Autoimmune Liver Diseases summarizes the recent high-impact research and clinical findings obtained in Japan in the study and treatment of autoimmune liver diseases. Although these disorders are relatively rare, they are recognized as an important group of refractory liver diseases, the most common of which are autoimmune hepatitis (AIH) and primary biliary cirrhosis (PBC). The book therefore comprises two major sections, one dealing with AIH, the other with PBC. AIH in Japanese patients creates a unique disease population, as its clinical features are different from those of Western patients resulting from the different genetic background of the two patient populations. Also, mouse models of neonatal thymectomy-PD-1 knockout mice, clinical analyses of acute hepatitis-like manifestations, and research findings on IgG4-related autoimmune hepatitis have been reported in Japan and are included in this book. A disease-susceptibility gene specific to Japanese PBC patients has also recently been discovered. Because of the relatively homogeneous population of Japan, analyses conducted with Japanese PBC patients have yielded findings that are highly relevant to the pathogenesis of the disease. Furthermore, new pathological staging criteria, anti-gp210 antibodies and the basis they provide for improved accuracy of prognosis, treatment with bezafibrate, and the outcomes of living-donor liver transplantation are also presented here. This volume therefore serves as a useful resource not only for hepatologists, but also for researchers, clinical residents, and medical students both in Japan and in other countries.

Since the success in chemical induction of cancer in rabbit's ear skin by K. Yamagiwa in 1915, oncologists of the world have come to believe that they can only solve their problems by means of animal experimen tation. The importance of environmental factors became moreevident in 1935 when T. Yoshida and T. Sasaki introduced azodye hepatocarcino genesis in rats. In the domain of the gastrointestinal tract, T. Sugimura has more recently accumulated enough evidence to indicate that locally active chemical mutagens are carcinogenic. In contrast, principal approaches to colorectal tumors have been quite different: emphasis has been placed on gene identification. Long before cancer of the large bowel was recognized, importance of the roles of adenomatosis coli and its familial occurrence attracted the attention of epidemiologists and geneticists. Morphological characteri zation and analysis of hereditary trends of human material have already bad a long history, and recently detailed analysis of genetic material has become feasible in the wake of rapid development in our knowledge of the oncoviruses, oncogenes, suppressor genes, chromosomal and DNA mapping, molecular mutation and so on. lt is true that in colorectal pathology, and in no other field, these areas of research have been explored more extensively and decisively. The identification of previ ously ill-defined lesions such as precancers and benign neoplasms have been improved because sequential changes can be observed in multiple samples spread over a wide area and followed up in due course.

Hepatocellular carcinoma is one of the most common fatal malignan cies of mankind. Up to a few decades ago it was looked upon as a cancer which aroused mainly academic concern but relatively little clinical interest, because its therapy and prognosis had a most un favorable outlook. Indeed, it was mostly recognized only at autopsy. Recently this pessimism has radically changed and is disappearing to a rapidly accelerating degree. Many of the scientific contributions at this change in outlook are the result of research in the Far East, first, Japan and then gradually extending to its neighbors. The introduction of experimental hepatocarcinogens by Yoshida more than 50 years ago may have been one of the first important steps. Hepatocellular car cinoma shows a characteristic geographical distribution. With the highest incidence in China, Taiwan, Southeast Asia and sub-Saharan Africa, followed by southern and eastern Europe, while generally the incidence is rather low in western and northern Europe and North and South America.

General Section. Progress in laparoscopy (new instruments, technical innovations, integration between laparoscopy and sonography). Special Section. Traditional and present indications for laparoscopy. Laparoscopy inliver diseases. Oncological lapaoscopy (diagnosis, staging and follow-up for malignant tumors). Emergency laparoscopy.

There is a tradition behind the current radiologic examination of the small bowel. Many of the great names in gastrointestinal radiology have established their reputations on the basis of their work in the small bowel. This is an area which is assuming ever greater importance for radiologists as its mucosal surface continues to elude the endos copist. Moreover, it is an aspect of radiology which calls for the greatest technical and interpretative skill. It is a great pleasure to welcome the English language version of this beautiful work on Radiology of the Small Intestine. English speaking physicians are frequently not as familiar with the large body of work published in French as they should be. Tant pis ! Dr. Bret and his co-workers have been pioneers in the pursuit of excellence in gastrointestinal radiology. During all the years that I have been involved in this field, I have admired their work.

Over the past 10 years there has been a veritable explosion of knowledge in working in this area are fortunate to meet their bile acid research. Those colleagues from time to time at International Meetings which are often held in attractive parts of the world. The 7th International Symposium on bile acids 'Bile Acids in Gastroenterology' was no exception. It took place in Cortina d'Ampezzo in the heart of the Italian Dolomites, from 17th-20th March 1982. This meeting was organised by a Scientific Committee, with representatives from Italy, the United States and Great Britain, in collaboration with the Italian Society of Gastroenterology. The format of the meeting was somewhat different from that of previous years. In addition to the free communications (verbal and poster presentations) which characte rise many scientific meetings, there was also an Advanced Postgraduate Course on bile acids given by a distinguished international panel of experts. Their contributions form the basis for this timely volume which should be of interest both to basic scientists and to clinical investigators alike. The editors are indebted to Dr Gian Germano Giuliani, Gipharmex SpA, Milano, whose generous support made the meeting possible. They also thank Mr P. M. Lister, Managing Editor, MTP Press Limited and Mrs Veronica Cesari, Italian Society of Gastroenterology for help with the publication of these proceedings. R. Herman Dowling ix 1 Liquid-solid extraction, lipophilic gel chromatography and capillary column gas chromatography in the analysis of bile acids from biological samples K. D. R.

Primary Liver Cancer: Surveillance, Diagnosis and Treatment focuses on the many therapies rapidly evolving to assist with controlling hepatocellular carcinoma as well as emerging technologies to assist in early diagnosis as well as prevention. All chapters are written by experts in their fields and include the most up to date information for diagnosis, treatment, surveillance, epidemiology, staging, recurrence and prevention. This volume will serve as a useful resource for clinical gastroenterologists, hepatologists, oncologists, pathologists, and physicians who treat patients with chronic liver disease and hepatocellular carcinoma.

Because of the increasing burden of hepatitis C and fatty liver disease, there is an explosion in the prevalence of chronic liver failure and hence its complications. The onset of Hepatic Encephalopathy (HE) in these patients has a significant impact on the quality of life, morbidity and mortality. Unfortunately, the approach observed by most clinicians to this complex disorder is minimalistic. This book provides a comprehensive review on pathophysiology and clinically important aspects in HE. Topics in basic physiology, nitrogen metabolism, new insights into pathogenesis and brain edema are covered in great detail. The authors have made a special effort by simplifying the complex aspects of pathogenesis and diagnosis so that it can be easily understood and applied clinically. This volume also focuses on recent developments regarding diagnoses of subtle forms of HE, also known as minimal or covert HE as well as on new treatments. Hepatic Encephalopathy will be of great value to gastroenterologists, hepatologists, pathologists, medical residents, fellows, internists and general practitioners who treat patients with hepatic encephalopathy.

Primary liver cancer is a rather unusual malignancy in that the incidence varies tremendously from one geographical area to another. While relatively uncom mon in Western countries, it is the most prevalent malignant neoplasm in Southeast Asia, South Africa, and many other regions; in all, the countries in which primary liver cancer is very prevalent account for more than two-thirds of the world's population. In China alone, approximately 100 000 people die every year from primary liver cancer, mostly hepatocellular carcinoma. The incidence is rising in some countries, especially Japan, where it has doubled among males in the past 15 years or so, a staggering and puzzling trend. Since the demonstration of an etiological relationship between hepatitis B virus infection and hepatocellular carcinoma, intensive research has been con ducted in an effort to elucidate the role of the virus in hepatocarcinogenesis. Though much progress has been made, a full understanding of the molecular events leading to malignant transformation of the hepatocyte will probably require many more years of rigorous investigation. Chemical carcinogens and several industrial pollutants may also be involved in the etiopathogenesis of neoplastic liver disease."

The percentage of the population which is elderly has been increasing steadily in many countries in the world; and as this tendency continues, the question of how to treat the elderly rises in importance. The problem of how to manage hypertension in the elderly has become one of the most important issues in the prevention and treatment of cardiovascular disease. However, not many of the cIinical studies performed so far to evaluate the effects of antihypertensive drug treatment have incIuded the elderly. Many important problems remain unsolved. How much bene- ficial effect can be expected from active antihypertensive drug treatment in the elderly? How can isolated systolic hypertension, which is fre- quently encountered in the elderly, have better prognosis when treated? When is drug treatment indicated, to what level should blood pressure be reduced and maintained in the e1derly, and how should drugs be selected? The elderly also frequently bear other medical problems, either re- cognized or unrecognized, such as mental depression, respiratory problems, infection, malignant neoplasms, and water and electrolyte im- balances. The body's ability to eliminate drugs also decreases with age and necessitates modified dosage. The 12th Scientific Meeting of the International Society of Hyperten- sion held in Kyoto, Japan on May 22-26, 1988 incIuded the satelIite symposium. "How Should Elderly Hypertensive Patients Be Treated?" wh ich focused on the pathophysiology and outcome of elderly hyperten- sive patients.

This is a carefully illustrated volume of surgical procedures. Well-known standard as well as alternative procedures in surgery of the stomach and the proximal duodenum are depicted with anatomical exactness. Possible complications, errors, and dangers and how to avoid them are discussed in detail. Each operative step is illustrated superbly and accompanied by a short, precise text. Both illustrations and text stem from the practical experience in the operating theater of the many renowned surgeons who have contributed to this volume. The book serves as an indispensable reference for surgeons; likewise, gastroenterologists, radiologists, pathologists, and anatomists will find this volume of immeasurable value in their daily work.

The treatment of bile duct benign pathology demands a multidisciplinary approach, involving a team of both specialised physicians and solid infrastructure. Radiologists, endoscopists, and surgeons are all involved in the treatment of these kinds of patients. This statement is also true for the diagnosis and treatment of the catastrophic results of bile duct injury. Cholecystectomy is one of the most common surgical procedures done either openly or through laparoscopy. The presence of bile duct injury is one of its most severe complications. The solution for this unfortunate event poses a technically demanding approach that involves an array of alternatives comprising surgical and radio-interventional procedures. This book focuses on benign bile duct diseases, mainly related to iatrogenic bile duct injury. The reader will find a complete and profound review of bile duct anatomy and function, a thorough explanation about the type of bile duct injuries and how to approach them, beautiful descriptions of both the surgical and radiological techniques used in the management of bile duct injuries, a compilation of the experience of a high-yield centre of this kind of diseases, and logical techniques to lower the incidence of these injuries. This text is aimed at an audience composed of health care professionals involved in the integrative treatment of iatrogenic bile duct injuries. In a world where the best medical evidence defines the most effective therapeutic alternative, this book focuses on giving a solid and broad enough basis upon which medical teams can approach this disease.

With a focus on practical patient related issues, Autoimmune Hepatitis: A Guide for Practicing Clinicians serves as a useful practical, and much needed, resource for all those physicians presented with managing patients diagnosed with autoimmune hepatitis, both acutely and over the long term. It provides a basis for clinicians to understand the etiology of the disease, as well as special circumstances where management dilemmas often arise. Emphasis is given to providing management advice of immediate use to clinicians, something not presently offered by other larger general texts. The chapters are written by those with an expertise and training in this field and include the most up to date information. The book will be of great value to Gastroenterologists, Hepatologists, and Internists at all levels who see patients presenting with autoimmune hepatitis.

In the last few years, human metabolic disorders have become some of the most prevalent and prejudicial diseases worldwide. Hepatic steatosis, among many health problems, has several risk factors related to the disease prognosis such as obesity, nutritional problems, diabetes, hypertension, hyperuricemia, and even sleep apnea. Alcohol abuse also can lead to a severe liver-steatosis state. The progression of hepatic steatosis can lead to complications such as cryptogenic cirrhosis and hepatocellular carcinoma. Drug therapy has instead been focused on the mitigation of risk factors, however new potential therapeutic perspectives are being discussed. This book presents the origins, diagnosis and epidemiology of hepatic steatosis with new perceptions. The authors also aimed to show the molecular basis and signaling involved in liver disorders, discussing the inflammatory process, lipid metabolism and angiogenesis mechanisms. The role of nutrition in the treatment and development of steatosis was also presented and new advances were highlighted. Recent studies revealed the need for the use of bariatric surgery, functional foods and the modulation of endogenous systems, such as the sirtuins and renin-angiotensin systems, to treat liver disease. In this context, we aimed to introduce, review and discusses one of the most widespread metabolic disorders in the world: hepatic steatosis and its repercussions.

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Dietary fibre is now recognized as a vital component of good daily nutrition, yet its properties and specific role in the digestive system are still being investigated. The involvement of government agencies, the food industry and health professionals - as well as public interest - make this global overview, Dietary Fibre - A Component of Food, an important contribution to the literature on the subject. The cooperation of experts from different research centers and their peer review of each other's papers enhance the value of the book, since it presents consolidated views and objective assessments on such key issues as fibre analysis and mineral bioavailability. The seventeen chapters are grouped into three sections. The background papers deal with biochemical and analytical characteristics: e.g. the physico-chemical properties of food polysaccharides and bacterial fermentation in the colon. The papers on physiological effects deal with the physiological function of dietary fibre throughout the gastrointestinal tract: its influence on protein, lipid and carbohydrate digestion and absorption and its role in bile acid metabolism and faecal bulking. The third section of papers focuses on the prevention and treatment of disease: gastrointestinal disorders, obesity, diabetes mellitus, and hyperlipidemias.

This book - the first multicenter book on orthotopic liver transplantatio- reflects the progress in this field. The first 'experience in hepatic transplantation' was documented in 1969 by Starzl and his group in Denver in the classic of the same name. It was followed in 1983 by 'Liver transplantation', edited by Caine, in which the experience of the Cambridge-King's College Hospital team was laid down. Apart from these the book of Lie and Giitgemann appeared in 1974. These books are fundamental for all who want to become involved with experimental and clinical liver transplantation. Developments in liver transplantation are fast (faster than the production of this book) and new knowledge now not only is coming from the pioneer centers but also from their off-spring, scattered over the world. In only a few years there has been an enormous increase in the number of liver transplantations and certainly there have been performed at least as many transplants since 1980 as between 1963 -the start of clinical liver transplantation- and 1980. Even if our understanding is better, many problems are the same as twenty years ago and for some there may be a long way to go before they are solved.

Intraductal papillary mucinous neoplasms (IPMNs) represent an opportunity to treat pancreatic tumors before they develop into aggressive, hard-to-treat cancers. Beginning with morphological classification and its clinical significance, natural history, and malignant change of both main duct and branch duct IPMNs, this book covers the whole field of IPMNs of the pancreas. It reviews the various methods of investigation: imaging, diagnostic investigation of cyst fluid, and those using pancreatic juice; and also examines aspects ranging from the development of malignancy to the timing and method of resection, focusing on both main duct and branch duct IPMNs.

Aimed at residents, clinical fellows, and pancreatologists who treat patients with this common disease of the pancreas, this book is a landmark in the current understanding and future perspectives of IPMNs of the pancreas.

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Experts from Europe, Japan and the United States have contributed to this in-depth volume on digestive disease pathology. Each chapter contains numerous electron micrographs, often supplemented byline drawings, and extensive references to the literature.The clear illustrations and text are an excellent aid for the diagnosis of pathological entities in the gastrointestinal tract.

Hepatic sinusoidal cells such as sinusoidal endothelial cells, Kupffer cells, hepatic stellate cells, and pit cells play an important role in hemodynamic and metabolic function and are involved in various liver diseases. The frequent involvement of sinusoidal cells in pathologic conditions is explained by the diverse actions of those cells, an understanding of which is essential to clinicians. Generously illustrated, this volume presents results of recent studies on hepatic sinusoidal cells in liver diseases, with an introduction to the structure and function of the various types of sinusoidal cells. The in-depth focus of the book is on the role of hepatic sinusoidal cells in relation to liver injury and regeneration, hepatic sinusoidal microcirculation, alcoholic liver diseases, hepatic fibrosis, liver tumor, liver transplantation, cholestasis, and congenital lipidosis, thus providing a valuable reference source for practitioners and researchers.

Hepatitis C Virus and Liver Transplantation is designed to provide a comprehensive and state-of-the-art overview of the major issues specific to the field of liver transplantation and hepatitis C virus infection. The sections of the book have been structured to review the overall scope of issues of recurrent hepatitis C in different complex settings, including retransplantation, HIV-coinfected patients or in the setting of suboptimal graft donors. This book provides up-to-date information on the application of new therapies to the field of liver transplantation. It provides the most recent data on their efficacy, the management of side effects, as well as the potential interactions and specific problems associated with their use in the transplant setting. Finally, an appraisal of the risks and benefits of using organs from anti-HCV positive donors is presented. This book provides concise and actual materials for several important topics that are simply not adequately covered by current available literature. Hepatitis C Virus and Liver Transplantation will provide a unique and valuable resource in the field of liver transplantation and will be of great value to Hepatologists, Transplant and Abdominal Surgeons, Oncologists, as well as Fellows and Residents training in these fields.

In the past 15 years much evidence has accumulated which indicates the paramount importance of sensory nerves in reg ulating functions of the gastrointestinal tract. In parallel, the attention of researchers in this field has been increas ingly attracted to the role played by neuropeptides in the normal and diseased gut. Basic research on the peculiar properties of capsaicin, the pungent ingredient from plants of the genus Capsicum, has allowed the gap between these two areas of research to be bridged. Sincethen, the study of gut afferents and neuropeptides has become more and more interconnected and recognized as a major avenue to understand ing the pathophysiology of various human diseases. It is widely recognized that a certain subset of primary afferents synthesize, store and release neuropeptides (such as tachykin nins and calcitonin gene-related peptide) from their central and peripheral endings, the latter being widely distributed in the alimentary canal and related organs (liver, pancreas). The First International Meeting on Sensory Nerves and Neuropeptides in Gastroenterology, held in Florence from December 4-5, 1989, sponsored and organized by Fondazione Internazionale Menarini, aimed to focus the current status of research in this field. The contributions presented at the meeting and in this book delineate a suggestive scenario in which sensory nerves of the gut, and the multiple messages they carry through the release of neuropeptides, are to be considered as a major target for the development of new drugs potentially useful in a number of diseases of the gastro intestinal tract."

Gastric secretions contain hydrogen ions at a concentration that is more than one million times higher than their intracellular concentration. This phenomenal gradient as well as the demonstrated ability of gastric juice to digest tissues has motivated clinicians and investigators alike to emphasize acid secretion and acid ablation in studying the pathogenesis and therapy of peptic ulcer disease. Conse quently, over the past 150 years, we have made considerable progress in under standing the mechanisms and regulation of acid secretion by the stomach. Not surprisingly, therapy for both peptic disease and mucosal injury has also been predominantly directed at either neutralizing acid or suppressing its production. During the past 10 years, attention has been focused on factors other than acid in the genesis and therapy of ulcer disease. Work done worldwide demon strated that acid hypersecretion is not a common event in peptic ulcer disease. Therefore, we began realizing that factors other than acid secretion may be important in the genesis of ulcer disease or in gastroduodenal mucosal damage. In addition, new physiological information has established that the gas troduodenal mucosa is normally protected by a complex series of events includ ing mucus and bicarbonate secretion, cell renewal, surface mucosal restitution, and preservation of the microvasculature and mucosal proliferative zone.

Autoimmune (IgG4-related) Pancreatitis and Cholangitis reviews the breadth of clinical, imaging, histological, laboratory, and imaging features associated with IgG4-associated systemic disease, especially AIP and IAC. Written by experts in their fields, each chapter includes an overview of existing data as well as the most up-to-date scientific information and emerging data. The book also addresses areas of uncertainty and controversy, briefly highlighting clinical and research needs relative to the respective topic. Comprehensive and easy to use, Autoimmune (IgG4-related) Pancreatitis and Cholangitis is a valuable resource for physicians who deal with or are interested in these complex disease processes, including gastroenterologists, hepatologists, and surgeons.