There is currently an explosive growth of basic and clinical research in inflammatory bowel diseases. The extensive interest of the medical community in these diseases is largely explained by the devastating impact the illnesses have on the quality of life, their high prevalence in the community, and the fact that so many medical disciplines are involved in tackling the immensely complex studies on pathogenesis, clinical expression and treatment possibilities. The Falk Symposium No. 85 held in The Hague, the Netherlands, 29 June-1 July 1995 brought together over 80 speakers and 1000 participants from all over the world. Plenary sessions and workshops allowed the discussion of basic and clinical research, enabling appropriate choices to be made. Topics reflected areas of high current basic research interest, clinical importance, and actual or future treatment potential. Audience: An important work for all disciplines involved in research and therapy of inflammatory bowel diseases.

Falk Symposium No. 82, held in Halle, Germany, November 1994, focuses on the advances made in understanding the aetiology and pathogenesis of inflammatory bowel disease (IBD). Sections of this book, the Proceedings of the conference, are devoted to extraintestinal manifestations, cancer development, IBD in the context of pregnancy, and the assessment of disease activity, prognosis and quality of life. The second half of the book is devoted to the discussion of standards and new developments in diagnosis, conservative management and surgery. Audience: All clinicians and basic scientists working in the field of IBD.

Despite recent advances, the pathogenesis and therapy of various forms of chronic inflammatory diseases of the gastrointestinal tract remains problematical. Especially threatening is the possible complication of the development of a malignant growth, but the role of the chronic inflammatory process in this is not known. Three examples are: H. pylori-induced gastritis is associated with gastric lymphomas and carcinomas; there is an increased incidence of intestinal T-cell lymphomas in tropical sprue; and chronic inflammatory bowel diseases, particularly ulcerative colitis, are associated with an increased incidence of carcinoma. In this book, the Proceedings of Falk Symposium No. 81, held in Berlin, November 3-5, 1994, an extensive exchange of information and opinions between international experts yields a state-of-the-art consensus on practical procedures in diagnostics, prophylaxis and therapy.

The last volume in the series Fibrin Sealing in Surgical and Nonsurgical Fields discusses various uses of fibrin glue in endoscopic surgery. During the last years fibrin sealant has been established in the treatment of gastrointestinal ulcers and esophageal fistulae.

This volume is a compendium of the lectures, presentations, and workshops of the International Congress entitled "Facing the Pancreatic Dilemma" and of the 17th Meeting of the Italian Association for the Study of the Pancreas, held in Verona on 16 -19 June 1993. Pancreatology is still a relatively young science. Many pathophysiological aspects of pancreatic disease are as yet obscure, and a fair number of the etio pathogenetic mechanisms adduced are no more than hypothetical. We have therefore chosen to compare and contrast in a single volume the various hypo theses and interpretations put forward by leading experts in the field. In view of the swift evolution of this branch of medical science, it is sound policy to bear in mind that yesterday's heresies have become today's orthodoxy, and that todays's heresies may well turn out to be accepted orthodoxy in a not too distant future. The various "pancreatic dilemmas" are addressed systematically in these pages, and we believe that the book will prove an invaluable tool for the special ist and for any physician dealing with pancreatic disease. The book also represents a tribute by the Verona School of Pancreatology to the memory of Prof. L. A. Scuro, founder of the School and one of the outstanding Italian pioneers of pancreatology."

This book contains the proceedings of the XIIIth International Bile Acid Meeting (Falk Symposium 80), an official satellite meeting of the World Congress of Gastroenterology, held in San Diego, California, U.S.A., September 30--October 2, 1994. It begins with presentations of major advances in bile acid chemistry, biology and pharmacology. The new structure proposed for the mixed micelles present in bile is reviewed, as are the properties of new synthetic analogues of bile acids. The mechanisms by which bile acids interact with cell membranes are discussed in order to provide insight into the hepatotoxic effects of bile acids in cholestatic liver disease. The book further shows the exciting progress in the molecular biology of bile acid transport by the hepatocyte and enterocyte, and concludes with a consensus on the use of ursodeoxycholic acid in cholestatic liver disease and as an adjunct to immunosuppressive therapy after liver transplantation, and to interferon therapy in chronic viral hepatitis.

Practising evidence-based medicine necessarily depends on the clinician having access to the best evidence available, but in a fast-moving field, keeping up to date with the latest developments is a challenging prospect. In this new volume, leading experts focus on the most important clinical issues associated with the management of Lipid Disorders, evaluating and interpreting the evidence available to provide the reader with a reliable summary of our current knowledge. Topics covered include therapeutic strategies for managing hereditary lipid disorders, including familial hypercholesterolaemia, both in adults and children, and familial combined hypercholesterolaemia. The authors also evaluate the evidence for a link between inflammatory disease and cardiovascular risk; the metabolic syndrome and the interconnections between dyslipidaemias and diabetes. They also look at therapeutic challenges such as the management of patients who are statin resistant, and the control of lipid levels in those suffering renal insufficiency. Tables highlight important data, evidence from trial results and expert reports, and each section concludes with a series of Key Points that present a summary of evidence-based recommendations for best practice, graded according to the quality of that evidence. The book provides the busy clinician with a unique analysis of the data supporting current therapies and will help the reader formulate effective strategies for treating their own patients.

Chronic inflammatory bowel disease still represents a major gastroenterological challenge, in view of the unclear aetiology and unsatisfactory therapy. This book, the proceedings of a Falk Symposium held in L beck, Germany on 4--5 March 1994, will act as a vehicle for our current knowledge, and promote the dialogue between clinicians and those involved with the associated sciences. The book begins with international experts discussing the more recent theories concerning the aetiology and pathogenesis. Later on, the discussion turns to questions of diagnosis, and the conservative and surgical treatment of Crohn's disease and ulcerative colitis are dealt with in detail. This volume in the Falk Symposium both represents a forum of experts for discussion of the most recent findings, and provides clinical gastroenterologists with an opportunity to inform themselves of the state of the art in the field of inflammatory bowel disease.

International researchers summarize the current understanding of peptic disease and trace the development of a novel new drug for peptic disease therapy-sucralfate. Contributors present laboratory research along side data from clinical trials as well as from the practice of medicine. Articles discuss the history of sucralfate's development, mechanisms of action, clinical efficacy, and future directions for research. This volume will be of interest to scientists and clinicians working in gastroenterology and gastrointestinal physiology.

The "Europe against Cancer" programme has, from its inception, emphasised the key role which general practitioners must play in the actions necessary to achieve its aim of reducing the incidence and the mortality from cancer in the European Community. General practitioners, because of their day-to-day direct and continuing contact with patients, playa role not only in primary prevention and education of patients, but also in motivating their patients to accept secondary prevention and screening, some of it carried out by general practitioners themselves. These preventive activities are in addi tion to their traditional role in the care and management of patients with cancer at home, and increasingly, their role in active treatment. In view of the importance of the general practitioner in the "Europe against Cancer" programme, the European Commission, with a view to providing general practitioners with up-to-date useful information, has sponsored the production of this series of publi cations on organbased cancers, especially written for general practitioners. Regis Malbois Advisor in charge of the "Europe against Cancer" programme Commission of the European Communities Brussels Preface Colorectal cancer is the second most common cause of death from malignant disease with a high incidence in many European countries. This book is part of a series of pub lications on major cancer diseases designed for the European family doctor. It is pub lished by the Commission of the European Communities within the context of the Eu rope Against Cancer Programme.

On the subject of stomach and gastric diseases, current cli- nical, morphological, pharmacological, biochemical as well as cellular and molecularbiological aspects will be presen- ted. The articles of the first part of this book will discuss the normal functions of the stomach (such as motility, secre- tion, tissue regeneration etc.). The second part deals with pathophysiological aspects (such as inflammation, ulceration and tumor formation) and modern possibilities of treatment. The authors aim at gaining a deeper knowledge of the sto- mach, its physiology and pathophysiology in order to use this knowledge for the better of their patients.

An experienced pathologist, radiologist and clinician combine forces to review the recent literature on coloproctology and give a precis of the results. Their Highlights in Coloproctology are the ideal source for a clinician or researcher who wants a quick overview of the subject. The book highlights the papers that have had an impact on developments in the field and brings the reader up to date with modern references.

Short chain fatty acids (SFCA) are synthesized by the colonic microflora primarily from non-absorbed carbohydrate; there is also some limited production from non-absorbed protein. In contrast, SFCA are not normally present in the diet. During the past 15 years SFCA have attracted considerable interest in human nutrition, physiology and pathophysiology as a result of the realization that SFCA represent an important mechanism for carbohydrate and calorie conservation and may play a role in various types of colitides and possibly in colonic neoplasia. In addition, SFCA, produced in large amounts by ruminants and other herbivores, have long been the province of veterinary physiologists. This book is based upon the presentations at the 73rd Falk Symposium held in Strasbourg, France, September 8--10, 1993, which brought together researchers and clinicians from five continents. It provides an excellent statement of the present state-of-the-art knowledge of SFCA.

The anastomotic technique plays a predominant role in gastrointestinal surgery. A feared complication is leakage due to the sutures. Such leakage cannot be detected early; consequently, infection spreads locally and systemically. An anastomotic method is generally evaluated according to its rate of leakage, related to the localization, bur real scientific comparisons, i.e., controlled studies, are almost totally lack ing. The criteria of evaluation include the type of suture, the localization, the auxiliary technical tools, practicability, the different forms of wound healing, angiogenesis, and vascularization, among others. The postoperative criteria are complications shortly after surgery, such as bleeding, ruptures, and stenoses of the anastomosis. A standard comparison is made difficult by the variety of cytophysiological and biochemical factors that influence wound healing. In the comparison of larger series one must always take into account differences of auxiliary tools, strategies, and inhomogeneity of patients. A change of one auxiliary tool or of one strategy implies the modification of various target criteria. Often enough, however, one does not sufficiently consider the surgeon's most. important role."

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.

"Updates in Colo-Proctology" covers the proceedings of the Anglo-Swiss Colo-Proctology Meeting held in St Moritz in 1990. The book contains the papers which were presented and dis cussed there by physicians of the various specialties concerned with the care of patients with diseases of the colon, rectum and anus. The authors, each distinguished in a particular field, have contributed across a wide range of subjects and different dis ciplines. The topics covered include surgical and investigative techniques, cancer, inflammatory bowel disease and specific infections. Being familiar with the previous literature, it is clear that little was really new among the themes presented in St Moritz, but few will deny that many of the techniques and methods of treatment described in this book are truly modern. Some contribute an entirely new dimension to the approach to well known colo-proctological conditions, while others may open up new paths for future research. In addition, in colo-proctology as in other disciplines, advances in treatment almost always bring new problems in the complications which attend them. These are the subject of some of the papers. Although it would be invidious to pick out individual contributions when there is so much that is new to talk about and so much that is old to be looked at in a new light, we should like to record how much we have enjoyed reading and collating these chapters. We hope that others will share our enthusiasm and pleasure.

Introducing this monograph by expressing our heartfeIt thanks to all those who have contributed to its success may seem no more than a rhetorical exercise. However, at the same time we feel duty bound to add our sincere apologies, for we know that many of the dis tinguished authors of the various chapters have been hard put to find any relevant information in the existing literature. The plain fact is that very little has been said and written about pancreatic fistulas compared with other aspects of pancreatic disease. Why is this? Essentially, we believe there may be two main reasons: one practical explanation may be their relative rarity, while the other reas on is, as it were, "psychological," i. e., pancreatic fistulas tend almost invariably to be regarded as complications of an imperfectly performed surgical procedure. However useful it might be if we were to do it more often, it goes against the grain to public1y admit one's own mistakes. Ever since I (P. P. ) started practising in medicine, it has been my destiny and privilege to work alongside Professor Dagradi, the pioneer ofpancreatic surgeryin Italy, and to assist him over the years in something like 2000 operations on the pancreatic gland. Clearly, then, any complication due or related to such surgery however rare, has become part and parcel of my practical day-to-day c1inical experience and scientific interests."

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.

Gastroenterology is one of the branches of medicine that can profit most from modem technology, whether this involves the advances in diagnostic instrumentation, in data and image processing and management, or in computer applications like expert systems. To evaluate current status of imaging, computerization, and expert systems in gastroenterology, a group of clinical researchers and computer experts met in Bologna, Italy, for several days' discussion. The presentations at this symposium are introduced in this volume, which we believe to be a useful contribution to a specialization of great importance for health care as a whole. Bologna, March 1991 P. R. DAL MONTE Contents Imaging in Gastroenterology A. TORSOLI ......... . 1 Experience with a Hospital-Wide Image Management and Communication System: Is Total Digital Radiology Possible? S.K. MUN (With 1 Figure) ... 3 New Approaches to Endoscopy with the Electronic Videoendoscope M. SCHAPIRO .... ......... . 15 Intraoperative Videocholangioscopy A. MONTORI, L. MASONI, and L. DE ANNA 19 Images and Communication F. VICARI .......... . 22 Didactic Potential of Videoendoscopy F. COSENTINO, E. MORANDI, G. RUBIS PASSONI, F. DI PRISCO, and S. TUCCIMEI ........................... 24 Interactivity Between Image Processing Systems and Videoendoscopy M.A. PISTOIA, S. GUADAGNI, L. LOMBARDI, F. PISTOIA, M. CATARCI, and I. CARBONI. . . . . . . . . . . . 27 Endoscopic Laser Therapy of Colorectal Tumors 30 P. SPINELLI, M. DAL FANTE, and E. MERONI ...

Dieses Buch pr{sentiert neueste Forschungsergebnisse zur Be- deutung von Pankreasenzymen f}r die normale Verdauung und untersucht die Notwendigkeit der Enzymsubstitution bei Un- terfunktion und Erkrankungen des Pankreas.

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.

A book that compiles symposia papers from the International Journal of Colorectal Disease on issues that are highly controversial and hotly debated.

This is a classification of tumours and tumour-like lesions of the gall- bladder and extrahepatic bile ducts, including the ampulla of Vater. Although most of the lesions are found in all three sites, variations in frequency of the histological types occur and will be noted. The incidence of carcinoma of the gallbladder varies in different parts of the world. Variation is also found in different ethnic groups within the same country. In the United States, for example, carcino- ma of the gallbladder is more common in American Indians than in Caucasians or in Blacks; the rate among female American Indians is 21 per 100000 compared with 1.4 per 100000 among Caucasian fe- males. In Latin American countries, the highest rates are found in Chile, Mexico and Bolivia. In other countries, such as Japan, the inci- dence rates are intermediate between those of American Indians and those of Caucasians. Despite certain features in common, carcinomas of the gallblad- der and carcinomas of the extrahepatic bile ducts show a number of differences. Gallbladder carcinomas are usually associated with cholelithiasis and have a strong female predominance. In contrast, extrahepatic bile duct carcinomas are seen less often, occur in both sexes with equal frequency, are usually not associated with choledo- cholithiasis, produce early biliary obstruction, and are better differen- tiated histologically as a group. Moreover, they are seen in patients with primary sclerosing cholangitis and ulcerative colitis.

Interventional Radiology has as its main goal the performance of surgical techniques using a percutaneous approach to simplify patient care. Percutaneous cholecystostomy now has many advocates; still, it is practised in comparatively few centers. Over many years it was used as a last resort at failed transhepatic cholangiography to provide images of the bile ducts in biliary obstruction. Transhepatic cholecystostomy is reputed to be safer than transperito- neal puncture, since bile leaks do not enter the peritoneum. The advo- cates of percutaneous cholecystolithotomy, almost without exception, fa- vour subcostal cholecystostomy and puncture of the fundus of the gall- bladder. There is no evidence of bile peritonitis after successfully making a track to the gallbladder 18 F in diameter or larger for stone removal. After 1-7 days a postlithotomy drain is removed from the gallbladder and the patient is allowed home. Transhepatic cholecystostomy for gallstone lysis, in contrast, requires only a 5-F track to the hepatic surface of the gallbladder. Loss of the gallbladder is not as great a fear with this technique as it is during dilata- tion of a subcostal track for cholecystolithotomy. During the latter pro- cedure this may result in laparotomy to avoid bile peritonitis, while in the former, if the gallbladder is still visualised, the procedure may be re- commenced immediately. Catheter dislodgement is a fear when prolon- ged catheterisation is considered.

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."