Developments in Surgery – serie

2. Stone extraction via the T-tube 89 3. Endoscopic method 89 4. Preparation for stone extraction 90 5. Technique 90 6. Results 91 7. Complications 91 8. Discussion 91 Index of Subjects 99 CHAPTER 1 INTRODUCTION This book was conceived as a descriptive atlas of most reliable indication for common bile duct ex­ routine biliary surgery i. e. , cholecystectomy and ploration. The cholangioscope allows a visual ex­ exploration of the common bile duct. For the pro­ ploration of the biliary tree and permits the re­ ject the two authors worked together for one week moval of common bile duct calculi and other as biopsy under direct visual con­ at Ninewells Hospital and Medical School, Dundee procedures such on a series of patients with biliary tract disease trol. Both procedures have been described in detail especially selected for the exercise. With the con­ with emphasis on the practical aspects of their use. sent of the Tayside Health Board and the patients The era of blind bilary surgery is over and the concerned, all the operations and peri-operative sooner this message is received by all concerned, procedures were filmed by the photographic mem­ the better the outcome of biliary surgical practice bers of the team, Mr. and Mrs. Paz-Partlow. Ad­ overall. ditional case material has been obtained from It has not been our intention to produce a com­ Cedars Sinai Medical Center, Los Angeles.

Diagnostic and therapeutic methods and controversies in the management of renovascular hypertension have undergone major ch- ges during the past few years. This book is based on the proceedings of a successful postgraduate Boerhaave Course held in 1982 at the Faculty of Medicine of the University of Leiden, The Netherlands. Current concepts concerning the diagnosis and treatment of reno­ vascular hypertension were presented during this course to an audience composed of physicians, nephrologists, cardiologists, surgeons, uro­ logists, and radiologists. Thus, this book aims at offering an overview of tho,se aspects of renovascular hypertension which are relevant to clinical pr- tice. An effort is made to review the currently available moda­ lities of diagnostic procedures, both on the basis of modern in­ sights in the pathology and pathophysiology of renovascular hyper­ tension, as well as timely r'esul ts of clinical research. In ad­ dition, several chapters deal with combinations of these di- nostic procedures in a fashion that can be of practical help in clin;cal decision making. The medical, surgical and angioplastic modalities of treatment are reviewed. Basic considerations concerning medical treatment and technical aspects of surgical as well as per­ cutaneous angioplasty are presented in detail, both separately and in combination. Special attention is given to the problem of renal artery stenosjs in k~dney transplants. This book offers up to date information on clinical aspects of renovascular hypertension, useful to a wide range of clinicians in a variety of disciplines.

After the Second World War the number of biliary diseases has abruptly risen and lithiasis has become in many regions the most frequent surgical disease of the abdomen. At present, though there are perspectives of rational conservative treat­ ment and though endoscopic techniques permit removing some of its complications even without laparotomy, the basic treatment method still remains, and probably shall remain for long the classical surgical intervention. On the contrary, the indications for such intervention are always widening, as its risks become always smaller and the requirements for prevention higher. Many books have been written on the surgery of biliary ducts, but recent knowledge is growing so rapidly that it forces within short periods its new integration and critical assessment. Attention is mostly paid to interventions on the biliary ducts with their wide scope of problems and to the prevention and treatment of postoperative disturbances. New and more perfect diagnostic possibilities and some more suitable technical procedures as well require comparison and verification, introduce new aspects on old problems, and even change some established rules.

The "shoulder-hand syndrome" or pain in the shoulder or arm is an extremely vital subject for the multi-disciplinary approach and usually re­ quires more than one speciality for complete evaluation. The proceedings of this symposium - organized by the department of general surgery of the University of Limburg - cover the field thoroughly with contributions from outstanding specialists from all over the world. Rheumatological, neuro­ surgical, orthopedic, and traumatological aspects are covered. Vascular surgeons considering both venous and arterial problems entwine with thoracic surgeons to review the thoracic outlet problem. Establishing a diagnosis in this multi-disciplinary field is extremely important and encom­ passes a combination of disciplines including neurology, orthopedics, sur­ gery, and physical medicine. Likewise, the role of each contributing factor must be assessed when multiple sources were responsible for pain. In addition to adequate diagnosis, it is important to institute the appropriate therapy and to establish the proper priority and timing of such therapies. The follow-up techniques particularly regarding thoracic outlet syndrome are extremely important to provide an objective basis for evaluation. Although many advances have been made in the field of objective diagnosis and therapy, there still is a great deal of overlap and confusion which has to be clarified. Professor Greep and his organizing committee have done a wonderful job in composing a program covering all aspects of this field. They are to be congratulated on bringing us a "timely current status" report on pain in the shoulder and arm.

This volume is based on a very successful meeting on organ transplantation that was held in Kuwait in 1990 under the auspices of the Middle East Society for Organ Transplantation. An international group of organ transplant experts attended this conference and their contributions and deliberations have been recent1y updated to produce this definitive and authoritative summary of current clinic al practice in organ transplantation. The initial chapters appropriately focus on the immunology of organ trans­ plantation with special emphasis on the initial events in the induction of alloreactivity, the mechanisms of rejection, and the potential for tolerance induction. A strong emphasis is placed on the diagnosis of rejection by cellular analysis. The section on immunosuppression deals with several new areas of clinical therapy. The section on renal transplantation is unique in several respects, the long-term results from various countries, including the Middle East, are summarized, the use of living unrelated donors and of ABO incom­ patible donors - all strategies to maximize organ availability - are presented.

This book is a unique work devoted to the subject of disordered defaecation. It contains chapters written by experts in the field of ano-rectal physiology and management of disordered defaecation. The various contributions present personal views and special clinical experience of individuals. There are some personal views which we felt should be commented upon and a few areas where the experience of others has been included into the text. For the sake of completeness of each chapter, a slight overlap in some cases was inevitable. We hope the book will serve as a useful collection of opinions on a subject which until recently has been largely ignored by the medical profession. The editors Major contributors H. O. ten Cate Hoedemaker Department of Surgery, University Hospital, Rijnsburgerweg 10,2333 AA Leiden, The Netherlands G. Coremans Department ofInternal Medicine, University Hospital Gasthuisberg, Here- straat 49, 3000 Leuven, Belgium S. Fasth Department of Surgery II, Sahlgrenska Hospital, S-413 45 G6teborg, Swe- den H. G. Gooszen Department of Surgery, University Hospital, Rijnsburgerweg 10, 2333 AA Leiden, The Netherlands J. A.Gruwez Department of General Surgery, University Hospitals KU, Brusselsestraat 63,3000 Leuven, Belgium M. M. Henry Department of Gastroenterology, Central Middlesex Hospital, Acton Lane, London NWlO 7NS, United Kingdom M. R. B. Keighley Department of Surgery, The General Hospital, Steelhouse Lane, Bir- mingham B4 6NH, United Kingdom J. H. C. Kuypers Department of Surgery, University Hospital St. Radboud, Geert Groote- plein Zuid 14,6500 HB Nijmegen, The Netherlands Ph. B.

This book reflects a broad spectrum of current opinions and progress in the surgical management of liver, pancreatic and biliary disease. The enormous advances in diagnostic imaging techniques and in interven­ tional, radiological and biliary approaches, the pathophysiological problems and their management manifest often as complications in the post-operative period, new techniques and the results of surgical approaches are all thorough­ ly documented. Historical background is commented upon by Dr. Kenneth Warren of Boston in the first chapter. Subsequent chapters deal with a variety of subjects but always emphasizing differences of opinion and approach and maintaining the discussive environment so typical to the present-day approach to the topic. Professor Bengmark's efforts to introduce a forum for wide discussion for diseases of the liver, pancreas and biliary tract and many recent advances in research and technology to aspects of the clinical management and outcome of patients is well rewarded in this balanced publication. Advances in this field of surgery have been and continue to be so rapid that such documentation is not only necessary but very welcome.

Urinary incontinence is becoming an increasingly dominant condition in daily urological and gynaecological practice, although the total number of patients suffering from the different forms ofincontinence remains unclear. An estimated figure for The Netherlands, with a population of 14 500000, has been given as between 500000 and 600000 patients, showing that approximately 4 % of the total population suffer from this condition, the majority being female. The impact ofthis number is tremendous, not only regarding health care costs, but even more with regard to the psycho-social consequences. It is obvious that continuing efforts must be made to under­ stand more fully the different forms of urinary incontinence. An exact diagnosis is the first step necessary for adequate therapy. We all know how disastrous it can be to institute inappropriate treatment as a consequence of misunderstanding the proper aetiology in each individual case. What has happened in the past 15 years? During that time we have developed sophisticated machinery to diagnose in more detail the exact ori­ gin of each type of urinary incontinence, and on entering a urodynamic laboratory, one is struck by the complexity of measuring equipment. But how reliable are all these measurements and how can they be translated into an effective therapy? This still remains one ofthe major problems, although continuing progress has been made and will be made by the research work of many experts in the field of urinary incontinence.