by Dr. Jan. J. Smulewicz Ultrasound imaging has reached a stage of sophistication where by diagnostic information can be gained without discomfort to the patient and with complete absence of morbidity and mortality. The procedure is quick, safe, noninvasive and in many instances can supersede and obviate more time-consuming procedures requiring catheterization, injection of a contrast material, and radiographic imaging. In obstetrical problems the danger of ionizing radiation to the fetus is eliminated. In debilitated and very ill patients this simple and painless method becomes the procedure of choice. Unique features of ultrasound equipment allow for pinpoint local ization oflesions and direct visual guidance of percutaneous puncture techniques for aspiration and biopsy. The accuracy of ultrasound guided punctures and the absence of side effects make this modality far superior to percutaneous invasive techniques performed with other imaging systems. Renal cyst puncture and amniocentesis are but two of the procedures in which ultrasonic guidance is the method of choice. v Dr. Hassani has throughly explained and carefully explored the wide variety of exam inations available with ultrasound. The large volume of material and the clear interpre- tion makes this book of great interest to all of the medical profession. In addition to the existing methods available for diagnostic in terpretations, this method of noninvasive diagnosis should find its way into every hospital or center where good medical care is provided. JanJ. Smulewicz, M.D."

The Italian Group for the Study of Liver Cirrhosis began its activity in 1980 on the basis of recognition and financial support from the Italian Ministry of the University, Scientific Research and Technology, having been chosen from several other scientific programs. The group is now called the National Group for the Study of Liver Cirrhosis and Viral Hepatitis and includes more than 40 centers throughout the nation under the auspices of the universities. The primary Imtlatlve of the group, to combine experimental and clinical approaches in the study of liver pathophysiology, remains unchanged. Annual meetings in January provide the possibility of comparing experimental and clinical results in the spirit of mutual comprehension and criticism. After 15 years and 6 volumes (published biannually), the actual improvement of Italian research in liver pathophysiology is evident. In fact, in order to let other researchers know what has been achieved we chose to publish the 7th volume, in spite of the economic difficulties at hand. We have gathered specific experiences of all the centers included in the national program. Each group was required to present an update in its own field of research, rather than specific or recently obtained results, which could have been reported only in relationship with other data already published by others. Like the 6th edition in our series, this volume affirms the specific competence of all the participants and summarizes the most important updates in liver pathophysiology.

Surgical Diseases of the Spleen written and edited by internationally renowned scientists will be a masterpiece for any institution. It provides an updated multidisciplinary review of diseases of the spleen. Experts in the field have customed their chapters to further ease the readers understanding offering all the information needed to progress in this area. Different sections on basic concepts, specific splenic diseases and operative techniques cover new aspects in immunology, infectious, traumatic and neoplastic conditions.

The advances in science and medicine we are now experiencing are unprec edented and exciting. Life expectancy is prolonged, and quality of life is much improved. We learn of fabulous new discoveries made at the bench or the bedside every week. Many diseases have been totally eliminated, others can be significantly improved by new therapeutic formulations. Much of the success can be attributed to a better understanding of disease processes and the specific targeting of new and more effective medications. As is the case in many areas of successful human endeavour, there can be a downside. In the case of drugs and chemicals it is their adverse effects which are of concern. Of course, every effort is made to devise medications that are safe, and the need to elucidate and understand mechanisms are crucial, yet adverse effects remain a problem. They can be unpredictable and diverse. Drugs have been shown to induce virtually the whole gamut of human liver pathology from acute fulminant hepatitis to chronic active hepatitis to cirrho sis and even malignancy. Hence the possibility of adverse drug effects must be considered in the differential diagnosis of many patients with liver disease. This is well recognized and is very important; indeed, removal of the offending agent can often lead to reversal of the adverse effect. This is an area of hepatology where we can really make a difference."

The purpose of this series of volumes is to present a comprehensive view of the complications that result from the use of acceptable diagnostic and therapeutic procedures. Individual volumes will deal with iatrogenic complications involving (1) the alimentary system, (2) the urinary system, (3) the respiratory and cardiac systems, (4) the skeletal system and (5) the pediatric patient. The term iatrogenic, derived from two Greek words, means physician-induced. Originally, it applied only to psychiatric disorders generated in the patient by autosuggestion, based on misinterpretation of the doctor's attitude and com ments. As clinically used, it now pertains to the inadvertent side-effects and com plications created in the course of diagnosis and treatment. The classic categories of disease have included: (1) congenital and developmental, (2) traumatic, (3) infectious and inflammatory, (4) metabolic, (5) neoplastic, and (6) degenerative. To these must be added, however, iatrogenic disorders-a major, although gen erally unacknowledged, source of illness. While great advances in medical care in both diagnosis and therapy have been accomplished in the past few decades, many are at times associated with certain side-effects and risks which may result in distress equal to or greater than the basic condition. Iatrogenic complications, which may be referred to as "diseases of medical progress," have become a new dimension in the causation of human disease."

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.

Dr. Dobranowski and his associates are to be highly commended for this excellent manual. I am not aware of a similar text covering the subject. Although all of us perform gastrointestinal studies in a differ ent manner, this text provides an excellent overview. The reader will discover that the text is especially well written and focuses on the important issues relating to GI contrast studies. Because Dr. Steven son's group performs endoscopic procedures, they are included in the manual. These authors are recognized scholars and leaders in gastrointesti nal radiology. Thus, it is easy to understand why the manual is so well done. I am particularly impressed with the emphasis placed on the patient-radiologist relationship before, during, and after completion of a study. All of us who teach gastrointestinal radiology are concerned about the decline in the number of gastrointestinal contrast studies. We are not sure how we can continue to teach our residents the proper tech niques and maintain high-quality teaching programs in gastrointesti nal radiology. A manual of this type is thus timely and appropriate. The manual will be a valuable addition to the library of all radiologists. It will be particularly useful for residents who are learning how to per form GI contrast studies."

Vaccines have historically been considered to be the most cost-effective method for preventing communicable diseases. It was a vaccine that en abled global eradication of the dreaded disease smallpo. ."

Diagnostic Pathology of the Intestinal Mucosa - An Atlas and Review of Biopsy Interpretation offers a comprehensive overview of intestinal mucosal structure as defined through peroral or endoscopic biopsy specimens obtained in normal and disease states. It describes small intestinal biopsy pathology in conjunction with morphologic, functional, and pathophysiologic correlations. Routine methods of processing tissues for light microscopy, electron microscopy, histochemistry, and light- and electron- microscopic-immunoperoxidase techniques are presented so that the novice in the area of intestinal structure may have an easily accessible reference for setting up a morphologic laboratory.

Drugs are often associated with adverse effects, and the digestive tract is the most frequent target. This volume collects a number of updated overviews from experts in this area to offer to the reader a single, complete source of information and reference on that subject.

Common Liver Diseases and Transplantation: An Algorithmic Approach to Work Up and Management provides a review of liver diseases and transplantation that is comprehensive enough to provide an intellectual basis for the data, yet simple enough to be read and assimilate into clinical practice rapidly. Common Liver Diseases and Transplantation by Dr. Robert S. Brown Jr is written with an intended flow and structure. The early chapters are summaries on topics such as early and late liver disease, workup and diagnosis, and pre- and post-transplant problems. The chapters that follow are liver disease-specific and cover the liver diseases physicians will encounter in their patients. The in-depth chapters provide disease-specific epidemiology and outcomes, as well as diagnostic tables and more detailed algorithms and management approaches. With two decades worth of teaching liver disease both formally as well as in rounds and informal "chalk talks" with residents and fellows, Dr. Robert S. Brown Jr presents a way to think about clinical liver problems with a simple algorithmic method. Common Liver Diseases and Transplantation: An Algorithmic Approach to Work Up and Management will serve as a useful resource for gastroenterologists, fellows, medical students, internists, and internal medicine residents.

Modern surgical oncology is characterized by multimodal therapy. In recent years numerous therapeutic approaches of pre-, peri-, intra-and postoperative treatment have been in vestigated with regard to their use in combination with surgi cal intervention. It now is time to analyze and to define the state of our knowledge. For tumors of the gastrointestinal tract there are several encouraging therapeutic approaches, such as preop erative chemotherapy in esophageal and perioperative chemotherapy in colon cancer. For some special tumors, like anal carcinoma, we have clearly defined combined therapies which even now must be viewed as standard treatment. It is also time to demonstrate the results of several clini cal studies that have been conducted within the last few years that combined surgical efforts with pre- or postinter ventional chemotherapy or radiotherapy. It is necessary to evaluate whether these trials contribute to progress in onco logical therapy. The editors of this volume - surgeons at the university hospitals of Heidelberg and Zurich - must be given the mer it of achieving these goals. It was especially appropriate for the Department of Surgery in Heidelberg, in close coopera tion with the Comprehensive Cancer Center Heidelberg/ Mannheim, to prepare a review of our present knowledge of surgical oncology as it is in the tradition of attempting to combine different therapeutic approaches to cancer therapy.

Hepatic cells are involved in the metabolization and elimination of a variety of endogenous and exogenous substances. They mediate the uptake, processing and subsequent secretion of biliary compounds, such as various drugs or hormones, and the passage of metabolites to be released into different blood compartments. To perform vectorial passages hepatocytes show a strong polarity with sites for endocytotic processes or specific carrier molecules, and a specified system of organelles for intracellular transport and sorting, metabolization and secretion of compounds. Several aspects, e.g. regulation, control and mechanisms of hepatic traffic are reported in detail - complemented by methodological approaches to analyse and monitor these processes.

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."

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."

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 volume reviews a series of different publications dealing with orotic acid. Orotic acid was isolated from cow's milk 75 years ago by Biscaro and Belloni in Italy. Fifty years later again Italian scientists described the growth-promoting activity of orotic acid in vitamin B -deficient animals. 12 Orotic acid is the precursor of pyrimidine nucleotides which are involved in many biochemical reactions: UTP and CTP, as substrates for RNA polymerase, and UDP sugars, as substrates for carbohydrate containing macromolecules, e.g. glycogen, glycoproteins and glycolipids. The biosynthesis of these pyrimidines is well regulated. Disturbance of the biosynthetic pathway or trapping of individual pyrimidine nucleotides may lead to severe metabolic and structural alterations of cells. Synthesis, biochemical aspects and physiological role are reviewed in nine chapters. In the last two decades increasing interest in orotic acid came from several studies showing protective or therapeutic or beneficial effects of this compound in different kinds of organ injuries: various forms of hepatic insufficiency, myocardial infarction, encephalopathy, memorization pro cesses, mentioned in Chapters 8 and 9. At the end of this overview a Bibliography in an alphabetical order with 673 references may give further insight in this topic."

The regenerative capacity of the liver cell is almost unlimited. Therefore after acute liver damage, be it viral, toxic, hypoxic, or surgical in origin, restitutio ad integrum is the usual outcome. In two forms of liver disease, however, this is not the case: in fulmi nant hepatic failure, liver regeneration often is not fast enough to keep the organism alive; in end-stage cirrhosis, regeneration is dis turbed by a hypertrophic architecture of fibrotic tissue. For these extreme forms of liver disease and for critical situations before and after liver surgery, artificial liver support is needed. This book contains the latest results in this area of research pre sented by scientists from allover the world at an international symposium held in Celle, Germany, June 2-4, 1980. Exciting new methods like continuous membrane plasma sepa ration and liver cell transplantation into the spleen have been de veloped. The older methods of hemoperfusion and dialysis have been improved. Enzymological methods and liver transplantation have made good progress. We hope that this volume will help the clinician in his decision-making and stimulate ingenious new re search for the benefit of our liver patients."

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."

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."

In this book, precursors of gastric cancer are described histopathologically, especially about the precancerous conditons and precancerous lesions of the stomach. In addition to those precancerous changes stated in previous monographs and textbooks, some newly recognized gastric dysplasias are proposed. In order to be able to ovjectively evaluate the atypism of dysplasic changes, achievements of morphometric studies were presented.

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).

This book deals with all aspects of surgery of the pancreas. The leading authorities from all over the world have contributed to this volume. Surgery of acute pancreatitis, chronic pancreatitis and pancreatic malignancies is demonstrated. This book defines standards for pancreaticand general surgeons. In addition all aspects of diagnostics, pathophysiology and basic scientific data with regard to pancreatic disease are presented.

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."

Parasitic Disease in Clinical Practice is the sixth monograph to appear in the now established and flourishing Bloomsbury Series in Clinical Science. Written by a distinguished authority in the field, the book gives a comprehensive and detailed description of parasitic infections and their clinical consequences. Such infections are no longer confined to tropical parts of the world and now have a widespread distribution. Rapid advances are being made in understanding their epidemiology and in diagnosing and treating particular infections. Current literature is largely directed to the parasites, their characteristics and their isolation; a clinical review is clearly needed. This has now been provided, for the author's stated objective is to "inculcate a greater awareness, understanding and appreciation of human parastic disease in the minds of all clinicians". London, March 1990 Jack Tinker Preface Homo sapiens has always existed in a finely balanced equilibrium with a great diversity of infective agents, almost all of them of great antiquity. Many must have exerted a profound effect on the evolution of the human genome. While the average physician is usually aware of potentially pathogenic viruses, bacteria (and rickettsia), and to a lesser extent fungi, hislher knowledge of protozoan and helminthic infections is frequently imperfect and often rudimentary.