This book addresses the contemporary multidisciplinary management of liver metastases. Throughout the text, experience from the paradigms of colorectal cancer metastases treatment strategies are used to point to new directions in the management of liver metastases from other cancers. The book will be invaluable for surgeons in general surgery, hepatobiliary surgery, upper GI surgery, colorectal surgery, medical and clinical oncologists with an interest in liver tumours, and radiologists with an interest in liver disease.

This is the first book to specifically deal with hidradenitis suppurativa, a common but overlooked disease that regularly causes significant problems for both patients and doctors. The first section of this book presents the best current knowledge about diagnosis, pathogenesis and complications. The second section offers comprehensive guidelines on diagnosis and therapy. The book will assist doctors in providing a broader range of treatments for their patients. To increase the practical usefulness of the book, a description of the patients' perspective and patient information is included.

The only book to deal specifically with constipation for specialists has been updated to include all the new advances since the first edition (1995). These advances include biofeedback, surgery for constipation, sacral nerve stimulation, the use of laparoscopy for rectal prolapse, treament and our understanding of some of the psychological problems of these patients. Innovations also include Professor Norman Williams Malone Procedure and the newer pharmacologic treatments such as nitric oxide and botulinum toxin injections.

Are you looking for concise, practical answers to those questions that are often left unanswered by traditional pediatric GI references? Are you seeking brief, evidence-based advice for complicated cases or controversial decisions? Curbside Consultation in Pediatric GI: 49 Clinical Questions provides quick answers to the tricky questions most commonly posed during a "curbside consultation" between pediatricians. Drs. Joel R. Rosh and Athos Bousvarous have designed this unique reference which offers expert advice, preferences, and opinions on tough clinical questions commonly associated with pediatric GI. The unique Q&A format provides quick access to current information related to pediatric GI with the simplicity of a conversation between two colleagues. Numerous images, diagrams, and references allow readers to browse large amounts of information in an expedited fashion. Some of the questions that are answered: * How is infantile colic diagnosed and treated? * How is GERD diagnosed in infants and what are the best treatments? * How can I optimize my treatment of childhood constipation and does this vary by age? * How can I effectively intervene in a child that is overweight or obese? * Celiac disease seems so much more common -- is this an epidemic? * Why have food allergies become so common and what are the most accurate means of diagnosis? Curbside Consultation in Pediatric GI: 49 Clinical Questions provides information basic enough for residents while also incorporating expert advice that even high-volume pediatricians will appreciate. Pediatricians, nurse practitioners, physician assistants, family practitioners and pediatric residents will benefit from the user-friendly, casual format and the expert advice contained within.

Genetic susceptibility refers to how variations in a person 's genes increase or decrease his or her susceptibility to environmental factors, such as chemicals, radiation and lifestyle (diet and smoking). This volume will explore the latest findings in the area of genetic susceptibility to gastrointestinal cancers, focusing on molecular epidemiology, DNA repair, and gene-environment interactions to identify factors that affect the incidence of GI cancers. Topics will include germline susceptibility, including Mendelian patterns of inheritance and gene-environment interactions that lead to cancer etiology.

Medical Parasitology is primarily intended to be an illustrated textbook which provides a review ofthe most important species ofparasite which occur in man; their areas ofdistribution, morphology and development, the typical disease symptoms resulting from infection, epidemiology and also methods of detection and indications for therapy. The main emphasis is on the protozoan and helmin thic diseases; medical entomology has only been covered in connection with the epidemiology of the diseases described here. Parasites sometimes occur exclusively in man (anthropoparasites) and sometimes also in animals (anthropozoonotic parasites). The monoxenous species complete theirdevelopmentinmanorinoneanimalalone (Scheme I). Heteroxenousspecies, which include most of the medically important parasites, develop partly in man and partly in animals in the course of their life cycle. They may even be forced to infect different species so that they can continue their development. This may sometimes be associated with a digenesis, the larval development taking place in one intermediate (Scheme II (R)) or in two different intermediate hosts (Scheme III (R), (c)), andthesexuallymaturestagedevelopinginanotherhost, the so-called definitive host (Scheme III (R)). The importance of the intermediate hosts can vary considerably (see below).

This work has true international scope, being a unique European/American joint venture that focuses on the state of the art in both diagnostic and therapeutic radionuclide methodology. Pertinent clinical applications are emphasized rather than attempting to cover everything included in the several large comprehensive texts available in our field. This "practical" approach should make it an essential guide to nuclear medicine physicians, technologists, students and interested clinicians alike.

A century ago the Italian pathologist Bizzozero described the relationships between spiral bacteria and the mammalian gastro intestinal tract. Since 1982, when Helicobacter pylori was discovered, gastroduodenal disease have been completely revised as a con sequence of the results of basic and clinical research in this field. Progress in understanding the pathogenesis of this bacterium has been made by studying H. pylori infection in animal models. More specific diagnostic tools have been developed using new molecular biology techniques. Future trends are directed towards preparing a specific H. pylori vaccine. A new classification for gastritis, the Sydney System, including H. pylori gastritis, was proposed in 1990. As concerns the clinical approach to peptic ulcer disease in the 1990's, the majority of authors agree on the importance of H. pylori eradication. Moreover, recent clinical studies suggest that H. pylori infection can be associated with other gastroduodenal diseases, such as non ulcer dyspepsia and gastric cancer. Multicenter trials to standardize serological methods and evaluate the efficacy of new antimicrobial therapy schedules are planned throughout different European countries. The fourth Workshop of the European Helicobacter Pylori Study Group was held in Bologna, Italy, in November 1991. Two years before Bologna University celebrated its ninth centennial, giving evidence of being the oldest University in the modern world. Thus the H. pylori story that has continued for more than a century has been discussed once again at the University with the oldest tradition in the world."

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

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

Campy/o/meler pylori was described for the first time in 1983. Up to now more than 100 papers have been published dealing with its microbiological properties and its clinical implications. The lime has come to survey the field, to evaluate the hith erto accumulated information, and 10 discuss the questions thai should be answered in the ruture. It was for these purposes that the First International Symposium on Campy/abaeter pylori was held. bringing together specialists from a variety of discipl ines, including basic scientists as well as clinicians. This book is based on papers given at the symposium. We are very grateful 10 Rohm-Pharma for undertaking to sponsor this meeting, and to Mrs. C. 1. Klein and her starr for the impeccable organisation which permillcd us to work in such a pleasant environment, In the interest of rapidity of publication, we have reduced the amount of editing to a minimum and have not, in any sense, "re fereed" the discussions, which were written by the contributors at the time of the question-and-answer session. They were also veiled by their authors at the proof stage, and we have done our best to retain their original spontaneous flavour. We hope, in this way. 10 have produced a satisfactory record of the events and an up-Io-dale overview of research on Campylobacrer pylori."

Since the small bowel except the duodenum and (1961), Pygott et al. (1960), Gianturco (1967) terminal ileum is largely inaccessible during en- and Bilbao et al. (1967). doscopic examination, radiology of the small Sellink, however, was really responsible for bowel attains special significance as a diagnostic the widespread recognition of enteroclysis method. Owing to the length and position of (1971, 1974, 1976). In spite of the increasing this organ, good images are difficult to obtain. popularity of this method, the necessity for sub- Furthermore, the considerable variation oftran- stituting this apparently viable method for the sit time, unpredictable response of the contrast peroral examination is still equivocal (Rabe medium, and superimposition with the filled etal. 1981; Fried etal. 1981; Maglinte etal. loops make small bowel radiology difficult. As 1982; Ott et al. 1985). Comparisons of both methods, however, (Fleckenstein and Pedersen a result, few radiologists specialize in this field. With the exception of Crohn's disease, disorders 1975; Sanders and Ho 1976; Ekberg 1977; Val- lance 1980) have confirmed the superiority of of the small bowel are relatively rare. Thus, not many clinicians and radiologists are interested enteroclysis. It achieves a high accuracy (Antes in the small intestine. and Lissner 1983).

Attempts to influence survival of patients with colorectal cancer (CRC) by adjuvant chemotherapy are limited by the variability of survival in different prognostic groups [4] and the paucity of drugs that have shown activity in the advanced disease [10]. Of the few drugs which are active in the advanced disease, only 5-fluorouracil (5-FU) and razoxane "+/-1,2-bis(3,4-dioxopiperazin-1-yl)propane) are suitable for long-term adjuvant treatment [2, 9]. 5-FU has been widely and intensively studied as adjuvant chemotherapy in CRC [7], but there is no unanimity that it has even the marginal influence on survival that has been claimed [3, 10]. Razoxane has not previously been tested for adjuvant or maintenance treatment in CRC. It has however a number of biological activities which might be thought useful in the treatment of residual or minimal tumours [1] and which might therefore make it useful as an adjuvant. Thus it specifically prevents tumour dissemination and metastases in some tumours and normalizes the neovasculature which the tumours induce [6, 8, 11]. The drug is not cytotoxic in the usual sense, does not affect non-dividing cells, and only blocks cell division during a brief period of the cell cycle in late G and/or early mitosis [12]. It does so non-selectively and most cells capable of 2 division examined so far have been affected by the drug. Even affected cells however are not destroyed immediately, but may increase in size and become multinucleate [5].

Colorectal Cancer Screening and Computerized Tomographic Colonography: A Comprehensive Overview is an authoritative volume on CT colonography. Structured in a manner that will allow the reader to understand the practical and larger public health issues surrounding both CT colonography and CRC screening in general, the text is designed to reach a broad audience of specialist clinicians and primary care physicians. The book provides an overview of the disease and risk factors of colorectal cancer, as well as the history and development of CTC as both a colorectal imaging and screening modality. The text also reviews the controversies, potential pitfalls, and exciting new directions and capabilities inherent in the practice of CTC. Filled with high quality images and authored by experts in the field, Colorectal Cancer Screening and Computerized Tomographic Colonography: A Comprehensive Overview is the definitive reference for clinicians interested in computerized tomographic colonography and CRC screening.

The last few years have witnessed major developments in molecular biology which have had a significant impact on biomedical knowledge. As a result new concepts in cell biology have emerged, new etiologic agents have been discovered, and new drugs have become available. Furthermore, the world of mediators, cytokines, and humoral factors has enlarged considerably in a relatively short period and this has modified our views of diverse physio pathologic processes as well as opened up new therapeutic prospects. In addition, recent technologic advances have revolutionized our diagnostic methodology and have greatly enhanced the power of our therapeutic resources. All these factors have contributed to a substantial remodeling of both liver science and clinical hepatology, and these changes have generated the motivation for the production of the present book, which attempts to give an account of well-known clinical facts in the light of current thinking. It is the fruit of the coordinated work of experts from different countries in three continents. In a sense, it is a manifestation of the fact that inter national cooperation is becoming increasingly important not only in the expansion of science but also in its exposition. We hope that Hepatobiliary Diseases will be useful to both students and clinicians and that internists, gastroenterologists, and general practitioners will find in its contents a satifactory coverage of their field of interest."

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.

Based on the results of the latest congress of the European Association for the Study of the Liver (EASL), this volume makes excellent reading since it explores in detail the role of free radical reactions in liver diseases. Studies in recent years using various methods have shown that free radicals play an important role in toxic liver disorders. For this reason, the current scientific knowledge is presented in this balanced, clinical portrayal. The account refers to the many observations, experiencesand evaluations that have been made both clinically and experimentally. Two major areas discussed concern the pathophysiological changes by free radicals and the therapeutic possibilities that have come to light.

There has long been disagreement about various aspects of the structure and function of the "gatekeeper" (Greek pyloros, from pyle = gate and ouros = guard). In recent years the problem has often been mentioned in anatomy, physiology, gastroenterology, radiology and even in nuclear medicine. For instance, while referring to manometric and gastric emptying studies, Schu- urkes and van Nuenten (1984 ) pointed out that there was considerable contro- versy as to whether a true pyloric sphincter existed in most species, and espe- cially in man. According to Reeve (1981) many functional aspects of sphincters are poorly understood; the exact mechanism of control of the transfer of chyme from stomach to duodenum through the pylorus is still not clear. Malagelada (1983) states that controversy surrounds the motor activity and function of the antro- duodenal junction; there is disagreement as to whether the pylorus functions as or as an integral part of the distal antrum. Ehrlein et al. (1984) a separate unit reiterate that pyloric motility is poorly understood, and according to Funch- Jensen (1987) there are many unsolved questions. Malagelada (1990) states that the stomach performs multiple functions with a deceivingly simple anat- omy; this is regarded as the key to the investigator's frustration when trying to uncover its secrets. One source of the many controversies surrounding the pylorus may be species differences, according to Schulze-Delrieu et al. (1984).

The therapeutic landscape in oncology has undergone momentous changes in recent years. The treatment options for gastrointestinal (GI) cancers, in particular, have increased with the introduction of novel pharmacological and other treatment modalities. Researchers have gleaned important insights into the molecular biology, pathophysiology and key features of the most prevalent GI cancers, including colorectal, pancreatic and liver. While these advances have resulted in improvements for many GI cancer patients, the emerging complexities and challenges have necessitated the revision of major U.S. and international staging, diagnosis, and treatment guidelines for GI cancers. Part of the Oxford American Mini-Handbook series, this concise yet comprehensive volume provides oncologists and other healthcare professionals with essential, evidence-based guidance on the diagnosis and treatment of all major GI malignancies, including colorectal, pancreatic, liver and esophageal cancers.
SERIES OVERVIEW
The Oxford American Mini-Handbooks are a series of concisely-formatted adaptations of Oxford American Handbooks. They provide a focused and succinct summary on a specific area of a particular discipline, serving as a portable, easily accessible resource at the point of care. These smaller volumes capture the essentials of assessment and treatment in an exceptionally affordable and more clinically relevant format. Featuring useful tables and bulleted lists, these books provide a readily available resource to specialists and general practitioners alike.

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.

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.

This book is written to assist those who have responsibility for the nutritional and gastrointestinal care of children with neurodisability. The emphasis throughout is on the importance of multidisciplinary care. It is concerned with the problems surrounding the nutritional management of children with neurological impairment who have difficulty swallowing and feeding. Written from a multidisciplinary perspective by a group of authors with considerable clinical and research experience in this area, it covers: ?The epidemiology of feeding disorders in children with cerebral palsy ?Nutritional assessment?Evaluation of oral-motor function?Dietetic management?Nursing issues in the nutritional care of the disabled child?Tube feeding?Gastrointestinal problems and their investigatio

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.

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."

Physicians treating patients with Inflammatory Bowel Disease (IBD) often face challenges due to the disease itself, associated conditions, and systemic effects. Recently, new medications have been introduced that allow for more aggressive and effective treatment of IBD. With these medications come the risks of adverse side effects, and physicians must vigilantly monitor for any complications. Drs. Miguel D. Regueiro and Jason Swoger have created a unique, user-friendly book that describes how to prevent, recognise, and manage complications encountered in the care of patients with IBD. Clinical Challenges and Complications of IBD aims to provide practical and clinically oriented information to assist physicians with commonly encountered complications of the natural history of IBD, extraintestinal manifestations of IBD, general health and metabolic complications of IBD, and complications arising from both the medical and surgical treatments of IBD. Formatted to allow for quick access of the information, Clinical Challenges and Complications of IBD is organised into sections that allow physicians to both identify potential pitfalls in treatment, as well as focus on health maintenance and specific challenges, including pregnancy, nutrition, and psychological issues. Clinical pearls will be emphasised and each chapter will provide a bulleted summary, along with suggestions for future reading. Clinical Challenges and Complications of IBD is an invaluable guide for gastroenterologists, nurse practitioners, physician assistants, and gastroenterology trainees as it is a one-of-a-kind resource for recognising and dealing with the challenges and complications in patients with IBD.