"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."

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.

Leading experts in the fields of gastroenterology, surgery, and radiology comprehensively review the pathophysiology, diagnosis, management, and treatment of acute bleeding disorders of the GI tract. The authors break down acute bleeding into upper and lower GI tract sources and provide a differential diagnosis for each disease, evidence-based algorithms for clinical practice, treatment modalities for its management, and standards of care. The authors outline the many dilemmas faced by physicians in their approach to their patients, such as localization of the bleeding source (upper vs lower), the need and timing for emergency endoscopy, and the timing for radiologic intervention and/or surgery.

"Neuropeptides and Stress" presents a comprehensive survey by leading pioneers in the field of the knowledge and concepts implicating neuropeptides in the regulations of responses to stress. Topics covered include: recent advances on the regulation and modulation of the behavioral, endocrine, autonomic, gastrointestinal, immune and analgesic responses to stress by neuropeptides. Neuroanatomical and biological data are considered. Special emphasis is given to corticotropin-releasing factor (CRF) and opioid peptides.

This volume reviews the most recent knowledge in the field of gastrointestinal motility in health and disease. The topics addressed include basic as well as clinical data concerning the motor functions of the entire gut: the lower oesophageal sphincter and the gastro-oesophageal reflux; the gastric emptying and the role of the pylorus; the motility of the biliary tract and its disorders; the cyclic motor activity of the gut and intestinal transit; the colonic and ano-rectal motility. There are also impOltant contributions in physiology and pharmacology relating to the neurohumoral regulation of the gut, and the function of digestive smooth muscle. Several papers explore the nature of the linkage between brain and gut. a link which has long been deduced by clinicians but not, until recently, systematically explored by scientists. The individual papers, selected from a large number of submissions, have been subject to 'peer-review' by an inter national committee which includes both cliniCians and basic scientists. Therefore this book should serve as an up to date source of information for researchers concerned with basic sciences as well as for clinicians in gastroenterology, medicine and surgery. C. Roman v This volume is dedicated to the memory of two friends and colleagues: Professor Dr J. HELLEMANS Professor Dr H. MONGES Acknowledgments This was the 9th of this series of symposia held alternatively in Europe and North America, and the first to be held in France."

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

The intestine, particularly the small bowel, represents a large surface (in the adult 2 human approximately 200m ) through which the body is exposed to its environment. A vigorous substrate exchange takes place across this large surface: nutrients and xenobiotics are absorbed from the lumen into the bloodstream or the lymph, and simultaneously, the same types of substrate pass back into the lumen. The luminal surface of the intestine is lined with a "leaky" epithelium, thus the passage of the substrates, in either direction, proceeds via both transcellular and intercellular routes. Simple and carrier-mediated diffusion, active transport, pinocytosis, phagocytosis and persorption are all involved in this passage across the intestinal wall. The term "intestinal permeation" refers to the process of passage of various substances across the gut wall, either from the lumen into the blood or lymph, or in the opposite direction. "Permeability" is the condition of the gut which governs the rate of this complex two-way passage. The pharmacologist's interest in the problem of intestinal permeation is twofold: on the one hand, this process determines thebioavailability of drugs and contributes significantly to the pharmacokinetics and toxicokinetics of xeno biotics; on the other hand, the pharmacodynamic effects of many drugs are manifested in a significant alteration of the physiological process of intestinal permeation.

Gastrointestinal Surgery: Pathophysiology and Management is an invaluable reference text for surgeons and surgical trainees. Written entirely by Dr. Haile T. Debas, Dean of School of Medicine and former Professor and Chairman, Department of Surgery, at the University of California, San Francisco, this book provides the unified approach only found in a single-authored text. Based on the three pillars of understanding particular disease processes -- fundamental anatomy and physiology, pathopysiology, and clinical correlations -- surgical treatment of GI disease is presented as the means to correct abnormal physiology and restore health. Using an integrated approach of basic science and clinical practice, Dr. Debas allows the student of surgery to gain a solid understanding of disease processes that minimizes the need for rote memorization. Thirteen lavishly illustrated chapters cover the GI system as well as gastrointestinal peptides and peptide-secreting tumors, abdominal trauma, the abdominal wall, surgery for morbid obesity, the liver, spleen, retroperitoneum, and perioperative care. Dozens of summary tables throughout each chapter condense "essentials" for quick reference. Comprehensive discussions of clinical disorders review the surgical treatment options. With 400 illustrations and tables, including hundreds of anatomical line drawings commissioned exclusively for this textbook, Gastrointestinal Surgery provides a clinical and therapeutic approach to surgical diseases which will prove invaluable to the surgical trainee and the practitioner preparing for recertification.

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.

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.

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

More than 70 years have elapsed since U. S. von Euler and I. H. Gaddum dis- covered an unidentified depressor substance in the brain and gut. The effects of the powdery extracts were marked as 'P' on the kymograph tracings, and the nondescript name of 'substance P' still carries the breath of this adventurous period. In the 1960s, substance P returned in another disguise, staging as a hypothalamic peptide that causes copious salivary secretion (see chapter by F. Lembeck and I. Donnerer). This time, though, the mysterious substance was tracked down by S. E. Leeman and her collaborators as an undecapeptide, after it had eluded its identification for some 40 years. Substance P turned out to be the mammalian counterpart of a family of peptides which had been extracted from amphibian and nonvertebrate species and which had been given the name 'tachykinins' by V. Erspamer. Soon novel members of this peptide family were discovered, and in mammals substance P was joined by neurokinin A and neu- rokinin B. The presence of tachykinins in frog skin as well as in venoms and toxins of microbes and arachnids raises the possibility that these peptides re- present an old system of biological weapons that have been transformed to a particular messenger system in mammals.

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.

The liver is an exceptionally complex and diverse organ that functions both as an exocrine and an endocrine gland. It secretes bile, which contains many con stituents in addition to bile salts, and it synthesizes and releases many substances in response to the body's demands, including prohormones, albumin, clotting factors, glucose, fatty acids, and various lipoproteins. It has a dual blood supply providing a rich mixture of nutrients and other absorbed substances via the portal vein and oxygen-rich blood via the hepatic artery. This functional heterogeneity is accompanied by cellular heterogeneity. The liver contains many cell types including hepatic parachymal cells, Kiipffer cells, Ito cells, and endothelial cells. The most abundant cell type, the parenchymal cells, are biochemically and structurally heterogeneous. The cells in the oxygen-rich areas of the portal triad appear more dependent on oxidative metabolism, whereas those around the central vein (pericentral, perivenous, or centrolobular areas) are more dependent upon an anaerobic mechanism. Throughout this volume the latter three terms are used synonymously by various authors to indicate the five to eight layers of cells radiating from the central vein. Structural and metabolic heterogeneity of hepatic parenchymal cells has been demonstrated by a variety of approaches, including histochemical, ultra structural, and ultramicrobiochemical studies. This microheterogeneity is linked to the physiological functions of the liver and its response to injurious substances."

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.

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 ..."

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.

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.

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."

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.

Gastroparesis is an increasingly recognized disorder. Treatment can be difficult due to the several mechanisms for symptom production. Gastroparesis: Pathophysiology, Presentation and Treatment serves as a concise reference on this disorder that allows clinicians to quickly access and evaluate the necessary information for treating and managing patients with gastroparesis. Each chapter is written byexperts in their respective area. The volume will enable the reader to better understand all aspects of this disorder. The book presents current concepts in a variety of areas opening with the epidemiology, clinical presentation and pathophysiology of gastroparesis. The natural history of patients is explored as well as evaluation of patients with suspected gastroparesis. This section includes chapters on Wireless Capsule Motility, Electrogastrography and Antroduodenal Manometry. This important resource concludes with a full section on treatment including dietary, prokinetic, antiemetic, sensory, electric stimulation, and surgical methods. New developments include the use of gastric electric stimulation for treatment, the use of SmartPill for diagnosis, and a number of new agents in development for this disorder. Gastroparesis: Pathophysiology, Presentation and Treatment is the ideal reference for gastroenterologists, and also for surgeons, endocrinologists, primary care physicians and nutritionists looking to keep pace with the latest information treatment options for their patients. "

Drugs are often associated with adverse effects, and the digestive tract is the most frequent target. This volume collects a number of updated overviews from experts in this area to offer to the reader a single, complete source of information and reference on that subject.