Charles M. Peterson - Böcker

The breadth of research efforts represented by the many excellent papers in these proceedings is an eloquent testimonial to the idea of one man­ Dr. Josiah Brown-to whose memory this volume is dedicated. His tragic and unexpected loss in a swimming accident in August 1985 brought to an abrupt close a long and distinguished career as a physician and scientist. The possibility of using fetal pancreas tissue for transplantation into insulin-deficient diabetic recipients had intrigued Dr. Brown for several years prior to 1972, when he began in earnest to assemble a research team to explore this idea in detail. He felt that improvements in the formulation and administration of insulin (even the later recombinant human insulin) had taken us about as far as we could go in treating diabetes, and that methods for achieving complete cures must be explored. Numerous advantages of the fetal pancreas quickly became apparent, and were explored scientifically by Dr. Brown and his group. Transplanted pancreas tissue from a fetal donor of the appropriate developmental stage engrafts quickly, and can reverse diabetes very efficiently (1-3). By shunting the venous'drainage of the graft into the hepatic portal vein, a single pancreatic rudiment can, in time, provide enough insulin to restore normoglycemia and urine volume in a diabetic adult recipient (4). As with fetal pancreas rudiments in culture, transplanted fetal pancreas tissue loses its exocrine character, while continuing to develop and maintain endocrine function.

Diabetic nephropathy is a tragic illness. Its often insidious onset in the insulin­ dependent (type I) diabetic, typically a young adult, heralds the last act in the course of a disease that will increasingly become the dominant preoccupation in the patient's shortened life. For most type II diabetics, the beginning of clinical renal insufficiency is but a phase in a continuous deterioration that affects the integrity ofjob, marriage, and family. The nephropathic diabetic is hypertensive, has worsening retinopathy, and more often than not, is also plagued by peripheral vascular insufficiency, heart disease, gastrointestinal malfunction, and deepening depression. Until the 1980's, few type I diabetics who became uremic (because ofdiabetic nephropathy) lived for more than two years. Hardly any attained true rehabilitation. This dismal prognosis is changing substantially for the better. Research in diabetes has resulted in striking advances at both ends of the type I diabetic's natural history. In one exciting clinical trial now underway in London, Ontario, halfofchildhood diabetics treated with cyclosporine within six weeks of onset evince"permanent" disappearanceofhyperglycemia and the need for insulin. At the otherendofthe natural historyofdiabetes for the nephropathic patientwith worsening eye disease (renal-retinal syndrome), who receives a kidney transplant, patient and graft survival, two years after cadaveric kidney transplantation in type I diabetics is now equal to that of the nondiabetic.

This ground-breaking title begins with an introductory overview of the Lower Extremity Gait Systems (LEGS) project, identifying concerns and observations as context for the reader to consider topics and challenges detailed in later chapters.  Next are chapters that explore relevant military and civilian needs, and an essential historical context of the capabilities and limitations of contemporary prosthetics.  The section concludes with an overview of essential components used in passive and active lower limb prosthetics, including sockets, foot, ankle, and knee systems, as well as emerging bionic systems.  A second section considers research and development in orthotics, synthetic and biological materials, volitional control, and wearable robotics (also known as exoskeletons).  Finally, expert authors explore advanced science and emerging medical perspectives in research related to limb salvage, osseointegration, limb transplantation, and tissue engineering.  Designed for medical practitioners, engineers, students, and researchers who use or develop prosthetic technology for civilian or military amputees, Full Stride: Advancing the State of the Art in Lower Extremity Gait Systems will be of great interest to trauma specialists, orthopedists, rehabilitation specialists, nursing staff and physical therapists, as well as researchers and scientists who specialize in fields that shape and inform advanced prosthetic device development such as materials sciences, engineering (electrical, mechanical, biomedical), robotics, and human physiology.