirty years have passed since Risdon's study made the apparently anomalous observation that the extent of damage to the tubulointerstitial compartment is the major determinant of renal outcome in a variety of human glomerular diseases. This volume covers various aspects of tubulointerstitial disease, and starts with an update on cystic disease of the kidney, by Drs. WILSON and FALKENSTEIN, which includes recent experimental data on the altered properties of cystic epithelium. My own chapter gives an overview of the mechanisms of tubulo­ interstitial damage in progressive renal disease and includes a dis­ cussion of the possible role of cytokines, vasoactive peptides and peptide growth factors found over the last few years to be secreted by renal tubular cells. These comments are expanded in the contribution by Dr. WOLF and Professor NEILSON, who provide a detailed account of the cellular biology of tubulointerstitial growth. The earliest studies from the 19608 attempted to correlate histo­ morphometry of the tubulointerstitium with renal outcome. Dr. KHAN and Professor SINNIAH provide us with an update on mor­ phometric methods as applied to the kidney using new techniques. Similar techniques are employed by Dr. IVANYI and Professor OLSEN who give a detailed stereomorphological account of tubulitis both in acute allograft rejection, where its- recognition is central to the diagnosis, and in other forms of tubulointerstitial disease.

This book presents the latest findings in the field of investigation of molecular mechanisms of mechanical stretch and the role of cytokines in response of different tissues to it. On the one hand this Volume demonstrates how mechanical stretch enhances cytokines production. It describes how cytokines influence tissues and cells on a background of a mechanical stretching. It provides a description of how cells in different tissues are activated by stretch and cytokines via various signaling pathways, and how they change their gene expression. The book is a unique collection of reviews outlining current knowledge and future developments in this rapidly growing field. Knowledge of biomechanics, and mechanisms which underlie it on molecular, cellular and tissue, is necessary for understanding of the normal functioning of living organisms and allows to predict changes, which arise due to alterations of their environment.

The Yearbook compiles the most recent, widespread developments of experimental and clinical research and practice in one comprehensive reference book. The chapters are written by well recognized experts in their field of intensive care and emergency medicine. It is addressed to everyone involved in internal medicine, anesthesia, surgery, pediattrics, intensive care and emergency medicine. (With approximately 90 contributions.)

Animal cell technology is a discipline of growing importance, which aims not merely at understanding structure, function and behaviour of differentiated animal cells, but especially at the development of their abilities useful for clinical application. Topics of interest in this regard include: viral vaccines, pharmaceutical proteins and novel applications such as gene therapy and organ culture. Undoubtedly, these Proceedings of the joint Meeting of the European Society for Animal Cell Technology and the Japanese Association for Animal Cell Technology (Veldhoven, The Netherlands, September 1994) review the most recent status of the field, and will be most valuable to anyone actively involved in the culture of animal cells and its applications. The contributions to this volume were strictly selected on the basis of quality and novelty of contents. Kluwer is honoured to be able to add this work to its strongly developing publication programme in cell and tissue culture, which now has its connections to all major Societies in this field worldwide. Audience: Cell biologists, biochemists, molecular biologists, immunologists, virologists and all other disciplines related to animal cell technology, working in an academic environment, as well as in (biotechnology or pharmaceutical) industry.

Heat shock proteins (HSP) were originally described in heat-shocked drosophila by Ritossa in the early 1960's. In the last 5 years it has become apparent that these heat shock proteins have important functions both in the normal cell and in the stressed cell. These proteins constitute an endogenous protective system; mutations in the heat shock proteins can be lethal, and there are no known organisms without heat shock proteins. The first observations on heat shock proteins and the heart were made in the 1980's and interest in these proteins increased over the decade. In the last few years there has been an exponential growth in number of papers published on heat shock proteins and the heart. Heat shock proteins have been implicated in a number of cardiovascular research areas including ischemia, hypertrophy, aging, and atherosclerosis, and this list is growmg. The purpose of this volume is to give an overview of our current understanding of the heat shock proteins in the cardiovascular system, and to summarize the approaches to the study of heat shock proteins in the heart. This volume assembles results from a number of different cardiovascular fields. and provides a comprehensive review of heat shock proteins in the cardiovascular system.

An involvement of the immune system is suspected in various cardiovascular diseases. Recent advances in the fields of molecular biology, genetics, cell biology, and immunology have made it possible to identify several pathomechanisms. However, still more questions arise with regard to the pathophysiology, diagnosis, and treatment of immunologically mediated cardiovascular diseases. In this book, leading scientists and clinicians from different areas of cardiology present the state-of-the-art knowledge on the involve­ ment of the immune system in myocardial and vascular diseases. In the field of myocarditis, both the virological and the immunological findings are presented, and the interactions between the virus and the immune system are discussed. Since the cellular immune system and its mediators play an important role in the inflammation by bacteria that cause endocarditis and septic shock, studies investigating the underlying pathomechanisms are de­ scribed. Another major topic in this volume is the involvement of the immune system in arteriosclerosis and coronary heart disease, which represents an important problem in clinical cardiology. The final chapter addresses the question of therapeutic options, presenting new approaches for a specific and effective therapy based on the current knowledge of immunologically mediated cardiovascular diseases.

The Yearbook compiles the most recent, widespread developments of experimental and clinical research and practice in one comprehensive reference book. It is addressed to everyone involved in internal medicine, anesthesia, surgery, pediatrics, intensive care and emergency medicine.

The relationship between angiotensin II and hypertension was established in 1898 when angiotensin II was shown to modulate systemic blood pressure. Over the intervening decades, a complete characterization of the renin-angiotensin system (RAS) has been achieved, and our understanding of its biochemistry and physiology has led to the directed development of agents such ·as ACE inhibitors and receptor antagonists capable of controlling hypertension. More recently, it was shown that angiotensin II is secreted within certain tissues and that these tissue-specific systems operate independently of the systemic RAS. The novel concept that angiotensin II regulates a number of cardiovascular processes that are unrelated to blood pressure has renewed the interest of both basic and clinical scientists in angiotensin II. The association between angiotensin II and cardiac growth, in particular, has indicated that therapies currently in use for hypertension may have direct application to the treatment of heart failure. The Manitoba Cardiovascular Forum on Angiotensin Receptor Blockade in Winnipeg was convened October 18-20, 1996 to examine the clinical and basic aspects of angiotensin receptor biology as they apply to hypertension and heart failure. In addition, the potential treatment of these conditions using specific angio­ tensin receptor antagonists was addressed within the context of their immediate therapeutic application and future potential.

Pathophysiology of Heart Failure brings together leading basic scientists and clinicians, presenting new approaches to this complex problem, involving cardiomyopathic processes and ischemia perfusion injury. The result is a synthesis of state-of-the-art information on molecular biology, cellular physiology and structure-function relationships in the cardiovascular system. The role which excess intracellular calcium plays in the genesis of cardiac dysfunction is described as a fundamental mechanism underlying heart failure; one which may lead to improved prevention and treatment. Audience: Clinical and experimental cardiologists will find the book a helpful source of ideas and inspiration.

Disturbances in peripheral O extraction can be produced in dogs treated with 2 endotoxin and thereby provide an opportunity to test theories for the origin of pathological O supply dependency or to try different treatment modalities. The 2 most serious deficiency in the current animal models is the inability to mimic the increased O demand that is observed in patients at 02 delivery rates in excess of 2 normal. A particular feature of this increased O demand is that it apparently does 2 not stimulate increased 02 extraction, although the limitation in O extraction has 2 not been explored in patients by lowering 02 supply, for obvious reasons. At least two possibilities to account for increased 02 demand could be investigated in animal models, however. The amount of 02 that is utilized in extramitochondrial pathways, which is normally on the order of 10%, may be greatly increased in ARDS and sepsis by O radical formation. There is presently no information 2 concerning how much 02 might be used in this way. Another strong possibility is that mitochondrial injury, perhaps as a result of 02 radical formation, uncouples oxidative phosphorylation. Some evidence presently in the literature supports this idea [19]. Indeed, the association of increased blood lactate levels with higher than expected 02 demands makes uncoupling a very attractive hypothesis that warrants further investigation in animal models using such agents as 2,4-dinitrophenol. References 1.

This book presents a comprehensive survey in which internationally recognized experts discuss specific topics. The wide spectrum of experimental and clinical investigations include the pathophysiologic, diagnostic and therapeutic aspects. Update 1990 represents the series'continuous effort to combine the most recent developments in one reference source for all those involved in cardiology, internal medicine, pediatrics, anesthesia, intensive care and emergency medicine.

This book presents a comprehensive survey in which internationally recognized experts discuss specific topics. The wide spectrum of experimental and clinical investigations include the pathophysiologic, diagnostic and therapeutic aspects. Update 1989 represents the series'continuous effort to combine the most recent developments in one reference source for all those involved in cardiology, internal medicine, pediatrics, anesthesia, intensive care and emergency medicine.

Nitric Oxide (NO) is a free radical, a gas, and a pluripotent product of mammalian cells. Only a few years ago, scientific discussions of NO were largely held in the context of the chemistry of air pollution. Now, however, the great significance of NO as a signalling and cytotoxic molecule has captured the attention of the biomedical community. This book provides a very up-to-date review of the role of NO in sepsis and ARDS. Consideration is given to NO both as a pathophysiologic mediator as well as a therapeutic agent. An internationally recognized group of scientists and clinicians have contributed chapters dealing with cutting-edge science and practical clinical strategies. Numerous tables and charts have been included to aid the reader in understanding this fascinating and important subject.

“Frontiers in Cardiovascular Drug Discovery” is an eBook series devoted to publishing the latest and the most important advances in Cardiovascular drug design and discovery. Eminent scientists write contributions on all areas of rational drug design and drug discovery including medicinal chemistry, in-silico drug design, combinatorial chemistry, high-throughput screening, drug targets, recent important patents, and structure-activity relationships. The eBook series should prove to be of interest to all pharmaceutical scientists involved in research in cardiovascular drug design and discovery. Each volume is devoted to the major advances in cardiovascular drug design and discovery. The eBook series is essential reading to all scientists involved in drug design and discovery who wish to keep abreast of rapid and important developments in the field.

Oxidative stress and inflammation are among the most important factors of disease. Chronic infections, obesity, alcohol and tobacco usage, radiation, environmental pollutants, and high-calorie diets have been recognized as major risk factors for a variety of chronic diseases from cancer to metabolic diseases. All these risk factors are linked to ch

Sepsis is a syndrome or sometimes it is a clinical condition evoked by uncontrolled endotoxin-reactions. These pathophysiological alterations can disturb the organism's homeostasis leading ultimately to a condition of severe organ dysfunction which in itself means a bad prognosis for patient survival. In the last decades researchers and clinicians have been involved in process directed to a better understanding of the basic mechanisms of sepsis and MODS. The best goal will be the achievement of preventive measures and optimization of management in patients suffering severe infections and critical conditions. This objective represents a true challenge at the dawn of the XXI century.

The management of critically ill patients has,in the past few years, been a discipline at the forefront of development which continues to make progress with the support of basic and clinical research in the broadest sense. The application of biotechnology in this particular area has revealed itself to be essential in an attempt to provide the best interpretation of the bio-humoral and functional alterations present in a long series of often complex clinical conditions. The care of the critically ill is also at the forefront in the application of increasingly sophisticated clinical monitoring systems that also contribute to standardizing certain procedures, establish guidelines, and evaluate the efficacy of therapeutic interventions and their costs.

There can be little doubt that, to use the parlance of the advertising world, the elasmobranch fishes have a'high profile image'in today's world. To most mem­ bers of the general public they are seen as terrors of the deep, perfect aquatic predators, and the stars (or more acurately, the villains) of major Hollywood movie films and innumerable television nature programmes. Such an image belies the fact that the vast majority of elasmobranch species feed on invertebrates and that, for man, the threat from shark attack is infinitesimal compared with even being struck by lightning! Similarly, there can be few biologists who have not carried out the classic vertebrate dissection of the dogfish at some stage early in the formative years of their scientific education. Yet elasmobranch species make up only a small proportion, perhaps little more than I%, of all vertebrates, and there are probably nearly 50 times as many teleost species as there are elasmobranchs. It is also curious that, as subjects for modern research, elasmobranchs seem to be chosen sometimes for their unique physiological characteristics and at other times because they represent excellent model systems for the study of some general process. Equally, it is for both these, seemingly contradictory, reasons that this book was proposed.

This book presents a comprehensive survey of acute heart failure. A series of experts recognized worldwide discuss specific topics so that, together, a wide spectrum of experimental and clinical investigations are covered. Pathophysiologic, diagnostic and therapeutic aspects are included. The present volume will help clinicians deal with the important problem of acute heart failure. It will help provide an up-to-date reference for those involved in cardiology, internal medicine, pediatrics, anesthesia, intensive care and emergency medicine.

This special issue of Molecular and Cellular Biochemistry contains original research papers as well as invited reviews dedi­ cated, on the occasion of the 40th anniversary of the inauguration of the Heart Research Group in Berlin-Buch that today forms a part there of the Max Delbriick Center for Molecular Medicine, to Professor Albert Wollenberger, founder of the Heart Research Group and for 21 years its head. The papers in this issue are written by researchers working in the field of cardiovascular research who together with Albert Wollenberger share the belief that an integrative application of advances in molecular and cellular biology will lead to new concepts for treatment and prevention of cardiovascular diseases. We hope that this special will serve as a good source of information in this regard. We wish to thank all of the contributors for their help and cooperation. We also wish to thank Mrs. Verona Kuhle for her secretarial help. We are grateful to Dr. Naranjan S. Dhalla, Editor-in-Chief of Molecular and Cellular Biochemistry for his interest and encouragement, and for agreeing to publish this issue in honor of Albert Wollenberger. ROLAND VETTER and ERNST -GEORG KRAUSE Max Delbriick Center for Molecular Medicine, Robert-Rossle-StraBe 10, 13122 Berlin-Buch, Germany PART I CARDIAC DEVELOPMENT AND REGULATION Molecular and Cellular Biochemistry 163/164: 5-11, 1996. © 1996 Kluwer Academic Publishers.

This book brings together basic scientists or clinicians from a variety of different backgrounds - immunology, infectious diseases or critical care - who share a common interest in understanding the changes that occur in immune responses in sepsis. It provides an up-to-date and unrivalled synthesis of current research in this rapidly developing field.

In this book current knowledge of the pathophysiology of shock, sepsis and multi organ failure is presented. The rapid progress which has been made and the results achieved in intensive care medicine are based on sound basic research, which is duly reflected in these chapters. Multiorgan failure is the foremost cause of postoperative and posttraumatic death and many complex mechanisms are involved. Only with a good foundation of basic research can abnormalities in the physiological, biochemical, and morphological course of shock be recognized and the necessary conclusions for treatment drawn. Therapy must proceed from profound knowledge of the multi variant physiological events in order to influence shock, sepsis and organ failure. Although numerous possibilities for therapy have arisen from pharmaceutical research in recent years, they are beyond the scope of this book and are not discussed here. To gain a better understanding of the pathophysiological events it was necessary to examine and to describe different models that simulate and reproduce these events. Here we describe the causative agents (shock) and the consequences (sepsis, organ failure) in two main sections, divided on the basis of their pathophysiology.

This volume contains contributions by well-known scientists and clinicians in the fields of microbiology, infectious diseases, physiology, internal medicine, surgery, anaesthesiology, and intensive care medicine. It provides an up-to-date overview of the mediators and pathophysology of sepsis and septic shock as well as the latest therapeutic approaches.

Leading international experts contribute to this selection of reviews covering the merging fields of growth factors, differentiation factors, and cytokines. These appear to play fundamental roles in a wide variety of physiological and pathophysiological processes that include the regulation of growth in normal and malignant cells, embryogenesis, the immune response, wound healing, inflammation, and atherogenesis. The major aspects of recent research and development are discussed, providing an important update in this pioneering field.

Although clinicians have recognized the importance of inflammatory mediators in the pathogenesis of heart disease for well over 200 years, it has taken nearly as many years for clinicians and scientists to focus on the basic biological mechanisms by which inflammatory mediators contribute to the pathogenesis of cardiac disease states. Over the past decade there has been increasing interest in the potential role that inflammatory mediators, play in a variety of cardiac disease states, including chronic heart failure. The Role of Inflammatory Mediators in the Failing Heart provides a state-of-the-art review on inflammatory mediators and the failing heart. This book will serve both as a useful introduction to the field, as well as an update for those interested in the role of inflammatory mediators and the failing heart.

Severe sepsis and septic shock are the most serious compli­ cations of bacterial infections. Both gram-positive and gram­ negative bacteria can trigger these extreme inflammatory re­ sponses and, by so doing, cause substantial morbidity and mortality. In the United States alone, over 400 000 patients suffer from septicaemia each year, and approximately 100 000 of these patients die despite optimal intensive care and modern antimicrobial therapy. These dramatic figures have prompted intensive research to define the bacterial and host factors involved in the septic response. Scientists from many disciplines, including chem­ istry, physics, biology, medical microbiology, immunology, and pharmacology, have worked closely with clinicians to achieve rapid and profound progress. To translate this newly acquired knowledge into clinical practice, clinical trials have also been performed to evaluate numerous new therapeutic drugs. The disappointing results from these trials have underscored a major lesson, namely, that sepsis constitutes an extremely complex syndrome and that basic and clinical research must be greatly intensified in order to illuminate its molecular mechan­ isms. At this stage, the editors of the present volume of Current Topics in Microbiology and Immunology considered it would be rewarding to compile a volume summarizing our present basic and clinical knowledge on sepsis. Our particular gratitude extends to those international experts who have followed our invitation and elaborated on particular areas of the basic and clinical aspects of this field.

Several aspects of clinical medicine are poised on the edge of a new era with the introduction of therapeutic antibodies. This revolution has been made possible by major advances in immune technology, which are now beginning to mature into clinical practice. This volume is aimed at all clinicians involved with this form of treatment, especially accident and emergency physicians, clinical immunologists, and pharmacologists. It covers both the basic technology, and also all the main clinical areas of application: septic shock, auto-immune disease, and cancer. The future of therapeutic antibodies is also discussed, including exciting new developments in'catalytic antibodies'. This is the first occasion on which all these topics have been brought together in a single volume, thus making it an important reference source for physicians and researchers in this fast-moving area.

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.