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.

Diagnostic ultrasound is changing dramatically because of the development of a variety of high resolution real-time scanning instruments. Until recently the standard instrument was the articulated arm contact scanner. Real-time scanners were viewed as adjunct instruments for specific and limited pur poses. The roles are reversing with real-time instruments more frequently accepted as the primary diagnostic tool and the contact scanner becoming the ancillary instrument for use mainly for viewing a large field that cannot be scanned with real-time instruments. Two recent editorials stated that real-time instruments were used as the sole diagnostic instrument for between 80% [Cooperberg (2)] and 98% [Bartrum and Crow (1)] of their abdominal examinations. This book introduces the reader to the field of real-time scanning in the abdomen. It presupposes an understanding of basic physical concepts of ultrasound, the appearance of both normal and pathologic conditions as produced by static articulated arm contact scanning, and a familiarity with the techniques of contact scanning. It is designed to acquaint the reader with the spectrum of real-time instrumentation, provide a basic understanding of the physics of ultrasound as related to these instruments, emphasize the special skills required in the use of this equipment, and describe applications of real-time scanning for various parts of the abdomen. While numerous illustrations of both normal and pathologic anatomy are shown, the book is an all-inclusive study of abdominal pathology as demonstrated by real-time imaging.

During the 7th International Bile Acid meeting held in Cortina d'Ampezzo., Italy, during March 1982, there were two important Workshops dealing with recent advances in two areas of bile acid metabolism - Serum Bile Acids i, n Health and Disease and The Pathophysiology of the Enterohepatic Circulation. These Workshops complemented the broad range of topics in bile acid metabolism which were presented formally as part of a Postgraduate Course. The proceedings of these formal presentations have already been pub lished by MTP Press under the title Bile Acids in Gastroenterology but in view of the exciting, important, new information which emerged during both Workshops, the organisers of the meeting felt that it would be valuable to record and edit the proceedings of the Work shops, which form the basis of this volume. The advent of new techniques for measurement of total and indi vidual bile acids in serum now means that accurate and reliable 7 PREFACE measurements of bile acids in peripheral circulation are available to all. This has resulted in a veritable explosion of information in the serum bile acid field and, therefore, the appearance of a critical evalu ation of the technical and basic scientific and clinical aspects of measuring serum bile acids is indeed timely."

Exciting major changes have occurred in the understanding and treatment of gallstone disease over the last two decades. In bygone years, books about gallstones were often based on postgraduate lectures which the author, usually a surgeon of distinction, had given. More recently, many books dealing with this subject have been based upon national or international conferences. The single-author text has the disadvantage that few authors today can authoritatively encompass a whole field: the reports of symposia, conferences or workshops often lack balance and auth ority. The merits of 'Gallstone disease and its Management' edited by Malcolm Bateson are clear. He has chosen 11 authors, all of whom write on topics relating to their own expertise, and the content of the book has been carefully planned to reflect the most modern ideas about the aetiology and management of cholesterol gallstones. It is worth repeating that we are experiencing rapid developments in the field of gallstone disease. Disappointingly the least progress has been made in identifying the cause (or causes) of the disease notwithstanding the many data implicating a variety of environmental factors. Most of these affect the chemistry of hepatic bile and the contribution of the gallbladder to lithogenesis remains uncertain and unstudied."

Over a decade has elapsed since the last volume in this series was published. At that time we considered that we had comprehensively covered all aspects relating to bile acid chemistry and physiology. However, major strides have been made in our understanding of the physiology and pathophysiology of bile acids, due largely to the great advances which have taken place in analytical technology. As a result, the need to document these advances was felt acutely, and therefore this volume is devoted to methodologies in bile acid analysis and their applications. This volume includes twelve chapters written by prominent scientists in the field of bile acid research. The initial chapter discusses techniques of extraction and isolation of bile acids from biological fluids. It is followed by descriptions of physical methods of analysis and discussions of the way these techniques have been applied in the field of bile acid research. Of practical value is the inclusion of a comprehensive list of spectra obtained for refer ences by nuclear magnetic resonance spectroscopy and mass spectrometry . These chapters are followed by reviews of biological methods of immuno assay and bioluminescence. Specific applications of these techniques are then addressed in contributions relating to bile acid analysis of tissue, serum, urine, and feces. With this integrated approach we have attempted to provide a volume which represents a comprehensive review of the analytical field of bile acids, while also serving as a useful reference book for those workers involved in bile acid analysis."

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."

This is the fifth symposium on Experimental and Clinical Hepatology to be convened by the organisers, and, in common with the previous four, reflects the importance placed upon continuing discussion by clinical investigators as well as basic physiological and pharmacological researchers. Previous meetings which were held at the Surgical Department of the Philipps University in Marburg were dedicated to problems of direct clinical application, such as haemodynamics of portal hypertension, surgical approach to hepatic tumours, liver regeneration and temporary hepatic support. Clinical investigation was a subject which frequently came under discussion and some of these investigations have since lead to direct improvements in clinical therapy and many patients have benefited as a result. This time, the convocation was called to the Medizinische Hochschule Hannover where remarkable advances in clinical liver trans plantation have been the most striking event in clinical hepatology. The concensus of the meeting was that while significant clinical progress has been made, a variety of basic problems remained unsolved which will require further investigation. Special attention has, therefore, been given to topics such as acute liver damage, particu larly within the transplanted liver, to chronic active hepatitis and its spontaneous prognosis, to isolated hepatocytes and their effect on functional support of the liver, to mechanisms of liver circulation which may be altered completely within the transplant and to liver perfusion which is still considered unsatisfactory for subsequent transplantation."

For the fourth English edition, this highly popular book has been thoroughly revised and updated to include such new sections as endoscopic digestive US and abnormalities related to AIDS. It is the only work available covering the diagnostic US of the whole abdomen, and its superb treatment of elementary symptoms enables beginners to become familiar with more complicated features. After an extensive technical introduction, the book covers the sonoanatomy and ultrasonic symptomatology of the diseases of the digestive system and the abdominal vessels. Numerous tips on avoiding pitfalls, as well as indications for other procedures, and backed by some 1000 illustrations, this is well on its way to becoming a standard text for practitioners and clinicians in the field.

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. ."

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.

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.

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.

Bile acids occupy a central position in in the absorption, excretion and metab olism of lipids within the body. Our understanding of their unique properties has illuminated many biochemical and biophysical processes. Animals have evolved a unique system of preserving these important detergent-like molecules within the body and reusing them many times - the enterohepatic circulation. Disorders of the enterohepatic circulation contribute to a correspondingly wide range of diseases, and recent developments have centred in particular on cholesterol gallstone disease and bile acid diarrhoea. Successful manage ment of these diseases is increasingly based on an understanding of the physicochemical and biochemical properties of bile acids, and of their pathophysiological role in disease. Professor Alan Hofmann starts this book with an overview of the enterohepatic circulation of bile acids. The first section then discusses biliary lipid synthesis, transport and secretion by the liver and the solubilisation of cholesterol in the bile. The next section applies this knowledge to the pathogenesis of cholesterol gallstones. Separate chapters focus on defects in biliary lipid secretion, in cholesterol solubilisation and in gallbladder motility. The succeeding sections then review posssible approaches to gallstone prevention, and assess recent developments in non-surgical forms oftreatment. Two exciting new therapies that receive particular attention are contact dissolution therapy with methyl tert-butyl ether and extracorporeal shock wave lithotripsy. Further sections turn to the absorptive functions of bile acids in health."

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.

Provides findings on acute pancreatitis in the fields of morphology, epidemiology, pathophysiology, enzymatic and in- strumental diagnosis, clinical aspects and pharmacological and surgical treatment. Emphasis on clinical implications on the local release and vasoactice and toxic substances, the high rate of bacterial infection in the necroses, and the causes of impairment of cardiocirculatory, pulmonary and re- nal organs.

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."

Primary human liver cancer, of which hepatocellular carcinoma (HCC) is by far the predominant type, is a major cause of cancer death world-wide, accounting for 700,000 deaths per year. The epidemiology of HCC is particular with both geographic and temporal patterns of incidence paralleling exposure to viral etiologic factors. The highest HCC incidence rates are areas endemic for chronic infection with Hepatitis B virus, mainly Asia and Africa. The pathways by which HCC develop are heterogeneous and influenced by a variety of environmental and host factors. This book is dedicated to hepatocellular carcinoma and includes contributions that span various aspects of the disease from epidemiology, mechanisms and viruses, to promising new biomarkers and targets for treatment.

This book provides a single reference for all transplant professionals involved in the care of HCV patients who have unique problems not encountered in other liver transplant patients. In the liver transplant community, it is well-known that decompensated cirrhosis from hepatitis C virus (HCV) is the leading indication for orthotopic liver transplantation (OLT) in the United States and most Western countries. Short-term results which initially seemed promising and comparable to other carefully selected liver transplant recipients now appear less encouraging with cirrhosis developing in 10-25% of patients by 5 years. Despite these concerns, there is an increased amount of data which supports re-transplantation in carefully selected patients.

Hepatologists, both researchers and front-line clinicians, now have a comprehensive guide to the treatment of patients with the HCV virus. This book focuses mainly on the efficacy and clinical use of antiviral therapies, including the use of antivirals post liver transplantation and in the presence of the HIV virus. It also explores the foundations for understanding antiviral therapies in HCV, such as the complex pharmacology and mechanisms of antiviral drugs. A 'late-breaking information' chapter contains the most recent trial results on the latest antiviral drugs.

Vascular Liver Disease: Mechanisms and Management covers all of the disease entities that stem from abnormalities that affect the hepatic vasculature. This multi-authored text includes the mechanisms and management of intrahepatic vascular disease, including the most common cause of vascular disease of the liver, cirrhosis. Other less common diseases of the liver vasculature are also covered such as sinusoidal obstruction syndrome (previously known as veno-occlusive disease), portal vein thrombosis, the Budd-Chiari syndrome and congenital vascular malformations. These entities, although rare, are a challenge to physicians and physician scientists. Although many textbooks have been written on the consequences of cirrhosis on the liver vasculature, this is the only volume that focuses on the liver vasculature as a separate entity, providing an innovative approach to liver disease management. Vascular Liver Disease: Mechanisms and Management will be of great value to clinical investigators and basic scientists interested in the liver circulation as well as clinical gastroenterologists and hepatologists, hepatobiliary surgeons and transplant surgeons, and to interventional radiologists with a particular interest in the liver.

Hepatocellular Carcinoma: Targeted Therapy provides a detailed repository of the latest information regarding HCC epidemiology, diagnosis, imaging, pathology, staging, and treatment options. This volume also provides an up-to-date guide for treatment that explores not only traditional treatments, but newer investigational treatment options including, surgical resection, liver transplantation, ablation (radiofrequency, microwave), percutaneous ethanol or acetic acid injection, transarterial chemoembolization (TACE), intra-arterial radiation therapy, and systemic chemotherapy. Heptocellular Carcinoma: Targeted Therapy will be of great value to all health care professionals and trainees worldwide who have an interest in the diagnosis and treatment of HCC, including surgeons, medical oncologists, radiologists, radiation oncologists, and pathologists.

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.

Chronic liver failure is a frequent condition in clinical practice that encompasses all manifestations of patients with end-stage liver diseases. Chronic liver failure is a multiorgan syndrome that affects the liver, kidneys, brain, heart, lungs, adrenal glands, and vascular, coagulation, and immune systems. Chronic Liver Failure: Mechanisms and Management covers for the first time all aspects of chronic liver failure in a single book, from pathogenesis to current management. Each chapter is written by a worldwide known expert in their area and all provide the latest state-of-the-art knowledge. This volume is specifically designed to provide answers to clinical questions to all doctors dealing with patients with liver diseases, not only clinical gastroenterologists and hepatologists, but also to internists, nephrologists, intensive care physicians, and transplant surgeons.

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.