First published in 1987. Routledge is an imprint of Taylor & Francis, an informa company.

Now that Helicobacter pylori is generally accepted as a key aetiological agent in gastric cancer as well as the main agent in peptic ulcer, it can claim to be the most important new discovery in clinical gastroenterology of the last decade, and yet there is no up-to-date book available on the subject that is designed primarily for the clinical gastroenterologist. This book aims to fill that niche. It should also be of interest to the basic scientist, to those providing a clinical laboratory service (microbiologists and histopathologists), and to epidemiologists and others involved in clinical research.

IS CROHN'S DISEASE A MYCOBACTERIAL DISEASE'! The fact that the differential diagnosis of inflammatory bowel disease includes intestinal infections has been a source of much interest and clinical concern for many years. Since the recognition of ulcerative colitis and Crohn's disease as clinical entities, numerous attempts have been made to identify a specific organism resulting in the clinical and pathologic picture of Inflammatory Bowel Disease. The first suggestion about a connection between Johne's disease, a chronic mycobacterial enteritis in cattle, and Crohn' s disease occurred in 1913, when Dalziel described enteritis in humans which, although resembling intestinal tuberculosis, he believed to be a new disorder. Since the work of Crohn in the thirties a few investigators attempted to look for mycobacteria in Crohn's disease. Until now the work of Van Patter, Burnham and others did not receive widespread recognition. In 1984 the isolation of M. paratuberculosis was reported by Chiodini et al. This report initiated the current interest and controversy about a mycobacterial etiology in Crohn's disease. The hypothesis "Crohn's disease is Johne's disease" did not receive widespread recognition, but has lead to the first muIticentered efforts to determine whether or not mycobacteria are associated with Crohn's disease.

Despite significant progress in modern gastroenterology, the aetiology of inflammatory bowel disease as well as coeliac disease is still to a great extent unknown and poorly understood. The principles of treatment - particularly of IBD - emphasize the importance of a combined medical and surgical approach. This book is the proceedings of an international symposium that brought together workers from many disciplines involved in the treatment of IBD and coeliac disease, and is a useful update on recent advances in paediatric and paediatric-surgical gastroenterology. F. Hadziselimovic, B. Herzog, A. Biirgin-Wolff vii List of Principal Contributors M. BUROELSKI F. HAOZISELIMOVIC Kinderklinik Department of Gastroenterology Medizinische Hochschule Hannover Basler Kinderspital Postfach 61 01 80 Rbmergasse 8 CH-4005 Basel 0-3000 Hannover 61 Switzerland FRG H. K. HARMS A. BURGIN-WOLFF Dr. V. Hauner'sches Kinderspital Basler Kinderspital Lindwurmstrasse 4 Rbmergasse 8 0-8000 Munich 2 CH-4005 Basel FRG Switzerland A. H. CO LOONY W. T. J. HEKKENS Department of Physiology Harvard Medical School Faculty of Medicine Division of Urology The Children's Hospital University of Leiden 300 Longwood Avenue Wassenaarseweg 62 Boston, MA 02115 PO Box 9604 NL-2300 RC Leiden USA The Netherlands C. P. FLIEGEL Department of Radiology B. HERZOG Basler Kinderspital Pediatric Surgery Rbmergasse 8 Basler Kinderspital CH-4005 Basel Rbmergasse 8 Switzerland CH-4005 Basel Switzerland J. -O. GEBBERS Institute of Pathology B. S. KIRSCHNER Kantonsspital Wyler Children's Hospital CH-6000 Luzern 16 5825 S. Maryland Avenue Switzerland Chicago, IL 60637 USA A. M. GRIFFITHS Division of Gastroenterology M. L.

This book focusses on the latest results related to the field of bile acids as signaling molecules and describes how these receptors have become a major pharmacological target. It covers all major areas of research in this field, from genetics, chemistry, in silico modeling, molecular biology to clinical applications, offering a cross-country view of the functional role of bile acids as signaling molecules, virtually acting on all major areas of metabolism. While FXR and GPBAR1 are essential bile acid sensors that integrate the de novo bile acid synthesis with intestinal microbiota and liver metabolism, in a broader sense, BARs play a pathogenic role in the development of common human alignments including liver, intestinal and metabolic disorders, such as steatosis (NAFLD) and steato-hepatitis (NASH), diabetes, obesity and atherosclerosis.

Modern Management of Cancer of the Rectum is intended to provide a comprehensive overview of all aspects of rectal neoplasms. It addresses epidemiology, biology, screening and chemoprevention, the role of imaging in diagnosis, staging and prognosis, radiation therapy, medical and surgical treatment, as well as new modalities of therapy, including laparoscopy, and transanal endoscopic surgery. A greater understanding of prognostic factors, patterns of spread and natural history has occurred during the past decade; together with new diagnostic modalities this has led to significant changes in the management of patients with rectal cancer. This book will be invaluable for all those who treat rectal cancer.

It is easy to make anecdotal claims for the efficacy of new forms of treatment based on the short term results in a small number of patients. Many authors have done this for endoscopic laser therapy in the gastrointestinal tract. It is very much more difficult to carry out a comprehensive assessment of the short and long term effects of new techniques and to compare these with the results of alternative treatments for the same diseases. This book, from one of the world's leading departments of gastroenterology, describes and analyses the largest series of patients yet reported from one centre treated endoscopically with the NdYAG laser for gastrointestinal disease. The follow up extends over 8 years and the results are impressive. Some of the early claims for laser therapy have been validated, others have not, but the real value of the book is that we now have a large amount of well organised data on which to judge the merits of laser therapy. Medical laser techniques are in their infancy and the potential for future develop ment is enormous, but ideas on current applications have been consolidated and that is essential before the next concepts evolve. This book has taught us how to walk. The world is now ready to learn to run! S. G. Bown, Director National Medical Laser Centre London Contents INTRODUCTION 3 Introduction and purpose of the study 5 1 General aspects of laser 6 1. 1.

In the past several decades, the medical community has witnessed professionals, instead of generalizing their knowledge, specialize in a specific area of practice. Head and neck surgery have thus become a major specialty within the surgical domain, and the management of specific gland disorders encompasses a broad array of both benign and malignant diseases. Diagnostic Techniques and Therapeutic Strategies for Parotid Gland Disorders is a collection of innovative research on the clinical and diagnostic techniques as well as several therapeutic strategies of parotid gland disorders. Serving as a quick reference and practice manual, the book addresses a wide range of topics including embryological development and anomalies, histology and surgical anatomy, physiology, parotid gland evaluation, xerostomia, traumatic injuries and fistulae, calculi, sialosis, sialadenitis, cysts and tumors of the parotid gland, and the various techniques and potential complications of parotidectomy including Frey's syndrome, in addition to extra-temporal facial nerve reconstruction procedures. It is ideally designed for medical professionals, surgeons, researchers, academicians, and medical students.

The Clinician's Guide to Swallowing Fluoroscopy is a comprehensive resource for all dysphagia clinicians. This beautifully-illustrated text is intended for SLP, ENT, radiology, GI, and rehabilitation specialists interested in swallowing and addresses the need for an up-to-date, all-inclusive reference. Topics covered include radiation safety and protection, fluoroscopic oral, pharygeal, and esophageal phase protocols and abnormalities, and objective measures of timing and displacement.

This book provides a comprehensive analysis of the value of contrast-enhanced ultrasound (CEUS) in the diagnosis of a wide variety of pathologies. Sonography reliably identifies a wide range of diseases, and the efficacy of modern ultrasound has dramatically improved with contrast enhancement. This book covers almost all aspects of CEUS starting from basic principles and ending with features of its application in individual organs. In particular, it explores the diseases of abdominal, retroperitoneal, and pelvic organs as well as superficial structures, highlighting the characteristic features of typical findings. Focal lesions are discussed in depth, with attention to their early detection and differential diagnosis. Besides, a practical approach to the stratification of the risk of malignancies is provided. The authors summarized their own experience with CEUS in oncology, hepatology, gynecology, urology, endocrinology, and other fields of medicine. The role of CEUS in differential diagnosis of various disorders of the female reproductive system is comprehensively discussed as well. The presentation is clear and concise, and richly illustrated. The book will be a helpful tool for both residents and practitioners approaching ultrasound diagnostics, as well for more experienced radiologists and other professionals.

Toby K. Eisenstein Symposium Committee Chairperson Temple University School of Medicine Philadelphia, Pennsylvania 19140 This symposium is the thirteenth biennial clinical microbiology program sponsored by the Eastern Pennsylvania Branch of the American Society for Microbiology in cooperation with the Philadelphia area medical schools and the Bureau of Laboratories of the Pennsylvania Department of Health. This year a generous contribution from Merck, Sharp and Dohme has helped to make the program a reality. The subject matter for this symposium represents an attractive spectrum of medical, biological and molecular approaches to the practical solution of a public health prob1em--name1y, prevention of infection with the hepatitis B virus. The symposium may be unique in that it focuses on a product which was first marketed less than three months ago, but included in the program are presen tations on two new approaches to hepatitis B vaccine production which may replace the one which is newly unveiled. The rapidity of progress in our present era of biological research is indeed astonishing."

Antimicrobial-associated diarrhea is often caused by Clostridium difficile; this disease can best be diagnosed by detection of fecal cytotoxin in a tissue culture assay and, when therapy is indicated, can be effectively treated with orally administered vancomycin. The cause of disease in most cases of antimicrobial-associated diarrhea that do not involve C. difficile is not known; fortunately, this form of diarrhea 1S usually mild. Antimicrobial-associated diarrhea may also rarely involve s. aureus and certain enteric pathogens. 37 QHAPTER 4 Qf. TECTlON. ISOLATION Al:iQ...IQENTlFICATlON OF CLOSTRIDIUM PIFFICILE S. P. BORRIELLO and PAULINE HONOUR Introduction 38 Detection of Co dlfflcile in stools 38 Direct methods 38 Indirect methods 39 Isolation of Co djfficjle 40 Identification of Co difflcile 44 38 DETECTION ISOLATION AND IDENTIFICATION OF CLOSTRIDIUM DIFFICILE S. P. Borriello and Pauline Honour Introduction In view of the mounting evidence generated world wide in the last few years that firmly implicates GBP. difficile as the aetiological agent in both antibiotic and non-antibiotic associated pseudomembranous colitis (Larson ~ al. , 1978, Bartlett ~ al. , 1978a, George ~ al. , 1978a), and also recent recognition of the fact that there may be a spectrum of gastrointestinal diseases associated with GBP. difficile infections (Borriello and Larson, 1981, Bolton ~ al. , 1980, Brettle ~ al. , 1982), an increasing number of laboratories are seeking to detect, isolate and identify GBP. difficile from clinical samples.

The impact of Helicobacter pylori on basic science and the clinical management of patients with the complications of this infection is bewildering. The explosion of new information both in the laboratory and at the bedside has progressed at an unprecedented rate. Our main objective in furthering this progress has been to integrate this new information and organize a series of top quality presentations and discussions between investigators and clinicians on all aspects of H. pylori research and to review the current position and future research directions. To that end, the second meeting Helicobacter pylori: Basic Mechanisms to Clinical Cure was organized in June 1996 in Ottawa, Canada, following the successful format of the first such meeting held in Amelia Island, Florida, in 1993. The meeting again focused on all timely aspects of H. pylori research. Internationally renowned basic and clinical scientists, all experts in their respective fields, explored in depth the spectrum of H. pylori infection and the related complications of gastritis, peptic ulcer, gastric cancer and lymphoma. The presentations covered: the genetic heterogeneity of the organism, including the expression of virulence factors determined by the genetic pathogenicity island; the intricate cascade of chemokines and cytokines leading to mucosal inflammation; the complexities of the mucosal immune response, favoring a slight Th1 over Th2 lymphocyte imbalance; the fundamental issue of the apparent paradox of the induction of both apoptosis and epithelial hyperproliferation; the pathophysiological consequences of gastric mucosal inflammation with respect to the elevation of gastrin and the acid secretory response; themechanisms leading to peptic ulcer disease, gastric carcinoma and gastric mucosa-associated lymphoid tissue (MALT) lymphoma; the established and novel therapeutic approaches to eradication and finally the prospects for successful therapeutic and preventative vaccination. The comprehensive manuscripts in this book of the proceedings of the meeting reflect the most up-to-date information and state of the art approaches to research and management of H. pylori infection and will provide an invaluable reference source.

In this issue of Physician Assistant Clinics, Guest Editor Jennifer R. Eames brings her considerable expertise to the topic of Gastroenterology. Top experts in the field cover key topics such as Hepatitis C, Celiac Disease, Inflammatory Bowel Disease, Gastrointestinal Bleeding, and more. Provides in-depth, clinical reviews on Gastroenterology for PAs, providing actionable insights for clinical practice. Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field; Authors synthesize and distill the latest research and practice guidelines to create these timely topic-based reviews. Contains 13 relevant, practice-oriented topics including Evaluating patients for Nutritional Deficiencies; Eosinophilic Esophagitis; Pathophysiology of Peptic Ulcer Disease; Updated Screening Strategies for Colorectal Cancer; and more.

This book, Mechanisms in the Pathogenesis of Enteric Diseases 2, is an out come of the Second International Rushmore Conference on Mechanisms in the Pathogenesis of Enteric Diseases, held September 3D-October 3, 1998 in Rapid City, South Dakota, USA. Its chapters represent many of the reviews and papers presented at the conference. The meeting was organized by members of the North-Central Regional Research Committee "NC-62," a consortium of researchers of bovine and swine enteric diseases from land-grant institutions supported by the United States Department of Agriculture. The Rushmore Conferences were conceived as a forum for an interdiscipli nary discussion of mechanisms of infectious enteric diseases. It was intended that such a discussion would stimulate cross-pollination of ideas, and nurture synergistic collabora tions among scientists who might otherwise not interact. Enteric diseases are caused by widely divergent pathogens and parasites in broadly different settings, and affect multi ple organ systems. Some enteric diseases affect a single species, while others may affect multiple species, perhaps including human beings. Some enteric diseases were present in antiquity, while others have recently emerged. Knowledge regarding a particular disease or pathogen has frequently proven useful in understanding another disease or pathogen, because common themes in pathogenesis exist. As this knowledge base grows, strategies in the prevention and control of various enteric diseases often converge. Cross-discipli nary discussions and collaborations facilitate growth of this knowledge base, as well as development of tools for disease interdiction."

This volume provides current protocols that can be used in various experimental settings involving bifidobacteria. Chapters guide readers through experimental protocols on procedures to isolate and cultivate bifidobacteria, taxonomic identification of bifidobacterial isolates, sequencing and annotate genomes, physiologically characterize bifidobacteria, and methods on the genetic manipulation of bifidobacterial strains. Written in the highly successful Methods in Molecular Biology series format, chapters include introductions to their respective topics, lists of the necessary materials and reagents, step-by-step, readily reproducible laboratory protocols, and tips on troubleshooting and avoiding known pitfalls. Authoritative and cutting-edge, Bifidobacteria: Methods and Protocols aims to be a useful practical guide to researches to help further their study in this field.

Despite the fact that the incidence of gastric cancer is declining in the Western world, it remains a significant problem with respect to accurate diagnosis and treatment since it has a high mortality rate. In June 1989 an International Conference was held at the University of Rome "La Sapienza" entitled "New Trends in Gastric Cancer: Background and videosurgery." During this meeting background information on the aetiopathogenesis of gastric cancer was presented together with talks and video presentations on the latest advances in the treatment of gastric carcinoma, both from the European and Japanese experience. Because of the poor prognosis of gastric carcinoma there is increasing pressure for early detection. Some of the problems in the early detection of gastric carcinoma are discussed together with methods of surveillance of high-risk subjects. It is generally accepted that the surgical approach to gastric carcinoma should take into account the site and extent of the lesion and there are chapters on new methods for pre and intraoperative staging of the disease which allow a more logical approach to surgery. A comparison between Japanese and Western rule and results was attempted and reasons for the differences were investigated. Since the field is still evolving not all aspects could be covered, and those angles not approached in this book will be addressed in a second International Conference to be held in Rome in June 1990.

Medical nutrition therapy plays a central role in the management of diseases including reducing disease risk, slowing disease progression, and monitoring nutritional status. Though a nutrition care process has been implemented in some countries, many do not have a national standard for nutrition and dietetic practices for different diseases including the scope of gastrointestinal disorders. Moreover, there is no guidance to dietetic practice by most of the governing bodies of the world. Cases on Medical Nutrition Therapy for Gastrointestinal Disorders presents real-world case studies on nutrition assessment, diagnosis, intervention, monitoring, and evaluation standards and practices. Moreover, the cases provide critical updates on the use of medical nutrition therapy for gastrointestinal disorders that include but are not limited to Celiac Disease, Crohn's Disease, Irritable Bowel Syndrome, constipation, and bowel obstructions and discusses strategies for the prevention and management of these disorders. Registered dietitians, dietetic interns, nutritionists, healthcare professionals, researchers, academicians, and students will benefit from the scenarios presented within this book.

Did you know that 62% of the food in our supermarkets is not only processed but 'ultra-processed' (ingredients from other foods are combined to make something 'new', often in colours that do not exist in nature) and that data shows that by eating this kind of food over time we are literally slowly poisoning ourselves?

In the hard-hitting, ground-breaking tradition of his NY Times bestseller FAT CHANCE, which revealed the dangers of sugar, Dr Robert Lustig persuasively presents a stark exposé of how our addiction to processed foods (aided and abetted by the food industry, big ag, big pharma, institutional medicine and the government) is behind the lethal increase in major non-communicable diseases, including diabetes, heart disease, fatty liver disease, cancer and dementia. We have come to accept that these chronic diseases are simply part of the 'natural ageing process', but Dr Lustig makes the case that this is simply not true.

The solution on both a personal and societal level is a return to unprocessed food and Dr Lustig offers a doable plan for us to heal and restore our own health and wellbeing with real food, and in the process boosting our immunity to viruses like Covid-19.

The obesity epidemic has generated immense interest in recent years due to the wide-ranging and significant adverse health and economic consequences that surround the problem. Much attention has been focused on behaviors that lead to obesity, in particular to over consumption of energy-dense food and to sedentary lifestyle. However, obesity is an extremely complex condition with poorly defined pathogenesis. Thanks to greatly enhanced research in the area, the discovery of pathways in the brain and peripheral organs that mediate energy homeostasis has provided a framework for understanding the biological basis of obesity. Metabolic Basis of Obesity adds an important new dimension to the growing literature on obesity by offering a comprehensive review of specifically how metabolic imbalance culminates in obesity. Developed by a team of expert authors, this important title discusses the principles of energy balance, genetics of body weight regulation, hormones and adipokines, and metabolic pathways in the brain, liver, muscle and fat, to name just several of the areas covered. The book also examines the connection between obesity and diabetes, cardiovascular disease and other complications. Current and future diagnostic and treatment strategies are also reviewed. Comprehensive and timely, Metabolic Basis of Obesity is an essential reference for understanding the burgeoning problem of obesity.

Psychiatry: a clinical handbook provides all the essential information required for a successful psychiatry rotation. Written by two recently qualified junior doctors and a consultant psychiatrist, the book offers an exam-centred, reader-friendly style backed up with concise clinical guidance. The book covers diagnosis and management based upon the ICD-10 Classification and the latest NICE guidelines. For every psychiatric condition: the diagnostic pathway is provided with suggested phrasing for sensitive questions the relevant clinical features to look out for in the mental state examination are listed a concise definition and basic pathophysiology/aetiology is outlined. The book also boasts a range of features to test your understanding of the subject: Self-assessment questions are provided at the end of each chapter. A common OSCE scenarios chapter with mark schemes, to aid practising with colleagues in preparation for exams. An exam-style questions chapter with detailed answers written by a Consultant Psychiatrist. Printed with an attractive full colour design, the book includes mnemonics, clinical photos, diagrams, OSCE tips and key fact boxes. Psychiatry: a clinical handbook is ideal for medical students, junior doctors and psychiatry trainees. From reviews: "This book excels as a guide for studying, for a variety of reasons. Notably, the pedagogic quality truly benefits from the authors' deliberate use of a variety of formats for presenting information. As a result, nearly any medical student could find this book easy to use." Doody, July 2016 "One of the best psychiatry books I have ever read. It is organised in a neat, concise manner with tables, colours, mnemonics, OSCE tips to name but a few." Amazon reviewer

By 1977 it was clear that the thermophilic campylobacters were a major cause of acute bacterial enteritis. In response to that observation an international workshop was convened in Reading, England, and attracted over 130 participants. Many of these individuals resolutely returned for the eighth in the series of biennial international workshops, this time held in Win chester, England, in July 1995. All were surprised at the continued, and even expanding, re search effort in this narrow microbiological field. Such a lasting interest is undoubtedly a reflection of a consistent rise in the incidence of infection, the growing number of closely re lated organisms and disease associations, and an ever-increasing awareness by the public and government agencies of public health and food safety issues. The second workshop in Brussels in 1983 was a forum that demonstrated the growing awareness in the campylobacter community of the existence of campylobacter-like organisms and provided the platform for presentations describing the association of these organisms, now classified in the genus Helicobacter. with gastroduodenal disease. The clinical aspects of the research into helicobacters is now thoroughly covered in several other meetings, and the remit of the international workshop has been expanded to provide a forum for the presentation of the basic microbiological research carried out on these bacteria. In a continuation of this ap proach the remit of the workshop has been further extended to other related organisms, reflect ing that there are many other campylobacter-like organisms still to identify and characterize."

An important milestone in medicine has been the recent completion of the Human Genome Project. The identification of 30,000 genes and their regulatory proteins provides the framework for understanding the metabolic basis of disease. This advance has also laid the foundation for a broad range of genomic tools that have opened the way for targeted genetic testing in a number of medical disorders. This book is designed to be the first major text to discuss genomics-based advances in disease susceptibility, diagnosis, prognostication, and prediction of treatment outcomes in various areas of medicine. After building a strong underpinning in the basic concepts of genomics, the authors of this book, all leaders in the field, proceed to discuss a wide range of clinical areas and the applications now afforded by genomic analysis.