This volume presents a concise yet comprehensive overview on all facets concerning the complications of cirrhosis. Structured in three sections, the book reviews the natural history of cirrhosis, the diagnostic and predictive tools available to assess the disease, complications, and treatment options such as liver assist devices and transplantation. Topical concerns in the management of patients with cirrhosis are also addressed, including issues pertaining to the delivery of quality care in this patient population. Written by experts in their fields, Complications of Cirrhosis: Evaluation and Management serves as a valuable resource for practitioners and physicians-in-training on the subject of cirrhosis.

The aim of this book is to present a unique compilation of lectures given by international speakers at the Hammersmith Hospital during the recent Meetings in Hepato-Pancreato-Biliary and Transplantation. New therapeutical approaches, advances in oncology and in diagnostic imaging, which reduce the need for invasive techniques and reach an improvement in survival and quality of life in cancer, are considered in this book. Modern literature has been reviewed with special reference to articles of general interest. In the clinical management of patients with liver, bile duct and pancreas diseases, it is important to assess the degree of disturbance and to diagnose the causative insult, and therefore clinical and laboratory methods of assessing each of these pathologies are of high interest. This version is an up-to-date account of diseases of the liver, biliary tract and pancreas, including transplantation, which we trust will be of value for surgeons, physicians and pathologists and also a reference book for medical students.

Hepatic Encephalopathy and Nitrogen Metabolism is an interdisciplinary symposium bringing together basic science and clinical applications. It contains up-to-date research findings at the highest scientific level.

Hepatology and Transplant Hepatology: A Case Based Approach presents a collection of interesting cases in liver disease seen at a very busy and large liver transplant center in the United States. These cases cover the full range of pathology that an internist or gastroenterologist may expect to see in a lifetime of taking care of patients with acute or chronic liver disease, before or after liver transplant. Each case is presented as you would see it in a clinical situation where a patient presents a complaint or something is noted on exam or blood work. The question/answer format will help one through the problem of making a diagnosis or in considering a differential diagnosis and also point to the best way to manage each condition. The volume is divided into pre-transplant and post-transplant hepatology. Each case is 3 pages with the first page presenting the case and pertinent lab data and 3-4 questions (i.e. differential diagnosis, tests to order, x-rays/CT required).The second page illustrates the tests, scans, biopsies and asks for the pertinent findings. The third page provides the diagnosis and what may have been expected with other diagnoses. Here is a single source dealing with questions specific for patients with complications of advanced liver disease and also clinical situations seen in transplant hepatology. Hepatology and Transplant Hepatology: A Case Based Approach will have great appeal to anyone in hepatology/transplant hepatology and also to residents/fellows and internists interested in gastroenterology.

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.

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.

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.

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.

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.

This is a multi-author book on hilar cholangiocarcinoma, written by an international team of world-renowned experts covering topics in their respective areas of expertise. There are altogether 71 authors from 14 countries/regions, mainly Argentina, Australia, China, Germany, Italy, Japan, Korea, Malaysia, Thailand, the Netherlands, the United Kingdom and the United States of America. This book aims to provide an up-to-date, fully referenced text that is as succinct as possible, but as comprehensive as necessary, addressing all topics in hilar cholangiocarcinoma. It provides the latest findings in the rapidly advancing field of hilar cholangiocarcinoma. Controversial aspects are discussed by highly regarded authorities who look at the problem from different perspectives. A helpful list of references is included at the end of each chapter. The extensive use of diagrams, figures and tables makes the text easy to read. This book is primarily intended for clinicians and researchers who are interested in hilar cholangiocarcinoma, including liver surgeons, hepatologists, interventional and diagnostic radiologists, and basic researchers. General physicians, general surgeons, trainees, epidemiologists, hospital administrators, pathologists and instrument manufacturers will also find this book to be a valuable reference work. Editor Lau is currently a Professor of Surgery at the Chinese University of Hong Kong, and an Academician of Chinese Academy of Sciences, China.

Hyponatremia is a common electrolyte disorder found in a variety of settings. Manifestations range from subtle abnormalities to convulsions and death. New treatment options, such as Antidiuretic Hormone (ADH) antagonists, have created the need for a resource presenting the latest evidence and clinical approaches. Hyponatremia: Evaluation and Treatment is a comprehensive review of hyponatremia, with an emphasis on managing this disorder from diagnosis to treatment. The incidence and occurrence of acute and chronic hyponatremia in general terms are covered, as well as disorders of the central nervous system, heart and liver with their relation to hyponatremia. Common clinical scenarios are presented along with both traditional and new methods of treatment. Authored by experts on this disorder from around the world, experienced members of the medical community and trainees alike will find Hyponatremia as an indispensible guide to diagnosis, managing and treating patients with hyponatremia.

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.

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.

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.

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.

Liver disease has been identified as a leading cause of death in HIV-infected patients since the introduction of highly active antiretroviral therapy (HAART) in 1996. The HIV treatment community has been caught largely unaware of this emerging dilemma. Many HIV care providers are ill-equipped to understand and interpret liver injury patterns, or to provide comprehensive care and management for viral coinfections which they are not familiar with. HIV and Liver Disease provides a comprehensive update of the field covering the epidemiology, pathogenesis, management and treatment of liver disease in patients with HIV infection. The volume will help HIV care providers understand and interpret liver injury patterns, and/or provide comprehensive care and management for viral coinfections. Gastroenterologists and hepatologists will gain an understanding of complex drug regimens that are used to treat HIV and which may impact HCV and HBV treatment. Written by expert clinicians and researchers across multiple disciplines, HIV and Liver Disease will be of great value to gastroenterologists, hepatologists, infectious disease practitioners, as well as other health care providers who provide care or participate in research in the field of HIV.

It is now widely accepted that multidisciplinary collaboration and multimodality treatment approaches are important in improving the survival of patients with hepatocellular carcinoma. In this comprehensive textbook, internationally renowned experts in the field present and discuss the various strategies employed in the treatment of the disease. Up-to-date information is provided on the indications for and outcome of a range of treatment options, including surgical resection, liver transplantation, radiofrequency ablation, transarterial chemoembolization, yttrium-90 transarterial radioembolization, and systemic therapy. In addition, important background information is included on biology, pathology, staging, and imaging. This book will be particularly helpful to all professionals and trainees worldwide who have an interest in the diagnosis and treatment of hepatocellular carcinoma.

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.

- Unlike previous atlases that deal with overall surgical techniques, this book goes into greater detail and focuses on individual cases.

- Lavishally illustrated with 534 illustrations, 133 of which are in color.

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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.

By 1977 it was clear that the thermophilic campylobacters were a major cause of acute bacterial enteritis. In response to that observation an international workshop was convened in Reading, England, and attracted over 130 participants. Many of these individuals resolutely returned for the eighth in the series of biennial international workshops, this time held in Win chester, England, in July 1995. All were surprised at the continued, and even expanding, re search effort in this narrow microbiological field. Such a lasting interest is undoubtedly a reflection of a consistent rise in the incidence of infection, the growing number of closely re lated organisms and disease associations, and an ever-increasing awareness by the public and government agencies of public health and food safety issues. The second workshop in Brussels in 1983 was a forum that demonstrated the growing awareness in the campylobacter community of the existence of campylobacter-like organisms and provided the platform for presentations describing the association of these organisms, now classified in the genus Helicobacter. with gastroduodenal disease. The clinical aspects of the research into helicobacters is now thoroughly covered in several other meetings, and the remit of the international workshop has been expanded to provide a forum for the presentation of the basic microbiological research carried out on these bacteria. In a continuation of this ap proach the remit of the workshop has been further extended to other related organisms, reflect ing that there are many other campylobacter-like organisms still to identify and characterize."