Nonsurgical Biliary Drainage is a survey of the current status of the endoscopic and percutaneous transhepatic approaches. The editors - internationally recognized leaders in gastroenterology - have gathered together articles which discuss both the principles and methodology of these techniques as well as their results and limitations. With the wealth of authoritative information it contains, this book will also help lay the groundwork for future advances in the field.

For a long time, approximately since Oberlin and Guerin described the multifocal origin of pancreatic cancers and precancerous pancreatic lesions, no important study dealing with the entire subject of pancreatic cancer has been published in France and probably in the international literature. For some decades the knowl- edge acquired 40years or more ago was not improved appreciably, though the fre- quency ofthe disease started to increase in occidental countries. This has recently changed, and the progress ofthe medical sciences has spread to the pancreas. Although the surgical or medical prognosis of the most frequent form of pancreatic cancer, exocrine adenocarcinoma, remains very bad, recent studies have shown the multiplicityofits pathological forms, some being less severe so that curative surgery is possible. New experimental models, particularly in the hamster, and the use of carcinogenic drugs allow experimental studies on lesions similar to those in man. Oncologic immunology is still at its beginnings but shows promise for diagnosis and treatment. Though modem techniques of imaging - sonography, aspirative cytology, CT scan, endoscopic catheterism, arteriography, and maybe in the future nuclear magnetic resonance - have not yet significantly in- fluenced prognosis,they have made the diagnosis easierand more precocious. Yet in a diseasethat diffuses so rapidly to deep lymph nodes, it has not been proved whether early diagnosis can improve prognosis.

Over the past decade a great deal of research activity has occurred on either side of the gastroduodenal epithelial interface, with the common goal of elucidating the mechanisms of mucosal protection and how these may be compromised in peptic ulcer disease. A prime stimulus to such research has been the realization that abnormal acid secretion or its delivery into the duodenum in excessive amount cannot fully explain ulcer pathogenesis in the majority of patients. One may envisage the stomach and proximal duodenum as being in a dynamic equilibrium, with aggressive luminal factors, such as acid and pepsin, being counteracted by protective mucosal mechanisms. Until recently, the mechanisms involved in mucosal protection had been poorly defined while the physiology and pathophysiology of acid and pepsin secretion had been elucidated. The impression that gastroduodenal mucosa was protected by a single mechanism has at last been replaced by a more realistic view, suggesting a number of protective zones acting in series. Some of these zones may act as first or second line defences against aggressive factors while certain zones may specifically protect against certain aggressors.

This book is a gift from the international community of amyloid friends, presented to Professor Dr. Enno Mandema on the occasion of his retirement from the University of Groningen, the Netherlands. It is the "precipitation" of up to date knowledge of amyloidosis, as presented at the International Course on Amyloidosis in Groningen, on the 10th and 11th of October 1986. Twenty years ago, Professor Mandema invited a group of scientists, who were studying the various aspects of amyloidosis from different points of view, to discuss their mutual interest in the subject. This "First International Symposium" was held for five days in September 1967. It was a wonderful experience for the participants, as most of them had until then only read each others work in the literature. The proceedings of that symposium, which contained the "lively" dis cussions, became a text-book for the following years. Research continued, and while the book was still in preparation, the revolutionary method of "water-soluble amyloid" was published. In the following years, different amyloid proteins were discovered and the mo lecular basis of the different amyloid syndromes was elucidated. The increase in knowledge parallelled the availability of modern, ingenious and also rapid methods in the biomedical sciences."

Bile acids occupy a central position in in the absorption, excretion and metab olism of lipids within the body. Our understanding of their unique properties has illuminated many biochemical and biophysical processes. Animals have evolved a unique system of preserving these important detergent-like molecules within the body and reusing them many times - the enterohepatic circulation. Disorders of the enterohepatic circulation contribute to a correspondingly wide range of diseases, and recent developments have centred in particular on cholesterol gallstone disease and bile acid diarrhoea. Successful manage ment of these diseases is increasingly based on an understanding of the physicochemical and biochemical properties of bile acids, and of their pathophysiological role in disease. Professor Alan Hofmann starts this book with an overview of the enterohepatic circulation of bile acids. The first section then discusses biliary lipid synthesis, transport and secretion by the liver and the solubilisation of cholesterol in the bile. The next section applies this knowledge to the pathogenesis of cholesterol gallstones. Separate chapters focus on defects in biliary lipid secretion, in cholesterol solubilisation and in gallbladder motility. The succeeding sections then review posssible approaches to gallstone prevention, and assess recent developments in non-surgical forms oftreatment. Two exciting new therapies that receive particular attention are contact dissolution therapy with methyl tert-butyl ether and extracorporeal shock wave lithotripsy. Further sections turn to the absorptive functions of bile acids in health."

For the fourth English edition, this highly popular book has been thoroughly revised and updated to include such new sections as endoscopic digestive US and abnormalities related to AIDS. It is the only work available covering the diagnostic US of the whole abdomen, and its superb treatment of elementary symptoms enables beginners to become familiar with more complicated features. After an extensive technical introduction, the book covers the sonoanatomy and ultrasonic symptomatology of the diseases of the digestive system and the abdominal vessels. Numerous tips on avoiding pitfalls, as well as indications for other procedures, and backed by some 1000 illustrations, this is well on its way to becoming a standard text for practitioners and clinicians in the field.

There has been incredible progress over the last decade in therapeutic endoscopy. Such therapies are either easier now than ten years ago or are possible when previously they were inconceivable. These advances have depended upon major improvements in diagnostic endoscopy for different subspecialties. Simultaneously, a major innovation for therapeutics through endoscopes is the application of medical lasers. This book is written by renowned biophysicists and laser endoscopists of different sub specialties where the application of lasers has revolutionized medical care. In some cases treatments which were not previously possible are now routine. Laser palliation of obstructing tumors in different sub specialties is an example of this. In other cases, resective surgery is obviated by the application of lasers via endoscopy such as for the control of gastrointestinal bleeding. The authors of different medical or surgical subspecialties which use endoscopic lasers write about the pathology and clinical problems, their personal experience and results. However, they also emphasize their techniques of laser endoscopy through case examples, technical discussions, and colored illustrations. Their discussions will give the reader a better understanding about the role of laser treatment of different conditions compared to routine medical or surgical therapy. In several instances, randomized controlled trials involving medical lasers were discussed in this book because they fundamentally changed our understanding of common problems such as upper gastrointestinal bleeding. We predict continued progress in therapeutic endoscopy.

Albumin is the most abundant serum protein produced by the liver. In clinical practice the serum level of albumin continues to be used as an important marker of the presence, progress or ofthe improvement of many diseases, even though it is the complex end result of synthesis, degradation a. nd distribution between intra- and extravascular space. The clinical history of albumin began as early as in 1837, when Ancell first recognized "albumen" and noted that this protein is needed for trans port functions, for maintaining fluidity of the vascular system and for the prevention of edema. However, the important physiological properties of serum proteins and their role in the regulation ofthe oncotic pressure were demonstrated later by the physiologist E. H. Starling in 1895. In 1917 the clinician A. A. Epstein first described the edema in patients with the nephro tic syndrome as being a result of a very low level of serum albumin. Al though the determination of serum albumin concentration became more popular after Howe in 1921 introduced the technique of separation of serum globulins from albumin by sodium sulfate, the first preparations of human serum albumin were made available for clinical use in only 1941 by the development of plasma fractionation by Cohn and his coworkers at Harvard Medical School."

by Dr. Jan. J. Smulewicz Ultrasound imaging has reached a stage of sophistication where by diagnostic information can be gained without discomfort to the patient and with complete absence of morbidity and mortality. The procedure is quick, safe, noninvasive and in many instances can supersede and obviate more time-consuming procedures requiring catheterization, injection of a contrast material, and radiographic imaging. In obstetrical problems the danger of ionizing radiation to the fetus is eliminated. In debilitated and very ill patients this simple and painless method becomes the procedure of choice. Unique features of ultrasound equipment allow for pinpoint local ization oflesions and direct visual guidance of percutaneous puncture techniques for aspiration and biopsy. The accuracy of ultrasound guided punctures and the absence of side effects make this modality far superior to percutaneous invasive techniques performed with other imaging systems. Renal cyst puncture and amniocentesis are but two of the procedures in which ultrasonic guidance is the method of choice. v Dr. Hassani has throughly explained and carefully explored the wide variety of exam inations available with ultrasound. The large volume of material and the clear interpre- tion makes this book of great interest to all of the medical profession. In addition to the existing methods available for diagnostic in terpretations, this method of noninvasive diagnosis should find its way into every hospital or center where good medical care is provided. JanJ. Smulewicz, M.D."

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.

Surgical Diseases of the Spleen written and edited by internationally renowned scientists will be a masterpiece for any institution. It provides an updated multidisciplinary review of diseases of the spleen. Experts in the field have customed their chapters to further ease the readers understanding offering all the information needed to progress in this area. Different sections on basic concepts, specific splenic diseases and operative techniques cover new aspects in immunology, infectious, traumatic and neoplastic conditions.

I am delighted to be able to write the foreword for this new book on Helicobacter pylori by three pioneers in the field, Vlf West blom, Steven Czinn and John Nedrud. Because of their long experience in both basic and clinical aspects of H. pylori, the editors have been able to produce a volume which is authoritative and up to date in the science of H. pylori, while still being concise and interesting for the practicing physician or H. pylori novice. To achieve this, they have collected a very distinguished group of authors from within the Vnited States and around the world. The chapters are sequenced in approximately the same order as developments in H. pylori science over the past 15 years. The first chapter on the discovery of H. pylori is by Cliodna McNulty, who was the first person to culture the organism in Europe. The epidemiology is then described followed by the main clinical as sociations, which are gastritis and dyspepsia, peptic ulcers, can cers and lymphoma. This naturally leads to discussion of the laboratory aspects of H. pylori, especially the microbiology, in cluding essential information on antibiotic resistance patterns. Next, virulence and pathogenicity of H. pylori are explained as defined in studies using animal models, then by discussion of the metabolism of the organism. Finally, the interaction of the bac terium with the host immune systems is dealt with, including the implications of these findings as they relate to the development of future vaccines."

The advances in science and medicine we are now experiencing are unprec edented and exciting. Life expectancy is prolonged, and quality of life is much improved. We learn of fabulous new discoveries made at the bench or the bedside every week. Many diseases have been totally eliminated, others can be significantly improved by new therapeutic formulations. Much of the success can be attributed to a better understanding of disease processes and the specific targeting of new and more effective medications. As is the case in many areas of successful human endeavour, there can be a downside. In the case of drugs and chemicals it is their adverse effects which are of concern. Of course, every effort is made to devise medications that are safe, and the need to elucidate and understand mechanisms are crucial, yet adverse effects remain a problem. They can be unpredictable and diverse. Drugs have been shown to induce virtually the whole gamut of human liver pathology from acute fulminant hepatitis to chronic active hepatitis to cirrho sis and even malignancy. Hence the possibility of adverse drug effects must be considered in the differential diagnosis of many patients with liver disease. This is well recognized and is very important; indeed, removal of the offending agent can often lead to reversal of the adverse effect. This is an area of hepatology where we can really make a difference."

These proceedings of an international meeting held as recently as December 1996 cover diagnostic procedures in pancreatic disease, together with the progress made over the last 10 years in treating acute and chronic pancreatitis as well as pancreatic cancer. The meeting also covered standards in medical and surgical treatment.

Pathology of the Stomach and Duodenum comprehensively surveys gastric and duodenal disease, including clinical findings, pathophysiology, and epidemiology, and emphasizing diagnostic gross and microscopic pathology. Topics discussed include anomalies, gastritis, peptic ulceration, hyperplasias and benign epithelial tumors, carcinoma of the stomach and duodenum, carcinoid tumors, reactive and neoplastic lymphoid lesions, gastric smooth muscle and nerve sheath tumors, and miscellaneous lesions and rare conditions reflecting gastroduodenal participation in systemic disease.

The Leiden-Edinburgh Boerhaave Course on 'The Gastro-intestinal Tract', held in Leiden on October 29 and 30, 1969, resulted from the renewed co-operation between the Medical Faculties of Edinburgh and Leiden, based on very old ties. As one will know, the Edinburgh Faculty of Medi cine was founded in 1726 on the principles guiding the Leiden Faculty of Medicine at that time, on the instigation of John Monro I, who had studied medicine in Leiden under the famous Boerhaave. These old ties were revived some 8 years ago, first by students, later by the Faculties themselves, with the special purpose to facilitate and en large the exchange of medical knowledge between two medical centres. One of the results of this was that it was considered whether physicians from both countries could not profit from the knowledge gained specific ally in both these faculties by letting the investigators from both faculties tell about their work within the framework of courses for post-academic medical training, in Leiden called the 'Boerhaave Courses'."

The purpose of this series of volumes is to present a comprehensive view of the complications that result from the use of acceptable diagnostic and therapeutic procedures. Individual volumes will deal with iatrogenic complications involving (1) the alimentary system, (2) the urinary system, (3) the respiratory and cardiac systems, (4) the skeletal system and (5) the pediatric patient. The term iatrogenic, derived from two Greek words, means physician-induced. Originally, it applied only to psychiatric disorders generated in the patient by autosuggestion, based on misinterpretation of the doctor's attitude and com ments. As clinically used, it now pertains to the inadvertent side-effects and com plications created in the course of diagnosis and treatment. The classic categories of disease have included: (1) congenital and developmental, (2) traumatic, (3) infectious and inflammatory, (4) metabolic, (5) neoplastic, and (6) degenerative. To these must be added, however, iatrogenic disorders-a major, although gen erally unacknowledged, source of illness. While great advances in medical care in both diagnosis and therapy have been accomplished in the past few decades, many are at times associated with certain side-effects and risks which may result in distress equal to or greater than the basic condition. Iatrogenic complications, which may be referred to as "diseases of medical progress," have become a new dimension in the causation of human disease."

Primary Liver Cancer: Surveillance, Diagnosis and Treatment focuses on the many therapies rapidly evolving to assist with controlling hepatocellular carcinoma as well as emerging technologies to assist in early diagnosis as well as prevention. All chapters are written by experts in their fields and include the most up to date information for diagnosis, treatment, surveillance, epidemiology, staging, recurrence and prevention. This volume will serve as a useful resource for clinical gastroenterologists, hepatologists, oncologists, pathologists, and physicians who treat patients with chronic liver disease and hepatocellular carcinoma.

The original series, Advances in Prostaglandin Research, edited by Sultan M. M. Karim, was published by MTP Press in three volumes in 1975 and 1976. A glance at those books illustrates the progress that has been made since then. The thromboxanes were mentioned twice (first publication 1975) and prostacyclin not once (first publication 1976); leukotrienes were only on the horizon. The amazing generation of research data in the last 10-15 years has given new, broad insights into many areas, including asthma, inflammation, renal, cardiovascular and gastrointestinal diseases and in reproduction, and has led in some instances to real clinical benefit. This series, Advances in Eicosanoid Research, reflects the current understanding of prostaglandins , thromboxanes and leukotrienes. The aim is to provide an introductory background to each topic and the most up-to-date information available. Although each book stands alone, the eicosanoids cut across many boundaries in their basic actions; selected chapters from each book in the series will provide illuminating and productive information for all readers which will advance their education and research. In the production of this series, I must acknowledge with pleasure my collaboration with editors and authors and the patient endeavours of Dr Michael Brewis and the staff at MTP Press. KEITH HlLUER University of Southampton England ix Preface This book is an appraisal of areas in human reproduction where eicosanoid studies (prostaglandins, leukotrienes and thromboxanes) are contributing to physiological and pathological awareness and clinical advances.

J. E. Fischer, M.D. Professor Greep, ladies and gentlemen. It is a great pleasure for me and the participants to be present at this International Meeting of Parenteral Nutri tion. This meeting would not have been possible five years ago. At that time we were still arguing about central vs. peripheral routes, efficacy of the tech nique, and still getting accustomed to our ability to support patients nutri tionally. Within the last five years these discussions, which seem almost futile in retrospect, have been put aside. Both techniques, we know how, work quite well and have their own indications. Having become comfortable with the technique, it is now time to enter the second phase of parenteral nutrition, and that is the differentiation of the technique for the benefit of different patients. Over the next two days we will be discussing several problems which at the present time are central to the entire subject of parenteral nutrition. Is a fat calorie the same as a carbo hydrate calorie? What is the effect on protein metabolism of the fat calorie as opposed to the carbohydrate calorie? Are they equivalent? Are'there situations in which one is superior to the other? Perhaps we will find out tomorrow in the panel."

New surgical techniques for the treatment of anal incontinence have given the increasing number of afflicted patients hope for a cure. Colorectal surgeons and more and more general surgeons are performing operations, yet until now they have not had a text that they can use as a reference work. The guidance and instruction that surgeons need are now available in this atlas. It describes every operation in technical detail, and the two-color illustrations clearly show the essential points of each procedure. The authors discuss thoroughly the indications for surgical treatment, its application to the individual patient, and post-operative care. The comprehensive scope of this book makes it a rich source of information for surgeons working outside highly specialized centers. For specialists, it is the only practical reference available on the subject.

Grouping ulcerative colitis with Crohn's disease (Inflammatory Bowel Disease) in a teaching seminar has historical support. The medical literature includes descriptions of both diseases in the latter half of the 19th century; they share many symptoms; in some instances, differentiating them may be very difficult; and the cause of each remains unknown. Furthermore, one member of a family may suffer with Crohn's disease while another has ulcerative colitis. And both processes are prone to the late complications of carcinoma at a site of previous involvement. Finally, the investigators and students of one disease have usually also contributed to the understanding of the other disease. The incidence of Crohn's disease seems to be increasing rapidly. This has been sug gested by reports from Sweden, the Netherlands, England, Scotland, and South Africa as well as the United States. Though methods of recording data vary, the increase is further supported by cases of greater virulence, still younger ages of onset, and more cases in the elderly. This is remarkable when we consider that fifty years ago, when the classic description from Mt. Sinai Hospital was being prepared, the disease was rare. Since the cause remains elusive, we must try to cope with this entity as skillfully as we can, with consideration of indications, and timing of drug and surgical intervention. The choice of forms of management has been controversial, even among the most experi enced physicians."

The secretion of bioactive products by tumors of the gastroenteropancreatic system results in the development of watery diarrhea that can lead to death in a very short period if not brought under control. Even if the consequences are less dramatic, the patients' ability to lead a normal daily life is seriously impaired, and they may become severely depressed. SandostatinR alleviates the condition by inhibiting peptide release, and its long duration of action makes it an effective and rational adjunct to therapy at all stages. Last year a consensus Round Table Meeting was held in Scottsdale, Arizona, to discuss the optimal use of SandostatinR in this indication. These guidelines offer the results of clinical research and the dosage recommendations arising from them, together with a critical summary of the points of view presented.

Exciting major changes have occurred in the understanding and treatment of gallstone disease over the last two decades. In bygone years, books about gallstones were often based on postgraduate lectures which the author, usually a surgeon of distinction, had given. More recently, many books dealing with this subject have been based upon national or international conferences. The single-author text has the disadvantage that few authors today can authoritatively encompass a whole field: the reports of symposia, conferences or workshops often lack balance and auth ority. The merits of 'Gallstone disease and its Management' edited by Malcolm Bateson are clear. He has chosen 11 authors, all of whom write on topics relating to their own expertise, and the content of the book has been carefully planned to reflect the most modern ideas about the aetiology and management of cholesterol gallstones. It is worth repeating that we are experiencing rapid developments in the field of gallstone disease. Disappointingly the least progress has been made in identifying the cause (or causes) of the disease notwithstanding the many data implicating a variety of environmental factors. Most of these affect the chemistry of hepatic bile and the contribution of the gallbladder to lithogenesis remains uncertain and unstudied."