In the spring of 1987, nearly 350 individuals gathered in a hotel in Bethesda, Maryland, just outside of Washington, D. C. , to participate in a two-day medical symposium devoted to the topic of liver diseases. A small minority of this group had been attracted by what promised to be an outstanding Continuing Medical Education course. The remainder, however, although obviously interested in the content of the symposium, had come primarily to honor a man who, over the years, had profoundly touched them, personally or professionally, for the course had been conceived as a tribute to an exceptional man of medicine, a man with remarkable scholarly and personal attributes: Hyman J. Zimmerman. Dr. Zimmerman, referred to affectionately by all as Hy, was born in 1914 in Rochester, New York, the city in which he received both his early schooling and his undergraduate education. In the late 1930s, he moved to Palo Alto to begin his medical education at Stanford University, from which he graduated cum laude in 1942, having spent an additional year acquiring a masters degree and as World War II in bacteriology. Almost immediately thereafter, he entered military service, was in progress, was assigned to duty in France. Soon after his arrival, he was made chief of an Army field hospital. A major medical problem plaguing U. S. troops at the time was viral hepatitis, which resulted in a deluge of patients admitted to his hospital.

Liver surgery has made extraordinary progress over the past 40 years, evolving from the first, timid partial resections in the 1950s to today's major resections and organ transplants. Examining the rea- sons for this progress, one cannot but be impressed by the substan- tial role that has been played by radiology. Formerly, preoperative planning was based on only nebulous scintigraphic scans. Today, surgeons have at their disposal a wide variety of radiological modalities for diagnosis and topography which are precise enough to exclude most operative surprises. Fur- thermore, the radiologist is becoming increasingly involved in ther- apy: prior to operation for tumor reduction by embolization and after resection for treatment of local complications - which could otherwise necessitate difficult and occasionally dangerous reoper- ations. As the author writes in his preface, it is not really astonishing that a radiologist is publishing a book on this topic, and he must be congratulated for his work-up, which combines important personal experience with a complete analysis of published papers on this topic.

In recent years there have been huge advances in the understanding of the genetic and molecular basis of the fibrocystic diseases. This volume provides a thorough review of fibrocyctic diseases that affect the liver. It contains in-depth discussions of the genetics, molecular biology, pathogenesis, histology, clinical presentations, complications of, treatment, and prognosis of the conditions affecting children and adults, and hence will be the gold-standard reference for these conditions. In addition, the histological features that distinguish these conditions from other potentially fibrosing hepatopathies are illustrated. Conditions with syndromic features involving the kidney or other organ systems are also reviewed. Thorough review of the clinical phenotypes, their presentations, treatment, potential complications of, and prognosis is discussed.

Fibrocystic Diseases of the Liver will be an invaluable resource for hepatologists, gastroenterologists, nephrologists, and hepatic surgeons who care for children and adults with liver disease, as well as basic scientists in molecular genetics, hepatobiliary pathophysiology, hepatology and nephrology.

Gastric secretions contain hydrogen ions at a concentration that is more than one million times higher than their intracellular concentration. This phenomenal gradient as well as the demonstrated ability of gastric juice to digest tissues has motivated clinicians and investigators alike to emphasize acid secretion and acid ablation in studying the pathogenesis and therapy of peptic ulcer disease. Conse quently, over the past 150 years, we have made considerable progress in under standing the mechanisms and regulation of acid secretion by the stomach. Not surprisingly, therapy for both peptic disease and mucosal injury has also been predominantly directed at either neutralizing acid or suppressing its production. During the past 10 years, attention has been focused on factors other than acid in the genesis and therapy of ulcer disease. Work done worldwide demon strated that acid hypersecretion is not a common event in peptic ulcer disease. Therefore, we began realizing that factors other than acid secretion may be important in the genesis of ulcer disease or in gastroduodenal mucosal damage. In addition, new physiological information has established that the gas troduodenal mucosa is normally protected by a complex series of events includ ing mucus and bicarbonate secretion, cell renewal, surface mucosal restitution, and preservation of the microvasculature and mucosal proliferative zone.

The discovery that the same or similar peptides are present in endocrine cells and in neurons is one of the most exciting and provocative recent developments in biology. Suddenly neurophysiologists and endocrinologists have found that they have a great deal to discuss with each other. Substances originally isolated as hypothalamic hormones turn out to be abundantly present in neurons of other parts of the brain and in endocrine cells and neurons of the gut and pancreas. Similarly, substances originally isolated as gut hormones are found not only in gut endocrine cells but also in gut neurons and in brain neurons. It turns out that the group of peptides that we are accustomed to call gastrointestinal hormones are not all confined to the gastrointestinal tract and are not all solely hormones. We are learning that the chemical transmitters of the neurocrine, endocrine, and paracrine systems form a single group of related substances. This volume contains the latest installments in this fascinating story. It tells how these pep tides were isolated and their amino acid sequences determined, how the heterogeneity of most, perhaps all, of these peptides is being revealed as variant forms of them are discovered, how antibodies to these peptides are used as powerful tools to measure their concentrations in body fluids and to localize the cells in which they are synthesized and stored, and, finally, how the role of these substances in normal physiology and in pathological states is being unraveled.

Both the investigation and treatment of cancer of the oesophagus are comprehensively presented in Management of Oesophageal Carcinoma. This information is otherwise not easily available in one source. The chapters are written by experts in the fields of anatomy, cancer research, radiology, and thoracic surgery and give up-to-date information on this difficult disease. All aspects are covered: anatomy, epidemiology, endoscopic and radiologic diagnosis, pathology, surgical treatment, radiotherapy, palliative and laser therapy, and the management of complications. Surgeons will be especially interested in the discussion of the recent technique of oesophagectomy without formal thoracotomy, and the use of stapling devices. This complete reference is ideal for all clinics and medical centers specializing in thoracic surgery or treatment of oesophageal carcinoma.

"Hedrology" - a term coined by G. B. E. SIMONETTI (Milan) - is the oldest of all surgical specialities. It was re-introduced as Proctology by European surgeons at the turn of the century. Excellent work was performed by the surgeons LIS FRANK, DIEFFENBACH, VELPEAU, VOLKMANN, KRASKE, VON REINEKE, QUENU, REHN and GOETZE. Today this specialty includes the research, recognition and treatment of disorders of the entire colon, rectum and anus. Ever since the days of W. VON REINEKE (1868-1901), this specialty has been cultivated with special care at the Chirurgische Universitatsklinik Erlangen; scientific investigation has progressed and the operative technique has been improved. Experts from 22 countries met here at the Third International Congress in order to exchange experience and to learn from the successes and failures of their col leagues. These opinions and this knowledge have been summarized in the congress report. Thus it presents a survey of today's problems in proctology. G. REGEMANN President of the rd 3 International Congress Contents The Future of Proctology, J. F. MONTAGUE . 1 I. Injuries of the Colon and Rectum Injuries of the Colon and Rectum, J. HOFERICHTER ..."

This book has been designed, as its title implies, as a practical book for medical practitioners, although it should be of interest to medical students and nutritionists. It attempts to provide essential information about this important group of substances rather than be an all embracing monograph on the subject. For this reason biochemical and physiological considera tions have been kept to a minimum, and aspects of animal disorders and animal husbandry have not been considered. The material is often presented in a rather dogmatic fashion and, with rare exceptions, references are not included since this makes reading more difficult. The exceptions, where references are provided, are the therapeutic claims, and the series of recent studies which have indicated that vitamin deficiencies are still widely present among certain groups of the population of many industrially developed countries. To add to this reference list there is a reading list which has been selected to give key books, reviews with extensive bibliography and important articles over the past 10 years. From this reading list it is possible to trace most of the literature on the vitamins since they were first described over half a century ago."

In their second year in medical school, students begin to learn about the differences between "disease" and "illness." In their studies of pathology they learn to understand disease as pertubations of molecular biological events. And we clinicians can show disease to them by our scans, lay it out even on our genetic scrolls, and sometimes even point out the errant nucleotide. Disease satisfies them and us; at Yale, lectures on the gastrointestinal tract run from achalasia to proctitis. There is, alas, little mention of functional bowel disease or of the irritable or spastic colon, for that is not easy to show on hard copy. Functional bowel disease represents "illness," the response of the person to distress, to food, to the environment, and to the existential problems of living. In real life such matters are most important. Richard Cabot first found out at the Massachusetts General Hospital almost a century ago that 50% of the patients attending the outpatient clinic had "functional" complaints. The figure had grown to over 80% when the very same question was reexamined 60 years later.

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.

I am very pleased to say once again that I was delighted at being invited to chair this Third International Workshop on Glucagon (Glucagon in 1987). The two previous ones were held in Madrid under the auspices of the Medical School of the Universidad Complutense of that city, the first in May 1978 and the second in October 1981, which resulted in two books (Glucagon in 1979, and Glucagon in Gastroenterology and Hepatology, 1982, Gastroenterology, both published by MTP Press), where the mounting interest in and develop ments concerning the therapeutic applications of glucagon were reflected. This time the meeting was held in Barcelona under the auspices of the Escuela de Patologia Digestiva of the Universidad Aut6noma of Barcelona, a change that we especially welcomed because it is not very often that we are able to assemble in our city such a distinguished group of scientists from all over the world. As can be seen from the title of the present book, this workshop focussed once again on the current status of glucagon in gastroenterology and hepatology, because although much has been said and discussed about the subject already, it still raises exciting and intriguing issues for debate. There were two parts to this meeting. The gastroenterology session was concerned with the physiology and pathophysiology of glucagon in the gastrointestinal tract and its applications in diagnosis, endoscopy and radiology."

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.

Handbook of Non-Motor Symptoms in Parkinson's Disease is designed to provide practical tips and emphasize key priorities for treatment of non-motor aspects of the disorder. The quick-reference handbook format, with key points highlighted by the use of figures and tables, will provide the reader with high-value practical information.

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."

It is with much pleasure that I introduce this first volume in a series of Topics in Gastroenterology aimed at the intelligent clinician. Dr. Peter Banks is first and foremost a clinician and teacher and therefore an ideal lead-off author. His very helpful review of pancreatitis is based not only on a thorough assimilation of clinical and experimental evidence but also on his long clinical practice in university hospitals and in private practice. Dr. Banks understands what we clinicians need to know about the patho physiology of this challenging disorder. I found much practical informa tion in this volume to help me in thinking about my own patients, and I recommend it with enthusiasm. Howard M. Spiro, M.D. vii Preface In the preparation of this book, I have made a special effort to provide detailed clinical information on the care of the patient with pancreatitis. The usefulness of newer diagnostic tests such as amylase/creatinine clearance ratio, ERCP, diagnostic ultrasound, and C-T scan has been carefully evaluated. Particular attention has been devoted to the manage ment of the more difficult therapeutic problems such as severe protracted pancreatitis, pancreatitis of unknown etiology, pancreatic pseudocyst, and pancreatic insufficiency. Points of controversy regarding medical and surgical alternatives in the treatment of acute and chronic pancreatitis have been reviewed with specific recommendations for therapy. In all discussions, emphasis has been placed on basic physiological principles that govern treatment. A comprehensive and current bibliography accom panies each chapter."

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.

Core Concepts in Colonoscopy covers all aspects of diagnostic and therapeutic colonoscopy, emphasizing overarching concepts that gastroenterology fellows and physicians must know to achieve success in both the technical and cognitive aspects of the procedure. In this comprehensive resource, Dr. Douglas G. Adler and his contributors provides a straightforward and practical review of colonoscopy. Core Concepts in Colonoscopy aims to address and convey the core concepts of colonoscopy: from the structure and function of the colonoscope itself, to insertion techniques, loop formation and reduction, polypectomy techniques for any situation, the avoidance and management of perforations and other adverse events, as well as advanced techniques including (but not limited to) endoscopic mucosal resection and colonic stenting. Each chapter inside Core Concepts in Colonoscopy is lavishly illustrated with multiple key images to accentuate and enhance the written text, as well as a plethora of tips, tricks, and accumulated points of wisdom in each chapter on all facets of colonoscopy. Additional Website Component! Core Concepts in Colonoscopy is accompanied by a video website with specific videos connected to individual chapters that will illustrate basic and advanced colonoscopic techniques from many leading experts and will further enhance the learning process. The addition of the video website allows for a more robust learning experience and allows the reader to watch, listen, view repeatedly, and reinforces the techniques presented in the written text. GI fellows, junior gastroenterologists, and even advanced physicians will appreciate Core Concepts in Colonoscopy because of the user-friendly and efficient structure that allows for the material to be quickly read, as well as easily absorb the wealth of key practical knowledge found inside.

Quick Reference Dictionary for GI and Hepatology is a unique, pocket-sized reference designed specifically to provide a magnitude of terms and their definitions, guidelines, and references essential to the gastroenterology profession. Led by Dr. Jonathan Fenkel and his contributors, this compact, concise, and informative reference contains over 1000 commonly used GI and hepatology terms and definitions. Additionally, Quick Reference Dictionary for GI and Hepatology offers more than 20 quick reference appendices related to common GI and liver diseases. Some appendices include: * Causes of acute liver failure * Approach to elevated liver enzyme tests * Peptic ulcer disease: therapy and re-bleeding rates * Colorectal cancer surveillance guidelines * Scoring of acute pancreatitis * Types of gallstones Quick Reference Dictionary for GI and Hepatology provides an at- your-fingertips guide for anyone who works in the gastroenterology profession, including gastroenterologists, medical students, residents, fellows, nurse practitioners, physician assistants, office staff, and industry sales representatives.

This volume provides in a conveniently accessible package a comprehensive collection of accurate and timely information on the management of patients with diarrhea, both in pediatric age and in the adult. As medical knowledge has recently expanded in this area, this volume is full of new practical, clinically useful material for the busy clinician. Illustrations are emphasized to permit rapid acquisition of practical information that is not readily available in the major texts. Each chapter is concise, concentrating on "clinical pearls," and new advances in diagnostic and therapeutic technology. Each chapter discusses the relative costs of diagnostic and therapeutic options to permit financial considerations to be taken into account in the decision making process. Additional unique features include, summaries of key points, recommendations, and indications for requesting GI subspecialty consultation. Providing a comprehensive but practical overview of the issues surrounding the diarrheal diseases, this volume will prove of great value and utility to gastroenterologists, surgeons, internists, primary care physicians.