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Buch. Zustand: Neu. Neuware - Medicine, morals and money have, for centuries, lived in uneasy cohabitation. Dwelling in the social institution of care of the sick, each needs the other, yet each is embarrassed to admit the other's presence. Morality, in particular, suffers embarrassment, for it is often required to explain how money and medicine are not inimical. Throughout the history of Western medicine, morality's explanations have been con sistently ambiguous. Pla.o held that the physician must cultivate the art of getting paid as well as the art of healing, for even if the goal of medicine is healing and not making money, the self-interest of the craftsman is satisfied thereby [4]. Centuries later, a medieval medical moralist, Henri de Mandeville, said: 'The chief object of the patient . is to get cured . the object of the surgeon, on the other hand, is to obtain his money . ([5], p. 16). This incompatibility, while general, is not universal. Throughout history, medical practitioners have resolved the problem - either in conscience or to their satisfaction. Some physicians have been so reluctant to make a profit from the ills of those whom they treated that they preferred to live in poverty. Samuel Johnson described his friend, Dr. Robert Levet, a Practiser of Physic: No summons mock'd by chill delay, No petty gain disdain'd by pride; The modest wants of ev'ry day The toil of ev'ry day supplied [3].…

Buch. Zustand: Neu. Neuware - During the 25 years since acute coronary care was focused into Coronary Care Units there have been three major Phases: I. prevention of death caused by arrhythmias; II. prevention of death due to myocardial failure; and III. limitation of infarct size. In the latter two Phases, there has been infringement upon the time honored concept of a prolonged period of rest for the patient in general and the heart in particular to minimize myocardial metabolic demands. During the second Phase of coronary care, patients with myocardial failure received aggressive measures to increase cardiac work via increase in preload, decrease in afterload, and direct increase in inotropy. It was believed that true cardiogenic shock was so irreversible that it should be prevented by vigorous efforts to improve the cardiac output despite the risk of extending the area of ischemic myocardium. However, Phase II produced minimal overall reduction in mortality. In the initial part of Phase III, myocardial infarct (MI) size limitation was attempted by reducing myocardial metabolic demands via either beta adrenergic or calcium channel blocking agents. We are currently several years into the second part of Phase III of coronary care where the principle means of limiting MI size is restoration of coronary blood flow.…

Buch. Zustand: Neu. Neuware.

Buch. Zustand: Neu. Neuware - In 1628 William Harvey published his discovery of the existence of the microcirculation which he deduced from careful anatomical and physiological study. Thirty-three years later, Malpighi confirmed the presence of capillaries through direct microscopical observation. Subsequent scientific advance has been slow, and in view of the fact that microvascular in the genesis and expression of many pathophysiology may be implicated diseases, our know ledge of human microvascular function is surprisingly limited. This ignorance attests to the difficulty of studying something that is both minute and inaccessible without disturbing the quantity that is being measured. In the last fifteen years, however, direct techniques have been developed for studying human microvascular pressure, flow and permeability. These methods have provided new insights into human microvascular function in health and disease. At the same time there has been a steady growth of new indirect techniques based on a w ide range of physical principles that reflect some or other aspect of microvascular function. …

Buch. Zustand: Neu. Neuware - The methodology of drug development has been the subject of extensive dis cussion by a relatively small group of individuals in industry and government who have been intimately concerned with the identification and study of new anticancer drugs. The Chemotherapy Program of the National Cancer In stitute has represented the major focus of initial efforts in drug development, as summarized in the historical perspective presented in chapter 1 and its references. It is no coincidence that the Chemotherapy Program was the origin of the Division of Cancer Treatment, a government entity that has had a pivotal role in the growth of clinical oncology. In an analogous fashion this book presents the methodology employed in the clinical study of anticancer drugs within the broad context of cancer treatment. The research orientation promulgated in the study of new drugs is a central theme in most oncolo gists' approach to the clinical problem of cancer. Therefore, we hope that this book will introduce readers to treatment research in clinical oncology. For the oncologist, the clinical evaluation of antitumor therapy is both part of the day-to-day management of specific patients and the critical considera tion of developing therapeutic alternatives. For physicians in other fields of medicine it is important to acquaint themselves with the basic tools of the oncologist. For people without medical training, including patients who might be interested in treatment research, many of the chapters may be overly technical.…