This book is unique for its comprehensive presentation of protease function in the stomach, colon, pancreas and liver under both physiological conditions and major diseases manifesting in these four organs. The individual chapters have been written by leaders in the field who outline in great detail the role of proteases in the pathogenesis, diagnosis and treatment of disease. Animal models and experimental data are discussed in the context of patient-derived data.

Pathology of the Stomach and Duodenum comprehensively surveys gastric and duodenal disease, including clinical findings, pathophysiology, and epidemiology, and emphasizing diagnostic gross and microscopic pathology. Topics discussed include anomalies, gastritis, peptic ulceration, hyperplasias and benign epithelial tumors, carcinoma of the stomach and duodenum, carcinoid tumors, reactive and neoplastic lymphoid lesions, gastric smooth muscle and nerve sheath tumors, and miscellaneous lesions and rare conditions reflecting gastroduodenal participation in systemic disease.

Malignant neoplasms occurring in the biliary tract and pancreas remain a therap- tic challenge. The mechanism of carcinogenesis as well as the growth and spread of these tumors is still poorly understood, making the development of rational tre- ment strategies difficult. In order to improve the clinical results achieved by sur- cal or other medical treatment of such malignant tumors, the establishment of an experimental animal model is critical. For this purpose, attempts were made to induce carcinoma experimentally in the biliary tree and finally an animal model using the hamster was established in 1994 at our laboratory. Because the tumor in this model mimicked the characteristics of human tumors, a series of experimental investigations were conducted to clarify the pathological characteristics of biliary carcinoma, the genetic alterations during biliary carcinogenesis, and the relationship between biliary inflammation and c- cinogenesis. The chemopreventive effects on the occurrence of biliary carcinoma were also successfully examined. In addition, in vitro studies led to the establi- ment of transplantable biliary cancer cell lines and biliary epithelial cell lines by utilizing the hamster model. This monograph represents the collective efforts in hepato-biliary and pancreatic disease research over the past 20 years. I hope that this monograph will be a source of useful knowledge for basic researchers as well as for clinicians involved in the care of patients with hepato-biliary and pancreatic neoplasms. Takashi Kanematsu, M.D., Ph.D.

Great advances have taken place in basic research and the clinical usefulness of dendritic cells (DCs). It has now been clearly established, for instance, that these cells play a crucial role in immune responses against infectious diseases and cancers. Antigen-presenting DCs are widely distributed in the body and regulate both immunity and immune tolerance. Experimental studies have provided important insights into DCs and how they can be used for treating animal models of various diseases that occur in humans. The role of these cells in pathogenesis and the treatment of human diseases is elaborately set forth in this valuable book. Researchers in the field are optimistic that DCs, already in use for treating patients with cancers, soon can be used therapeutically for patients with chronic infections, autoimmune diseases, and allergic manifestations. This volume provides a working definition of DCs and also explains the phenotypes and functions of DCs so that these can be readily understood not only by clinicians but by immunologists, researchers, and students as well.

- Written by international contributors including specialists in surgery, hematology and oncology.

- The information is presented in an instructive manner, allowing the phycisian to utilize the content immediately.

- Discusses new techniques such as minimally invasive approaches to surgery and new cancer treatments.

"...excellent, well-organized, and timely." -Lester Packer and Enrique Cardenas, University of Southern California, Los Angeles, from the Series Preface The liver is a vital organ that is responsible for a wide range of functions, most of which are essential for survival. The multitude of functions the liver performs makes it vulnerable to a wide range of diseases. Mitochondrial dysfunction plays an important role in many liver diseases including drug-induced liver injury, alcoholic liver disease, and nonalcoholic fatty liver disease. Mitochondria in Liver Disease gathers the most current research regarding the role of mitochondria in the liver and various diseases to which it is susceptible. The book is separated into two sections, the first of which highlights the latest developments in mitochondrial research. It includes cutting-edge topics such as the regulation of mitochondrial respiration using hydrogen sulfide and the regulation of mitochondrial fusion-fission via the endoplasmic reticulum. The second section reviews the most current research on the role of mitochondria in a wide range of liver diseases. It also addresses novel topics such as the importance of liver mitochondrial constituents as biomarkers of liver injury in plasma and as regulators of the immune system. Mitochondria in Liver Disease represents the current state of knowledge and research on mitochondrial roles in liver diseases. Written by a group of global experts, it provides an authoritative and comprehensive overview of the latest advances and methods that mark key starting points for future research.

Liver Transplantation: Challenging Controversies and Topics grew out of a need I perceived within the fields of transplant hepatology and liver transplantation. Liver transplantation has rightly gained recognition as an established therapy for end-stage liver disease. Few would argue that liver transplantation is one of the few truly lifesaving and life-altering treatments within medicine and surgery. Not many realize that 20 years passed from the time of the first human liver transplantation in 1963 to its acceptance as therapy by the 1983 NIH Consensus Conference on Liver Transplantation. In 2008, 25 years will have passed since the 1983 NIH conference-a mere 25 years for a field that has provided patients hope, doctors options, and to some the "gift of life. " Many issues in liver transplantation involve indications, patient selection, and outcomes after transplantation-these are standard topics, covered by textbooks of hepatology and transplantation. In contrast, the field of liver tra- plantation is young, evolving, dynamic, and issues and decisions are often controversial. Thus, Dr. Trotter and I, as well as our colleagues at the University of Colorado, felt that a text with a different focus was required, one that highlighted controversy and challenged dogma. Out of this perceived need emerged Liver Transplantation: Challenging Controversies and Topics. To meet the transplant community's need for emerging information about liver transplantation, Dr. Larry Chan, Dr. Igal Kam, and I initiated the Controversies in Transplantation Conference.

Managing the Complications of Cirrhosis: A Practical Approach is a simple pocket guide for the community gastroenterologist and primary care provider who manages liver disease. While there are other books on the market available on the management of cirrhosis, this reference includes information geared toward the busy practitioner, allowing the reader to reference a chapter that easily addresses the clinical issue at hand. Dr. Atif Zaman provides essential and current information on the management of cirrhosis for the non-hepatologist. Each chapter in Managing the Complications of Cirrhosis: A Practical Approach is broken down into four sections, including a summary of the issue at hand, diagnosing the problem, treating algorithm in a figure, and what to do if the treatment algorithm is ineffective. In addition, each chapter highlights complex cases that have no standard treatment, but have emerging concepts or data. Chapter Topics Include: * Preventative health issues in patients with cirrhosis * Nutrition in patients with cirrhosis * Management of heptocellular carcinoma * Pulmonary issues in patients with cirrhosis * Timing for referral for liver transplant With algorithms, tables, and tabbed chapters for easy access to information, Managing the Complications of Cirrhosis: A Practical Approach is the perfect book for all community gastroenterologists, primary care practitioners, medical residents and fellows, physician assistants, and nurse practitioners who provide care in the area of liver disease.

Liver and Biliary Surgery provides an illustrative, instructive, and comprehensive review that depicts the rationale of basic operative principles essential to liver and biliary surgical therapy. The chapters provide pertinent and concise summaries of how to deal with various liver and biliary disorders, spanning benign and malignant problems and minimally invasive procedures. Stages of operative approaches with relevant technical considerations are outlined in an easily understandable manner. Complications are reviewed when appropriate for the organ system and problem. The text is illustrated throughout by line drawings and photographs that depict anatomic or technical principles. A concise, handbook-sized reference work, this book is a valuable resource for all general surgeons and residents in training.

Hepatobiliary and pancreatic surgery is a relatively new specialty and the vast majority of patients present initially outside tertiary referral centres. Many conditions such as gallstones, acute and chronic pancreatitis, obstructive jaundice and malignancies of the liver, biliary tract and pancreas are still managed outside specialist centres or are not suitable for referral. Many general surgeons continue to manage these problems and in some parts of the world the geography and distances involved makes referral for specialist care difficult or impossible. The relative scarcity of specialist centres for the management of these difficult conditions also means that the majority of trainees do not get sufficient exposure prior their definitive appointment to equip them with the tools needed to confidently manage many of the problems they may face.
Operative Solutions in Hepatobiliary and Pancreatic Surgery combines clearly written, practical text with over 200 illustrations and numerous flow charts which take the reader through the management of all the commonly encountered hepatobiliary and pancreatic pathologies and procedures. All aspects of hepatobiliary and pancreatic surgery are discussed in a clear and consistent style, while the flow charts are designed to be modified by the reader to adapt them to local practice and the facilities and expertise available. This book is invaluable for the senior trainee or newly appointed specialist who requires clear, practical advice on how to manage the wide range of problems that present to surgeons outside specialist centres.

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.

Hepatology is an expanding field -- it's hard to keep up. The liver has been sitting there the whole time, but the knowledge surrounding this perplexing organ is exploding; this makes it hard to prepare for board and recertification exams, where 1 in every 4 questions pertains to hepatology. Until now, there has been no single, slim, but high-yield volume that summarizes the hepatology you need to know for the boards. This book has it nailed. The authors have collected every pearl of wisdom, high-yield factlet, liver "board buzzword," hepatic micrograph, and classic liver imaging study they could muster, all while keeping the book a manageable size - because who has time for more than manageable when you're busy? The answer to your study questions (and study time ) can be found inside: Acing the Hepatology Questions on the GI Board Exam: The Ultimate Crunch-Time Resource. Traditional textbooks usually feature long and detailed discussions that are not directly related to Board and recertification exams. On the flip side, many Board review manuals provide lists and bullet points lacking sufficient background and context. Inside Acing the Hepatology Questions on the GI Board Exam, Drs. Brennan Spiegel and Hetal Karsan present time-tested and high-yield information in a rational, useful, and contextually appealing format. Why You Will Need to Read Acing the Hepatology Questions on the GI Board Exam: * Focuses exclusively on Hepatology review -- an area that comprises 25% of the Board exam * Carefully vetted board-style vignettes with color images * Comprehensive yet succinct answers using a high-yield format * Emphasis on key clinical pearls and "board buzzwords" * Answers to classic board "threshold values" questions that you need to know but always seem to forget: If an echinococcal liver cyst exceeds XX cm, then the risk of rupture is clinically significant and surgery is warranted * Rapid fire crunch-time exam with 135 classic

This book will be an affordable, highly practical handbook on hepatology, aimed at residents/trainees in gastroenterology, GI nurses, and recently qualified consultants to use as a quick reference when managing patients presenting with possible or overt liver disease.

It will be of particular use for those GI internists/residents who have an interest specifically in hepatology. It does not aim to be a specialist textbook, but a shorter, 250pp guide that provides key clinical information on each area of hepatology in an accessible form. Extracting relevant material from large reference textbooks can be very time consuming and for this reason, information in this handbook will be presented succinctly in a style suitable for quick reference and easy understanding.

The chief emphasis will be on the clinical assessment and management of these patients, and all the major areas of liver disease will be covered, from liver cirrhosis to viral hepatitis, to autoimmune liver failure.

Chapters will use a variety of structural features and colour coded boxes to increase the accessibility for residents. These include: key points/take-home points, case history, practice points and management algorithm/flow-charts. Each chapter will also contain sample multiple choice questions that the reader will be able to test themselves on.

This book is serving the surgical trainee and the experienced transplant surgeon as a compendium of the various topics in split liver grafting. It is comprised of articles by faculty members of the first International Course on Split Liver Transplantation. Covering the main aspects of Split Liver Transplantation, this excellent volume helps livertransplant-surgeons select the best technique and getting aware of pitfalls. Detailed instructions on the different procedures are round off by an overview on technical development, status quo as well as the experience to date.

This is a classification of tumours and tumour-like lesions of the liver. It is based primarily on the microscopic characteristics of the tumours, and is therefore concerned with morphologically identi- fiable cell types and histological patterns. The haematoxylin- and eosin-stained section remains the mainstay of morphological diag- nosis, but special histochemical stains are often helpful and have been referred to in the explanatory notes. Readers interested in specific special stains mentioned in the text should consult Labora- tory Methods in Histotechnology of the Armed Forces Institute of *Pathology, Washington, D. c., USA. 1 The results of immunohisto- chemical methods for identifying various tumour "markers" have also been noted whenever indicated. The present classification incorporates all the previously classi- fied tumours, but also includes several new lesions, viz. biliary papil- lomatosis, the fibrolamellar variant of hepatocellular carcinoma and epithelioid haemangioendothelioma. Several subtypes of hepato- blastoma are mentioned. A serous type of bile duct cystadenoma is described. The section on tumour-like lesions has been expanded to include focal fatty change and inflammatory pseudotumour. The section on adenomatous hyperplasia, including macroregenerative nodules, has been amplified. The number of photomicrographs has been increased from the original 56 to 150. Unlike the first edition, the photomicrographs in the second edition are mostly black and white. All are new and were taken of representative cases on file at the Armed Forces Institute of Pathology.

Biliary tract complications are still the major cause of morbidity following orthotopic liver transplantation. This book deals systematically with the large variety of possible cholangiographic changes. The figures are the results of a review of cholangiograms from more than 280 patients who underwent orthotopic liver transplantation. The etiology, clinical aspects, and treatment of these complications are reviewed on the basis of the authors' experience in radiology, endoscopy, and transplant surgery.

Chronic viral hepatitis remains one of the major medical problems worldwide. Neither a cure nor eradication of this disease is in sight. The chronic disease caused by hepatitis viruses type B, C and D is a much greater problem than the acute disease caused by the same viruses or by hepatitis viruses type A and E. Chronic viral hepatitis often remains unrecognized until the patient develops decompensated liver cirrhosis or hepatocellular carcinoma. Furthermore, unrecognized chronic virus carriers are a persistent source of infection by sexual and other close contacts as well as during many medical procedures. The viruses of chronic hepatitis are very different from each other from a taxonomical point of view, but they share many common pathogenic properties and they often coinfect individuals. Six years ago Carlo De Bac, Gloria Taliani (Rome) and I undertook an effort to bring together, under the auspices of the European Society against Virus Diseases, clinicians, laboratory physicians, epidemiologists, pathologists and molecular biologists whose primary research interest is chronic viral hepatitis. The contributions from these quite divergent participants to a meeting devoted solely to chronic viral hepatitis were most stimulating and valuable. As a result of the success of the first meeting in Fiuggi (Italy), a second followed in Siena (Italy) 1990 and the recent third meeting was held in Pisa (Italy). Most of the speakers expressed interest in publishing their contributions in the form of a proceedings volume, as was done in the case of the Siena meeting.

Chronic viral hepatitis is discussed here in a multidisciplinary approach. The editors' goal was to assemble contributions from clinicians, laboratory physicians, epidemiologists, pathologists, and molecular biologists to provide a synopsis of all the important aspects of this disease. A key element in the chronic evolution of viral hepatitis is the persistent coexistence of a cytotoxic immune response and viral gene expression which is discussed in eleven articles on immune pathogenesis. The oncogenicity of hepatitis B virus at the molecular level and of hepatitis C virus at the epidemiological level is discussed in two chapters. The application of PCR for the detection of hepatitis viruses and their variants is a major topic of both practical and theoretical interest. The clinical significance of newly developed serological assays for diagnosis and prevention is discussed in depth by specialists from clinics, transfusion centers and virological laboratories. The therapy of chronic viral hepatitis is still unsatisfactory, but some slow progress is described in several articles. Furthermore, the volume has a special chapter on the often neglected topic of chronic hepatitis in childhood.

Well-organized and vibrantly illustrated throughout, Handbook of Liver Disease is a comprehensive yet concise handbook providing authoritative guidance on key clinical issues in liver disease. The quick-reference outline format ensures that you'll find answers when you need them, and cover-to-cover updates keep you abreast of the recent rapid changes in the field. Written by leading international experts in hepatology, this reference is ideal for hepatologists, gastroenterologists, internists, family practitioners, trainees, and others who diagnose and manage patients with liver disorders. Uses a highly templated outline format, key points in each chapter, alert symbols, and highlighted review points to provide a "just the facts" approach to daily clinical questions on liver disease. Expert ConsultT eBook version included with purchase. This enhanced eBook experience allows you to search all of the text, figures, Q&As, and references from the book on a variety of devices. Features expanded hepatitis chapters, including completely updated coverage of new, safe, and effective oral regimens for the treatment of hepatitis C. Provides completely updated coverage of: alcoholic liver disease * autoimmune hepatitis * portal hypertension * primary biliary cholangitis * hepatic tumors * cirrhosis * nonalcoholic liver disease * liver transplantation * and more. Includes the latest information on adolescents with liver disease moving into adult care. Covers the revised criteria for prioritizing liver transplantation using the MELDNa score, new options for the treatment of hepatocellular carcinoma, and improved management of hepatorenal syndrome.

Clinical Dilemmas in Non-Alcoholic Fatty Liver Disease offers hepatologists practical, up-to-date and expert guidance on the most topical dilemmas, difficulties and areas of controversy/difficulty surrounding this ever-increasing area of liver disease they face in daily practice. Roger Williams and Simon Taylor-Robinson, two of Europe s leading hepatologists, have recruited leading figures from across the world to assist them, resulting in a truly international approach. Each chapter covers a specific area of difficulty, containing clear learning points and providing evidence-based expert guidance on the latest hot topics in clinical management such as: * Is NAFLD different in absence of Metabolic Syndrome? * Are the pros outweighed by the cons of obtaining a liver biopsy? * Is progression to cirrhosis more likely in children with NAFLD? * What are the dangers as well as the true benefits of bariatric surgery? * How is it best to use antifibrotic agents in clinical practice? Clinical Dilemmas in Non-Alcoholic Fatty Liver Disease provides the answers to the questions and challenges that clinicians face every day in this area. It is essential reading for hepatologists of all levels and researchers in hepatology, as well as all those involved in the care of patients with NAFLD, including gastroenterologists, pathologists and specialist hepatology nurses.

Gastric Carcinoma/Classification, Diagnosis, and Therapy presents the most current perspective on gastric carcinoma, with particular emphasis on the surgical and chemotherapeutic modalities that offer hope for future treatment. The book discusses epidemiology, pathogenesis, and precancerous and clinical stage classification of the disease and provides valid practical guidelines for stage-specific diagnosis, therapy, and patient guidance. Topics explored include endoscopic criteria for premalignant lesions and early gastric carcinoma; clinical staging of gastric cancer by ultrasound, computerized tomography, and magnetic resonance tomography; surgical treatment of carcinomas of the gastroesophageal junction; possibilities for palliative treatment in surgical practice for advanced tumors; adjuvant treatment of gastric cancer; and chemotherapy of advanced gastric carcinomas in elderly and high-risk patients.

These exercises are meant for students and practitioners who wish to familiarize themselves with the normal and pathologieal computerized tomographie radioanatomy of the abdomen. The iconography is suffieiently characteristic to be read without the help of clinical or biological data. It comprises both normal and pathologie findings. Analysis of scans is comprised of two steps. The first part consists of the detailed study of normal scans, whieh serve as a reference. For this, eight main slice levels have been considered necessary and sufficient: neces sary since a certain number of slices are indispensable for the exploration of the abdomen; sufficient because a larger number of slices would risk rendering memorization difficult. The second part involves a study of the pathologie findings, organ by organ. Acknowledgements. Appreciation is extended to all those who have helped in realizing this study and, more particularly, to our friends and colleagues, J. L. DIETEMANN, C. Roy, J. L. BURGUET, M. VOUGE, and J. W. SOUITER. We would also like to thank Dr. J. WIECZOREK for his friendly assistance and advice in the planning and presentation of figures and schemata. 1 Technical Note Computerized tomography of the abdomen begins with an initial image called "scout view". This numbered radio graph of the abdomen is an analogous representation of the information and allows the location of the eight selected slice levels; these are represented by horizontallines. The slices are 10 mm thick and are taken at intervals of 2.5 cm.

Transcutaneous ultrasonography is an established procedure for diagnosis and therapy in gastroenterology. However, ultrasonic images can often be hampered by pulmonary and intestinal gas and by bony and adipose tissue. In 1956 Wild and Reid reported the first results of transrectal ultrasound of the prostate [1]. In 1976 Lutz introduced an A-mode ultrasonic probe which could be introduced via the biopsy channel of an endoscope [2]. In 1978 and 1980 Hisanaga performed echocardiography using an ultrasonic transducer attached to the tip of a flexible instrument [3, 4]. In animal studies and later on in humans Di Magno has used an echoendoscope in which a small transducer was attached at the tip of a fiberoptic endoscope [5, 6]. The purpose was to overcome the limitations of transcutaneous ultrasonography by directly approaching target lesions with a high-frequency ultrasound source via the gastroin testinallumen. SJlbsequently, the first series of endoscopic ultrasonography (EUS) examinations were reported during the European congress in Stockholm [7]. The purpose of this book is: 1. To evaluate the technique and the equipment for endoscopic ultrasonography 2. To evaluate in detail the endosonographic pattern of the normal and abnormal wall structure 3. To analyze a large consecutive series of various gastrointestinal malignancies in order to determine the usefulness and accuracy of EUS in the detection, staging, and therapy of malignant diseases 4. To compare EUS with other imaging techniques References 1.

International Congress for Infectious Diseases, Rio de Janeiro - April 17-21, 1988. F.-A. Waldvogel, President