Nonsurgical Biliary Drainage is a survey of the current status of the endoscopic and percutaneous transhepatic approaches. The editors - internationally recognized leaders in gastroenterology - have gathered together articles which discuss both the principles and methodology of these techniques as well as their results and limitations. With the wealth of authoritative information it contains, this book will also help lay the groundwork for future advances in the field.

Over the past decade a great deal of research activity has occurred on either side of the gastroduodenal epithelial interface, with the common goal of elucidating the mechanisms of mucosal protection and how these may be compromised in peptic ulcer disease. A prime stimulus to such research has been the realization that abnormal acid secretion or its delivery into the duodenum in excessive amount cannot fully explain ulcer pathogenesis in the majority of patients. One may envisage the stomach and proximal duodenum as being in a dynamic equilibrium, with aggressive luminal factors, such as acid and pepsin, being counteracted by protective mucosal mechanisms. Until recently, the mechanisms involved in mucosal protection had been poorly defined while the physiology and pathophysiology of acid and pepsin secretion had been elucidated. The impression that gastroduodenal mucosa was protected by a single mechanism has at last been replaced by a more realistic view, suggesting a number of protective zones acting in series. Some of these zones may act as first or second line defences against aggressive factors while certain zones may specifically protect against certain aggressors.

Bile acids occupy a central position in in the absorption, excretion and metab olism of lipids within the body. Our understanding of their unique properties has illuminated many biochemical and biophysical processes. Animals have evolved a unique system of preserving these important detergent-like molecules within the body and reusing them many times - the enterohepatic circulation. Disorders of the enterohepatic circulation contribute to a correspondingly wide range of diseases, and recent developments have centred in particular on cholesterol gallstone disease and bile acid diarrhoea. Successful manage ment of these diseases is increasingly based on an understanding of the physicochemical and biochemical properties of bile acids, and of their pathophysiological role in disease. Professor Alan Hofmann starts this book with an overview of the enterohepatic circulation of bile acids. The first section then discusses biliary lipid synthesis, transport and secretion by the liver and the solubilisation of cholesterol in the bile. The next section applies this knowledge to the pathogenesis of cholesterol gallstones. Separate chapters focus on defects in biliary lipid secretion, in cholesterol solubilisation and in gallbladder motility. The succeeding sections then review posssible approaches to gallstone prevention, and assess recent developments in non-surgical forms oftreatment. Two exciting new therapies that receive particular attention are contact dissolution therapy with methyl tert-butyl ether and extracorporeal shock wave lithotripsy. Further sections turn to the absorptive functions of bile acids in health."

For the fourth English edition, this highly popular book has been thoroughly revised and updated to include such new sections as endoscopic digestive US and abnormalities related to AIDS. It is the only work available covering the diagnostic US of the whole abdomen, and its superb treatment of elementary symptoms enables beginners to become familiar with more complicated features. After an extensive technical introduction, the book covers the sonoanatomy and ultrasonic symptomatology of the diseases of the digestive system and the abdominal vessels. Numerous tips on avoiding pitfalls, as well as indications for other procedures, and backed by some 1000 illustrations, this is well on its way to becoming a standard text for practitioners and clinicians in the field.

There has been incredible progress over the last decade in therapeutic endoscopy. Such therapies are either easier now than ten years ago or are possible when previously they were inconceivable. These advances have depended upon major improvements in diagnostic endoscopy for different subspecialties. Simultaneously, a major innovation for therapeutics through endoscopes is the application of medical lasers. This book is written by renowned biophysicists and laser endoscopists of different sub specialties where the application of lasers has revolutionized medical care. In some cases treatments which were not previously possible are now routine. Laser palliation of obstructing tumors in different sub specialties is an example of this. In other cases, resective surgery is obviated by the application of lasers via endoscopy such as for the control of gastrointestinal bleeding. The authors of different medical or surgical subspecialties which use endoscopic lasers write about the pathology and clinical problems, their personal experience and results. However, they also emphasize their techniques of laser endoscopy through case examples, technical discussions, and colored illustrations. Their discussions will give the reader a better understanding about the role of laser treatment of different conditions compared to routine medical or surgical therapy. In several instances, randomized controlled trials involving medical lasers were discussed in this book because they fundamentally changed our understanding of common problems such as upper gastrointestinal bleeding. We predict continued progress in therapeutic endoscopy.

by Dr. Jan. J. Smulewicz Ultrasound imaging has reached a stage of sophistication where by diagnostic information can be gained without discomfort to the patient and with complete absence of morbidity and mortality. The procedure is quick, safe, noninvasive and in many instances can supersede and obviate more time-consuming procedures requiring catheterization, injection of a contrast material, and radiographic imaging. In obstetrical problems the danger of ionizing radiation to the fetus is eliminated. In debilitated and very ill patients this simple and painless method becomes the procedure of choice. Unique features of ultrasound equipment allow for pinpoint local ization oflesions and direct visual guidance of percutaneous puncture techniques for aspiration and biopsy. The accuracy of ultrasound guided punctures and the absence of side effects make this modality far superior to percutaneous invasive techniques performed with other imaging systems. Renal cyst puncture and amniocentesis are but two of the procedures in which ultrasonic guidance is the method of choice. v Dr. Hassani has throughly explained and carefully explored the wide variety of exam inations available with ultrasound. The large volume of material and the clear interpre- tion makes this book of great interest to all of the medical profession. In addition to the existing methods available for diagnostic in terpretations, this method of noninvasive diagnosis should find its way into every hospital or center where good medical care is provided. JanJ. Smulewicz, M.D."

Surgical Diseases of the Spleen written and edited by internationally renowned scientists will be a masterpiece for any institution. It provides an updated multidisciplinary review of diseases of the spleen. Experts in the field have customed their chapters to further ease the readers understanding offering all the information needed to progress in this area. Different sections on basic concepts, specific splenic diseases and operative techniques cover new aspects in immunology, infectious, traumatic and neoplastic conditions.

The impact of Helicobacter pylori on basic science and the clinical management of patients with the complications of this infection is bewildering. The explosion of new information both in the laboratory and at the bedside has progressed at an unprecedented rate. Our main objective in furthering this progress has been to integrate this new information and organize a series of top-quality presentations and discussions between investigators and clinicians on all aspects of H. pylori research and to review the current position and future research directions. To that end, the second meeting 'Helicobacter pylori: Basic Mechanisms to Clinical Cure' was organized in June 1996 in Ottawa, Canada, following the successful format of the first such meeting held in Amelia Island, Florida, in 1993. The meeting again focused on all timely aspects of H. pylori research. Internationally renowned basic and clinical scientists, all experts in their respective fields, explored in depth the spectrum of H. pylori infection and the related complications of gastritis, peptic ulcer, gastric cancer and lymphoma.

These proceedings of an international meeting held as recently as December 1996 cover diagnostic procedures in pancreatic disease, together with the progress made over the last 10 years in treating acute and chronic pancreatitis as well as pancreatic cancer. The meeting also covered standards in medical and surgical treatment.

The advances in science and medicine we are now experiencing are unprec edented and exciting. Life expectancy is prolonged, and quality of life is much improved. We learn of fabulous new discoveries made at the bench or the bedside every week. Many diseases have been totally eliminated, others can be significantly improved by new therapeutic formulations. Much of the success can be attributed to a better understanding of disease processes and the specific targeting of new and more effective medications. As is the case in many areas of successful human endeavour, there can be a downside. In the case of drugs and chemicals it is their adverse effects which are of concern. Of course, every effort is made to devise medications that are safe, and the need to elucidate and understand mechanisms are crucial, yet adverse effects remain a problem. They can be unpredictable and diverse. Drugs have been shown to induce virtually the whole gamut of human liver pathology from acute fulminant hepatitis to chronic active hepatitis to cirrho sis and even malignancy. Hence the possibility of adverse drug effects must be considered in the differential diagnosis of many patients with liver disease. This is well recognized and is very important; indeed, removal of the offending agent can often lead to reversal of the adverse effect. This is an area of hepatology where we can really make a difference."

The purpose of this series of volumes is to present a comprehensive view of the complications that result from the use of acceptable diagnostic and therapeutic procedures. Individual volumes will deal with iatrogenic complications involving (1) the alimentary system, (2) the urinary system, (3) the respiratory and cardiac systems, (4) the skeletal system and (5) the pediatric patient. The term iatrogenic, derived from two Greek words, means physician-induced. Originally, it applied only to psychiatric disorders generated in the patient by autosuggestion, based on misinterpretation of the doctor's attitude and com ments. As clinically used, it now pertains to the inadvertent side-effects and com plications created in the course of diagnosis and treatment. The classic categories of disease have included: (1) congenital and developmental, (2) traumatic, (3) infectious and inflammatory, (4) metabolic, (5) neoplastic, and (6) degenerative. To these must be added, however, iatrogenic disorders-a major, although gen erally unacknowledged, source of illness. While great advances in medical care in both diagnosis and therapy have been accomplished in the past few decades, many are at times associated with certain side-effects and risks which may result in distress equal to or greater than the basic condition. Iatrogenic complications, which may be referred to as "diseases of medical progress," have become a new dimension in the causation of human disease."

The original series, Advances in Prostaglandin Research, edited by Sultan M. M. Karim, was published by MTP Press in three volumes in 1975 and 1976. A glance at those books illustrates the progress that has been made since then. The thromboxanes were mentioned twice (first publication 1975) and prostacyclin not once (first publication 1976); leukotrienes were only on the horizon. The amazing generation of research data in the last 10-15 years has given new, broad insights into many areas, including asthma, inflammation, renal, cardiovascular and gastrointestinal diseases and in reproduction, and has led in some instances to real clinical benefit. This series, Advances in Eicosanoid Research, reflects the current understanding of prostaglandins , thromboxanes and leukotrienes. The aim is to provide an introductory background to each topic and the most up-to-date information available. Although each book stands alone, the eicosanoids cut across many boundaries in their basic actions; selected chapters from each book in the series will provide illuminating and productive information for all readers which will advance their education and research. In the production of this series, I must acknowledge with pleasure my collaboration with editors and authors and the patient endeavours of Dr Michael Brewis and the staff at MTP Press. KEITH HlLUER University of Southampton England ix Preface This book is an appraisal of areas in human reproduction where eicosanoid studies (prostaglandins, leukotrienes and thromboxanes) are contributing to physiological and pathological awareness and clinical advances.

Rapid and profound changes are taking place in the field of hepatitis C therapeutics. More than ever, these changes necessitate a current, clinically pertinent review of the broader scope of hepatitis C, including its epidemiology, diagnosis, natural history, and clinical features. This handbook provides that concise survey of the field. Acute and chronic hepatitis C are addressed as are important new treatment options for hepatitis C, management of side effects, and a convenient summary of clinical trials on the treatment of chronic hepatitis C. Part of the Oxford American Infectious Disease Library, this evidence-based clinical resource will appeal to clinicians directly involved in the care of patients with hepatitis C.

The secretion of bioactive products by tumors of the gastroenteropancreatic system results in the development of watery diarrhea that can lead to death in a very short period if not brought under control. Even if the consequences are less dramatic, the patients' ability to lead a normal daily life is seriously impaired, and they may become severely depressed. SandostatinR alleviates the condition by inhibiting peptide release, and its long duration of action makes it an effective and rational adjunct to therapy at all stages. Last year a consensus Round Table Meeting was held in Scottsdale, Arizona, to discuss the optimal use of SandostatinR in this indication. These guidelines offer the results of clinical research and the dosage recommendations arising from them, together with a critical summary of the points of view presented.

It was with very much pleasure that I accepted the invitation to chair this workshop on Glucagon in Gastroenterology. Not least among the reasons for my accepting was the fact that it would get me out from behind my administrator's desk at the univer sity and enable me to spend what promised to be a few refreshing hours in a field where so much is apparently happening. Another reason for my accepting was the attractiveness of the format planned for the workshop. It was to be a working event. The programme had been carefully planned to ensure that all aspects of the subject were covered and a very tight schedule was drawn up for we had to deal with the whole field in just one day. There was to be a small, truly international, list of participants, and, apart from those presenting papers, only two or three specially invited observers were to be present. Above all, perhaps, was the fact that the meeting was to be a multi disciplinary one."

New surgical techniques for the treatment of anal incontinence have given the increasing number of afflicted patients hope for a cure. Colorectal surgeons and more and more general surgeons are performing operations, yet until now they have not had a text that they can use as a reference work. The guidance and instruction that surgeons need are now available in this atlas. It describes every operation in technical detail, and the two-color illustrations clearly show the essential points of each procedure. The authors discuss thoroughly the indications for surgical treatment, its application to the individual patient, and post-operative care. The comprehensive scope of this book makes it a rich source of information for surgeons working outside highly specialized centers. For specialists, it is the only practical reference available on the subject.

The scientific main programmes of these series of symposia changed from time to time following the international scientific trends. The main programmes of the First Symposium were: 1. Gastric and intestinal cytoprotection; 2. Hepatoprotection; 3. Pancreatic protection. For the second one: 1. Gastrointestinal mucosal 'cytoprotection'; 2. Liver 'cytoprotection'; 3. Pancreatic 'cytoprotection'; 4. Free radicals and scavangers; 5. Computer approach to cytoprotec tion. For the third one: 1. Basic, central, peripheral and cellular mechanisms of gastrointestinaol cytoprotection; 2. Esophagal protection; 3. Gastric protection; 4. Small intestinal injury and protection; 5. Large bowel injury and protection; 6. Liver injury and protection; 7. Pancreas injury and protection. The main scientific programmes of the Fourth International Symposium on 'Cell Injury and Protection in the Gastrointestinal Tract' are: 1. General mechanisms of gastrointestinal injury and protection; 2. Cell injury and protection in the stomach; 3. Cell injury and protection in the small intestine and in the large bowel; 4. Cell injury and protection in the liver and pancreas; 5. Cell injury and protection of the premalignant status and malignant diseases in the gastrointestinal tract. The presented papers are published in this book. The abstracts of this meeting were published in Digestive Diseases and Sciences, and we record appreciation of the Editor ofthatjoumal for their publication. Some of the papers published here have appeared in Inflammopharmacology 1996;4:331-398."

Bacterial diarrheal diseases are a very important problem for human health, and many people, especially infants and children, die every year from diarrheal diseases, particularly in developing countries. Thus, in 1978 the World Health Organization initiated a Diarrhoeal Diseases Control Programme and is now working actively to control diarrheal diseases. The "International Symposium on Bacterial Diarrheal Diseases" which took place in Osaka from March 23rd to 25th, 1982, was organized by Osaka University with the support of the Ministry of Education, Science and Culture of the Japanese Government. The aim of this Symposium was to promote exchange of scientific information on bacterial diarrheal diseases, few years due since studies in this field have progressed rapidly during the last to work in many laboratories throughout the world. It seems appropriate that this Symposium was held in Osaka, since during the past century Japanese bacteriologists have made a number of important con tributions in the field of bacterial diarrheal diseases. Outstanding among these contributions are the recognition of Shigella as a causative agent of bacillary dysentery by Dr. Kiyoshi Shiga and the serotyping of Vibrio cholerae into the Ogawa, Inaba and Hikojima serotypes by Drs. Kabeshima and Nobechi. Moreover more recently, Dr. Tsunesaburo Fujino of Osaka University discovered Vibrio parahaemolyticus as the causative agent of an important diarrheal disease."

Dr. Dobranowski and his associates are to be highly commended for this excellent manual. I am not aware of a similar text covering the subject. Although all of us perform gastrointestinal studies in a differ ent manner, this text provides an excellent overview. The reader will discover that the text is especially well written and focuses on the important issues relating to GI contrast studies. Because Dr. Steven son's group performs endoscopic procedures, they are included in the manual. These authors are recognized scholars and leaders in gastrointesti nal radiology. Thus, it is easy to understand why the manual is so well done. I am particularly impressed with the emphasis placed on the patient-radiologist relationship before, during, and after completion of a study. All of us who teach gastrointestinal radiology are concerned about the decline in the number of gastrointestinal contrast studies. We are not sure how we can continue to teach our residents the proper tech niques and maintain high-quality teaching programs in gastrointesti nal radiology. A manual of this type is thus timely and appropriate. The manual will be a valuable addition to the library of all radiologists. It will be particularly useful for residents who are learning how to per form GI contrast studies."

Vaccines have historically been considered to be the most cost-effective method for preventing communicable diseases. It was a vaccine that en abled global eradication of the dreaded disease smallpo. ."

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

Recent Advances in Coloproctology provides a thorough overview of modern developments in the surgical treatment of disorders of the lower intestine including ulcerative colitis/severe acute colitis, Crohn's disease, carcinomas, haemorrhoids and anal incontinence. Recognizing that the surgeon does not work in isolation, the book also integrates recent progress in imaging techniques for the anal canal and rectum, and highlights medico-legal considerations in separate chapters. Aimed at current practitioners and trainees, Recent Advances in Coloproctology discusses key concepts that will assist general surgeons and colorectal consultants in their management of patients with a broad spectrum of anorectal and colonic disorders. With a problem-oriented slant, this book is essential reading for all those with interest in coloproctology.

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.

Diagnostic Pathology of the Intestinal Mucosa - An Atlas and Review of Biopsy Interpretation offers a comprehensive overview of intestinal mucosal structure as defined through peroral or endoscopic biopsy specimens obtained in normal and disease states. It describes small intestinal biopsy pathology in conjunction with morphologic, functional, and pathophysiologic correlations. Routine methods of processing tissues for light microscopy, electron microscopy, histochemistry, and light- and electron- microscopic-immunoperoxidase techniques are presented so that the novice in the area of intestinal structure may have an easily accessible reference for setting up a morphologic laboratory.

The world of inflammatory bowel disease (IBD) knowledge is vast. Within that world is a sub-set of knowledge that is especially important for everyday clinical care. And a sub-set of that is testable for the Board exam. The testable material includes time-honoured, locked-in-stone, mostly uncontroversial facts that have withstood the test of time. The answer to your study questions (and reduction of your study time!) can be found inside Acing the IBD Questions on the GI Board Exam: The Ultimate Crunch-Time Resource. Until now, there has been no single, slim, but high-yield volume that summarises the IBD you really need to know for the board exams, preparing for rounds, or just plain read. The authors have collected every pearl of wisdom, high-yield factlet, IBD ""Board buzzword"", micrograph, and classic imaging study they could muster, all while keeping Acing the IBD Questions on the GI Board Exam: The Ultimate Crunch-Time Resource a manageable size. In today's fast-paced world it is hard to keep up with the burgeoning IBD literature. Traditional textbooks usually feature long and detailed discussions that don't directly address board and recertification exams. On the flip side, many board review manuals provide lists and bullet points lacking sufficient background and context. Acing the IBD Questions on the GI Board Exam by Drs. Brennan Spiegel and Hetal Karsan, fills the unmet need in board review by presenting time-tested and high-yield information in a rational, useful, and contextually appropriate format. With its focus on pearl after pearl, emphasis on images, and attention to high-yield "tough stuff" vignettes you don't know the answers to (yet), Acing the IBD Questions on the GI Board Exam: The Ultimate Crunch-Time Resource will help you ace the GI and recertifying examinations, look good on clerkship rounds, simply challenge you with interesting and entertaining vignettes, and take optimal care of your IBD patients in clinical practice.