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.

Epidemiologists, on the basis of studies carried out chiefly in Africa, have suggested that depletion of fiber in the modern Western diet affects health adversely. D. P. Burkitt, who has been in the forefront of this investigation, has included among the "diseases of civilization" hiatus hernia, ischemic heart disease, cholelithiasis, polyps of the colon, and cancer of the colon. All of these conditions appear to have the same geographic distribution. In these areas, the diets were characterized by increased amounts of fat and meat protein, and by an apparent deficit of fiber. It is noteworthy that while an increased intake of refined sugars also has been implicated in the Western diet, the consumption of sugar and other sweetners in the United States actually has remained fairly stable since about 1925 when the use of complex carbohydrates in the form of starchy foods began to decline. The mechanism whereby deficiency of fiber in the diet contributes to the development of colonic diverticula, presumably is by facilitating the development of segmentation of the colon and pockets of intracolonic high pressure zones associated with prolonged transit time of bowel content. Preliminary therapeutic observations, furthermore, have suggested that the addition of fiber in the form of bran to the diet may promote regularity of bowel function and perhaps lessen the likelihood that new diver ticula will be formed after the resection of involved colonic segments."

The immunology of mucosal surfaces is one of the most exciting and relevant areas of medical veterinary and dental research since it applies basic research to tissues in volved in everyday defence against microbes and against environmental and food antigens. This book is based on the contributions presented at the International Con gress of Mucosal Immunology, held in London in July 1989 and organised by the Mu cosal Immunology Affinity Group of the British Society for Immunology. The meet ing was attended by over 500 delegates from 27 countries, including virtually all of the leading investigators in the field. The contents give comprehensive and up-to date information on such topics as antigen presentation and processing in the gut, mucosal vaccines in man and animals, HIV infection in the gut, the role of yo T cells in the gut epithelium, recent advances in inflammatory bowel disease and coeliac dis ease, the role of cytokines in the regulation of the IgA response, mucosal mast cells and cell migration. The contributions reflect the rapid pace of research in mucosal immunology, and the great strides which are taking place in the understanding of the immunology, molecular biology and biochemistry of host response at mucosal sur faces."

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 the rapidly evolving field of Helicobacter infection new data on pathogenetic and pathophysiological mechanism have appeared. New methods which will be more sensitive and specific in the diagnosis of the infection are being developed and in this proceedings the first attempt using PCR technology is published. From the clinical point of view, a challenging aspect that needs clarification, is the observation which suggests an appearance of a correlation between the presence of the bacteria and abdominal pain and other symptoms in children whereas in old age no such correlation is evident. The relationship of H. pylori and gastric cancer is studied with histopathological data and epidemiological approaches. On the treatment side schemes using short courses and new antibiotic combinations are being investigated and preliminary data are reported.

The Symposium "Esophageal Carcinoma - State of the Art" has aroused very great interest. The numerous enquiries have caused us to publish the congress proceedings in the present volume. Particular attention was paid to current topical problems. One of the areas on which the present volume focuses is the epidemiol- ogy and pathology of esophageal adenocarcinoma. Compared to squamous epithelial carcinoma, this is increasing in incidence in Europe. Modern diagnostic methods are described such as laser- induced fluorescence spectroscopy or the optical coherence endo- scopic technique. The latter enables normal mucosa to be distin- guished from dysplastic or malignant lesions, in contrast to con- ventional endoscopy. As in other tumors of the gastrointestinal tract, neoadjuvant therapy is becoming of increasing importance. Since the indication crucially depends on the tumor stage, two contributions deal with postoperative staging, with the diagnostic reliability of the individual techniques and new methods such as endoluminal MRI. There is no doubt that neoadjuvant chemo- therapy is indicated in tumors which are irresectable and in tumor stages in which resectability is uncertain. However, to what extent it should also be applied in the resectable stage will be discussed in the individual contributions both for adenocarci- noma and for squamous epithelial carcinoma. In the meantime, surgical treatment of esophageal carcinoma has been largely stan- dardized. Differences with regard to radicality are still found in the extent of lymphadenectomy, especially in inclusion of cervi- cal lymph nodes.

The larvae of Anisakis, whose adult form lives on sea mammals such as whales, seals, and dolphins, are parasitic upon many species of salt-water fish. When the final host animals eat paratenic hosts, the larvae grow to adulthood in the hosts' stomach. However, when hu mans eat these infested fish, the larvae die instead, causing a disease called anisakiasis. In 1960, in the Netherlands, van Thiel et al. found a worm in the intestinal wall of a patient who had eaten raw herring and had suffered symptoms of acute abdomen. The impact of this report was tremendous among Japanese parasitologists because of the Japanese habit of eating raw fish. In 1964, the Special Research Group from the Ministry of Education was established to investigate the disease, stimulating progress in the study of anisakiasis. Three types of worm, Anisakis simplex larva (previously known as Anisakis larva type I), Anisakis physeteris larva (Anisakis larva type II), and Pseudoterranova decipiens larva type A, are believed to cause anisakiasis. As many as 165 kinds of fish and squid in the seas near Japan are hosts to Anisakis simplex, and 9 species are hosts to Pseudoterranova decipiens larvae. Contra caecum has experimentally been observed to invade the gastrointestinal tract, but no infection by this larva has been reported in humans. A case of infection by Pseudoterranova decipiens type B has been described. In Japan, the name Terranova decipiens (Shiraki 1974) has been adopted instead of Phocanema decipiens (Mozgovoi 1953)."

Causes and Control of Colorectal Cancer: A Model for Cancer Prevention is a ground- breaking monograph which takes a global, multidisciplinary approach to the causes, carcinogenesis and control of colorectal cancer. Over 1000 key studies were analyzed on colorectal cancer cause, carcinogenesis, primary prevention, early detection using modern screening techniques, and surveillance after tumor excision. All major research results are included up to the date of publication. The key chapters include those on morphology, molecular biology and evolution of tumors, etiology chapters on heredity, diet, alcohol, smoking, physical activity, life stress and others, while major chapters in the area of colorectal cancer control are on primary prevention, early detection by screening and surveillance, and post-tumor excision surveillance. Important recommendations on primary prevention, screening and surveillance of colorectal tumors are made in keeping with the most current research data. Causes and Control of Colorectal Cancer: A Model for Cancer Prevention takes colorectal cancer control into the 21st century, and suggests this to be the first cancer in which control will be largely achieved within the next generation, as a result of the unprecedented multidisciplinary research into causation, primary prevention, screening and surveillance over the past 30 years. The book also serves as a model for the control of other common malignancies, particularly cancers of the breast and prostate, the causes and prevention of which are less well understood.

A physician with a broad consultative practice, Dr. Floch combines his clinical experience with a zeal for exploring what has been written by others. Chief of Medicine at the Norwalk Hospital for the past decade and still an active consult ing gastroenterologist, Dr. Floch has given us a volume which every clinician dealing with digestive disorders will want to have at his or her desk. Not everyone will agree with all that Dr. Floch has prescribed in the way of detailed dietary help for the common afflictions of mankind's gut, but in this book the reader can get at the background of the controversy. All clinicians have had problems in assessing when to use elemental diets, how to apply advances in peripheral and intravenous alimentation, and in many other matters which are discussed in detail in this fine volume. Dr. Floch displays what is available in dietary therapy, evaluates the nutritional inadequacies surrounding most diges tive disturbances, and calmly evaluates competing claims. He gives a brief overview of gastrointestinal physiology pertaining to an understanding of nutri tional complications as well as the genesis of the major gastrointestinal dis orders. In this sense his book can be read as a mini-physiological text. I am delighted to have this book in our gastrointestinal series and I hope that the reader will profit from it as much as I have."

Proceedings of the Second International Workshop on Epidemiology and Prevention of Gallstone Disease, held in Rome, December 4-5, 1989

This book aims to be a synthesis of our current knowledge about the normal and pathological esophagus. Although a number of excellent monographs on limited aspects of esophageal pathology are available, a recent handbook treating the whole of esophageal physiology and pathology is lacking. We attempted to present the collected material in such a way that even the neophyte in the field would not get lost in the wealth of data. For this reason we have included a number of illustrations such as classical radiological and endoscopic images, manometric tracings and uncomplicated graphs, which may seem superfluous for specialists but will be helpful to the reader who wants to be initiated in the subject. At the same time we tried to be fairly complete so as to make available to the esophageal specialist a book of references, to which he can readily turn when faced with rare diseases or unusual physiological or pathophysiological pheno mena. In order to achieve both aims the authors often give their own point of view when faced with controversal topics, while classical as well as more recent features and concepts are mentioned and diverging opinions discussed."

This study assembles current and new information on the mechanisms involved in intracellular calcium regulation and their actual or potential relationship to cellular calcium transport. Topics discussed in detail are calcium channels, cellular calcium extrusion, sodium/calcium exchange, calcium-binding proteins with special reference to the vitamin D-induced calbindin, calcium transport and disorders thereof. Each topic is introduced with an overview followed by research papers dealing with relevant topics in each category. New information deals with calcium channels which are not voltage-sensitive, the structure and function of the plasma membrane Ca ATPase, the role of the Na/Ca exchanger in intracellular Na and proton regulation, a comprehensive overview of calcium transport with quantitative analysis of the role of the intestinal and renal calcium-binding proteins, description of the structure and function of the calbindin genes, and identification of calcium transport defects in diabetes and hypertension. Readers will be brought up-to-date on current knowledge and concepts in this rapidly expanding field and be directed to the relevant primary and secondary literature.

It is now more than 40 years since Drs. Wild and Reid published their first experience with rectal ultrasonography from the Surgery Department at the University of Minnesota. Professor Owen H. Wangen steen, in whose laboratory the studies were carried out, recognized at that time the need for early detection in the treatment of cancer. Technical improvements over the past 20 years have made endoscopy the procedure of choice for examination of the hollow organs of the genital, urinary and gastrointestinal tracts. The simultaneous development of endosonography has had an equally dramatic impact on the practice of medicine and surgery. The technology has been demonstrated to be helpful in both benign and malignant conditions. One of the so-called benign conditions of the anorectum is fistula-in-ano. Fistula surgery has always relied on excellent anatomic delineation of the intramuscular tracts. There is hope that adaptation of ultrasonographic technology will aid in the surgical management of this malady. Clearly, rectal ultrasonography has considerable potential in the management of rectal carcinoma. Accuracy rates in the range of 90% for the depth of neoplastic invasion have been reported. This ability for accurate assessment will undoubtedly lead to a better definition of the population of patients that can be managed by local therapeutic means.

Provides findings on acute pancreatitis in the fields of morphology, epidemiology, pathophysiology, enzymatic and in- strumental diagnosis, clinical aspects and pharmacological and surgical treatment. Emphasis on clinical implications on the local release and vasoactice and toxic substances, the high rate of bacterial infection in the necroses, and the causes of impairment of cardiocirculatory, pulmonary and re- nal organs.

A new presentation of physiological regulatory mechanisms and therapeutic applications is given in this book. It represents a collection of the most up-to-date information in cholecystokinin (CCK) research, especially focusing on the development and characterization of CCK antagonists. The book contains chapters on the synthesis, biochemical and pharmacological characterization of potent and selective CCK antagonists as well as physiological applications of these compounds. The last section of the book is devoted to the involvement of CCK in pathological states and potential clinical applications of CCK antagonists.

Imaging of Gastrointestinal Tract Tumors describes current imaging practice for the most commonly encountered benign and malignant digestive tract tumors and gives a review of the literature for less frequent tumors. General features (anatomic data, frequency, clinical and biologic signs, treatment) are discussed for all pathologies prior to description of imaging techniques, which include barium studies, ultrasonography and angiography, and above all CT. MRI appears particularly indicated for esophageal carcinoma and pelvic recurrences of colorectal cancers. The book is divided into three main section - benign tumors, malignant tumors, and tumors with an indeterminate prognosis - reflecting the value of different imaging strategies as a function of a tumor's natural history. The thorough analysis of literature for both frequent and less common tumors allows global evaluation of the diagnostic possibilities of imaging techniques, making Imaging of Gastrointestinal Tract Tumors a reference work for all specialists concerned with digestive tract pathologies.

For the first time four crucial aspects of gastrointestinal endoscopy are combined in a single text. Drugs for sedation and monitoring of the patient are addressed with particular reference to safety issues and comfort and acceptability for the patient. Resource management and health economic techniques are applied to endoscopy to determine quality and outcome. Problems of negligence and informed consent form the basis of a medico-legal examination of endoscopic practices.

Investigation of anorectal disorders has become a very wide field reaching from case history and simple plain radiography to advanced techniques such as defecography, nuclear medicine, endosonography, computed tomography, and magnetic resonance imaging. The place and value of defecography, thedynamic demonstration of bowel evacuation, have not previously been clearly defined. In this highly illustrated volume, radiologists experienced in thisfield describe techniques, radiation risks, and the interpretation of normal and abnormal findings using the aforementioned techniques of investigation. Anorectal surgeons and gastro- enterologists also participatein the discussion of indications and the influence of abnormal findings on patient management. This book will be helpful as a practical guide tothe choice, performance, and interpretation of the appropriate investigationfor a patient with functional anorectal disorders. As such it represents an excellent addition to the library of every physician and specialist withan interest in anorectal disease.

The most comprehensive and conceptual one-volume treatment of this field available and the first to emphasize the cellular and molecular aspects of gut peptide biology. Authored by an array of internationally distinguished scientists, it deals with issues of peptide localization and biosynthesis in gastrointestinal cells, mechanisms of peptide release and inactivation and the nature of peptide receptors. The breadth and readability make it an invaluable reference source for scientists in all disciplines interested in any aspect of brain-gut peptides.

Only a few years ago, most treatises on sonography covered all the diagnostic applications of ultrasound, de scribing organs from the brain down to the placenta. Dr. Bruneton and his associates must be thanked for pre senting this book devoted to the spleen. It probably offers the most complete presentation of details and the richest images available in its field. This book will thus become the ultimate reference in most libraries of books on son ography. March 1988 F. Weill The authors wish to thank Christine Rostagni, Fran ise Fein, and Bernard Fontaine for their assistance in the preparation of this book. Contents 1 Sonographic Anatomy of the Normal Spleen, Normal Anatomic Variants, and Pitfalls B. Senecail . . . . . . . . . . . . . . . . . . . . . . 1 1. 1 Anatomy of the Spleen. . . . . . . . . . . . . . . . 1 1. 1. 1 Morphology and Structure . . . . . . . . . . . . . 1 1. 1. 2 Location and Relations of the Spleen. . . . . . . . 3 1. 1. 3 Average Dimensions of the Cadaver Spleen . . . . 5 1. 1. 4 Congenital Anomalies and Normal Variants. . . . 5 1. 1. 4. 1 Fissured Spleen. . . . . . . . . . . . . . . . . . . . 5 1. 1. 4. 2 Lobulated Spleen. . . . . . . . . . . . . . . . . . . 5 1. 1. 4. 3 Spleen with Two Hili. . . . . . . . . . . . . . . . . 5 1. 1. 4. 4 Wandering or Ectopic Spleen . . . . . . . . . . . . 6 1. 1. 4. 5 Numeric Anomalies . . . . . . . . . . . . . . . . . 6 Ultrasonography of the Spleen . . . . . . . . . . . 1. 2 6 1. 2. 1 Equipment . . . . . . . . . . . . . . . . . . . . . . 6 1. 2. 2 Patient Examination . . . . . . . . . . . . . . . . . 7 1. 2. 3 Scanning Technique . . . . . . . . . . . . . . . . . 7 1. 3 Sonographic Features of the Normal Spleen. . . . 7 1. 3. 1 Splenic Contour . . . . . . . . . . . . . . . . . . . 7 1. 3. 2 Echo Pattern of the Splenic Parenchyma. . . . . ."

In recent years, the area of pharmacotherapy of GI inflammation has witnessed important progress, with new drugs and therapeutic approaches being introduced. The volume reviews the pharmacotherapy of selected gastrointestinal inflammatory conditions chosen on the basis of their clinical importance and/or the areas where important and exciting progress has been made recently. Besides discussing current pharmacotherapy to treat the most important GI inflammation conditions, the book also indicates possible future therapeutic avenues likely to become available in a few years.
The book is of interest to various sectors of the scientific community ranging from clinicians to pharmacologists and from biochemists to microbiologists, who will find it a useful tool for their clinical practice and research activity.

The aim of this symposium was to provide a framework for fruitful discussion on intestinal transport, not only for advanced scientists but also for younger people starting in this field of research. Invited lectures, communications and poster presentations were focused on four central themes, all treating the prop erties of the sole intestinal epithelium, deliberately leaving aside problems dealing with more integrative functions of the whole intestine. The importance of motility or blood circulation, for instance, is certainly capital in the overall intestinal function, but these aspects by themselves deserve another meeting. This volume has compiled the manuscripts of the invited lectures which sub stantially comprised the four sessions of the Symposium. Part 1 is designed to emphasize actual knowledge of the transport of water, inorganic as well as organic ions and molecules across the isolated intestinal epithelium. An enormous wave of investigations has emerged from studies per formed with "Ussing chambers," which roused interest in studies on absorption mechanisms and subsequently on secretory processes. This has triggered off a trend to research on isolated cells as absorption and secretion are the main func tion of the different cell types constituting the intestinal epithelium. In this first session not only the importance of the parallel arrangement of these different cellular entities is stressed, but also the role played by the paracellular route."

In July, 1988, more than 300 scientists from 29 different countries gathered at Tiibingen, W. Germany, in order to spend 4 days discussing their favourite trace element, selenium. This meeting continued the good tradition of three previous meetings held in Corvallis/Oregon, 1976, in Lubbock/Texas, 1980, and in Beijing/China, in 1984. Incidentally, the University of Tiibingen provided a unique historical background for a Symposium devoted to recent advances in biochemistry, pharmacology, human nutrition and human health; here, the first independent depart ment of Physiological Chemistry in Germany was founded in 1845. Pro fessor H9Ppe-Seyler elucidated here the hemin structure and his student Friedrich Miescher discovered the nucleic acids. This book contains one-half of the oral or poster presentations which were selected before the meeting was held on the basis of a one page abstract. It is the reader who will have to decide whether this time consuming policy of quality assessment was warranted or not."

Dr. Raymond Pederson, Dr. Jill Dryburgh and I commenced work on GIP in 1968, when, with the generous help of Professor Viktor Mutt and Professor Erik Jorpes of the Karolinska Inst, itute, Stockholm, we were able to establish that there existed an inhibitory material for acid secretion in cholecystokinin-pancreozymin prepara tions. Once the physiological evidence for the inhibitor was established it seemed appropriate to seek help in its isolation. Dr. J. Dryburgh and Dr. R. Pederson were left to bioassay fractions in Vancouver whilst I enjoyed the company of Professor Mutt at the Karolinska for one year, as a Medical Research Council of Canada Visiting Scientist. Purification of the inhibitory factor proceeded rapidly due, in no small measure, to Professor Mutt's untirmg efforts on my behalf. Later that year, Dr. Dryburgh joined us in Stockholm to begin the sequence work on GIP. This was completed late in 1970 in Vancouver. In Stockholm in June 1970, I met a fellow Canadian Dr. John Dupre (McGill University) at a cocktail party who kept commenting about the possibility of GIP being an insulinotropic hormone, the "incretin" of earlier days. At that time, gastrointestinal physiologist as I was, I did not recognize the importance of his comment. This became apparent two or three years later when Dr. Dupre demonstrated that GIP was insulinotropic in man. In 1972, Maryanne Kuzio and Dr."

Congenital hip dysplasia and dislocation are common diseases of newborns and small infants, with frequently severe consequences if orthopaedic therapy is not initiated at an early stage. Therefore many clinicians have been looking for a simple method for the investigation of the hip joint in the early neonatal period. Up to 1980 the diagnosis of hip dysplasia could usually not be made before the 3rd month of life, by means of pelvic roentgenography. Only incomplete or complete unilateral dislocations were diagnosed in the neonatal age group. In 1980, however, Graf, an Austrian orthopaedic surgeon, began using ultrasound investigation ofthe hip joint in newborns and small infants in order to make an early diagnosis and to avoid radiation exposure. The intention of the present study was to compare ultrasound of the hip joint with other established diagnostic procedures and to establish whether it is suitable as a screening procedure in newborns. 2 Incidence of Congenital Hip Dysplasia and Dislocation In 1972 Barlow reported that 90 % of hips which are unstable at birth develop to normal joints spontaneously without any therapy. Visser (1984) thus suggested determining the percentage of hip dislocations after the 2nd - 3rd month of life so that children with spontaneous stabilisation would be excluded.