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Addiction and Art
by Patricia B. Santora Margaret L. Dowell Jack E. HenningfieldHighly Commended in Psychiatry, 2011 BMA Medical Book Awards. British Medical AssociationAddiction to alcohol, tobacco, and other drugs is one of the major public health issues of our time. It accounts for one of every five deaths in the United States and costs approximately one-half trillion dollars per year in health care expenditures and lost productivity. Its human costs are untold and perhaps uncountable. Addiction and Art puts a human face on addiction through the creative work of individuals who have been touched by it.The art included here presents unique stories about addiction. Many pieces are stark representations of life on the edge. Others are disturbing contemplations of life, meaning, and death. Some even reflect the allure of addiction and a fondness for substance abuse. A panel of addiction scientists, artists, and professionals from the art world selected the 61 pieces included here from more than 1,000 submissions. Accompanied by a written statement from the artist, each creation is emblematic of the destructive power of addiction and the regenerative power of recovery. Stunning and occasionally unsettling, this unique portfolio reveals addiction art as a powerful complement to addiction science.
Addiction and Change
by Carlo DiclementeThe stages-of-change model has become widely known as a framework for conceptualizing recovery. Less well known are the processes that drive movement through the stages or how the stages apply to becoming addicted. From Carlo C. DiClemente, codeveloper of the transtheoretical model, this book offers a panoramic view of the entire continuum of addictive behavior change. The author illuminates the common path that individuals travel as they establish and reinforce new patterns of behavior, whether they are developing an addiction or struggling to free themselves from one, and regardless of the specific addictive behavior. The book addresses crucial questions of why, when, and how to intervene to bolster recovery in those already addicted and reach out effectively to people at risk.
Addiction and Change, Second Edition: How Addictions Develop and Addicted People Recover
by Carlo C. DiClementeNot everyone who experiments with substance use or risky behavior becomes addicted, and many who are addicted have been able to recover. This authoritative book, now revised and updated, has given tens of thousands of professionals and students a state-of-the-art framework for understanding the journey both into and out of addiction. From Carlo C. DiClemente, codeveloper of the transtheoretical model (TTM), the book identifies the stages and processes involved in initiating, modifying, maintaining, or stopping any pattern of behavior. Grounded in extensive research, and illustrated with vivid case examples, the book shows how using the TTM can help overcome obstacles to change and make treatment and prevention more effective. New to This Edition *Incorporates 15 years of research advances, contemporary prevention and treatment approaches, and the ongoing development of the TTM. *Chapter on current developments in intervention research. *Expanded discussions of neuroscience; self-regulation; behavioral economics; self-help, mutual help, and spirituality; motivational issues; "process addictions" (gambling and sex addiction); and more. *Deeper coverage of risk and protective factors across adolescent and young adult development.
Addiction and Opiates
by Alfred R. LindesmithThis classic study is concerned with addiction to opiate-type drugs and their synthetic equivalents. Lindesmith proposes and systematically elaborates a rational, general theoretical account of the nature of the experiences which generate the addict's characteristic craving for drugs. While this theoretical position has obvious implications for addictions that resemble opiate addiction in that they also involve drugs which produce physical dependence and withdrawal distress, the author does not extend the theory to these other forms of addiction, such as alcoholism.The central theoretical problem is posed by the fact that some persons who experience the effects of opiate-type drugs and use them for a period sufficient to establish physical dependence do not become addicts, while others under what appear to be the same conditions do become addicted. The focus of theoretical attention is on those aspects of addiction which may reasonably he regarded as basic or essential in the sense that they are invariably manifested by all types of addicts regardless of place, time, method of use, social class, and other similar variable circumstances. Lindesmith then makes a brief statement of a view of current public policy concerning addiction in the United States reform which, it is believed, would substantially reduce the evils now associated with addiction and the large illicit traffic in drugs. He interviews approximately fifty addicts over a fairly extended period of time sufficient to establish an informal, friendly relationship of mutual trust.The attempt to account for the differential reactions among drug users requires specification of the circumstances under which physical dependence results in addiction and in the absence of which it does not. It also requires careful consideration of the meaning of "addiction," spelled out in terms of behavior and attitudes characteristic of opiate addicts everywhere. This book strives to understand these aspects of addiction with t
Addiction and Recovery in Gay and Lesbian Persons
by Robert J KusThis book provides chemical dependency clinicians a sampling of the work being done in the fields of gay and lesbian chemical dependency to enable clinicians to provide better care for their gay and lesbian clients.After an overview of 7 research studies which examine the incidence of alcoholism and/or chemical dependency in gay and lesbian persons, the contributing authors explore the special concerns of recovering gay and lesbian addicts.Chapters focus not only on issues in the fields of gay and lesbian chemical dependency but how clinicians can use this knowledge to better care for their gay and lesbian clients. Readers will find new information on: working with HIV positive persons homophobia as a critical root in chemically dependent gays and lesbians positive changes for dysfunctional relationships common with gays and lesbians spirituality in gay and lesbian communities the special needs of the rural gay/lesbian client gay men&’s groups in AA a retrospective of NALGAP resources and referrals for chemically dependent gay and lesbian personsAddiction and Recovery in Gay and Lesbian Persons assists social workers and other helping professionals working with chemically dependent clients learn more about how to adequately treat them. Gay and lesbian persons recovering from a chemical addiction will also find this book enlightening.
Addiction and the Brain: Knowledge, Beliefs and Ethical Considerations from a Social Perspective
by Michael Egerer Matilda Hellman Janne Stoneham Sarah Forberger Vilja Männistö-Inkinen Doris Ochterbeck Samantha RundleThis book investigates the neuroscientific knowledge on addiction as an epistemic project.
Addiction and the Medical Complications of Drug Abuse
by Steven B. KarchExtracted from the Drug Abuse Handbook, 2nd edition, to give you just the information you need at an affordable price.Addiction and the Medical Complications of Drug Abuse explores the physiological and psychological phenomenon of addiction including the nature of dependence, the dependence potential of drugs, and the i
Addiction at Work: Tackling Drug Use and Misuse in the Workplace
by Hamid GhodseDrugs and the workplace just don't mix. Yes, most users of illicit drugs are employed adults and there's a high correlation between levels of stress, income and alcohol abuse amongst professional and managerial employees. But the risks associated with drug use and abuse in the workplace have been well defined. Addiction at Work enables you to understand the background and extent of the problem: the cost of drug abuse to your organization; the role your own organizational culture may have in encouraging drug misuse; the risks associated with dangerous or stressful jobs. There are also chapters to help you understand the symptoms of drug abuse and the potential risks associated with perfectly legal prescription or over-the-counter medicines. The right kind of drug policy can be a significant weapon to fight this problem. So Addiction at Work explores your responsibility as an employer and how to design, communicate and implement a policy that is appropriate for your organization. Finally, there are chapters on the tools and techniques open to your organization for tackling the problem head on; ways of addressing problem behaviours; the advantages and disadvantages of drug screening and the ethics associated with this practice; employee assistance programmes and specialist care and, finally, the employment law issues around drugs. Addiction at Work has been written by some of the world-authorities on drug use in the workplace. It is an essential reference for organizations seeking a way through the human, ethical and legal issues (and the risk they present to any employer) of a social problem that is increasingly impacting employees whatever their work or the nature of their workplace.
Addiction for Nurses
by G. Hussein RassoolNurses are acknowledged as key agents in addressing alcohol and drug misuse at individual, family, and community levels. Addiction nursing is central to the assessment, management, and care of people with problematic use of psychoactive substances (both legal and illegal). Work takes place in a wide range of settings, from traditional hospital clinics and wards to community locations such as police custody suites and needle exchange facilities. Addiction for Nurses is a comprehensive textbook for students, explaining the role of the nurse at each stage of intervention. Early chapters approach the subject from sociological, historical, and cultural perspectives, covering significant topics such as the nature of addiction, its social context, and addiction theory. The book then presents vital information about each of the main areas of addiction (nicotine, alcohol, opiates, cannabis, psychostimulants, and hallucinogens) with clinical and practical guidance on recognition, assessment, and treatment intervention strategies. Further chapters consider dealing with emergencies, blood-borne viruses, harm reduction, and work with specific client groups (for instance, black and ethnic minority communities, or those with special needs). This book is an essential resource for all those who come into contact with alcohol and drug misusers and for specialist addiction nurses preparing for practice in this complex and rewarding field.
Addiction in South and East Africa: Interdisciplinary Approaches
by Grivas Muchineripi Kayange Yamikani NdasaukaThis book explores both the existence and prevalence of addiction in South and East Africa, departing from traditional assumptions about addiction in the region. The authors employ an interdisciplinary approach to understand the actual prevalence of addiction and the forms it takes in South and East Africa. The book also addresses the perceptions and conceptualisation of addiction in the region, in addition to discussing specific issues related to drug and alcohol abuse and addiction, social media addiction, and sex addiction.
Addiction in the Family: Helping Families Navigate the Challenges, Emotions, and Recovery
by Louise StangerA practical and supportive guide for families struggling with addictionGet compassionate guidance that shows you how to navigate the unique challenges faced when a family member is suffering from a substance use disorder (SUD). Addiction in the Family helps you better understand what your loved one is going through while also offering realistic advice for approaching their addiction and how it affects your entire family.Drawing on Dr. Louise Stanger's years of experience as an SUD and family trauma clinician, Addiction in the Family allows you to take things at your own pace and concentrate on the areas where you need the most help. Whether it's finding ways to help your loved one, concentrating on your own self-care, or starting the healing and recovery journey, you'll find practical and thoughtful guidance.Addiction in the Family is:Family-focused—Get advice that addresses the dynamics and challenges of dealing with a partner, child, or other family member who is suffering from SUD.Practical and hopeful—Learn how to set boundaries, deal with strong emotions, and find addiction treatment options, as well as the best ways to communicate with a loved one compassionately and honestly.Filled with real-life examples—Realize that you aren't alone thanks to composite anecdotes—drawn from Dr. Louise's practice—that help you contextualize your experiences.Addiction in the Family will help you discover a measured and considerate way to approach a family member suffering from SUD.
Addiction, Assessment, and Treatment with Adolescents, Adults, and Families
by M. Carolyn HilarskiTime-effective intervention and prevention tools for dealing with addictionAddiction, Assessment, and Treatment with Adolescents, Adults, and Families examines addiction concerns ranging from prevention to relapse, offering effective intervention techniques and assessment tools to ensure delivery of the best possible service to clients who represent a variety of populations and mental health issues. Leading addiction researchers address new developments in theory, methodology, treatment, and assessment on counselor beliefs, contingency management, group treatment, rapid assessment instruments, behavioral couples therapy (BCT), family-based intervention, motivational interviewing, and 12-step programs and faith-based recovery. This essential professional and academic resource presents case studies, reviews, research findings, and empirical papers that offer unique perspectives on a variety of topics, including evidenced-based practice, theory of reasoned action, harm reduction, juvenile justice, and treatment outcomes.Addiction, Assessment, and Treatment with Adolescents, Adults, and Families presents sophisticated, cutting-edge theory and practice concepts that provide professionals, practitioners, and educators with a more varied focus than most current available books on addiction. Counselors working in mental health settings and EAP programs, psychiatric nurses working in hospitals and outpatient settings, social workers, and students pursuing degrees in social work, nursing, psychology, and criminal justice will benefit from the book&’s wide range of appropriate addiction, treatment, and prevention methodologies.Topics addressed in Addiction, Assessment, and Treatment with Adolescents, Adults, and Families include: understanding the gap between research and practice in substance abuse counseling prevalence and patterns of illicit drug use among juvenile offenders the relationship between the reported substance abuse of African-American and Hispanic youth and their perceived attachments with their primary caregivers using a harm reduction approach to the evaluation of treatment outcomes using a nonconfrontational approach to substance abuse counseling when addressing client denial why contingency management interventions are underutilized, especially in community settings how to determine if and when Motivational Interviewing (MI) and Adapted Motivational Interviewing (AMI) are effective how to use nonabstinence-based prevention services in working with adolescents how to use and score the K6 scale to screen serious mental illnesses how to use Receiver Operating Characteristics analysis to evaluate rapid assessment instrumentsAddiction, Assessment, and Treatment with Adolescents, Adults, and Families is a vital professional resource and an invaluable aid to adults, adolescents, and families of anyone suffering with some level of addiction.
Addiction: A Disorder of Choice
by Gene M. HeymanIn a book sure to inspire controversy, Gene Heyman argues that conventional wisdom about addiction—that it is a disease, a compulsion beyond conscious control—is wrong. Drawing on psychiatric epidemiology, addicts’ autobiographies, treatment studies, and advances in behavioral economics, Heyman makes a powerful case that addiction is voluntary. He shows that drug use, like all choices, is influenced by preferences and goals. But just as there are successful dieters, there are successful ex-addicts. In fact, addiction is the psychiatric disorder with the highest rate of recovery. But what ends an addiction? At the heart of Heyman’s analysis is a startling view of choice and motivation that applies to all choices, not just the choice to use drugs. The conditions that promote quitting a drug addiction include new information, cultural values, and, of course, the costs and benefits of further drug use. Most of us avoid becoming drug dependent, not because we are especially rational, but because we loathe the idea of being an addict. Heyman’s analysis of well-established but frequently ignored research leads to unexpected insights into how we make choices—from obesity to McMansionization—all rooted in our deep-seated tendency to consume too much of whatever we like best. As wealth increases and technology advances, the dilemma posed by addictive drugs spreads to new products. However, this remarkable and radical book points to a solution. If drug addicts typically beat addiction, then non-addicts can learn to control their natural tendency to take too much.
Addictive Disorders in Arctic Climates: Theory, Research, and Practice at the Novosibirsk Institute
by Bernard SegalDiscover fresh perspectives on alcoholism treatment and research with this enlightening new book describing the work of researchers at the Novosibirsk Medical Institute, USSR. By using specific examples of their studies in Siberia, the reserachers offer an innovative approach to the treatment of addictive disorders in general. Instead of focusing on the drinking behavior itself, the treatment focuses on the relation of the problem to the interaction of economic, social, and psychological factors. To address the question of whether alcoholics should all be treated in the same way, or if alcholism treatment should be more individualized in approach, chapters are devoted to the differences between alcoholism in women, adolescents, and alchoholics who are afflicted with “rapid development of alcholism syndrome.” The research examples in Addictive Disorders in Arctic Climates benefits professionals involved in the treatment of alcholism by introducing new perspectives and broadening contemporary research.
Additive Manufacturing Processes in Biomedical Engineering: Advanced Fabrication Methods and Rapid Tooling Techniques (Sustainable Manufacturing Technologies)
by Ankit Sharma Vivek Jain Atul Babbar Dheeraj GuptaThis book covers innovative breakthroughs in additive manufacturing processes used for biomedical engineering. More and more, 3D printing is selected over traditional manufacturing processes, especially for complex designs, because of the many advantages such as fewer restrictions, better production cost savings, higher quality control, and accuracy. Current challenges and opportunities regarding material, design, cost savings, and efficiency are covered along with an outline of the most recent fabrication methods used for converting biomaterials into integrated structures that can fit best in anatomy while still obtaining the necessary architecture, mechanical reliability, biocompatibility, and anti-bacterial characteristics needed. Additional chapters will also focus on selected areas of applications such as bionics, affordable prostheses, implants, medical devices, rapid tooling, and drug delivery. Additive Manufacturing Processes in Biomedical Engineering: Advanced Fabrication Methods and Rapid Tooling Techniques acts as a first-hand reference for commercial manufacturing organizations which are mimicking tissue organs by using additive manufacturing techniques. By capturing the current trends of today’s manufacturing practices this book becomes a one-stop resource for manufacturing professionals, engineers in related disciplines, and academic researchers.
Additive Manufacturing for Biomedical Applications: Recent Trends and Challenges (Biomedical Materials for Multi-functional Applications)
by Anil Kumar Anurag Dixit Dayanidhi K. PathakNew fabrication techniques and biomaterials have advanced significantly as attention toward healthcare innovations in recent decades has increased. This book provides a comprehensive overview of the application of additive manufacturing for biomedical devices. The book focuses on the use of biomaterial for hard and soft tissue engineering. These materials can imitate the mechanical, structural, and biological characteristics of the parent tissue, repairing or replacing its functioning. It provides details on the use of various biomaterials for different biomedical applications. It highlights the present trends and potential of various techniques and materials for various applications. The chapters in this book written by eminent experts highlight recent developments in additive manufacturing for biological mimicking and surgical planning. It discusses latest advances in various 3D printing technologies in the fabrication of biomedical devices for orthopaedic and cardiovascular applications, along with rising trends in designing and creating tissue replacement substitute simulants. This book can serve as a fundamental textbook for research in additive manufacturing, fabrication of implants or scaffolds and medical device development, biomaterials, tissue engineering, and biomedical engineering. This book can be a valuable resource for mechanical and biomedical engineers, academicians, healthcare researchers, and professionals interested in tissue engineering.
Additive Manufacturing in Multidisciplinary Cooperation and Production (Springer Tracts in Additive Manufacturing)
by Igor Drstvensek Snehashis Pal Nataša Ihan HrenThis book publishes the latest findings and ideas in the field of additive manufacturing presented by authors from prominent institutions around the world at the iCAT 2023 conference. The authors address various technological and medical aspects, ranging from materials science to the specific behaviour of the technology under different working conditions. The book is divided into four sections, three of which are dedicated to the purely technological aspects of additive manufacturing, covering metal processes, polymer processes and simulation. The fourth part of the book is dedicated to the medical applications of additive manufacturing, covering areas ranging from orthopaedic surgeries to materials used in medical AM.Overall, the book provides insight into the current state of the science and applications of additive manufacturing.
Additive Manufacturing in Pharmaceuticals
by Subham BanerjeeThis book presents the different 3D/4D printing technological applications of Additive Manufacturing (AM) in Pharmaceutical Sciences. The initial chapter provides the historical perspective and current scenario of AM in pharmaceuticals. The book further discusses about different 3D printing platform technologies such as FDM, SLA, SLS, SSE, Ink-jet & binder jet principles & applications in developing advanced drug delivery systems. It also covers the methodology, materials for AM and important parameters associated with these platform technologies. The book highlights the progress and practical applications of 4D-printing technology in healthcare & pharmaceuticals fraternity as well including the essence of bioprinting in pharmaceuticals. Finally, the book reviews the regulatory guidelines, perspectives, and integration of Artificial Intelligence (AI)/Machine learning (ML) in pharmaceutical AM. This book is indeed a valuable resource for students, researchers/scholars, young start-ups/entrepreneurs, and pharmaceutical professionals by providing thorough detailing about AM in Pharmaceuticals.
Additive Manufacturing of Polymers for Tissue Engineering: Fundamentals, Applications, and Future Advancements (Sustainable Manufacturing Technologies)
by Ankit Sharma Ranvijay Kumar Atul Babbar Vikas Dhawan Nishant RanjanApplication of additive manufacturing and tissue engineering in the fields of science and technology enables the manufacturing of biocompatible, customized, reliable, and cost-effective parts, restoring the functionality of a failed human body part. This book offers a platform for recent breakthroughs in additive manufacturing related to biomedical applications. This book highlights some of the top innovations and advances in additive manufacturing and processing technologies that are the future of the manufacturing industry while also presenting current challenges and opportunities regarding the choice of material. This book includes areas of applications such as surgical guides, tissue regeneration, artificial scaffolds, implants, and drug delivery and release. Throughout the book, an emphasis is placed on rapid tooling for engineering applications. Additive Manufacturing of Polymers for Tissue Engineering: Fundamentals, Applications, and Future Advancements acts as a first-hand source of information for academic scholars and commercial manufacturers as they make strategic manufacturing and development plans.
Addressing The Nation's Changing Needs For Biomedical And Behavioral Scientists
by National Research CouncilAs biomedical and behavioral research progresses into new areas, the number of scientists active in various fields rises and falls, and the health needs of the U.S. population evolve, it is important to ensure that the preparation of future investigators reflects these changes. This book addresses these topics by considering questions such as the following: What is the current supply of biomedical and behavioral scientists? How is future demand for scientists likely to be affected by factors such as advances in research, trends in the employment of scientists, future research funding, and changes in health care delivery? What are the best ways to prepare prospective investigators to meet future needs in scientific research?In the course of addressing these questions, this volume examines the number of investigators trained every year, patterns of hiring by universities and industry, and the age of the scientific workforce in different fields, and makes recommendations for the number of scientists that should be trained in the years ahead.This book also considers the diversity of the research workforce and the importance of providing prospective scientists with the skills to successfully collaborate with investigators in related fields, and offers suggestions for how government and universities should structure their research training programs differently in the future.
Addressing Unhealthy Alcohol Use in Primary Care
by Richard SaitzWhile there is a wealth of published information on addiction medicine, the psychological aspects of alcohol abuse, and behavioral medicine with regard to addiction, virtually none of these resources were written with the primary care provider in mind. Addressing Unhealthy Alcohol Use in Primary Care is a resource for primary care clinicians who are confronted by patients with these problems daily, and who wish to successfully address these issues in their practice. It would focus on the literature and science relevant to primary care practice and cover the range of interventions appropriate for this setting. Topics include assessment, brief counseling interventions, pharmacotherapy, referrals to both specialty care and Alcoholics Anonymous (and other self-help programs), psychiatric co-morbidity and other drug use, and other information specific to the needs of the primary care provider.
Addressing Violence, Abuse and Oppression: Debates and Challenges
by Barbara Fawcett Fran WaughEveryone working in health and social care is at one point or another confronted by violent behaviour and its consequences. Addressing Violence, Abuse and Oppression provides a broad overview of violence in relation to a range of groups and areas that involve human service professionals. Adopting an international perspective, this book looks at the ways in which violence, abuse and oppression can be clearly associated with power imbalances which are often gendered and which are covertly or overtly manifested at a range of levels including the interpersonal as well as the organizational and the political. It explores debates and challenges with regard to theoretical orientations, policy frameworks and how power imbalances intersect with a range of influencing factors including gender, poverty, indigenous/ethnic issues, class and sexuality. Examining the implications for human service professionals, each chapter of Addressing Violence, Abuse and Oppression provides an historical overview, explores theoretical perspectives, examines specific policy and practice context, appraises the contribution from research and assesses the impact for individuals and groups.
Addressing the Threat of Drug-Resistant Tuberculosis: A Realistic Assessment of the Challenge - Workshop Summary
by Institute of Medicine of the National AcademiesTuberculosis is one of the leading causes of death in the world today, with 4,500 people dying from the disease every day. Many cases of TB can be cured by available antibiotics, but some TB is resistant to multiple drugs--a major and growing threat worldwide. The Institute of Medicine's Forum on Drug Discovery, Development, and Translation hosted a workshop on November 5, 2008, to address the mounting concern of drug-resistant TB. The session brought together a wide range of international experts to discuss what is known and not known about this growing threat, and to explore possible solutions.
Adeno-Associated Virus: Methods and Protocols (Methods in Molecular Biology #807)
by Richard O. Snyder Philippe MoullierToday, progress in rAAV-mediated gene transfer is so robust that long-term, efficient, and regulatable transgene expression is reproducibly achieved in large animal models. The complexity of gene transfer agents in the context of their clinical use requires investigators from a wide variety of backgrounds to have an understanding -- or at least an appreciation of -- the regulatory environment and constraints that affect vector design, manufacturing, pre-clinical testing, and clinical use, with an emphasis on patient protection. In Adeno-Associated Virus: Methods and Protocols, experts from the United States and Europe have contributed current knowledge of this multi-dimensional field relating to the biology of AAV, rAAV vector design, vector manufacturing and product testing, performance of rAAV vectors in major organs, rAAV-related immunological issues, design of animal and clinical studies, and clinical experience. Written in the successful Methods in Molecular BiologyTM series format, chapters include introductions to their respective topics, lists of the necessary materials and reagents, step-by-step, readily reproducible protocols, and notes on troubleshooting and avoiding known pitfalls. Authoritative and accessible, Adeno-Associated Virus: Methods and Protocols provides a complete and comprehensive understanding of this multi-disciplinary and rapidly progressing field.
Adenocarcinoma of the Esophagogastric Junction: Adenocarcinoma Of The Esophagogastric Junction (Recent Results in Cancer Research #182)
by Paul M. SchneiderAmong malignant tumors, adenocarcinomas of the esophagogastric junction show the highest increase in incidence over the past three decades in Western industrialized countries. This special volume, with contributions from experts in the field, covers all aspects of the disease. Etiology, pathogenesis, classification, and clinical staging are discussed, and there is special emphasis on state of the art treatment techniques. The latter range from endoscopic mucosal resections or limited surgical resections for early cancers to multimodality treatment options for locally advanced tumors. Emerging quality issues in surgical management are addressed. Detailed attention is also paid to other important recent developments, including molecular response prediction, early metabolic response evaluation by PET and PET-CT, the diagnosis of micrometastases, and the use of sentinel node technology. This volume will be of interest to all clinicians concerned with the diagnosis and management of this malignancy.