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.

Hepatology has come of age in the last decades. Biology of the liver has flour ished long before. As the largest homogeneous organ of the body the liver served as useful model in the development of biochemistry and related discip lines. Only gradually were these biological investigations applied to the clinical study of liver disease. This was particularly stimulated by the recognition that in the greater part of the world, the developing countries and what we now call the Third World, liver disease represents a major threat to overall public health. It leads to morbidity and mortality of persons in their productive years from liver cancer, cirrhosis and parasitic disease, particularly, schistosomiasis. Moreover, the growing emphasis on the social impact of diseases focused on disorders of the liver because malnutrition, poverty, and drug addiction contrib ute greatly to their spread. This is compounded by the increase of alcohol abuse, recently on the rise even in the developing countries. Concern with envi ronmental pollution has also raised the interest in liver diseases, in part because the liver acts as a guardian against polluting chemicals and in part because it is considered, possibly to an exaggerated degree, a vulnerable target of such chemicals.

Studies on the colon not only serve medical interest or clinical purposes, but are also a highly interesting subject of comparative physiology, from which we can learn much about the basic principles in physiology. Presented here are examples of research on colonic ion transport of each vertebrate group, including the classical models of epithelia, rat and rabbit, and also on the special and unique features in fish, amphibians, reptiles, birds, and selected mammals such as the guinea pig. Physiology and pathophysiology of ion transport in the human large intestine are as well covered as the use of colonic cell cultures as model systems for crypt cell properties.

Colorectal cancer was the subject of the Third Symposium on Clinical Oncology organized by the Royal College of Radiolo gists, London, in February 1981. This publication of collected papers is based on the presentations at that meeting. The purpose of these symposia is to encourage a multidis ciplinary approach to our understanding and management of cancer. They bring together not only clinicians of different specialities, but also non-clinical scientists who also have made a significant contribution both to basic knowledge and to applications of direct clinical relevance. It is hoped that sym posia of this kind will be a stimulus to increasing collaborative research. Colorectal cancer is now one of the most important causes of cancer deaths. The incidence of the disease varies greatly throughout the world but is particularly common in North America, Canada, and Western Europe. The aetiology of colorectal cancer is reviewed and a clear description is given of the factors associated with its high incidence in affluent Western societies. There is still no evidence of a direct associa tion between dietary constituents and colorectal cancer, and so changes in our dietary habits that might help to reduce the incidence of this disease cannot be advised. While research VI Preface in this important field continues, improvements must be sought in techniques of early diagnosis, assessment and management."

Continuing progress has been made since the first edition of Artificial Liver Support was published. Liver transplantation has however become an estab lished therapy for a relatively small number of patients who remain patients for life. There therefore continues to be a great need for the development of other forms of artificial liver support. Improved intensive care utilizing improved plasma exchange, dialysis, sclerotherapy, and intracranial pressure monitoring have improved survival in fulminant hepatic failure. Progress has also been made in lipid membrane detoxification, in cell cultures, and in cell transplantation, and the isolation of various liver cell growth factors has led to deep insight into the mechanisms of liver regeneration. This book gives the clinician and the researcher detailed information about established new methods of clinic work and laboratory research, and describes new experimental approaches indicating the direction of future research. G. BRUNNER M. Mno Preface to the First Edition The regenerative capacity of the liver cell is almost unlimited. Therefore after acute liver damage, be it viral, toxic, hypoxic, or surgical in origin, restitutio ad integrum is the usual outcome. In two forms of liver disease, however, this is not the case: in fulminant hepatic failure, liver regeneration often is not fast enough to keep the organism alive; in end-stage cirrhosis, regeneration is disturbed by a hypertrophic architecture of fibrotic tissue. For these extreme forms of liver disease and for critical situations before and after liver surgery, artificial liver support is needed.

Pioneering work on hepatitis B virus and hepatitis delta virus, and the discovery of hepatitis B-like virus in animals during the 1970's has been followed, over the past ten years, by an explosion of interest in how these viruses replicate, maintain chronic infections, and cause liver disease and hepatocellular carcinoma. The purpose of this book is two-fold. First, the authors of each chapter provide a summary of their specialty that will not only serve as an introduction, but will also provide the newcomer to hepatitis B virology with up-to-date information and insights into the goals and accomplishments of each area of investigation. Second, since the diversification of interests and increased specialization of hepadnaviruses researchers has reached a level where it is no longer possible for any one individual to read all the primary literature, this book will help to refocus interest on what is, after all, the major objective: to understand and ultimately treat or prevent chronic liver disease and liver cancer. Accordingly, chapters are included which span a range of interests, from the management of hepatitis B patients to new approaches to antiviral therapy, from the role of hepadnavirus gene expression in DNA replication to the role of ribozymes in the delta virus life cycle, from liver cancer in naturally infected woodchucks to liver disease in HBV transgenic mice to the use of hepatitis virus vectors to treat inherited enzyme deficiencies.

Parasitic diseases are the most widespread of all the major diseases, currently 9 affecting about 3 x 10 people and innumerable domestic animals. There is no doubt that among these parasitic diseases, the helminthic infections of the gastrointestinal tract are about the most important because of their global distribution, their high prevalence, their effects on the nutritional status of men and animals, their effects on the physical and mental development of children, and their economic effects on the production of animals. Anthelmintics are important elements in the control of these gastrointestinal helminthic infections. In this volume the editors and authors have tried to find a way through the immense amount of information on anthelmintic drugs that is scattered throughout the literature. Different authors have critically examined this information from different angles. However, the aim of all has been to provide the information needed by veterinarians, physicians, and public health workers to select the most suitable drug for a given situation.

Alcohol abuse ranks among the most common and also the most severe environmental hazards to human health. Its significance is heightened by the possibility of prevention by elimination of the habit, however, rarely exerted. The incidence of deleterious effects on human health has relentlessly risen in the past years for a variety of factors. They include migration of populations and, particularly, increased urbanization. Thus, in some parts of the world, population groups previously spared have become involved, which is also re flected in the increasing number of breweries and distilleries in the developing countries. Social, religious, and gender-related barriers to alcohol consumption are loosening, and the financial improvement of some segments of populations now enable them to buy alcoholic beverages. Thus the greatest percentage rise in the United States has recently been in black women. Adolescents and young people drink more alcoholic beverages than ever, and growing alcohol abuse by pregnant women has let to an increase of the incidence of the fetal alcohol syndrome. While the social and behavioral, including psychiatric, consequences of alcoholism are staggering, the gastrointestinal and, particularly, hepatic manifestations are the most widespread somatic effects, and chronic hepatic disease in alcoholics appears to cause the greatest cost to society. Indeed, mortality from liver cirrhosis is considered a reliable index of alcohol consumption in a country."

In observing the development of modern scientific knowledge, many indivi duals have expressed concern over the rapid growth of information in various specialized disciplines. Over 100 years ago the first Secretary of the Smith sonian Institution, and more recently Dr. Vannevar Bush while proposing the modern expansion of the National Institutes of Health, both noted prob lems that prevented the proper utilization of information by individuals in medical and related scientific fields. These observations, tagether with con comitant implications of future difficulty, are particularly pertinent to the field of oncology. The rapid evolution of the latter discipline has largely been aided by the incorporation of concepts and methods developed over a long period of time, and drawn from a wide variety of other scientific fields. The large body of discoveries that have contributed to our current understanding of neoplasia, however, cannot be viewed as being made up of equal parts. They bring to mind Claude Bernard's view "des determinismes simples et complexes" in the physiological and biochemical regulation of bod ily functions. He was able to observe that the most important and basic of physiologic processes were destined to be fewer in number than those of less fundamental and more highly specialized purpose. He understood that in the future development of medical science, sturlies of the lauer would occupy much of the time and attention of investigators, and were likely to contribute much to scientific literature."

In this work, leading physicians; hepatologists; pharmacologists; pathologists; and transplant surgeons discuss the most recent advances in the field of liver disease and its 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.

Primary and metastasizing malignant carcinoma of the liv er represent a challenge to both the diagnostician and the therapist. For this reason, it appears a worthwhile task to review the current status of knowledge about the treatment of primary and metastasizing tumors of the liver. The ques tion is whether modem diagnostic methods and new thera peutic concepts can help to improve the prospects of treat ment. Of particular interest is the role played by therapeu tic procedures directly involving the liver. Thus, it is equally important to discuss the pathophysiological and pharmacological bases for a modem therapy concept as it is to consider diagnostic issues and possible definitions of stages of progression. Therapeutic concepts comprise sys temic therapy and organ-related therapeutic methods, in cluding surgical resection, changes in the blood supply, re gional selective chemotherapy, and other localized or regional, highly specialized forms of therapy. This survey of the various possibilities in the field is meant too to stimulate further scientific research, given that methods of treatment are as yet by no means stan dardized, but are still in the stage of clinical research, where experimental models can find an application. The only well-established operative procedure is surgery on the isolated liver tumor. In this area, specialized techniques and various intraoperative procedures are discussed. There is a wealth of information available on all the top ics covered."

The development and the widespread clinical application of various di agnostic imaging modalities, such as diagnostic ultrasonography, X-ray computed tomography, single photon emission computed tomography, and magnetic resonance imaging, have been beyond all expectation. In particular, ultrasonography and X-ray computed tomography have be come major diagnostic tools for diseases of the liver, the biliary tract, and the pancreas. They often have virtually replaced other conventional imag ing modalities including invasive angiography and percutaneous trans he patic cholangiography. One modality may complement or conflict with another or other modalities. Each modality should be carefully selected with due regard for its diagnostic efficacy. In this book, the first section contains nine chapters dealing with current techniques of each diagnostic modality applicable to the liver, the biliary tract, and the pancreas. The second section deals with diseases of the liver, the biliary tract, and the pancreas and takes the form of case presentation with discussion of the significance of diagnostic imagings and diagnostic procedure. Preparation of the manuscript was made possible by the help of Dr. S. Fujita, who prepared the photographs, and Mrs. Sobajima, who typed the original manuscript. Dr. S. Miura and Miss Y. Shimizu under took the labor of translating our manuscript from Japanese into English. I would like to express my deep appreciation to all these persons, as well as to the contributors to this book, and also to the publishers, Shujunsha, Japan and Springer-Verlag.

Technical improvements over the past twenty years have made endos copy the procedure of choice for examination of the hollow organs of the genitourinary and gastrointestinal tracts. The development of electro surgical techniques, laser technology, injection therapy, and a wide variety of other modalities now allow the endoscopist to treat many problems that in the past required open surgery. The simultaneous development of transcutaneous abdominal sonography has had an equally dramatic impact on the practice of gastrointestinal and geni tourinary surgery. The marriage of these proven technologies, known as endoscopic sonography, provides an exciting new modality that promises to further revolutionize the diagnosis and management of many intraabdominal diseases. Endoscopic sonography opens new frontiers by overcoming the primary limitations of its parent technologies. Fiberoptic endoscopy is limited by the inability to see beyond the luminal surface, this is particularly important when considering neoplastic disease because depth of wall invasion is a key factor in determining treatment. The limiting factor in transcutaneous sonography is the distance between the transducer and the target organ. With endoscopic sonography, the transducer is placed in close proximity to the target organ. This allows the use of high frequency waves (greater than 5 MHz), which provide better tissue resolution and eliminates the image distortion caused by overlying structures.

Helieobaeter pylori has recently been recognized as a new genus according to specific taxonomic criteria; the "popular" name Campylobaeter pylori has been corrected by scientific progress. Following the discovery of the spiral microorgan ism in gastric mucosa by Marshall and Warren in 1982, it took only a few years for H. pylori to become established as a factor in the pathogenesis of gastritis and peptic ulcer disease. Interest in different aspects of H. pylori has grown continuously and has attracted scientists from various medical and biological disciplines such as gastroenterology, microbiology, pathology, immunology, and pharmacology. Indeed H. pylori provides an excellent model for interdisciplinary interaction and cooperation. To promote this concept of interdisciplinary research and exchange of knowledge, a European Campylobacter (Helicobacter) Pylori Study Group was founded in 1987 in Copenhagen. The second meeting of this expanding group was held from October 12-14,1989 in Ulm, FRG. The fact that more than 500 participants attended the conference and that 187 original contributions from all five continents were presented clearly confirmed that H. pylori has "scientifically infected" the whole world. Our understanding of the microbiological and pathogenetic aspects of H. pylori is continuously being challenged as new results follow swifthy from different research areas. This book includes an update and progress report on the various aspects of H. pylori presented and discussed in special workshops held during the meeting in Ulm.

The first portion of this work is devoted to a consideration of the practical aspects of the proctoscopic examination and thus presents the indications for performing a proctologic evaluation, the information that may be obtained from the patient's medical history, an example of a preprinted data form for use in the recording of the physician's findings, the preparation and positioning of the patient, and the preliminary examination of the anus including the digital rectal examination. The instruments needed to perform proctoscopy are uncomplicated, and the basic tools are inexpensive. The instruments currently available do not really differ from each other except in minor details. In the text, therefore, we have only described the prototype instruments, and details about the pro posed advantages of any particular instrument can be obtained from its manufac turer. The concluding portion of the text describes how the proctoscopic and colonoscopic examinations are performed. The atlas itself is a topographical stratification of the various diseases that may involve the perianal region, the anus, and the adjacent portions of the large bowel as well as their classification according to morphologic criteria, for example, inflammatory bowel diseases and tumors. Since many pathologic findings in the rectum and sigmoid colon are comparable to those in the upper portions of the large bowel, a duplication of these proctoscopic and colonoscopic illustrations has been avoided.

Since the beginnings of diagnostic ultrasound in the 1950s, each decade has seen significant advances in this technology. Commer cialization of ultrasound occurred during the 1960s with the introduction of many of the clinical uses that are in existence today. The 1970s showed the most dramatic changes with the commercial introduction of gray-scale and real-time ultrasound. In the 1980s many new advances were introduced, including color Doppler, as well as a wide variety of endoluminal approaches, including endorectal, endovaginal and transesophageal. The decade of the 1990s promises even more significant advances with further transducer miniaturization, three-dimensional ultra sound, and the introduction of a variety of ultrasound contrast agents. With such rapid changes occurring, it becomes important to disseminate knowledge in as rapid a fashion as possible, thus it was quite appropriate that a meeting such as this be held to provide an in-depth review of the many new areas of ultrasound imaging that show promise for the future. Emphasis was on the new uses of ultrasound in gastrointestinal diseases. Many of these advances will, of course, also have applications in many other areas of the body. It is hoped that those in attendance will acquire a much broader understanding of where ultrasound is now and where it is headed in the not too distant future.

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.

Major advances have been made in the understanding of the molecular mechanisms of atherosclerosis, the disease that still affects more than 50 percent of the population in the highly industrialized countries. This volume covers the most recent advances in the treatment of hyperlipidemia. It represents a necessary update because molecular mechanisms of atherogenesis have been discovered in the past few years and their molecular mechanisms of action identified. Extensively treated are the molecular mechanisms of disease etiology of arteriosclerosis in relation to the major risk factor "hyperlipidemia," rationale for more effective treatment of this disease by dietary means, the treatment of associated or causing diseases, and the treatment using hypolipidemic drugs.

Boston University School of Medicine has established a series of Medical Education Programs in Nutrition held each summer since 1975. These deal with controversies in human clinical nutrition. The subjects have covered various topics, including those dealing with the relation ships between diet and heart disease, diet and cancer, breast. versus bottle-feeding, and dietary fiber and disease. Other noncontroversial topics were also covered at these conferences; they were discussed simply to bring to the attention of the health professional new happenings in nutritional research. These topics dealt with the relationships of nutrition to immune function, to neurotransmitters, to infection, to obesity, and to chemotherapy. This text is a compilation of selected manuscripts of interest to the health professional in the area of human clinical nutrition. Whatever success this text enjoys is in no small way due to the ad ministrative and editorial efforts of our administrative assistant, Mrs Geraldine Rankin - our sincere thanks."

This book is a unique work devoted to the subject of disordered defaecation. It contains chapters written by experts in the field of ano-rectal physiology and management of disordered defaecation. The various contributions present personal views and special clinical experience of individuals. There are some personal views which we felt should be commented upon and a few areas where the experience of others has been included into the text. For the sake of completeness of each chapter, a slight overlap in some cases was inevitable. We hope the book will serve as a useful collection of opinions on a subject which until recently has been largely ignored by the medical profession. The editors Major contributors H. O. ten Cate Hoedemaker Department of Surgery, University Hospital, Rijnsburgerweg 10,2333 AA Leiden, The Netherlands G. Coremans Department ofInternal Medicine, University Hospital Gasthuisberg, Here- straat 49, 3000 Leuven, Belgium S. Fasth Department of Surgery II, Sahlgrenska Hospital, S-413 45 G6teborg, Swe- den H. G. Gooszen Department of Surgery, University Hospital, Rijnsburgerweg 10, 2333 AA Leiden, The Netherlands J. A. Gruwez Department of General Surgery, University Hospitals KU, Brusselsestraat 63,3000 Leuven, Belgium M. M. Henry Department of Gastroenterology, Central Middlesex Hospital, Acton Lane, London NWlO 7NS, United Kingdom M. R. B. Keighley Department of Surgery, The General Hospital, Steelhouse Lane, Bir- mingham B4 6NH, United Kingdom J. H. C. Kuypers Department of Surgery, University Hospital St. Radboud, Geert Groote- plein Zuid 14,6500 HB Nijmegen, The Netherlands Ph. B.

Bei der Entstehung von Magengeschw}ren ist in den letzten Jahren die Bedeutung einer Ausl|sung durch Campylobacter pylori bekannt geworden. Neue systematische Untersuchungen f}hrten zu einer Namens{nderung: Helicobacter. Der Band gibt eine Obersicht }ber den derzeitigen Wissensstand.

There have been many advances in the field of gastrointestinal pa thology which are of considerable clinical significance during the 13 years since the last publication of a volume of Current Topics in Pathology devoted to this subject. Many have arisen from the app lication of new techniques of histochemistry, immunocytochemi stry, quantitative morphometry and molecular and cell biology to gastrointestinal diseases, but some, notably the recognition of the association of Campylobaeter pylori with the commonest type of chronic gastritis, have been achieved using such long established 'routine' histological procedures that one wonders how their signifi cance had escaped recognition for so long. The topics covered in this volume have been selected because they present advances of relevance to the diagnostic clinical pathologist. However, they re present the personal selection of the editor, and are in no way exhaustive. Many other examples of progress in our understanding of the pathophysiology of gastrointestinal diseases have been omit ted, either because of the confines of space or because they have been well reviewed recently in other publications. Most of the workload of the practising gastrointestinal patholo gist involves the diagnosis and assessment either of inflammation or of neoplasia in the alimentary tract, and this is reflected in the topics presented in this book."

This volume comprises a series of original articles, updates and reviews on relevant topics in hepatology which were presented at a meeting in Freiburg im Breisgau to honour the 60th anniversary of Dr. Herbert Falk. Since 1967, Dr. Falk and the Falk Foundation have generously sponsored more than 40 congresses and symposia on liver diseases, held mostly in Freiburg, The Black Forest or in Basel, which have become milestones in the ex change of scientific information in hepatology (see 'To Herbert Falk on his Sixtieth Birthday' in this volume). Many of these congresses and symposia have been published in the 'Falk Symposia' series by MTP Press. We asked hepatologists who took part in former Falk liver meetings to contribute to a one day symposium to celebrate Dr. Falk's anniversary. We were greatly gladdened by the spontaneous and unrestrained acceptance that we received from all sides. We wish to express our deep appreciation to all the speakers and moderators who travelled, at their own expense, from all parts of the world to Freiburg and who with their presentations, made the meeting a stimulating and refreshing event. The editors' thanks are also addressed to Mr. D. G. T. Bloomer and Mr. P. M. Lister from MTP Press for their valuable cooperation in preparing this volume for publication. This book testifies to the worldwide appreciation and gratitude held for Dr. Falk by the community of hepatologists. The Editors ix List of Contributors P. BACK K. F. A."