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.

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."

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.

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.

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.

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.

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.

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."

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."

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.

In the past 30 years, gastroesophageal and reflux disease (GERD) has become an important area of clinical medicine. GERD has gradually become associated with other common but unexplained disorders. These conditions have been designated as the extraesophageal manifestations of GERD. Dr. Anthony J. DiMarino, Jr. and Dr. Sidney Cohen and their contributors have written Extraesophageal Manifestations of GERD with the purpose to identify associations with conditions like hoarseness, laryngeal cancer, sleep disorders, and dental caries, and to explore possible causation and mechanisms of disease or possible noncausal relationships. The extraesophageal disorders have become widely accepted in clinical practice. The evidence supporting the pathogenesis of these conditions falls into three major categories: guilt by association, observed mechanistic studies, and therapeutic response to treatment. Inside the pages of Extraesophageal Manifestations of GERD the reader will find recognition and balance in treating patients with common symptom-based disorders. Final resolution of some of the controversies inherent in these associations may require advanced diagnostic tools and advanced pharmacological therapies. With chapters written by experts in the fields of medicine, pediatrics, otolaryngology, and dentistry, Extraesophageal Manifestations of GERD will be a must have for gastroenterologists, internal medicine residents, surgeons, otolaryngologists, and pediatricians.

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."

Liver disease in children is increasing in prevalence, placing a huge burden on healthcare systems and often requiring long-term management. Offering an integrative approach to the science and clinical practice of pediatric hepatology, this is the definitive reference text for improved diagnosis and treatment strategies. In the new edition of this authoritative text, chapters have been thoroughly revised in line with major advances in the field, such as recognizing the increased frequency of fatty liver disease, and how genetic testing has the potential to establish earlier diagnoses for a variety of diseases. Disorders covered include cholestasis, metabolic disorders and hepatitis, with their presentation across the spectrum of infancy, childhood and adolescence discussed. The indications and surgical aspects of liver transplant are explained and post-transplant care is described in detail. This is a valuable resource for pediatricians, hepatologists, gastroenterologists and all clinicians involved in the care of children with liver diseases.

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.

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.

The classification of tumors is important for understanding tumor histogenesis, for predicting prognosis, for differential diagnosis, and for recommending appropriate therapy. Since 1836, when pancreatic cancer was first described, progress has been made in pancreatic cancer morphology, and a number of classifications have been proposed. All of these classifications are mainly based on morphological characteristics. Some are too detailed to be of practical use while others are more pragmatic. Some of the inherent problems in the previous classifications included difficulties in obtaining an adequate number of pan creatic tumors for examination and insufficient clinical data and follow-up. With the increasing incidence of pancreatic cancer in many parts of the world during the past six decades, and with the availability of more tumors to patho logists, advances have been made in pancreatic tumor studies. Classifications by Cubilla and Fitzgerald and by Kloppel, which are generally similar, mostly considered prominent morphological features and their histogenesis. These pathology-oriented classifications, although complete, were not practical from the standpoint of clinicians concerned with the prognosis of individual tumors."

More than a century ago, Cripps successfully employed the direct and complete division of the anal sphincters as a means of approaching the lower rectum and anal canal, and reported on a series of 36 patients who had been treated in that fashion. Cripps was pleasantly surprised to find good fecal continence in over two-thirds of the patients during later follow-ups, despite the fact that the divided sphincters had not been repaired. The transsphincteric procedure was largely forgotten in subsequent years, however, and only the parasacral proctotomy of Kraske, which spared the anal sphincters, can be said to have gained an established place in the" surgical armamentarium. " It remained for York Mason to redirect the attention of the surgical community to the great potential of the trans sphincteric approach and the excellent continence that can be achieved through adequate repair of the divided sphincters. Having recognized the outstanding practical value of this procedure, we felt it necessary to define more precisely the anatomical prerequisites that would ensure minimum operative bleeding, and to bring the procedure more in line with current knowledge of normal continence and defecation. Dr. A. Huber, in consultation with the director of the Institute for Clinical Anatomy of our surgical department, Prof. A. von Hochstetter, did many months of dissection work on fresh anatomic preparations in an effort to explore and refine the various aspects of the trans sphincteric ap proach."