Chronic viral hepatitis affect hundreds of millions of people worldwide, and each year millions more people become infected. In Chronic Viral Hepatitis, Second Edition, a panel of distinguished clinicians and clinical investigators build upon the first edition by comprehensively reviewing all the relevant new information regarding resistance, side effects, and therapies for chronic viral hepatitis. The text covers recent advances in the understanding of pathogenesis of viral hepatitis while discussing promising agents in development for its treatment. The authors devote special attention to reactivation of hepatitis B with chemotherapy and immunosuppression, herbal and non-traditional therapies, chronic viral hepatitis in the pediatric population, and immunology and immunotherapy of HCV and provide relative costs for all diagnostic and therapeutic options. Authoritative and up-to-date, Chronic Viral Hepatitis, Second Edition offers today's gastroenterologists, internists, hepatologists, and infectious disease specialists a practical guide to the recognition, diagnosis and treatment of chronic viral hepatitis from a multidisciplinary approach.

This volume contains the papers presented at the Inter- national Symposium on "Cirrhosis, Hepatic Encephalopathy and Ammonium Toxicity", held in Valencia, Spain, November 27-29, 1989. Hepatic cirrhosis as well as other liver failures usual- ly lead to hepatic encephalopathy which is an important cause of death in occidental countries. However the molecular bases of the pathogenesis of hepatic encephalopathy remain unclear and several hypotheses have been proposed. Hyperammonemia is considered one of the main factors responsible for the mediation of hepatic encephalopathy. Therefore, a part of the book is devoted to the effects of hyperammonemia on cerebral function, ammonia and amino acid metabolism, brain microtobules, astrocytes and synaptic trans- mission and their possible role in the pathogenesis of hepatic encephalopathy. Carnitine has a remarkable protective effect against acute ammonium intoxication. Thus some results regarding this effect are also presented, as well as the clinical use of car- nitine. The alterations of the metabolism of ammonia and of seda- tives in liver diseases and their clinical implications are also discussed. The possible role of altered GABA-ergic neurotransmission on the pathogenesis of hepatic encephalopathy has received considerable attention recently. Results of these studies and those on benzodiazepine receptor ligands are presented as well as those on the hypothesis of the role of altered synaptic plasma membrane on the pathogenesis of hepatic encephalopathy.

In an attempt to attain the best possible delimitation of all the problems posed today by benign diseases of the esophagus, 181 authors each agreed to answer one or more of 210 questions that had been drawn up on the subject. These questions, each one deliberately limited and difficult, mostly concerned reflux esophagitis: its natural history, the means of its diagnosis, all existing treatments, and its eventual degeneration. The authors approached are today's most reputed specialists in the fields of epidemiology, gastroenterology, endoscopy, pathology, and surgery of esophageal diseases. The authors were all assigned one or more questions in their own field, none of which was simple: all did their best to synthesize in their replies their own experience on the precise point under review and included all the most useful bibliographical references on the topic. The book is thus the result of an original, individual approach to try to pinpoint the heart of a problem. The 210 answers succeed one another in logical progression according to the different diagnostic and therapeutic stages, specifying, at each step, the degree of precision sought. Consequently, the reader has at his disposal an exceptional synthesis of facts and concepts. Opening the book at random he will find at once the detail he is looking for, the professional opinion he is lacking, or the development of a question he had perhaps not yet asked himself.

Biopsy of the gastrointestinal tract has been revolution less busy) teaching hospital. These sort of techniques, which I confess interest me greatly because of the ized by the introduction of fibreoptics; the proximal additional information which they can yield when rightly reaches, as far as the second part of the duodenum, and chosen, are naturally linked with improved methods of the whole large bowel back to the caecum can now be tissue preservation in general, bearing in mind that the sampled under direct vision and multiple small biopsies need for special techniques often becomes apparent can be obtained. Only in the jejunum and ileum are there only when the biopsy has been conventionally still limitations on the sampling of localized as opposed to generalized conditions. The sheer volume of gastro processed and examined. However, I have firmly intestinal material passing through our own laboratories stabled this hobbyhorse and have included little that has risen steeply over the last years to form some 25% cannot be done in a district general hospital and nothing that I am not prepared to do myself. I have tried to of the total current work load and the rise continues; stress, particularly, common lesions which can cause nearly all of it is in biopsy form rather than as resected specimens."

This is the fourth Falk Symposium devoted to the study of intestinal abso~ l 3 tion. As in the case of its predecessors - , I hope that the relaxed atmosphere will enable the participants from all comers of the world to exchange views, not only in this room, but also at less formal moments in the cellar, on the lake, or in the buses that transport us to different parts of the Schwarzwald. We are all eternally grateful to Dr Herbert Falk for undertaking to sponsor this meeting, and to him and his staff for the impeccable organisation which will permit us to work in such a pleasant environment. In the organisation of the programme, one or two innovations have been in troduced which are perhaps foreign to routine gastroenterological meetings. First, the average age in this room is rather lower than at most gatherings of this nature, which means that those who carry out the experiments will be responsible for their presentation; they are after all the ones who have made the relevant small observations which lead to the advancement of knowledge.

Several methods have been used to demonstrate the vasculature of different organs in man and other species. Many attempts to evaluate the precise microangioarchitecture of organ systems remained unproductive, others were controversial. The development of electron microscope in thirties opend new perspectives in researching microvascular systems. Transmission electron microscopy provided a two-dimensional view on microcirculatory system at higher magnifications, however, its standardization was delayed unnecessarily. The use of methyl methacrylate and related compounds for obtaining replicas of vascular beds, and their study in scanning electron microscope opened a new window in micromorphological research. For the first time, a three-dimensional image analysis of the vascular system was possible. The microvascular corrosion casting method has meanwhile attracted the interest of many contemporary scientists. Its application to medical and biological problems justify it to be used as a routine method for microvascular investigations. The first investigators who used this method, focused either on methodological details or they dealt with the normal microanatomy of organs. The advantages of this method in demonstrating pathological microvascular patterns are also evident.

The literature of medicine continues to expand at a remarkable pace. The number of papers and monographs published has increased dramatically in the past five years. Nowhere has this increase been as dramatic as in the field of acute and chronic hepatitis. Why then should there be still another book? Despite the sheer volume of words published, it is still difficult to find in anyone volume a compilation of all of the most significant work. Most mono graphs have considered either chronic or acute hepatitis, not both. Few works have addressed both the clinician and the basic scientist. This book addresses both of these audiences and considers both of these diseases. It was designed to provide an authoritative but concise assessment of our changing concepts of acute and chronic hepatitis. It covers what is currently known and, based on the most convincing research, believed about these diseases. To fulfill this ambitious goal, only authors with international reputations in their fields of expertise were invited to contribute. In the evolution of our current thoughts on the pathogenesis and manage ment of acute and chronic hepatitis, our ideas have changed several times. This book presents the facts as they are known today and, in areas where all the facts are not established, presents the well-founded opinions of those considered to be authorities. The authors present established and usually confirmed data and do not deal extensively with areas of speculation or unconfirmed material."

Inflammatory dieseases of the pancreas occur with increasing incidence in western industrialized countries. This volume deals with all aspects of CHRONIC PANCREATITIS including epidemiology, etiology, morphology and pathophysiology, dia- gnostic imaging as well as conservative and operative treat- ment. Very recent data based on experimental and clinical research projects are presented. The contributions have all been written by a team of internationally well recognized authorities in the various fields involved. Topics of parti- cular interest include feed-back regulation, new aspects of conservative and interventional treatment as well as modern surgical approaches including organ-preserving procedures.

Epidemiologists, on the basis of studies carried out chiefly in Africa, have suggested that depletion of fiber in the modern Western diet affects health adversely. D. P. Burkitt, who has been in the forefront of this investigation, has included among the "diseases of civilization" hiatus hernia, ischemic heart disease, cholelithiasis, polyps of the colon, and cancer of the colon. All of these conditions appear to have the same geographic distribution. In these areas, the diets were characterized by increased amounts of fat and meat protein, and by an apparent deficit of fiber. It is noteworthy that while an increased intake of refined sugars also has been implicated in the Western diet, the consumption of sugar and other sweetners in the United States actually has remained fairly stable since about 1925 when the use of complex carbohydrates in the form of starchy foods began to decline. The mechanism whereby deficiency of fiber in the diet contributes to the development of colonic diverticula, presumably is by facilitating the development of segmentation of the colon and pockets of intracolonic high pressure zones associated with prolonged transit time of bowel content. Preliminary therapeutic observations, furthermore, have suggested that the addition of fiber in the form of bran to the diet may promote regularity of bowel function and perhaps lessen the likelihood that new diver ticula will be formed after the resection of involved colonic segments."

Drugs are often associated with adverse effects, and the digestive tract is the most frequent target. This volume collects a number of updated overviews from experts in this area to offer to the reader a single, complete source of information and reference on that subject.

The immunology of mucosal surfaces is one of the most exciting and relevant areas of medical veterinary and dental research since it applies basic research to tissues in volved in everyday defence against microbes and against environmental and food antigens. This book is based on the contributions presented at the International Con gress of Mucosal Immunology, held in London in July 1989 and organised by the Mu cosal Immunology Affinity Group of the British Society for Immunology. The meet ing was attended by over 500 delegates from 27 countries, including virtually all of the leading investigators in the field. The contents give comprehensive and up-to date information on such topics as antigen presentation and processing in the gut, mucosal vaccines in man and animals, HIV infection in the gut, the role of yo T cells in the gut epithelium, recent advances in inflammatory bowel disease and coeliac dis ease, the role of cytokines in the regulation of the IgA response, mucosal mast cells and cell migration. The contributions reflect the rapid pace of research in mucosal immunology, and the great strides which are taking place in the understanding of the immunology, molecular biology and biochemistry of host response at mucosal sur faces."

In the rapidly evolving field of Helicobacter infection new data on pathogenetic and pathophysiological mechanism have appeared. New methods which will be more sensitive and specific in the diagnosis of the infection are being developed and in this proceedings the first attempt using PCR technology is published. From the clinical point of view, a challenging aspect that needs clarification, is the observation which suggests an appearance of a correlation between the presence of the bacteria and abdominal pain and other symptoms in children whereas in old age no such correlation is evident. The relationship of H. pylori and gastric cancer is studied with histopathological data and epidemiological approaches. On the treatment side schemes using short courses and new antibiotic combinations are being investigated and preliminary data are reported.

The Symposium "Esophageal Carcinoma - State of the Art" has aroused very great interest. The numerous enquiries have caused us to publish the congress proceedings in the present volume. Particular attention was paid to current topical problems. One of the areas on which the present volume focuses is the epidemiol- ogy and pathology of esophageal adenocarcinoma. Compared to squamous epithelial carcinoma, this is increasing in incidence in Europe. Modern diagnostic methods are described such as laser- induced fluorescence spectroscopy or the optical coherence endo- scopic technique. The latter enables normal mucosa to be distin- guished from dysplastic or malignant lesions, in contrast to con- ventional endoscopy. As in other tumors of the gastrointestinal tract, neoadjuvant therapy is becoming of increasing importance. Since the indication crucially depends on the tumor stage, two contributions deal with postoperative staging, with the diagnostic reliability of the individual techniques and new methods such as endoluminal MRI. There is no doubt that neoadjuvant chemo- therapy is indicated in tumors which are irresectable and in tumor stages in which resectability is uncertain. However, to what extent it should also be applied in the resectable stage will be discussed in the individual contributions both for adenocarci- noma and for squamous epithelial carcinoma. In the meantime, surgical treatment of esophageal carcinoma has been largely stan- dardized. Differences with regard to radicality are still found in the extent of lymphadenectomy, especially in inclusion of cervi- cal lymph nodes.

Causes and Control of Colorectal Cancer: A Model for Cancer Prevention is a ground- breaking monograph which takes a global, multidisciplinary approach to the causes, carcinogenesis and control of colorectal cancer. Over 1000 key studies were analyzed on colorectal cancer cause, carcinogenesis, primary prevention, early detection using modern screening techniques, and surveillance after tumor excision. All major research results are included up to the date of publication. The key chapters include those on morphology, molecular biology and evolution of tumors, etiology chapters on heredity, diet, alcohol, smoking, physical activity, life stress and others, while major chapters in the area of colorectal cancer control are on primary prevention, early detection by screening and surveillance, and post-tumor excision surveillance. Important recommendations on primary prevention, screening and surveillance of colorectal tumors are made in keeping with the most current research data. Causes and Control of Colorectal Cancer: A Model for Cancer Prevention takes colorectal cancer control into the 21st century, and suggests this to be the first cancer in which control will be largely achieved within the next generation, as a result of the unprecedented multidisciplinary research into causation, primary prevention, screening and surveillance over the past 30 years. The book also serves as a model for the control of other common malignancies, particularly cancers of the breast and prostate, the causes and prevention of which are less well understood.

The larvae of Anisakis, whose adult form lives on sea mammals such as whales, seals, and dolphins, are parasitic upon many species of salt-water fish. When the final host animals eat paratenic hosts, the larvae grow to adulthood in the hosts' stomach. However, when hu mans eat these infested fish, the larvae die instead, causing a disease called anisakiasis. In 1960, in the Netherlands, van Thiel et al. found a worm in the intestinal wall of a patient who had eaten raw herring and had suffered symptoms of acute abdomen. The impact of this report was tremendous among Japanese parasitologists because of the Japanese habit of eating raw fish. In 1964, the Special Research Group from the Ministry of Education was established to investigate the disease, stimulating progress in the study of anisakiasis. Three types of worm, Anisakis simplex larva (previously known as Anisakis larva type I), Anisakis physeteris larva (Anisakis larva type II), and Pseudoterranova decipiens larva type A, are believed to cause anisakiasis. As many as 165 kinds of fish and squid in the seas near Japan are hosts to Anisakis simplex, and 9 species are hosts to Pseudoterranova decipiens larvae. Contra caecum has experimentally been observed to invade the gastrointestinal tract, but no infection by this larva has been reported in humans. A case of infection by Pseudoterranova decipiens type B has been described. In Japan, the name Terranova decipiens (Shiraki 1974) has been adopted instead of Phocanema decipiens (Mozgovoi 1953)."

The classification of tumors is important for understanding tumor histogenesis, for predicting prognosis, for differential diagnosis, and for recommending appropriate therapy. Since 1836, when pancreatic cancer was first described, progress has been made in pancreatic cancer morphology, and a number of classifications have been proposed. All of these classifications are mainly based on morphological characteristics. Some are too detailed to be of practical use while others are more pragmatic. Some of the inherent problems in the previous classifications included difficulties in obtaining an adequate number of pan creatic tumors for examination and insufficient clinical data and follow-up. With the increasing incidence of pancreatic cancer in many parts of the world during the past six decades, and with the availability of more tumors to patho logists, advances have been made in pancreatic tumor studies. Classifications by Cubilla and Fitzgerald and by Kloppel, which are generally similar, mostly considered prominent morphological features and their histogenesis. These pathology-oriented classifications, although complete, were not practical from the standpoint of clinicians concerned with the prognosis of individual tumors."

More than a century ago, Cripps successfully employed the direct and complete division of the anal sphincters as a means of approaching the lower rectum and anal canal, and reported on a series of 36 patients who had been treated in that fashion. Cripps was pleasantly surprised to find good fecal continence in over two-thirds of the patients during later follow-ups, despite the fact that the divided sphincters had not been repaired. The transsphincteric procedure was largely forgotten in subsequent years, however, and only the parasacral proctotomy of Kraske, which spared the anal sphincters, can be said to have gained an established place in the" surgical armamentarium. " It remained for York Mason to redirect the attention of the surgical community to the great potential of the trans sphincteric approach and the excellent continence that can be achieved through adequate repair of the divided sphincters. Having recognized the outstanding practical value of this procedure, we felt it necessary to define more precisely the anatomical prerequisites that would ensure minimum operative bleeding, and to bring the procedure more in line with current knowledge of normal continence and defecation. Dr. A. Huber, in consultation with the director of the Institute for Clinical Anatomy of our surgical department, Prof. A. von Hochstetter, did many months of dissection work on fresh anatomic preparations in an effort to explore and refine the various aspects of the trans sphincteric ap proach."

This study assembles current and new information on the mechanisms involved in intracellular calcium regulation and their actual or potential relationship to cellular calcium transport. Topics discussed in detail are calcium channels, cellular calcium extrusion, sodium/calcium exchange, calcium-binding proteins with special reference to the vitamin D-induced calbindin, calcium transport and disorders thereof. Each topic is introduced with an overview followed by research papers dealing with relevant topics in each category. New information deals with calcium channels which are not voltage-sensitive, the structure and function of the plasma membrane Ca ATPase, the role of the Na/Ca exchanger in intracellular Na and proton regulation, a comprehensive overview of calcium transport with quantitative analysis of the role of the intestinal and renal calcium-binding proteins, description of the structure and function of the calbindin genes, and identification of calcium transport defects in diabetes and hypertension. Readers will be brought up-to-date on current knowledge and concepts in this rapidly expanding field and be directed to the relevant primary and secondary literature.

Provides findings on acute pancreatitis in the fields of morphology, epidemiology, pathophysiology, enzymatic and in- strumental diagnosis, clinical aspects and pharmacological and surgical treatment. Emphasis on clinical implications on the local release and vasoactice and toxic substances, the high rate of bacterial infection in the necroses, and the causes of impairment of cardiocirculatory, pulmonary and re- nal organs.

It is now more than 40 years since Drs. Wild and Reid published their first experience with rectal ultrasonography from the Surgery Department at the University of Minnesota. Professor Owen H. Wangen steen, in whose laboratory the studies were carried out, recognized at that time the need for early detection in the treatment of cancer. Technical improvements over the past 20 years have made endoscopy the procedure of choice for examination of the hollow organs of the genital, urinary and gastrointestinal tracts. The simultaneous development of endosonography has had an equally dramatic impact on the practice of medicine and surgery. The technology has been demonstrated to be helpful in both benign and malignant conditions. One of the so-called benign conditions of the anorectum is fistula-in-ano. Fistula surgery has always relied on excellent anatomic delineation of the intramuscular tracts. There is hope that adaptation of ultrasonographic technology will aid in the surgical management of this malady. Clearly, rectal ultrasonography has considerable potential in the management of rectal carcinoma. Accuracy rates in the range of 90% for the depth of neoplastic invasion have been reported. This ability for accurate assessment will undoubtedly lead to a better definition of the population of patients that can be managed by local therapeutic means.

This book aims to be a synthesis of our current knowledge about the normal and pathological esophagus. Although a number of excellent monographs on limited aspects of esophageal pathology are available, a recent handbook treating the whole of esophageal physiology and pathology is lacking. We attempted to present the collected material in such a way that even the neophyte in the field would not get lost in the wealth of data. For this reason we have included a number of illustrations such as classical radiological and endoscopic images, manometric tracings and uncomplicated graphs, which may seem superfluous for specialists but will be helpful to the reader who wants to be initiated in the subject. At the same time we tried to be fairly complete so as to make available to the esophageal specialist a book of references, to which he can readily turn when faced with rare diseases or unusual physiological or pathophysiological pheno mena. In order to achieve both aims the authors often give their own point of view when faced with controversal topics, while classical as well as more recent features and concepts are mentioned and diverging opinions discussed."

Modern surgical oncology is characterized by multimodal therapy. In recent years numerous therapeutic approaches of pre-, peri-, intra-and postoperative treatment have been in vestigated with regard to their use in combination with surgi cal intervention. It now is time to analyze and to define the state of our knowledge. For tumors of the gastrointestinal tract there are several encouraging therapeutic approaches, such as preop erative chemotherapy in esophageal and perioperative chemotherapy in colon cancer. For some special tumors, like anal carcinoma, we have clearly defined combined therapies which even now must be viewed as standard treatment. It is also time to demonstrate the results of several clini cal studies that have been conducted within the last few years that combined surgical efforts with pre- or postinter ventional chemotherapy or radiotherapy. It is necessary to evaluate whether these trials contribute to progress in onco logical therapy. The editors of this volume - surgeons at the university hospitals of Heidelberg and Zurich - must be given the mer it of achieving these goals. It was especially appropriate for the Department of Surgery in Heidelberg, in close coopera tion with the Comprehensive Cancer Center Heidelberg/ Mannheim, to prepare a review of our present knowledge of surgical oncology as it is in the tradition of attempting to combine different therapeutic approaches to cancer therapy.

A new presentation of physiological regulatory mechanisms and therapeutic applications is given in this book. It represents a collection of the most up-to-date information in cholecystokinin (CCK) research, especially focusing on the development and characterization of CCK antagonists. The book contains chapters on the synthesis, biochemical and pharmacological characterization of potent and selective CCK antagonists as well as physiological applications of these compounds. The last section of the book is devoted to the involvement of CCK in pathological states and potential clinical applications of CCK antagonists.

The Bloomsbury Series in Clinical Science is growing and changing. Its Editorial Board and contributors were all originally selected from, or had links with, the University College and Middlesex School of Medicine. Now, as the Series develops, board members and con tributors alike identify with the wider reaches of Bloomsbury and Islington. The aims of the Series remain, however, to highlight, to review and to record significant areas of research and development in the field of clinical science. All contributors are experts in their particular field and monographs may be the work of a single author or several, guided by individual editors. Diseases in the Homosexual Male is the third monograph in the Series. Edited by Michael Adler, Professor of Genito-Urinary Medicine at the University College and Middlesex School of Medicine, it presents contributions from a number of distinguished workers with special expertise. AIDS has perhaps highlighted the problem but this monograph illustrates the wider profile and gives wit ness to the multidisciplinary nature of clinical science."