The intestinal protozoan Giardia was first described over 300 years ago in 1681 by Leeuwenhoek, from his own stools. In his description of Giardia, he noted the size, movement, and morphology of the organism, and associated its presence with the diarrheic nature of his stools and his dietary habits. This truly remarkable account contains the first description of Giardia in morphologic, pathogenic, and epidemiologic terms. Our knowledge of the organisms in the genus Giardia has advanced tremendously in the past two decades. With the advent of new tech nologies, including techniques in electron microscopy, biochemistry, immunochemistry, tissue culture, and physiology, a tidal wave of information has appeared on the organization and function of this parasitic protozoan and its interaction with its host. The purpose of this book is to celebrate the tricentennial discovery of Giardia by Leeuwenhoek by presenting the above-mentioned advances in our knowledge of Giardia and giardiasis. In the first section of this book, the dominant theme is the biology of the organism and the correlation of structure-function relationships."

In the past 15 years much evidence has accumulated which indicates the paramount importance of sensory nerves in reg ulating functions of the gastrointestinal tract. In parallel, the attention of researchers in this field has been increas ingly attracted to the role played by neuropeptides in the normal and diseased gut. Basic research on the peculiar properties of capsaicin, the pungent ingredient from plants of the genus Capsicum, has allowed the gap between these two areas of research to be bridged. Sincethen, the study of gut afferents and neuropeptides has become more and more interconnected and recognized as a major avenue to understand ing the pathophysiology of various human diseases. It is widely recognized that a certain subset of primary afferents synthesize, store and release neuropeptides (such as tachykin nins and calcitonin gene-related peptide) from their central and peripheral endings, the latter being widely distributed in the alimentary canal and related organs (liver, pancreas). The First International Meeting on Sensory Nerves and Neuropeptides in Gastroenterology, held in Florence from December 4-5, 1989, sponsored and organized by Fondazione Internazionale Menarini, aimed to focus the current status of research in this field. The contributions presented at the meeting and in this book delineate a suggestive scenario in which sensory nerves of the gut, and the multiple messages they carry through the release of neuropeptides, are to be considered as a major target for the development of new drugs potentially useful in a number of diseases of the gastro intestinal tract."

General Section. Progress in laparoscopy (new instruments, technical innovations, integration between laparoscopy and sonography). Special Section. Traditional and present indications for laparoscopy. Laparoscopy inliver diseases. Oncological lapaoscopy (diagnosis, staging and follow-up for malignant tumors). Emergency laparoscopy.

There is a tradition behind the current radiologic examination of the small bowel. Many of the great names in gastrointestinal radiology have established their reputations on the basis of their work in the small bowel. This is an area which is assuming ever greater importance for radiologists as its mucosal surface continues to elude the endos copist. Moreover, it is an aspect of radiology which calls for the greatest technical and interpretative skill. It is a great pleasure to welcome the English language version of this beautiful work on Radiology of the Small Intestine. English speaking physicians are frequently not as familiar with the large body of work published in French as they should be. Tant pis ! Dr. Bret and his co-workers have been pioneers in the pursuit of excellence in gastrointestinal radiology. During all the years that I have been involved in this field, I have admired their work.

As in the first edition of Inflammatory Bowel Diseases this new edition continues to provide readers with a concise, yet in-depth review of many of the important areas in the history, epidemiology, pathogenesis, diagnosis, and treatment of the inflammatory bowel diseases (ulcerative colitis and Crohn's disease), as well as associated issues: extraintestinal manifestations, ostomy care, women's issues, economics, etc. This Second Edition provides the reders with up-to-date, state-of-the art approaches to these disease states, with expansion into the newer topics that have emerged in the past few years which include the expansion of biological agents for treatment, new studies in the epidemiology of IBD, the changing economics of IBD, breakthroughs in new endoscopic evaluations, major advances in novel radiographic techniques, the detection of colorectal cancer in patients with IBD and new findings in the genetics of IBD. New Trend / Developments (* These all emerged since our last edition) The most critical trend that has arisen over the past few years has been the introduction and expansion of biological agents in the treatment of inflammatory diseases worldwide. While only one agent, infliximab (Remicade), existed at the time of publication of my first edition, there have been multiple other agents either approved or pending approval for the treatments of these diseases, or in the upper-stages of development. The impact is not only upon the patients, but also on the health-care providers, policy makers, researchers, biotech and pharmacompanies, and the business community. Major changes worldwide in the epidemiology of IBD has spurred new studies in the demographics of who is getting these diseases and why. Previously characterized as diseases primarily affected Caucasians in industrialized countries, there has been an explosion of growth amongst the African American and Hispanic populations in the United States, and well as in pockets of these and other ethnic groups worldwide. The economics of IBD has been changing greatly, given the issues raised above, as well as major changes in the United States Medicare program, and other insurance changes. The growing proportion of the GNP that healthcare costs are consuming in the US and worldwide has shifted attention to decreasing utilization of health care services, and other cost-savings measures. Again, up to this point this has been an exclusive part of our IBD book. New findings in the genetics of IBD have been recently published. Our first edition had the finding of the first Crohn's disease gene inserted just before going to press; so much has been published about the phenotypes and other genotypes that have emerged. Breakthroughs in new endoscopic evaluations of the bowel (ie. Capsule endoscopy, double-balloon enteroscopy, endoscopic ultrasound) and their use in the inflammatory bowel diseases will be a key highlight of this new book. Major advances in novel radiographic techniques employed in patients with inflammatory bowel disease (ie. CT enterography, MR enterography, advanced ultrasounds, etc.) will also an important component of our work. There have been numerous areas related to the development and detection of colorectal cancer in patients with IBD that have emerged in the past few years. Techniques of better detection (ie. Narrow band imaging; special mucosal staining; endoscopic histological evaluations) as well as research in the putative role of mesalamine and other agents for colorectal cancer prevention are all hot topics that will attract much interest from a variety of interest groups I described above. Identification of additional disease states that probably belong in the IBD family, such as microscopic colitis (including lymphocytic colitis), and collagenous colitis add to the diseases that will be discussed in this new edition.

The meeting that provided the material for this book was the 58th Symposium of the Federation of European Microbiological Societies (FEMS) entitled MOLECULAR PATHOGENESIS OF GASTROINTESTINAL INFECTIONS which was held in Helsingor, Denmark from 2nd to 4th September, 1990. The aim of this meeting was to bring together scientists from a range of discipline- microbiology, cell biology, molecular biology and immunology - to consider how microbes, including parasites, colonize and infect the gastrointestinal tract. The programme was designed to focus particular attention on the range of strategies whereby enterovirulent bacteria and parasites colonize the gastrointestinal mucin layer, how they adhere to and penetrate the epithelial layer by entering the cells or passing between them, and how various protein toxins may facilitate these processes. Speakers were especially encouraged to highlight the recent expansion in our knowledge of the molecular mechanisms by which enterotoxigenic and enteropathogenic Escherichia coli, shigellae, salmonellae and Yersinia enterocolitica cause intestinal disease. There were also discussions of recently-discovered gastrointestinal pathogens such as Clostridium difficile and Helicobacter pylori as well as accounts of how virulent determinants can be used to develop new diagnostic methods based on DNA gene probes and the polymerase chain reaction (PCR). These presentations provided the basis for the chapters in this book.

Practical Colonoscopy Jerome D. Waye, MD, Director of Endoscopic Education, Clinical Professor of Medicine, Mount Sinai Medical Center, New York, NY, USA James Aisenberg, MD, Clinical Professor of Medicine, Mount Sinai Medical Center, New York, NY, USA Peter H. Rubin, MD, Associate Clinical Professor of Medicine, Mount Sinai Medical Center, New York, NY, USA Are you looking for a rapid-reference, step-by-step guide to teach you all that you need to know in order to perform high-quality colonoscopy? Then Practical Colonoscopy is the perfect resource for you. Drawing upon their collective century of experience performing and teaching colonoscopy, Drs. Waye, Aisenberg and Rubin share the pearls and principles that they find most useful in every day practice. The team is led by Dr. Jerry Waye, one of the world s leading practitioners and teachers of endoscopy. Up-to-date, practical, clinically-focused, succinct and packed full of outstanding illustrations and videos, this multi-media tool guides you through the core aspects of best colonoscopy practice. Key features include: * Lucid,step-by-step explanations of the techniques and principles that will help you to achieve outstanding results * A companion website that contains 39 videos illustrating important techniques, findings, and problems * Text-boxes that highlight and organize the pearls and pitfalls of colonoscopy practice * Line diagrams that illustrate important strategies and maneuvers * High-resolution still photographs that depict important findings and techniques GI trainees will find this the perfect introductory guide to colonoscopy, and more experienced specialists will value it as a refresher tool that is replete with hundreds of new pearls provided by world experts. Practical Colonoscopy is a must-have tool for today s colonoscopist.

Chronic liver failure is a frequent condition in clinical practice that encompasses all manifestations of patients with end-stage liver diseases. Chronic liver failure is a multiorgan syndrome that affects the liver, kidneys, brain, heart, lungs, adrenal glands, and vascular, coagulation, and immune systems. Chronic Liver Failure: Mechanisms and Management covers for the first time all aspects of chronic liver failure in a single book, from pathogenesis to current management. Each chapter is written by a worldwide known expert in their area and all provide the latest state-of-the-art knowledge. This volume is specifically designed to provide answers to clinical questions to all doctors dealing with patients with liver diseases, not only clinical gastroenterologists and hepatologists, but also to internists, nephrologists, intensive care physicians, and transplant surgeons.

The functional and organic alterations of the colon constitute one of the leading reasons why patients consult gastroenterologists. The irritable colon is one of the most com mon causes of discomfort in human beings. The organic pathology of the large bowel (malignancy and chronic inflammatory disease) contributes, particularly among Occi dental peoples, to discouragingly high levels of morbidity and mortality. One realizes the importance of having a thorough physiologic knowledge of the colon in order to scientifically plan the functional treatment of organic colonic dis eases. If we consider the large amount of material published on the physiology of the esophagus, stomach, small bowel, pancreas, and liver, we realize that the colon has been relatively neglected. The chapters in this book have been written by people who have done their utmost to alter this imbalance. I want to thank all the contributors for their generous collaboration that allows me to present in one volume virtually all the information known about the structure and function of the colon, and to record my deep graditude to Dr. Howard Spiro for his willingness to include this volume in his series. I would also like to express my sincere appreciation to Plenum Publishing Corporation for making this book possible. A spe cial thanks goes to Dr."

Inflammation in gastrointestinal mucosa can remodel the topography of the overlying epithelium. If such inflammation is chronic, it has fundamental clinical consequences, the principal of which is premalignant metaplasia throughout the alimentary tract. Furthermore, mucosal inflammation, even if subtle, is the single most common pathway for GI cancer. This book discusses all aspects of the relation between inflammation and GI cancer, from the basic science through to the translational science which is helping in the optimization of clinical management strategies. Among the topics considered are the impact of inherited syndromes; the roles of acid reflux, H. pylori, inflammatory bowel disease, and primary sclerosing cholangitis; screening strategies; targeted drug therapies; genetics; and the use of endoscopic methods. The authors are the best in their field, and this book is designed for the enthusiastic student as well as the professional in GI science and medicine.

Dietary therapy has always been important to medical practice even if it has more often been sacramental than physiological in effect. "You are what you eat" meant a lot to primitive tribes whose new leader had to eat part of his predecessor, and giving diets brought out the priest in the physician even if he or she had heard that "nothing that enters into a man defiles a man. " What people eat began to take on new meaning, however, a generation ago when Schoenheimer and others made clear that body fat and muscle protein were not the sluggish unchanging masses they had appeared but instead were store houses of energy and material influenced by food, activity, and metabolic pro cesses. Fiber, or residue as it was then still called, however, seemed unimpor tant; even the gastroenterologist concerned with keeping the bowels open by three cooked fruits, three cooked vegetables, and twelve glasses of water each day sometimes felt like a shaman if his cure for constipation worked. Nobody any longer read Arbuthnot Lane's charming Victorian book, The Way Out, which placed the blame for most human ailments on constipation; Lane even removed the bowel to cure the costive ills. Burkitt revived a scientific interest in fiber and the possible connection between diet. constipation, and many physical disorders by observing the vol ume and frequency of stools on an African diet and on an English diet."

Primary liver cancer is a rather unusual malignancy in that the incidence varies tremendously from one geographical area to another. While relatively uncom mon in Western countries, it is the most prevalent malignant neoplasm in Southeast Asia, South Africa, and many other regions; in all, the countries in which primary liver cancer is very prevalent account for more than two-thirds of the world's population. In China alone, approximately 100 000 people die every year from primary liver cancer, mostly hepatocellular carcinoma. The incidence is rising in some countries, especially Japan, where it has doubled among males in the past 15 years or so, a staggering and puzzling trend. Since the demonstration of an etiological relationship between hepatitis B virus infection and hepatocellular carcinoma, intensive research has been con ducted in an effort to elucidate the role of the virus in hepatocarcinogenesis. Though much progress has been made, a full understanding of the molecular events leading to malignant transformation of the hepatocyte will probably require many more years of rigorous investigation. Chemical carcinogens and several industrial pollutants may also be involved in the etiopathogenesis of neoplastic liver disease."

The percentage of the population which is elderly has been increasing steadily in many countries in the world; and as this tendency continues, the question of how to treat the elderly rises in importance. The problem of how to manage hypertension in the elderly has become one of the most important issues in the prevention and treatment of cardiovascular disease. However, not many of the cIinical studies performed so far to evaluate the effects of antihypertensive drug treatment have incIuded the elderly. Many important problems remain unsolved. How much bene- ficial effect can be expected from active antihypertensive drug treatment in the elderly? How can isolated systolic hypertension, which is fre- quently encountered in the elderly, have better prognosis when treated? When is drug treatment indicated, to what level should blood pressure be reduced and maintained in the e1derly, and how should drugs be selected? The elderly also frequently bear other medical problems, either re- cognized or unrecognized, such as mental depression, respiratory problems, infection, malignant neoplasms, and water and electrolyte im- balances. The body's ability to eliminate drugs also decreases with age and necessitates modified dosage. The 12th Scientific Meeting of the International Society of Hyperten- sion held in Kyoto, Japan on May 22-26, 1988 incIuded the satelIite symposium. "How Should Elderly Hypertensive Patients Be Treated?" wh ich focused on the pathophysiology and outcome of elderly hyperten- sive patients.

The physiological role of histamine in gastric secretion has been controversial since Popielski demonstrated that histamine sti- mulates this secretion. The results using H2-receptor antagonists, together with the findings that histamine is produced and stored in the fundic mucosa and released upon vagal or hormonal stimulation, indicate that this amine is the major physiological stimulant of the parietal cells. The concepts of histamine as a 'final common chemo- stimulator' of parietal cells, and as part of a 'multi-messenger' potentiating interaction of various hormonal secretagogues on parietal cells, have both been proposed to explain the involvement of hista- mine in gastric secretory mechanisms. Histamine may also be an im- portant factor in the pathogenesis of gastric hypersecretion and peptic ulcer disease since its mobilization from gastric mucosal stores is accelerated in peptic ulcer disease, and since treatment with vagotomy or H2-receptor antagonists decreases histamine release and increases its degradation in the gastric mucosa. REFERENCES Angus, J. A. , 1982, Histamine receptors - their classification and role in gastric acid secretion, in: Receptor Update; Proceedings. Excerpta Medica, Geneva, 29. Angus, J. A. , and Black, J. W. , 1978, Production of acid secretion in the isolated stomach by electrical field stimulation, Br. J. Pharmacal. 62: 460P. Angus, J. A. , and Black, J. W. , 1982, The interaction of choline esters, vagal stimulation and H2-receptor blockade on acid secretion in vitro, Eur. J. Pharmacal. 80: 217. Ash, A. S. F. , and Schild, H. O.

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."

3 The help of Mr Phil Johnstone and editorial staff at Kluwer Academic Publishers in producing this book and the publication in the Journal is most gratefully acknowl- edged. INFLAMMOPHARMACOLOGY Basic and clinical studies on Inflammation and its phannacologlcal control Aim. and Scope The joumal Innammopharmacology publishes papers on all aspects of inflammation and its phannacological control, emphasizing comparisons of (a) dillerent inflammatory states, and (b) the actions, therapeutic eflicacy and safety of dr\lgs employed in the treatment of inflammatory conditions. The comparative aspects of the types of inflammatory conditions include gastrointestinal disease (e. g. ulcerative colitis, Cmhn's dsease) i , parasitic diseases, toxicological manifestations of the effects of dr\lgs and envimnmental agents, and arthritic conditions. Inflammophannacology covers all the major aspects of the experimentally-induced clinical pathology, Its bkx:hemistry and cell biology, as well as the clinical and experimental phannacology and toxk:ology of therapeutic agents. The emphasis on comparative aspects of the actions of drugs Is intended to highlight their eflicacy and toxicity pmfiles as well as the variability In their clinical response and safety.

The human pancreas consists of two organs in one: the exocrine gland made up of pancreatic acinar cells and duct cells that produce digestive enzymes and sodium bicarbonate, respectively; the endocrine gland made up of four islet cells, namely alpha-, beta-, delta- and PP-cells that produce glucagon, insulin, somatostatin and pancreatic polypeptide, respectively. While the physiological role of exocrine p- creas is to secrete digestive enzyme responsible for our normal digestion, absorption and assimilation of nutrients, the endocrine pancreas is to secrete islet peptide h- mones maintaining our glucose homeostasis. The pancreatic functions are nely regulated by neurocrine, endocrine, paracrine and/or intracrine mechanisms. Thus, dysregulation of these pathways should have signi cant impacts on our health and disease. Nevertheless, the underlying mechanisms by which pancreatic functions are regulated remain poorly understood. Recent basic science and clinical studies con rm myriad physiological and pathophysiological roles of the tissue renin-angiotensin systems (RAS). Of parti- lar interest is the recent identi cation of a local and functional RAS in the pancreas, which in uences both its exocrine and endocrine function. Its role in the pat- genesis of pancreatic diseases including diabetes and pancreatitis is increasingly recognized, as is the therapeutic potential of RAS antagonism: RAS blockade l- its disease progression of type 2 diabetes mellitus and impaired glucose tolerance, and may also protect against pancreatic in ammation.

Colorectal cancer is the third most commonly diagnosed cancer in the US and the third most recently linked to cancer deaths. The national annual incidence rate of colorectal cancer is approximately 148,000+, striking slightly more females than males. The lifetime risk of colorectal cancer is 5-6%, however patients with a familial risk (with two or more first or second degree relatives) make up 20% of the patients. Persons who carry genetic mutations linked to hereditary colorectal cancer are the most likely to develop the disease.

Acute and chronic viral hepatitis infections are serious public health threats around the world. The different infections have different epidemiology and natural his- ries, and children play important roles in each of these. For example, children are important reservoirs for acute hepatitis A, childhood infections are responsible for most of the global morbidity associated with chronic hepatitis B, and perinatal transmission of hepatitis C continues to occur, even as the overall incidence of new infections wanes. Some non-A through E viral hepatitis infections are seen p- dominantly in infants and young children, while others have specific implications for this population. Therapeutic options for children with chronic viral hepatitis are limited when compared to those available for adults, especially for hepatitis B, and considerations given to long-term therapy have dramatic implications when dealing with the long life expectancy of these young patients. With these issues in mind, this unique volume has been created to address the special considerations regarding viral hepatitis in children. It includes the latest information and recommendations specifically directed at the pediatric population, and highlights the knowledge gaps which will need to be filled to improve our understanding of these infections and treatment of this special group. Experienced practitioners from around the world have contributed these reviews, incorporating the latest studies, the current recommendations, and the distinctive pediatric issues that shape clinical care, and will determine the research agenda for this field going forward.

This Trends in Inflammatory Bowel Disease Therapy Symposium was held in Vancouver, British Columbia, Canada, 27 29 August 1999. This is the seventh international symposium, sponsored by Axcan Pharma Canada Inc., since the first symposium in 1986. The Canadian Association of Gastroenterology has co-sponsored these symposia since 1990. Each symposium has been published, and reflects and updates the extensive research and education, and the understanding of the mechanisms and treatment of inflammatory bowel disease. From the beginning, Canadian and international experts have been involved, maintaining a consistently high quality, both in their presentations, during discussions, and the subsequent publication of their work. There have been major advances since the symposium held two years ago, and these are presented in this book. In keeping with modern educational practice, objectives are provided, and all presentations were subject to written independent evalu ation. All participants are asked to declare any conflicts of interest. MOCOMP and educational credits are available."

The contents of this book represent papers which were presented at the Third International Meeting on "Side-Effects of Anti-Inflammatory and Analgesic Drugs" which was held under the auspices of the University of Verona, Institute of Pharmacology in Verona on 8-11 May 1991. This meeting was held in conjunction with the 13th European Workshop on Inflammation and although publications from this part of the meeting are not published here (they appear in Agents and Actions), we were fortunate in having a group of people interested in inflammation from varying backgrounds. The success of the third meeting followed previous meetings held in Cambridge and Verona respectively and continue a tradition which has now become well established. The meeting brought together physicians, scientists and those concerned with the production and use of anti-inflammatory drugs to a very stimulating conference to discuss basic issues affecting all aspects of side-effects of anti-inflammatory and analgesic drugs as well as their detection and treatment. The meeting was held in the Auditorium of Glaxo Italy and we are very grateful to that company for use of their facilities as well as to the University of Verona, Institute of Pharmacology, for valuable secretarial and administrative help. The success of the conference would not have been possible without valuable financial assistance of the companies listed separately (under Acknowledgements) as well as to the organizers of the 13th European Workshop on Inflammation who collaborated with us.

Gastrointestinal diseases present a considerable problem in human medicine in terms of both morbidity and mortality. The aim of this book is to cover the different immunological disorders of the gut with special reference to immunopathological and protective mechanisms. It will be of general interest to clinicians, scientists and students concerned with the gastrointestinal tract. Topics covered include: the current status of research into toxin-secreting pathogens, Campylobacter, Giardia and HIV; the immunological features of idiopathic inflammatory gut diseases such as Crohn's disease and intractable diarrhoea; the genesis of the flat mucosa; the iatrogenic diseases of the gut such as graft-versus-host disease and small bowel allografts; the immune mechanisms and lesions in the gut of patients with parasitic nematode infections (very important in the tropics). Basic background on the immune apparatus in the intestine is also discussed, as are the effects of inflammation on intestinal permeability.

Helicobacter pylori has attracted widening interest from basic scientists and clinical investigators and the information on this organism is increasing exponentially. It is now accepted that H. Pylori is the most important cause of chronic active gastritis. Furthermore, data have confirmed a marked reduction in the relapse rate of both duodenal and gastric ulcer after eradication of the organism. These important clinical observations have served as a strong stimulus to the investigation of the basic mechanisms involved in the pathogenesis of H. pylori-associated inflammation and the subsequent alterations of gastroduodenal function and gastric mucosal architecture. The book contains chapters by a multidisciplinary, international group of basic scientists and clinical investigators who focus on various microbiological aspects of H. pylori, on the role of H. pylori in peptic ulcer and gastric cancer, and the current status of therapy. The book contains the proceedings of the conference on `Helicobacter pylori: Basic Mechanisms to Clinical Cure', held at Amelia Island, Florida, U.S.A., on November 3--6, 1993.

The second volume of Operative Manual of Endoscopic Surgery covers some of the operative endoscopic procedures which have been introduced into clinical practice since the publication of VoI. 1. In the general section, we have included an updated chapter on instrumentation and new chapters on anaesthetic manage ment of patients undergoing endoscopic surgery and on video image and record ing. Both topics are of importance to the practice of endoscopic surgery and have not been adequately covered in the reported literature. Volume 2 deals with endoscopic procedures)nthechest and abdomen. There have been significant advances in thoracoscopic surgery duririg the past 2 years; particular reference rs made to anatomical pulmonary resections and oesophageal resections. As far as the gastrointestinal trad is concerned, we have included gastric and allied operations but have not covered the colorectal region as we believe that more evaluation is needed before definitive accounts can be written on endoscopic colorectal resections, especially for cancer. For this reason, we have decided to defer this important topic to VoI. 3, which is in preparation. The same applies to laparoscopic repair of abdominal hernias. The same layout has been adopted as in VoI. 1 of the series, with heavy em phasis on illustrative representation of the operative steps and techniques. In the diagrams on sites of trocar/cannulae, we have indicated not only the site and size but also the functional role of each port.

During the last two decades significant advances have been made in the in vivo-diagnosis of gastrointestinal diseases. Although Ultrasound and CT as well as Endoscopy have had a major impact on the evaluation of liver, pancreas and bile diseases, there are a lot of indications for Nuclear Medicine procedures. These include new investigational procedures like esophageal scintigraphy, proof of bleeding sites, scintigraphy of inflammatory diseases, and intestinal resorption tests. Further, immunoscintigraphy with radiol- elled antibodies has gained wide-spread application especially in colon cancer. The differential diagnosis of liver tumors like haemangioma and focal nodular hyperplasia by means of blood pool and HID A-scintigraphy is nowadays a routine procedure. Other established methods like hepatobiliary scintigraphy and liver perfusion scintigraphy have proved to be reliable tools in the pre-and postoperative evaluation of patients with bile duct obstruction and portal hypertension. The aim of this book is to present the entire spectrum of Nuclear Medicine in Gastroenterology to our colleagues from internal medicine and surgery. Ultrasound and Sonography as well as CT will rule the field of gastroenterology, but there remain a certain number of unanswered questions. Nuclear Medicine provides a lot of reliable answers. H. J. Biersack and P. H. Cox July 1990 VB List of contributors Duncan M. Ackery, Department of Nuclear Medicine, Southampton General Hospital, Tremona Road, Southampton, Hampshire S09 4XY, U. K. Roland Bares (co-author: U. Buell), Department of Nuclear Medicine, Te- nical University of Aachen, Pauwelsstr. 1, DW-5100 Aachen, Germany.