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."

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 The impression that gastroduodenal mucosa was protected by a single mechanism has at last been replaced by a more realistic view, suggesting a number of protective zones acting in series.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.

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.

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.

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."

This book is a unique work devoted to the subject of disordered defaecation. It contains chapters written by experts in the field of ano-rectal physiology and management of disordered defaecation. The various contributions present personal views and special clinical experience of individuals. There are some personal views which we felt should be commented upon and a few areas where the experience of others has been included into the text. For the sake of completeness of each chapter, a slight overlap in some cases was inevitable. We hope the book will serve as a useful collection of opinions on a subject which until recently has been largely ignored by the medical profession. The editors Major contributors H. O. ten Cate Hoedemaker Department of Surgery, University Hospital, Rijnsburgerweg 10,2333 AA Leiden, The Netherlands G. Coremans Department ofInternal Medicine, University Hospital Gasthuisberg, Here- straat 49, 3000 Leuven, Belgium S. Fasth Department of Surgery II, Sahlgrenska Hospital, S-413 45 G6teborg, Swe- den H. G. Gooszen Department of Surgery, University Hospital, Rijnsburgerweg 10, 2333 AA Leiden, The Netherlands J. A. Gruwez Department of General Surgery, University Hospitals KU, Brusselsestraat 63,3000 Leuven, Belgium M. M. Henry Department of Gastroenterology, Central Middlesex Hospital, Acton Lane, London NWlO 7NS, United Kingdom M. R. B. Keighley Department of Surgery, The General Hospital, Steelhouse Lane, Bir- mingham B4 6NH, United Kingdom J. H. C. Kuypers Department of Surgery, University Hospital St. Radboud, Geert Groote- plein Zuid 14,6500 HB Nijmegen, The Netherlands Ph. B.

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."

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."

It was with very much pleasure that I accepted the invitation to chair this workshop on Glucagon in Gastroenterology. Not least among the reasons for my accepting was the fact that it would get me out from behind my administrator's desk at the univer sity and enable me to spend what promised to be a few refreshing hours in a field where so much is apparently happening. Another reason for my accepting was the attractiveness of the format planned for the workshop. It was to be a working event. The programme had been carefully planned to ensure that all aspects of the subject were covered and a very tight schedule was drawn up for we had to deal with the whole field in just one day. There was to be a small, truly international, list of participants, and, apart from those presenting papers, only two or three specially invited observers were to be present. Above all, perhaps, was the fact that the meeting was to be a multi disciplinary one."

The rapid growth of fibre-optic endoscopy in recent than 7,500 examinations has been accumulated. years has had two consequences for the radiology of In part I of this study the theoretical background the stomach and the duocienum. and the technique of examination proper are de- scribed. The basic principles of interpretation of DC 1. Radiology has lost its previously rather auton- studies are stated. omous position in this field. Part II deals with the results. Chapter 5 consists of 2. As a result of the constant feed-back from the general remarks on the results, and on the comple- endoscopist, which the radiologist can and should mentary role of radiological examination and endos- have, he is in an excellent position to re-evaluate copy. Chapter 6 deals with a quantative study of and improve his own technique of examination. standard biphasic-contrast examinations in patients The author believes that the radiological exam- over a period of 3 years. This study was restricted to ination retains its value as a screening technique and malignant lesions, because it is only in this group a complementary method to gastroscopy and biop- that the definite criterion, a histological diagnosis, is sy. Only a sophisticated radiological technique will obtained. The natural history of malignant lesions fulfil these requirements. In 1973 the author devel- also makes follow-up studies possible. Results of the oped a standard examination that was called "bi- diagnosis of Early Gastric Cancer (EGC) are phasic", because it combines the advantages of included.

This volume comprises a series of original articles, updates and reviews on relevant topics in hepatology which were presented at a meeting in Freiburg im Breisgau to honour the 60th anniversary of Dr. Herbert Falk. Since 1967, Dr. Falk and the Falk Foundation have generously sponsored more than 40 congresses and symposia on liver diseases, held mostly in Freiburg, The Black Forest or in Basel, which have become milestones in the ex change of scientific information in hepatology (see 'To Herbert Falk on his Sixtieth Birthday' in this volume). Many of these congresses and symposia have been published in the 'Falk Symposia' series by MTP Press. We asked hepatologists who took part in former Falk liver meetings to contribute to a one day symposium to celebrate Dr. Falk's anniversary. We were greatly gladdened by the spontaneous and unrestrained acceptance that we received from all sides. We wish to express our deep appreciation to all the speakers and moderators who travelled, at their own expense, from all parts of the world to Freiburg and who with their presentations, made the meeting a stimulating and refreshing event. The editors' thanks are also addressed to Mr. D. G. T. Bloomer and Mr. P. M. Lister from MTP Press for their valuable cooperation in preparing this volume for publication. This book testifies to the worldwide appreciation and gratitude held for Dr. Falk by the community of hepatologists. The Editors ix List of Contributors P. BACK K. F. A."

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.

Bacterial diarrheal diseases are a very important problem for human health, and many people, especially infants and children, die every year from diarrheal diseases, particularly in developing countries. Thus, in 1978 the World Health Organization initiated a Diarrhoeal Diseases Control Programme and is now working actively to control diarrheal diseases. The "International Symposium on Bacterial Diarrheal Diseases" which took place in Osaka from March 23rd to 25th, 1982, was organized by Osaka University with the support of the Ministry of Education, Science and Culture of the Japanese Government. The aim of this Symposium was to promote exchange of scientific information on bacterial diarrheal diseases, few years due since studies in this field have progressed rapidly during the last to work in many laboratories throughout the world. It seems appropriate that this Symposium was held in Osaka, since during the past century Japanese bacteriologists have made a number of important con tributions in the field of bacterial diarrheal diseases. Outstanding among these contributions are the recognition of Shigella as a causative agent of bacillary dysentery by Dr. Kiyoshi Shiga and the serotyping of Vibrio cholerae into the Ogawa, Inaba and Hikojima serotypes by Drs. Kabeshima and Nobechi. Moreover more recently, Dr. Tsunesaburo Fujino of Osaka University discovered Vibrio parahaemolyticus as the causative agent of an important diarrheal disease."

The most complete presentation of basic and advanced laparoscopic techniques available, due to its integration of procedures from general surgery and other subspecialities. Enhanced by over 750 illustrations (113 of them in full colour) and written by no less than 132 international, interdisciplinary experts, this definitive reference covers all aspects of this still new and expanding technique. Four main sections deal with: basic laparoscopy; laparoscopy and thoracoscopy in general surgery; laparoscopy in surgical subspecialities (gynaecology, urology, angioscopy); plus the technological aspects of laparoscopy. Throughout this authoritative volume, the surgeon will find in-depth reviews of the literature and extensive clinical and scientific data on the rationale for using laparoscopic procedures.
Certain to become a standard in the field.

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."

The inflammatory bowel diseases, of unknown etiology and for which there are no cures, continue to attract the attention and interest of gastroenterologists, internists and surgeons. International symposia are common and it is safe to say that there is at least one major symposium held somewhere in the world each year. This book encompasses the proceedings of two recent symposia held in Victoria, British Columbia, Canada. The symposia were the fifth and sixth international meetings focused on inflammatory bowel disease in Canada in the last eight years. Once again they were sponsored by Axcan Pharma, Inc. (formerly Interfalk Canada, Inc.) and endorsed by the Canadian Association of Gastroenterology. As has become traditional at such meetings the faculty was drawn from an international roster ofleaders in the field of inflammatory bowel disease and gastroenterology. The chapters of the proceedings provide a timely, up-to-date review of the major issues, including those within the realm of basic science and others dealing with clinical problems. The first symposium, 'Basic Research and Clinical Implications', was co-ordinated by John Wallace in association with Stephen Collins and Stephan Targan. The themes of this section were organized under the general topics of predisposing factors (genetics, animal models, infection, permeability, and immune deficits) and the pathophysiology of intestinal inflammation. The second symposium, Trends in Therapy' was organized by Lloyd Sutherland along with Franc; ois Martin, Robin McLeod and Noel Williams.

Pancreatic Disease: Towards the Year 2000 provides a clear picture of the current research activity in pancreatic disease and its related basic science. Experts currently contributing to advances in understanding and treatment have provided concise and clear reviews of their subject. Each contribution summarises the relevant literature and describes recent advances whilst highlighting those areas where current research will impinge on clinical practice in the next few years. The reader will find in this book all the latest material related to pancreatic disease, cancer, acute and chronic pancreatitis and a number of other topics including transplantation and the relationship between endocrine and exocrine disease and cystic fibrosis. The book will supplement existing texts and will be of value to practising specialists who deal with pancreatic disease as well as specialist trainees in surgery and medical gastroenterology.

Vaccines have historically been considered to be the most cost-effective method for preventing communicable diseases. It was a vaccine that en abled global eradication of the dreaded disease smallpo. ."

Dr. Dobranowski and his associates are to be highly commended for this excellent manual. I am not aware of a similar text covering the subject. Although all of us perform gastrointestinal studies in a differ ent manner, this text provides an excellent overview. The reader will discover that the text is especially well written and focuses on the important issues relating to GI contrast studies. Because Dr. Steven son's group performs endoscopic procedures, they are included in the manual. These authors are recognized scholars and leaders in gastrointesti nal radiology. Thus, it is easy to understand why the manual is so well done. I am particularly impressed with the emphasis placed on the patient-radiologist relationship before, during, and after completion of a study. All of us who teach gastrointestinal radiology are concerned about the decline in the number of gastrointestinal contrast studies. We are not sure how we can continue to teach our residents the proper tech niques and maintain high-quality teaching programs in gastrointesti nal radiology. A manual of this type is thus timely and appropriate. The manual will be a valuable addition to the library of all radiologists. It will be particularly useful for residents who are learning how to per form GI contrast studies."

Diagnostic Pathology of the Intestinal Mucosa - An Atlas and Review of Biopsy Interpretation offers a comprehensive overview of intestinal mucosal structure as defined through peroral or endoscopic biopsy specimens obtained in normal and disease states. It describes small intestinal biopsy pathology in conjunction with morphologic, functional, and pathophysiologic correlations. Routine methods of processing tissues for light microscopy, electron microscopy, histochemistry, and light- and electron- microscopic-immunoperoxidase techniques are presented so that the novice in the area of intestinal structure may have an easily accessible reference for setting up a morphologic laboratory.

Recent Advances in Coloproctology provides a thorough overview of modern developments in the surgical treatment of disorders of the lower intestine including ulcerative colitis/severe acute colitis, Crohn's disease, carcinomas, haemorrhoids and anal incontinence. Recognizing that the surgeon does not work in isolation, the book also integrates recent progress in imaging techniques for the anal canal and rectum, and highlights medico-legal considerations in separate chapters. Aimed at current practitioners and trainees, Recent Advances in Coloproctology discusses key concepts that will assist general surgeons and colorectal consultants in their management of patients with a broad spectrum of anorectal and colonic disorders. With a problem-oriented slant, this book is essential reading for all those with interest in coloproctology.

Colorectal Cancer Screening and Computerized Tomographic Colonography: A Comprehensive Overview is an authoritative volume on CT colonography. Structured in a manner that will allow the reader to understand the practical and larger public health issues surrounding both CT colonography and CRC screening in general, the text is designed to reach a broad audience of specialist clinicians and primary care physicians. The book provides an overview of the disease and risk factors of colorectal cancer, as well as the history and development of CTC as both a colorectal imaging and screening modality. The text also reviews the controversies, potential pitfalls, and exciting new directions and capabilities inherent in the practice of CTC. Filled with high quality images and authored by experts in the field, Colorectal Cancer Screening and Computerized Tomographic Colonography: A Comprehensive Overview is the definitive reference for clinicians interested in computerized tomographic colonography and CRC screening.