When I gave a presentation on return to work after heart valve replacement at the Tenth Congress of the German Society for Thoracic and Cardiovascular Surgery in 1981, I was surprised by the relatively low level of interest that cardiac surgeons seemed to have in this subject. This stimulated me to intensify my research in this area and to extend it to patients with coron ary heart disease. Obviously, physiological and mechanical aspects of medical treatment are of special interest to the surgeon. For the majority of cardiac surgical patients, that is those with coronary heart disease, the technical problems of the operative procedure have been solved to a great extent. Many studies have demonstrated that, aside from reduction of symptoms, aortocoronary bypass operation can lead to improvement of cardiac performance un der stress conditions. However in spite of the technical solutions to hemodynamic problems, it has become very clear that the reintegration of patients into their social sphere has not been accomplished to the extent that might be expected, as exempli fied by the relatively low rate of postoperative return to work.

In the network of cardiologists within the European Society of Cardiology Working Group on Cardiac Rehabilitation and Exercise Physiology there is a strong view that the time indeed is right to publish definitively on the methods involved in cardiovascular prevention and rehabilitation. We are facing a transition from conventional cardiac rehabilitation to a phase of combined preventive and rehabilitative efforts, as witnessed in the recent Joint Task Force Guidelines on Preventive Cardiology. For this revision of our clinical routines we lack a practical textbook, based upon the conditions and resources of European health care. This textbook is designed to fill that gap.

primary goal of all forms of therapy is not just prolonging life, but improving the quality of life, has forced analysis of what constitutes quality of life, a concept whose structure pervades all walks of life and eludes definition. Global well being, happiness, morale, vitality, fullness of social life, and satisfaction must be integrated and assessed for the effects of the disease and the therapy, in the context of specific personality traits, attitudes to life, family situation, and socio-economic and political freedom. A growing inter est in research on this subject has led to a clearer understanding of the components which come to determine quality of a patient's life, and how they can be measured in a reproducible manner so that valid comparisons can be made. Keeping these recommendations of analysing quality of life within the context of patients who have undergone open heart surgery, it seemed appro priate to me to separate the influence of various forms of open heart surgery into five aspects of life which can comprehensively reflect the quality of life outcome of the operation. These five 'components' are (1) Physiological state, which summarises the traditionally reported incidence of operative mortality and morbidity, objectively and subjectively measured physical ca pacity, and the residual symptoms, treatment and long-term survival. (2) Intellectual functioning relates to the psychoneurolgocial deficit in memory, reasoning or judgement because of cerebral microembolism and hypo perfusion during cardiopulmonary bypass.

Despite considerable effort in primary prevention, coronary heart disease continues to be the leading cause of death in the industrialized nations. The patient who survives his first myocardial infarction carries approximately a tenfold risk of recurrence and sudden death when compared to the normal population. The concept of secondary prevention, therefore, has emerged as an active strategy aimed at the reduction of fatal and non-fatal recurrences of myocardial infarction. Apart from risk factors of relevance in primary prevention, secondary prevention is dependent on the extent of the disease itself; in other words the number of vessels involved, the extent of myocar dial damage and the degree of electrical instability. Nonmedical aspects such as the level of education, the degree of social support and the attitude towards stress also appear to influence the prognosis. The aim of this volume is to bring together all those factors relevant to achieving the maximal life span in patients afflicted with a disease that by its very nature is a lifelong process. However, as the late Paul Dudley White stated appropriately more than 40 years ago, it is not sufficient merely to add years to a life, one should also add life to the years. This concept truly is the nucleus of secondary prevention, sine only a life worth living generates the motivitation needed to take all the steps necessary in secondary pre vention. The authors and the editor are most grateful to Pharma Schwarz Inc.

Despite the apparently distinct differences between the disciplines of ergonomics and rehabilitation, they deal with the same issues, although at different ends of the spectrum. Keeping this in mind, Ergonomics for Rehabilitation Professionals explores their philosophies and goals, their parallel, divergent, and complementary aspects. It traces the

Coronary surgery encompasses two thirds of all adult cardiac surgery cases. With the endless pursuit of better outcomes, modern coronary artery bypass grafting (CABG) has become technically more complex in ways that are well beyond the training of the average cardiac surgeon. The old concept of "one-technique-fits-all" has been abandoned in favour of a specialized approach tailored to the individual patient. In fact, in recent years, there is a growing movement towards establishing coronary surgery as a super-specialization of cardiac surgery. Technical Aspects of Modern Coronary Artery Bypass Surgery aims to expand on both the basics and complexities of the technical aspects of coronary surgery. It serves as an up to date resource that illustrates and details the advancement and techniques in this field which may soon become a separate super-specialty. With a particular emphasis on illustrations, the book will be an essential reference book for both established surgeons that have no experience in advanced CABG, and the new generation of CABG surgeons. - A complete and concise resource on all aspects of coronary surgery - In-depth illustrative review of various coronary techniques - Covers both current recommendations and well-established practices in the field

Because the increasing complexities of diagnos testing and training, for example) are of neces ing and treating coronary artery disease are at sity discussed in more than one chapter with times overwhelming for many physicians, the appropriate cross referencing. Special attention purpose of this book is to bring together in one has been directed at making the references as comprehensive yet reasonably concise text a current as possible. Since the aim of the book is to do more than just update the concepts, the scholarly but clinically oriented analysis of the reader is also informed of the pertinent contro major aspects of coronary artery disease. The book is mainly intended for internists versies in the field. The word controversy is used in its most liberal form, so as to include areas of and clinical cardiologists as well as for those in training for these respective disciplines, but it disagreement or of uncertainty as well as should also be of interest to primary care physi changes in traditional views. Each of the con cians responsible for the management of pa tributors has been asked to identify specifically tients with coronary artery disease. Each of the the most important of the controversies in his contributors-whether cardiologist, radiologist, particular area of interest and to address himself or surgeon-has been selected for his special to these issues in the course of the chapter.

Numerous new and important findings relating to the reconstruction of disturbed circulatory conditions in the coronary area are reported in this book. Fundamental aspects of therapeutic and prophylactic possibilities are covered in detail. Recommendations are then made to practitioners and clinicians for their everyday work. Critical standards for the indications and risks of the recommended procedures are given. Particular emphasis is laid on the possibilities for revascularization by means of dissolution of blood thrombi. The book aims to present top-level guidance to the pros and cons of reconstructive measures in coronary disorders.

It gives us great pleasure to write the preface to this book, the second in the series of monographs produced by the European Academy of Rehabilitation Medicine. No part of medicine, no clinical intervention, is complete without thinking about its effect on the person’s life and the quality thereof. One of the most powerful determinants of this is work; a source not only of income, but of satisfaction and a sense of purpose and worth. The Academy, founded in 1969, is composed of senior European doctors spec- lising in Rehabilitation and Physical Medicine. It meets regularly to discuss matters of importance in the field, including teaching, research and ethical matters. It recognises that the ability of the speciality and of related ones to decrease dependency and increase autonomy and quality of life needs to be better known. Hence the production of these monographs. They will help readers access a vast amount of literature on the practice of rehabilitation and its effectiveness. They should be particularly useful to young doctors preparing for the European Boards certification in Physical and Rehabilitation Medicine as they are authoritative and cover subjects in depth. Topics covered in the series range from basic sciences to the most applied areas.