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.

Albumin is the most abundant serum protein produced by the liver. In clinical practice the serum level of albumin continues to be used as an important marker of the presence, progress or ofthe improvement of many diseases, even though it is the complex end result of synthesis, degradation a. nd distribution between intra- and extravascular space. The clinical history of albumin began as early as in 1837, when Ancell first recognized "albumen" and noted that this protein is needed for trans port functions, for maintaining fluidity of the vascular system and for the prevention of edema. However, the important physiological properties of serum proteins and their role in the regulation ofthe oncotic pressure were demonstrated later by the physiologist E. H. Starling in 1895. In 1917 the clinician A. A. Epstein first described the edema in patients with the nephro tic syndrome as being a result of a very low level of serum albumin. Al though the determination of serum albumin concentration became more popular after Howe in 1921 introduced the technique of separation of serum globulins from albumin by sodium sulfate, the first preparations of human serum albumin were made available for clinical use in only 1941 by the development of plasma fractionation by Cohn and his coworkers at Harvard Medical School."

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.

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 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."

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.

J. E. Fischer, M.D. Professor Greep, ladies and gentlemen. It is a great pleasure for me and the participants to be present at this International Meeting of Parenteral Nutri tion. This meeting would not have been possible five years ago. At that time we were still arguing about central vs. peripheral routes, efficacy of the tech nique, and still getting accustomed to our ability to support patients nutri tionally. Within the last five years these discussions, which seem almost futile in retrospect, have been put aside. Both techniques, we know how, work quite well and have their own indications. Having become comfortable with the technique, it is now time to enter the second phase of parenteral nutrition, and that is the differentiation of the technique for the benefit of different patients. Over the next two days we will be discussing several problems which at the present time are central to the entire subject of parenteral nutrition. Is a fat calorie the same as a carbo hydrate calorie? What is the effect on protein metabolism of the fat calorie as opposed to the carbohydrate calorie? Are they equivalent? Are'there situations in which one is superior to the other? Perhaps we will find out tomorrow in the panel."

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."

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."

The rapid growth of fibre-optic endoscopy in recent than 7,500 examinations has been accumulated. years has had two consequences for the radiology of In part I of this study the theoretical background the stomach and the duocienum. and the technique of examination proper are de- scribed. The basic principles of interpretation of DC 1. Radiology has lost its previously rather auton- studies are stated. omous position in this field. Part II deals with the results. Chapter 5 consists of 2. As a result of the constant feed-back from the general remarks on the results, and on the comple- endoscopist, which the radiologist can and should mentary role of radiological examination and endos- have, he is in an excellent position to re-evaluate copy. Chapter 6 deals with a quantative study of and improve his own technique of examination. standard biphasic-contrast examinations in patients The author believes that the radiological exam- over a period of 3 years. This study was restricted to ination retains its value as a screening technique and malignant lesions, because it is only in this group a complementary method to gastroscopy and biop- that the definite criterion, a histological diagnosis, is sy. Only a sophisticated radiological technique will obtained. The natural history of malignant lesions fulfil these requirements. In 1973 the author devel- also makes follow-up studies possible. Results of the oped a standard examination that was called "bi- diagnosis of Early Gastric Cancer (EGC) are phasic", because it combines the advantages of included.

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.

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.

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."

The functional and organic alterations of the colon constitute one of the leading reasons why patients consult gastroenterologists. The irritable colon is one of the most com mon causes of discomfort in human beings. The organic pathology of the large bowel (malignancy and chronic inflammatory disease) contributes, particularly among Occi dental peoples, to discouragingly high levels of morbidity and mortality. One realizes the importance of having a thorough physiologic knowledge of the colon in order to scientifically plan the functional treatment of organic colonic dis eases. If we consider the large amount of material published on the physiology of the esophagus, stomach, small bowel, pancreas, and liver, we realize that the colon has been relatively neglected. The chapters in this book have been written by people who have done their utmost to alter this imbalance. I want to thank all the contributors for their generous collaboration that allows me to present in one volume virtually all the information known about the structure and function of the colon, and to record my deep graditude to Dr. Howard Spiro for his willingness to include this volume in his series. I would also like to express my sincere appreciation to Plenum Publishing Corporation for making this book possible. A spe cial thanks goes to Dr."

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. ."

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."

The inflammatory bowel diseases, of unknown etiology and for which there are no cures, continue to attract the attention and interest of gastroenterologists, internists and surgeons. International symposia are common and it is safe to say that there is at least one major symposium held somewhere in the world each year. This book encompasses the proceedings of two recent symposia held in Victoria, British Columbia, Canada. The symposia were the fifth and sixth international meetings focused on inflammatory bowel disease in Canada in the last eight years. Once again they were sponsored by Axcan Pharma, Inc. (formerly Interfalk Canada, Inc.) and endorsed by the Canadian Association of Gastroenterology. As has become traditional at such meetings the faculty was drawn from an international roster ofleaders in the field of inflammatory bowel disease and gastroenterology. The chapters of the proceedings provide a timely, up-to-date review of the major issues, including those within the realm of basic science and others dealing with clinical problems. The first symposium, 'Basic Research and Clinical Implications', was co-ordinated by John Wallace in association with Stephen Collins and Stephan Targan. The themes of this section were organized under the general topics of predisposing factors (genetics, animal models, infection, permeability, and immune deficits) and the pathophysiology of intestinal inflammation. The second symposium, Trends in Therapy' was organized by Lloyd Sutherland along with Franc; ois Martin, Robin McLeod and Noel Williams.

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.

Pancreatic Disease: Towards the Year 2000 provides a clear picture of the current research activity in pancreatic disease and its related basic science. Experts currently contributing to advances in understanding and treatment have provided concise and clear reviews of their subject. Each contribution summarises the relevant literature and describes recent advances whilst highlighting those areas where current research will impinge on clinical practice in the next few years. The reader will find in this book all the latest material related to pancreatic disease, cancer, acute and chronic pancreatitis and a number of other topics including transplantation and the relationship between endocrine and exocrine disease and cystic fibrosis. The book will supplement existing texts and will be of value to practising specialists who deal with pancreatic disease as well as specialist trainees in surgery and medical gastroenterology.

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.

The explosion of new information on Helicobacter pylori-related disease, both in the basic sciences and in clinical medicine, has continued to progress at an unprecedented pace. In many instances H. pylori infection, both in man and in the laboratory animal, has become a model to investigate fundamental biological issues such as micro-organism host interactions, intracellular signaling, development of mucosal atrophy, mechanism of microbial resistance, disease modifying factors etc. In view of this bewildering flood of new information, another meeting on H. pylori in the successful series Basic mechanisms to clinical cure' was organized in January 1998 in San Diego, California, to define the state-of-affairs' in H. pylori research at this time. The main objective was to integrate this new information in a series of top-quality presentations and discussions between investigators and clinicians addressing all aspects of H. pylori research and to review the current position and future research directions. The format included state-of-the-art presentations by world experts heavily involved in H. pylori research followed by in-depth discussion on intriguing or controversial issues. The presentations were grouped according to the leading theme: characteristics of the organism, mode of transmission, mechanisms of H. pylori-induced inflammation, causation of disturbances of gastric secretory and motor function, aspects of clinical presentation and management, problems related to H. pylori-associated gastric adenocarcinoma and MALT-lymphoma, novel aspects of antimicrobial therapy and vaccination. The meeting concluded with a synoptic agenda of suggested future studies for the microbiologist, the histopathologist and the clinician. The chapters published in these proceedings accurately reflect the content of the superb presentations. The reader will readily appreciate the excellent level of the cutting-edge' research which was described and discussed. These proceedings are another testimony to the enormous impact on basic science and clinical medicine of the H. pylori discovery. Although much was achieved, it is also readily apparent that many questions remain to be answered and many problems remain to be solved.

This volume contains the papers presented at the International Symposium on "Cirrhosis, Hyperammonemia and Hepatic Encephalopathy," held in Valencia, Spain, January 24th-27th, 1994. Liver cirrhosis and other hepatic dysfunctions such as fulminant hepatic failure and congenital defects of urea cycle enzymes can lead to hepatic encephalopathy, coma and death. Hepatic encephalopathy is one of the main causes of death in western countries. The ability to detoxify ammonia by its incorporation into urea is diminished by impaired liver function, resulting in increased ammonia levels in blood and brain. Hyperammonemia is considered one of the main factors in the mediation of hepatic encephalopathy and the classical clinical treatments are directed towards reducing blood ammonia levels. However, the molecular bases of the pathogenesis of hepatic encephalopathy and the role of hyperammonemia in this process remain unclear and several hypotheses have been proposed. To clarify the mechanisms involved in hepatic encephalopathy and hyperammonemia suitable animal models are necessary. The animal models available and the ideal features of an animal model are presented in the initial part of the book.

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.

Crohn's disease is an inflammatory bowel disease, whose symptoms are similar to other intestinal disorders, such as irritable bowel syndrome and ulcerative colitis; it can therefore be difficult to diagnose. Its knowledge and understanding have increased considerably in the last years; new advances in genetics, medical and surgical management offer today new possibilities for patients suffering from an inflammatory bowel disease. However, Crohn's disease remains a difficult disease to deal with, both from a research and clinical point of view. This book provides general practitioners with a basic knowledge of the disease, offering in the same time an update on new facts about Crohn's disease to specialists. It can also be useful for residents willing to develop a deeper knowledge of inflammatory bowel diseases.

This volume contains the papers presented in the International Summer Course on "Cirrhosis, Hyperammonemia and Hepatic Encephalopathy," which was one of the prestigious Summer Course, of the Complutense University of Madrid held in EI Escorial, Spain, during August 10-14, 1992. Liver cirrhosis is one of the main causes of death in western countries. In addition there is a series of liver dysfunctions including fulminant hepatic failure, Reye's syndrome and congenital defects of urea cycle enzymes that could lead to hepatic encephalopathy, coma and death. As a consequence of impaired liver function, the ability to detoxify ammonia by its incorporation into urea is diminshed, resulting in increased ammonia levels in blood and brain. Hyperammonemia is considered one of the main factors in the mediation of hepatic encephalopathy and the classical clinical treatments are directed towards reducing blood ammonia levels. A part of the book is therefore devoted to the study of certain aspects of ammonia metabolism such as the regulation of the urea cycle, the main mechanism of ammonia detoxification in mammals, which is located mainly in the liver. The metabolism of ammonia in other tissues, including brain, is also presented, as well as the effects of hyperammonemia on brain metabolism and function and on brain microtubules. The control of cerebral protein breakdown is reviewed. The classical and some recently proposed clinical treatments as well as nutritional considerations in the management of patients with liver failure are also discussed.