Basic and clinical research have in recent years contributed towards clarifying certain aspects ofthe epidemiology, pathogenesis, prevention, and treatment of liver diseases. New diagnostic techniques have, moreover, facilitated observations on the evolution of such diseases. Nevertheless, a numberofquestions still remain, especially in the assess- ment and management ofliver patients. The hope that such questions can be answered justifies publications like the present one, which provide experts an opportunity to pre- sent the results oftheir research. The papers collected in this volume cover all aspects of the assessment and man- agement of hepatobiliary disease. The focal points are three summaries ofthe state of the art. The first deals with the highly topical problem of liver transplants from the point ofview ofpatient selection. Roger Williams in fact stresses the urgent need to ex- ercise caution in the selection ofsuitable candidates. This is especially true at the pre- sent time when cyclosporin A, a new immunosuppressive drug now available on the market, has significantly changed the natural history ofsurvival after liver transplanta- tion.

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.

The last decade has seen tremendous developments in many fields of gastroenterology and hepatology. The aim of this series is to highlight some of these topics that deserve particular interest. Research in the field of viral hepatitis has been very intense and successful in recent years. The hepatitis B virus is one of the best explored at the current level of virology. Not only the nucleotid sequence of the viral DNA can be decoded, but also the amino acid compounds of its genetic products are known today. Since the techniques of molecular biology have increasingly found access to clinical laboratory use, hepatitis B virus infection can serve as an example for the importance of molecular biology in clinical hepa tology. Another example for the interdependence of basic science and clini cal medicine represents the research on bile acid metabolism. The investigation of bile acids has revealed new diagnostic approaches to hepatic and intestinal disorders. Commercial kits for the routine measurement of serum bile acids in clinical laboratories by enzymatic or radioimmunologic techniques are now available. The diagnostic value of these measurements in gastroenterology and hepatology shall be defined. Another aspect of bile acid research leads to new per spectives in the treatment of gallstone disease. The dissolution of cholesterol gallstones by chenodeoxycholic acid (therapy) may be quoted as the best example for the development of new phar macotherapeutic principles derived from basic bile acid research."

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.

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."

Hepatocellular carcinoma (HCC) is common in the Far East and South Africa, but is rare in the United States and Europe. The vast experience of the East, which has led to marked improvement in the prognosis of patients with HCC, is made available to researchers worldwide in this monograph. The book is based on an enormous amount of data that has been collected and analyzed by the Liver Cancer Study Group of Japan. The data stems from a survey on HCC in Japan since 1965 and contains information from more than 30,000 patients with regard to age distribution, past medical history, diagnostic procedures, frequency of HBV-associated antigens and antibodies, surgical and conservative treatments, gross anatomical and histological features of the tumors, pathology of the noncancerous portions, distant metastasis, and survival rate. This data is a tremendous contribution to our understanding of the epidemiology, pathology, and the latest developments of the molecular biology and clinical problems of primary liver cancer.

Adenomatous Polyps of the Colon: Pathobiological and Clinical Features consolidates the vast body of basic science and clinical data associated with adenomatous polyps of the colon, much of it inspired by the realization that most colorectal carcinomas seem to arise in such polyps. This book strives to evaluate these data, with particular emphasis on their implications for management of polyp-bearing subjects. Topics comprehensively explored include anatomy and histology of the normal colon; pathologic characteristics of adenomatous polyps, differential diagnosis, and grading schemes for degree of dysplasia and villosity; adenomatous polyposes; histologic and epidemiologic evidence for the malignant potential of adenomatous polyps; and detection and management, with special attention to endoscopy, endoscopic polypectomy, the malignant polyp, and post-polypectomy surveillance schedules.

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 has its roots in a monograph on cancer of the esophagus and gastric cardia edited by us in 1965 and published in Chinese on ly. Along with a number of colleagues in various fields, we summa rized our work in the epidemiology, pathology, diagnosis, radiother apy, and surgery of carcinoma of the esophagus and gastric cardia, carried out chiefly at Peking Union Medical College Hospital, Fu wai Hospital, and the Cancer Institute of the Chinese Academy of Medical Sciences during the 25 years from 1939 to 1964. In the 18 years since the publication of that monograph, further progress has been made in China in various aspects of research and surgical treatment. Abundant material has been accumulated on the long term results of surgery, and a number of newer principles and meth ods for diagnosis and management have been evolved. In order to meet the need for the exchange of scientific and technical informa tion, both domestically and internationally, we have invited a group of our current colleagues working on the different aspects of carci noma of the esophagus and gastric cardia to contribute to the pre sent volume, which is being printed in both Chinese and English. The Chinese edition, like the original monograph, is being publish ed by Shanghai Science and Technology Publishers. Through the kind invitation of Dr. Heinz Gotze, the English text is being publish ed for international circulation by Springer-Verlag.

The LEC strain of rats, which spontaneously develop acute hepatitis as sociated with jaundice, chronic hepatitis, and ultimately hepatocellular carcinomas, was established by scientists in Sapporo, Japan. Careful ob servation and breeding led to the initial discovery of this characteristic, inherited liver disease in rats. Subsequent collaboration between scientists in Sapporo and other centers has revealed an autosomal recessive nature of inheritance, along with a variety of histopathological and biochemical findings. The causative mechanism(s) underlying this abnormality remained a mystery for some time, providing a challenge for many scientists who were attracted to the quest for clues to this enigma. In particular, the mech anism of spontaneous development of hepatocellular carcinomas in rats overcoming the acute phase of hepatitis and surviving with chronic hepatitis proved extremely interesting, because the involvement of a causative virus had been excluded in the early stages of investigation. Professor Michio Mori of Sapporo Medical College played a key role in the study of LEC rats, especially in the elucidation of the pathogenesis of hepatitis and hepatocellular carcinoma. He is one of the editors of this monograph which is composed of original contributions by the many scientists who have carried out their own studies on LEC rats. Of the various histopathological and biochemical alterations which have been reported, some are clearly secondary or tertiary events sequential to the primary change caused by gene mutation."

It is a great pleasure for me to introduce and to recommend this much needed text on double contrast examination of the colon. It is aimed both at clinicians who request X-ray examinations of the colon and at radiologists who must per form and interpret these studies. Over the past decade there has been renewed interest in X-ray examination of the colon despite the tremendous advances in endoscopy and imaging tech nology. This renewed interest is evidenced by the proliferation of new books on radiology of the colon. However, previous discussions of double contrast ex amination have concentrated primarily on the technique with too little attention to the understanding and interpretation of the radiologic images. This volume is unique in its emphasis on the basics of image formation and interpretation. It emphasizes the importance of the anteroposterior relation ships of the colon in determining the distribution of barium and air. It also rec ognizes the influence oflocation on the radiologic appearance of the lesion. The authors demonstrate a profound understanding of the principles of double contrast diagnosis as applied to the colon. They also have a good grasp of the gross pathologic changes underlying the radiologic images. The material is presented in a logical and analytical method which should be particularly useful to the beginner in this field. There are many helpful diagrams and the ra diographic illustrations are of excellent quality."

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.

The following papers were presented at an international symposium on the mechanisms and treatment of nausea and vomiting in man held in Oxford in 1984. I believe that this meeting was the first occasion on which representatives from such a wide variety of scientific and clinical specialities had come together to review and debate the spectrum of the vomiting phenomenon. An attempt was made to put before an invited international audience all the pertinent facts on the different facets of the topic and then to encourage extensive discussion of the contentious issues. The first day of the meeting was devoted to the basic science ap proach to the problem and the second day to the more clinical aspects. This format has been broadly retained in the layout of the book, with the addition of summary chapters reviewing each day's contributions and focusing upon areas of particular importance. Acknowledgement must here be made to the enormous input from the many participants who either spoke in the debate or rose and themselves gave small presenta tions in addition to those of the invited speakers. The meeting occurred at a time of increasing interest in the problem of nausea and vomiting, especially because of its importance in cancer chemotherapy and radiation therapy, and even in space travel."

This atlas is a selection of roentgenograms of patients who visited the radiology departments at the University Hospital in Leiden between 1970 and 1978, the Free University Hospital in Amsterdam in 1979, and the radiology department at the Indiana University Medical School in Indianapolis in 1977. The most common radiological abnormalities of the small intestine are illustrated clearly, unhindered by flocculation or segmentation of the contrast fluid. The authors believe this book is a definite contribution to the goal of precise early small bowel diagnosis. However, the key to good diagnosis is not only a superb examination technique, but also the knowledge, the character, and the personal perfectionism of the physician. If these factors are optimal, then the best possible roentgenographic series will be obtained - at least as far as the technique is concerned. All patients illustrated here were examined by using the enteroclysis technique. With this method of small bowel examination, the contrast fluid is administered via an infusion directly into the duodenum instead of orally. The infusion method has added a new dimension to the usual radiological examination of the small intestine. This method is also especially suited for the comparative evaluation of motility, and the study of disturbed motility. Throughout the course of the examination, the technique can be adapted to special situations at any given moment and can be modified to produce precise diagnostic roentgenograms and diagnosis.

An international symposium on inflammatory bowel diseases was held in Jerusalem on September 7th-9th, 1981. The symposium was sponsored by the Hebrew University-Hadassah Medical SchooL and the Israeli Gastroenterological Society. The idea was to bring together leading workers in the field, to invite all those interested to present their new work on IBD and thus to enable exchange of information and cross fertilization needed to improve our understanding and handling of these diseases. The symposium was organized into four panels devoted to state of the art reviews. presentation of new findings and approaches on the follow ing topics: New pathological concepts. etiology. pathogenesis and management of IBD. In addition. 89 abstracts were presented as posters during the symposium. all of which were published in the book of abstracts. The concluding panel outlined new directions for future research on IBD. We owe our gratitude to Drs. J. B. Kirsner, G. L. Gitnick and C. E. Rubin, members of the Organizing Committee, without whose encouragement and help the symposium could not have taken place. The Organizing Committee owes a considerable debt of gratitude to all the contributors who presented their work in a clear and concise manner, to all those who presented posters and to all the participants who came from 27 countries. Their stimulating presentations and discussions con tributed to the success of the meeting."

Despi te a slow decrease in the incidence of peptic ulcer in the Western world during the past decade, general practitioners, physicians, gastroenterologists, and surgeons deal with patients suffering from peptic ulcer and its complications almost daily. It has been estimated that some 10% of the population in the Western world becomes af flicted by peptic ulcer at least once and many of them have chronic relapsing disease. This lays a heavy burden on the amount of money which is spent in general health care. In recent years our understanding of peptic ulcer disease has in creased tremendously, but considerable gaps in our knowledge remain. Originally the increase in our knowledge has been stimulated by the development of fibre-optic endoscopy in the sixties, and later by the development of new surgical techniques and drugs in the seventies. New insights into the pathophysiology of the disease resulted from these developments and revived the scientific interest in peptic ulcer disease. However, the field remains complicated and the studies are be devilled by the large number of variables which can affect the results. In the symposium 'PEPTIC ULCER TODAY' we have attemp ted to bring together recent knowledge on basic and clinical aspects of peptic ulcer disease."

Diagnostic ultrasound is changing dramatically because of the development of a variety of high resolution real-time scanning instruments. Until recently the standard instrument was the articulated arm contact scanner. Real-time scanners were viewed as adjunct instruments for specific and limited pur poses. The roles are reversing with real-time instruments more frequently accepted as the primary diagnostic tool and the contact scanner becoming the ancillary instrument for use mainly for viewing a large field that cannot be scanned with real-time instruments. Two recent editorials stated that real-time instruments were used as the sole diagnostic instrument for between 80% [Cooperberg (2)] and 98% [Bartrum and Crow (1)] of their abdominal examinations. This book introduces the reader to the field of real-time scanning in the abdomen. It presupposes an understanding of basic physical concepts of ultrasound, the appearance of both normal and pathologic conditions as produced by static articulated arm contact scanning, and a familiarity with the techniques of contact scanning. It is designed to acquaint the reader with the spectrum of real-time instrumentation, provide a basic understanding of the physics of ultrasound as related to these instruments, emphasize the special skills required in the use of this equipment, and describe applications of real-time scanning for various parts of the abdomen. While numerous illustrations of both normal and pathologic anatomy are shown, the book is an all-inclusive study of abdominal pathology as demonstrated by real-time imaging.

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.

par Prof. Dr. E. VAN OYE, Bruxelles Les Salmonella constituent un groupe de germes parmi les plus repandus, les plus cosmo- polites et les plus ubiquitaires des microorganismes potientiellement pathogi'mes. On les rencontre chez tous les animaux a sang froid ou a sang chaud, du plus humble puceron aux plus impressionnants des mammiferes tels les baleines ou les e16phants. On les retrouve aussi partout dans Ie milieu ambiant, en particulier dans les eaux superficielles, qu'elles aoient douces ou salees. nest aiae de comprendre que les aliments les plus divera et les produits les plus inattendus en sont parfois contamimls. Non seulement les Salmonella jouent un role de premier plan dans la pathologie humaine et dans la pathologie animale mais egalement, vu leur ubiquiM, dans de nombreux sec- teurs de l'economie et non seulement celui de l'alimentation. La lutte contre les affections que ces germes provoquent - les salmonelloses - est avant tout baaee sur la prevention. Celle-ci, pour etre efficace, demande d'iltre informe aussi exactement que possible, sur l'identite des germes en cause. Or il existe de par Ie monde plus de 2000 especes differentes de Salmonella pouvant presenter d'innombrables varian- tes sur les plans de la serologie, de la biochimie ou de la lysotypie.

The development and improvement of new technologies have made pancreatic disease more accessible to diagnosis in the last decade. The cooperation and coordination of experts in the fields of gastro enterology, radiology, biochemistry, immunology, and pathology are necessary if the methods are to be made available and the progress made to be fully exploited. Each of the new methods requires special training, and extensive experience is needed to guarantee high standards in the diagnosis of pancreatic disease. New methods have to be tested carefully against established diagnostic procedures, though at the same time we must be ready to adopt a new approach to diagnosis. The aim of this book is to update the material already published and to focus on the various imaging methods and functional tests currently available, the features specific for each, and their integrative potential in the detection of pancreatic disease. The various pathologic findings are analyzed with reference to the clinical stages of pancreatic disease. As an introduction to the morphological and functional features of acute pancreatitis, chronic pancreatitis, and pancreatic cancer revealed by the different imaging methods and functional tests, basic knowledge of the patho-physiological and pathomorphological events is provided by research workers. This knowledge is essential for the understanding and interpretation of the diagnostic findings recorded in pancreatic diseases.

This book represents the culmination of the major aspect of Dr. Margot Shiner's professional career. It was she who devised the technique of jejunal biopsy which opened up whole new fields of small intestinal research, including microbiology, immunology, histochemistry and histopathology, thus greatly expanding our knowledge of fundamental aspects of absorptive patho physiology. Later the application of electron microscopy demonstrated the individual cell with its mechanisms both for absorption and for the production of so many chemicals such as mucus, enzymes and hormones. Like the vision from the peak in Darian, it opened up new worlds. The contribution to our understanding of cell structure and function has been greater than the direct elucidation of specific diseases but nevertheless, there are pointers to different mechanisms which could have wide applications. It is a book which serves a double function: On the one hand it is highly technical and a publication for the super expert, recording new landmarks of knowledge and interpretation. On the other hand, it is a book which can indeed fire the imagination of the rising generation of gastroenterologists, paediatricians, pathologists and medical scientists. Having seen the emergence of the art and science of present-day gastro enterology within my professional lifetime and having been able to provide the facilities for her work in the very early days, it is with particular pleasure and pride that I write this foreword."

Exciting major changes have occurred in the understanding and treatment of gallstone disease over the last two decades. In bygone years, books about gallstones were often based on postgraduate lectures which the author, usually a surgeon of distinction, had given. More recently, many books dealing with this subject have been based upon national or international conferences. The single-author text has the disadvantage that few authors today can authoritatively encompass a whole field: the reports of symposia, conferences or workshops often lack balance and auth ority. The merits of 'Gallstone disease and its Management' edited by Malcolm Bateson are clear. He has chosen 11 authors, all of whom write on topics relating to their own expertise, and the content of the book has been carefully planned to reflect the most modern ideas about the aetiology and management of cholesterol gallstones. It is worth repeating that we are experiencing rapid developments in the field of gallstone disease. Disappointingly the least progress has been made in identifying the cause (or causes) of the disease notwithstanding the many data implicating a variety of environmental factors. Most of these affect the chemistry of hepatic bile and the contribution of the gallbladder to lithogenesis remains uncertain and unstudied."

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.

For a long time, approximately since Oberlin and Guerin described the multifocal origin of pancreatic cancers and precancerous pancreatic lesions, no important study dealing with the entire subject of pancreatic cancer has been published in France and probably in the international literature. For some decades the knowl- edge acquired 40years or more ago was not improved appreciably, though the fre- quency ofthe disease started to increase in occidental countries. This has recently changed, and the progress ofthe medical sciences has spread to the pancreas. Although the surgical or medical prognosis of the most frequent form of pancreatic cancer, exocrine adenocarcinoma, remains very bad, recent studies have shown the multiplicityofits pathological forms, some being less severe so that curative surgery is possible. New experimental models, particularly in the hamster, and the use of carcinogenic drugs allow experimental studies on lesions similar to those in man. Oncologic immunology is still at its beginnings but shows promise for diagnosis and treatment. Though modem techniques of imaging - sonography, aspirative cytology, CT scan, endoscopic catheterism, arteriography, and maybe in the future nuclear magnetic resonance - have not yet significantly in- fluenced prognosis,they have made the diagnosis easierand more precocious. Yet in a diseasethat diffuses so rapidly to deep lymph nodes, it has not been proved whether early diagnosis can improve prognosis.

Over a decade has elapsed since the last volume in this series was published. At that time we considered that we had comprehensively covered all aspects relating to bile acid chemistry and physiology. However, major strides have been made in our understanding of the physiology and pathophysiology of bile acids, due largely to the great advances which have taken place in analytical technology. As a result, the need to document these advances was felt acutely, and therefore this volume is devoted to methodologies in bile acid analysis and their applications. This volume includes twelve chapters written by prominent scientists in the field of bile acid research. The initial chapter discusses techniques of extraction and isolation of bile acids from biological fluids. It is followed by descriptions of physical methods of analysis and discussions of the way these techniques have been applied in the field of bile acid research. Of practical value is the inclusion of a comprehensive list of spectra obtained for refer ences by nuclear magnetic resonance spectroscopy and mass spectrometry . These chapters are followed by reviews of biological methods of immuno assay and bioluminescence. Specific applications of these techniques are then addressed in contributions relating to bile acid analysis of tissue, serum, urine, and feces. With this integrated approach we have attempted to provide a volume which represents a comprehensive review of the analytical field of bile acids, while also serving as a useful reference book for those workers involved in bile acid analysis."