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.

In Drugs and the Liver: High Risk patients and Transplantation, leading physicians, hepatologists, pharmacologists, pathologists and transplant surgeons discuss the most recent advances in the field of liver disease and their treatment. Attention is focused on epidemiology, the diagnosis of disease (clinical chemistry, histopathology, medical imaging analysis), prognosis, prediction, and clinical management. Pathogenesis of diseases such as liver cirrhosis following viral disease or alcohol abuse are discussed at length, and special attention is dedicated to high risk patients (children, fulminant hepatitis). The other major topics include terminal liver failure, for which transplantation is now routine. The latter is discussed in depth, starting from the organ donor management, organ evaluation and preservation, new surgical techniques, post-transplant patient follow-up including side effects of immunosuppression, and reports of the latest drugs used to prevent rejection.

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.

Presenting patient- and problem-oriented review articles, this series is designed to keep the internist, general surgeon, and specialist in gastroenterology and hepatology abreast of the latest advances in the field.

This volume contains the papers presented at the International Symposium on "Cirrhosis, Hyperammonemia and Hepatic Encephalopathy," held in Valencia, Spain, De- cember 2nd_4th, 1996. Liver cirrhosis is one of the main causes of death in occidental countries. There are other hepatic dysfunctions such as fulminant hepatic failure, Reye's syndrome, or congenital deficiencies of urea cycle enzymes which can also lead to hepatic encephalopathy, coma and death. However, the molecular bases ofthe pathogenesis of hepatic encephalopathy remain unclear. One ofthe consequences of hepatic failure is the reduced ability to detoxify ammonia by incorporating it into urea. This leads to increased blood ammonia levels. Hyperam- monemia is considered one of the main factors responsible for the mediation of hepatic encephalopathy and classical clinical treatments are directed towards reducing blood ammo- nia levels. Altered neurotransmission is an essential step in the pathogenesis of hepatic encephalopathy. The first part of the book is devoted to the discussion of the recent advances in the understanding of the alterations of different neurotransmitter systems in hepatic encephalopathy. The alterations of tryptophan metabolism and neurotransmission in hepatic encephalopathy and the implications for the clinical use of neuropsychoactive drugs are reviewed. The alterations in glutamate transport and neurotransmission in hepatic encephal- opathy due to acute liver failure are also reviewed. The role of NMDA receptors in the molecular mechanism of acute ammonia toxicity is discussed as well as its modulation by metabotropic glutamate receptors and muscarinic receptors.

The aim of this Atlas is to present the three-dimensional arrangement of the liver structures, which should be familiar to those who diagnose and treat diseases of the liver, particularly in an era when the methods of diagnostic imaging and surgical treatment are becoming increasingly sophisticated. For this purpose a series of corrosive preparations of the blood vessels and bile ducts of the liver was made and photographed. In addition to the normal situations, many frequent and rare variations are shown. The Atlas also shows some blood vessels that have not been adequately described or are not well-known in the reference literature, but are nevertheless of great importance in performing segmental liver resections.This Atlas takes a fresh approach to the subject. The method used allows the size, three-dimensional arrangement and structure of the blood vessels and bile ducts of the liver to be preserved. The majority of photographs were taken from the direction from which surgeons see the liver during an operation. This, together with the schematic presentations complementing most of the photographs, gives a further instructional value to the work. With colour photographs and explanatory text, the Atlas forms a basic guide to orientation inside the liver parenchyma, to understanding and diagnosing certain pathological processes and to planning surgcial procedures.

Abnormal metabolism and distribution of both copper and zinc occurs in many inflammatory and degenerative diseases. The pattern of these changes varies at different stages of these diseases and with differing types of conditions. The corollary to this situation is the possibility of using drugs or metal complexes to modify both the perturbed status of copper and zinc and thus the disease states. This book comprehensively reviews the clinical and experimental data on the changes in copper and zinc status in different diseases and the use of various complexes of these metals or drugs to treat a diversity of inflammatory and degenerative conditions.

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 role of the immune response in both the pathology of liver disease and in the modulation ofliver injury has been the subject of intense research. This book aims to present the current understanding of the involvement of the immune response in liver disease. The first chapters examine the role of the immune response in viral infections of the liver. These viruses cause hepatitis of varying severity and it is thought that many of the mechanisms responsible for liver cell injury are immunologically mediated. In addition three of these viruses, hepatitic B, C, and D, are associated with persistent infection and chronic liver disease. The role of the immune response in viral persistence is discussed. Further chapters are devoted to the three major autoimmune liver diseases which are thought to be the result of loss of tolerance to autologous liver tissue. There has been much recent research on cellular immune responses in these diseases but knowledge of the immunological processes which lead to the breakdown of tolerance and the mechanisms of tissue damage are limited. Other research has concentrated on the identification of the antigens which are the targets of this immune response. Linkage disequilibrium between MHC alleles and autoimmune diseases has suggested a role for immunogenetic factors.

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.

This volume contains the papers presented in the International Summer Course on "Cirrhosis, Hyperammonemia and Hepatic Encephalopathy," which was one of the prestigious Summer Course, of the Complutense University of Madrid held in EI Escorial, Spain, during August 10-14, 1992. Liver cirrhosis is one of the main causes of death in western countries. In addition there is a series of liver dysfunctions including fulminant hepatic failure, Reye's syndrome and congenital defects of urea cycle enzymes that could lead to hepatic encephalopathy, coma and death. As a consequence of impaired liver function, the ability to detoxify ammonia by its incorporation into urea is diminshed, resulting in increased ammonia levels in blood and brain. Hyperammonemia is considered one of the main factors in the mediation of hepatic encephalopathy and the classical clinical treatments are directed towards reducing blood ammonia levels. A part of the book is therefore devoted to the study of certain aspects of ammonia metabolism such as the regulation of the urea cycle, the main mechanism of ammonia detoxification in mammals, which is located mainly in the liver. The metabolism of ammonia in other tissues, including brain, is also presented, as well as the effects of hyperammonemia on brain metabolism and function and on brain microtubules. The control of cerebral protein breakdown is reviewed. The classical and some recently proposed clinical treatments as well as nutritional considerations in the management of patients with liver failure are also discussed.

The explosion of new information on Helicobacter pylori-related disease, both in the basic sciences and in clinical medicine, has continued to progress at an unprecedented pace. In many instances H. pylori infection, both in man and in the laboratory animal, has become a model to investigate fundamental biological issues such as micro-organism host interactions, intracellular signaling, development of mucosal atrophy, mechanism of microbial resistance, disease modifying factors etc. In view of this bewildering flood of new information, another meeting on H. pylori in the successful series Basic mechanisms to clinical cure' was organized in January 1998 in San Diego, California, to define the state-of-affairs' in H. pylori research at this time. The main objective was to integrate this new information in a series of top-quality presentations and discussions between investigators and clinicians addressing all aspects of H. pylori research and to review the current position and future research directions. The format included state-of-the-art presentations by world experts heavily involved in H. pylori research followed by in-depth discussion on intriguing or controversial issues. The presentations were grouped according to the leading theme: characteristics of the organism, mode of transmission, mechanisms of H. pylori-induced inflammation, causation of disturbances of gastric secretory and motor function, aspects of clinical presentation and management, problems related to H. pylori-associated gastric adenocarcinoma and MALT-lymphoma, novel aspects of antimicrobial therapy and vaccination. The meeting concluded with a synoptic agenda of suggested future studies for the microbiologist, the histopathologist and the clinician. The chapters published in these proceedings accurately reflect the content of the superb presentations. The reader will readily appreciate the excellent level of the cutting-edge' research which was described and discussed. These proceedings are another testimony to the enormous impact on basic science and clinical medicine of the H. pylori discovery. Although much was achieved, it is also readily apparent that many questions remain to be answered and many problems remain to be solved.

Gastrointestinal lymphomas have attracted increasing interest over the past few years and are a topic characterized by intensive and ongoing activity. Insights into their pathogenesis and biological behavior have expanded impressively. However, this increased understanding has also raised many new questions. Experts from all over the world came together to exchange their experiences and to discuss new concepts at an international symposium in Wurzburg, Germany, in 1998. This book summarizes the presentations."

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.

This volume contains the papers presented at the International Symposium on "Cirrhosis, Hyperammonemia and Hepatic Encephalopathy," held in Valencia, Spain, January 24th-27th, 1994. Liver cirrhosis and other hepatic dysfunctions such as fulminant hepatic failure and congenital defects of urea cycle enzymes can lead to hepatic encephalopathy, coma and death. Hepatic encephalopathy is one of the main causes of death in western countries. The ability to detoxify ammonia by its incorporation into urea is diminished by impaired liver function, resulting in increased ammonia levels in blood and brain. Hyperammonemia is considered one of the main factors in the mediation of hepatic encephalopathy and the classical clinical treatments are directed towards reducing blood ammonia levels. However, the molecular bases of the pathogenesis of hepatic encephalopathy and the role of hyperammonemia in this process remain unclear and several hypotheses have been proposed. To clarify the mechanisms involved in hepatic encephalopathy and hyperammonemia suitable animal models are necessary. The animal models available and the ideal features of an animal model are presented in the initial part of the book.

Colorectal cancer is the third most common cancer worldwide, and in many parts of the western world, it is the second leading cause of cancer-related deaths. This book covers colon cancer metastasis from the most fundamental aspects to clinical practice. Major topics include physiopathology, genetic and epigenetic controls, cancer initiating cells, epithelial-mesenchymal transition, growth factors and signalling, cell adhesion, natures of liver metastasis, angiogenesis and lymphangiogenesis, inflammatory response, prognostic markers, sentinel node and staging, and finally diagnosis and treatment. Each chapter has been contributed by leaders in the field. A key feature is that it connects with a large readership including students, fundamentalists and clinicians. Another specific feature of the book is that the chapters are written in a didactic and illustrative fashion. These characteristics coupled with the choice of the topics and authors, makes this book a reference in the field. It represents an essential acquisition for medical libraries, clinicians as well as medical and graduate students.

Hepatitis viruses research started more than fifty years ago. The names of hepatitis A and hepatitis B were introduced in 1947 when it became clear that there were two types of hepatitis that were transmitted either enterically or parenterally. It became apparent in the 1970's that there were additional hepatitis viruses distinct from hepatitis A and hepatitis B, and thus, the term non-A, non-B hepatitis was introduced. The non-A, non-B hepatitis was further divided into post-transfusion non-A, non-B hepatitis and enterically-transmitted non-A, non-B hepatitis in the 1980's. By the end of the 1980's, both post-transfusion non-A, non-B virus and enterically-transmitted non-A, non-B virus had been identified and renamed hepatitis C virus and hepatitis E virus, respectively. Hepatitis delta antigen was first recognized as an antigen associated with hepatitis B virus infection in the 1970's. In the early 1980's, a virus was isolated and named hepatitis delta virus. These five different hepatitis viruses have distinct replication pathways and are major health concerns. They have become an important topic for teaching to graduate-level and medical students.Hepatitis Viruses provides a comprehensive, up-to-date review of these viruses to readers. Each chapter is written by one of the top researchers in the field, and topics include: * the epidemiology and the natural history of infection of these viruses, * the molecular biology and the replication cycle of individual hepatitis viruses, * host-virus interactions and the pathogenesis of hepatitis viruses, * the immunology of hepatitis viruses, * the relationship between hepatitis viruses and hepatocellular carcinoma, * the viral vaccines and antiviral drugs. This book can serve as a supplemental reading material to graduate students and medical students, and to any researcher who would like to learn more about hepatitis viruses.

This book, Mechanisms in the Pathogenesis of Enteric Diseases 2, is an out come of the Second International Rushmore Conference on Mechanisms in the Pathogenesis of Enteric Diseases, held September 3D-October 3, 1998 in Rapid City, South Dakota, USA. Its chapters represent many of the reviews and papers presented at the conference. The meeting was organized by members of the North-Central Regional Research Committee "NC-62", a consortium of researchers of bovine and swine enteric diseases from land-grant institutions supported by the United States Department of Agriculture. The Rushmore Conferences were conceived as a forum for an interdiscipli nary discussion of mechanisms of infectious enteric diseases. It was intended that such a discussion would stimulate cross-pollination of ideas, and nurture synergistic collabora tions among scientists who might otherwise not interact. Enteric diseases are caused by widely divergent pathogens and parasites in broadly different settings, and affect multi ple organ systems. Some enteric diseases affect a single species, while others may affect multiple species, perhaps including human beings. Some enteric diseases were present in antiquity, while others have recently emerged. Knowledge regarding a particular disease or pathogen has frequently proven useful in understanding another disease or pathogen, because common themes in pathogenesis exist. As this knowledge base grows,strategies in the prevention and control of various enteric diseases often converge. Cross-discipli nary discussions and collaborations facilitate growth of this knowledge base, as well as development of tools for disease interdiction.

Pancreatic Disease: Basic Science and Clinical Management summarises the state of the art in basic science and clinical management of pancreatic disease. This book provides a clear and up-to-date review of the advancing areas in clinical pancreatology and clinical research related to the pancreas. Written by leading experts in the field, this comprehensive review directs the interested reader towards important and current published source material. Covering all aspects of pancreatic disease, contributions are included from pancreatic surgeons and medical pancreatologists on pancreatic cancer, acute pancreatitis and chronic pancreatitis. Special features include a systematic review of the evidence for the use of gemcitabine in pancreatic cancer prepared for the National Institute of Clinical Excellence (NICE), the UK body charged with evaluating new drug treatment. Gemcitabine has FDA approval. There are several contributions dealing with the management of pancreatic neuroendocrine tumours. This book will be useful to gastroenterologists, internists and surgeons, and specialist clinicians with an interest in pancreatic disease. Trainees in medical and surgical pancreatology will find it a companion to supplement standard textbooks.

"When a thing ceases to be a subject of controversy, it ceases to be a subject of interest. " WILLIAM HAZLITT (1778-1830) This is the fourth volume in a series which we started in 1997. In 1976, Varco and Delaney edited a "surgical bestseller" entitled Controversy in Surgery. This was fol lowed by a second volume in 1985. The immense success of these books among both surgical trainees and experienced surgeons, and their wide international ap peal, supported the editors' notion that a view of controversy is integral to teach ing. However, despite major advances in surgical science and practice, no other similar publication has since been put together with the objective of addressing major controversies in surgery. The aim of this series is to address such deficiency by covering the most crucial current controversies in general, vascular and trauma surgery. Since almost everything is controversial in surgery, we will be able to tackle different issues almost each year. The editors have selected a nationally/internationally recognized authority for each topic. Most books available today are either "North American: ' "British-Com monwealth" or "British-European: ' contributing to the constant transatlantic rival ry. Our series specifically aims to bridge this "culture gap" and includes North American, British, European, and other authors while maintaining a cohesive structure. This will hopefully also broaden the appeal of such a book across both sides of the Atlantic and beyond."

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.

The past 20 years have seen a surge of research into colorectal cancer, which is a reflection of the need to improve our methods of treating patients suffering from this increasingly common form of cancer. Greater knowledge of the basic mechanisms involved in colorectal carcinogenesis is an essential prerequisite to improvements in cancer prevention. In this volume the editors have brought together an impressive list of experts to cover the epidemiology, pathophysiology, morphology and basis for new diagnostic and therapeutic approaches to early detection and prevention. This broad scientific approach provides the reader with up-to-date review of our current state of knowl edge of colorectal carcinogenesis and indicates how this information can be used to generate more research and create new opportunities for diagnosis and treatment. This is a book of knowledge and ideas, some of them still at the stage of theoretical interest, but others with practical potential for the care of patients. I recommend it to those who have a research interest in colorectal carcinogenesis, as well as to readers who wish to know just how far medical scientists have progressed in their efforts to achieve the ideal of cancer prevention."

At the Mie International Symposium held in Japan in April 1994, leading scientists reviewed recent advances in the understanding of the contractile mechanism in smooth muscle. The present volume collects the papers presented at the symposium, summarizing the latest advances in smooth muscle function and emphasizing important components of the contraction-relaxation cycle. Topics include a discussion of the smooth muscle cell membrane, with emphasis on its ion channels; the regulation of cytosolic Ca2+ levels and the relationship to force in smooth muscle; aspects of the two key regulatory enzymes involved with myosin phosphorylation-dephosphorylation; the molecular basis for pharmacomechanical coupling in smooth muscle; developments in the basic contractile mechanisms involving the crossbridge cycle of tonic and phasic muscle; the role of myosin light chains; and many others. The approach is broad and presents contemporary opinions in pharmacology, physiology, and biochemistry as they relate to smooth muscle function. The book will appeal not only to those working in these disciplines, but to vascular clinicians, obstetric-gynecological physicians, and gastroenterologists as well.

Clinical experts synthesize for the practicing physician all the important developments that have occurred recently in the diagnosis and treatment of acid-related diseases. They address the evaluation of patients suspected of harboring both peptic ulcers and ulcers from other causes, with emphasis on novel aspects of H. pylori infection. New information is also provided to assist clinicians in efficiently managing patients with dyspepsia and in the diagnosis and treatment of gastroesophageal reflux disease (GERD), including its extraesophageal manifestations and upper gastrointestinal bleeding. Authoritative and highly readable, Diseases of the Gastroesophageal Mucosa: The Acid-Related Disorders distills a wealth of cutting-edge clinical practice into one readable volume that will help every clinician manage patients with today's best diagnostic and treatment practice.