The liver is an exceptionally complex and diverse organ that functions both as an exocrine and an endocrine gland. It secretes bile, which contains many con stituents in addition to bile salts, and it synthesizes and releases many substances in response to the body's demands, including prohormones, albumin, clotting factors, glucose, fatty acids, and various lipoproteins. It has a dual blood supply providing a rich mixture of nutrients and other absorbed substances via the portal vein and oxygen-rich blood via the hepatic artery. This functional heterogeneity is accompanied by cellular heterogeneity. The liver contains many cell types including hepatic parachymal cells, Kiipffer cells, Ito cells, and endothelial cells. The most abundant cell type, the parenchymal cells, are biochemically and structurally heterogeneous. The cells in the oxygen-rich areas of the portal triad appear more dependent on oxidative metabolism, whereas those around the central vein (pericentral, perivenous, or centrolobular areas) are more dependent upon an anaerobic mechanism. Throughout this volume the latter three terms are used synonymously by various authors to indicate the five to eight layers of cells radiating from the central vein. Structural and metabolic heterogeneity of hepatic parenchymal cells has been demonstrated by a variety of approaches, including histochemical, ultra structural, and ultramicrobiochemical studies. This microheterogeneity is linked to the physiological functions of the liver and its response to injurious substances."

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.

Medical Parasitology is primarily intended to be an illustrated textbook which provides a review ofthe most important species ofparasite which occur in man; their areas ofdistribution, morphology and development, the typical disease symptoms resulting from infection, epidemiology and also methods of detection and indications for therapy. The main emphasis is on the protozoan and helmin thic diseases; medical entomology has only been covered in connection with the epidemiology of the diseases described here. Parasites sometimes occur exclusively in man (anthropoparasites) and sometimes also in animals (anthropozoonotic parasites). The monoxenous species complete theirdevelopmentinmanorinoneanimalalone (Scheme I). Heteroxenousspecies, which include most of the medically important parasites, develop partly in man and partly in animals in the course of their life cycle. They may even be forced to infect different species so that they can continue their development. This may sometimes be associated with a digenesis, the larval development taking place in one intermediate (Scheme II (R)) or in two different intermediate hosts (Scheme III (R), (c)), andthesexuallymaturestagedevelopinginanotherhost, the so-called definitive host (Scheme III (R)). The importance of the intermediate hosts can vary considerably (see below).

More than a century ago, Cripps successfully employed the direct and complete division of the anal sphincters as a means of approaching the lower rectum and anal canal, and reported on a series of 36 patients who had been treated in that fashion. Cripps was pleasantly surprised to find good fecal continence in over two-thirds of the patients during later follow-ups, despite the fact that the divided sphincters had not been repaired. The transsphincteric procedure was largely forgotten in subsequent years, however, and only the parasacral proctotomy of Kraske, which spared the anal sphincters, can be said to have gained an established place in the" surgical armamentarium. " It remained for York Mason to redirect the attention of the surgical community to the great potential of the trans sphincteric approach and the excellent continence that can be achieved through adequate repair of the divided sphincters. Having recognized the outstanding practical value of this procedure, we felt it necessary to define more precisely the anatomical prerequisites that would ensure minimum operative bleeding, and to bring the procedure more in line with current knowledge of normal continence and defecation. Dr. A. Huber, in consultation with the director of the Institute for Clinical Anatomy of our surgical department, Prof. A. von Hochstetter, did many months of dissection work on fresh anatomic preparations in an effort to explore and refine the various aspects of the trans sphincteric ap proach."

Campy/o/meler pylori was described for the first time in 1983. Up to now more than 100 papers have been published dealing with its microbiological properties and its clinical implications. The lime has come to survey the field, to evaluate the hith erto accumulated information, and 10 discuss the questions thai should be answered in the ruture. It was for these purposes that the First International Symposium on Campy/abaeter pylori was held. bringing together specialists from a variety of discipl ines, including basic scientists as well as clinicians. This book is based on papers given at the symposium. We are very grateful 10 Rohm-Pharma for undertaking to sponsor this meeting, and to Mrs. C. 1. Klein and her starr for the impeccable organisation which permillcd us to work in such a pleasant environment, In the interest of rapidity of publication, we have reduced the amount of editing to a minimum and have not, in any sense, "re fereed" the discussions, which were written by the contributors at the time of the question-and-answer session. They were also veiled by their authors at the proof stage, and we have done our best to retain their original spontaneous flavour. We hope, in this way. 10 have produced a satisfactory record of the events and an up-Io-dale overview of research on Campylobacrer pylori."

Since the small bowel except the duodenum and (1961), Pygott et al. (1960), Gianturco (1967) terminal ileum is largely inaccessible during en- and Bilbao et al. (1967). doscopic examination, radiology of the small Sellink, however, was really responsible for bowel attains special significance as a diagnostic the widespread recognition of enteroclysis method. Owing to the length and position of (1971, 1974, 1976). In spite of the increasing this organ, good images are difficult to obtain. popularity of this method, the necessity for sub- Furthermore, the considerable variation oftran- stituting this apparently viable method for the sit time, unpredictable response of the contrast peroral examination is still equivocal (Rabe medium, and superimposition with the filled etal. 1981; Fried etal. 1981; Maglinte etal. loops make small bowel radiology difficult. As 1982; Ott et al. 1985). Comparisons of both methods, however, (Fleckenstein and Pedersen a result, few radiologists specialize in this field. With the exception of Crohn's disease, disorders 1975; Sanders and Ho 1976; Ekberg 1977; Val- lance 1980) have confirmed the superiority of of the small bowel are relatively rare. Thus, not many clinicians and radiologists are interested enteroclysis. It achieves a high accuracy (Antes in the small intestine. and Lissner 1983).

The last few years have witnessed major developments in molecular biology which have had a significant impact on biomedical knowledge. As a result new concepts in cell biology have emerged, new etiologic agents have been discovered, and new drugs have become available. Furthermore, the world of mediators, cytokines, and humoral factors has enlarged considerably in a relatively short period and this has modified our views of diverse physio pathologic processes as well as opened up new therapeutic prospects. In addition, recent technologic advances have revolutionized our diagnostic methodology and have greatly enhanced the power of our therapeutic resources. All these factors have contributed to a substantial remodeling of both liver science and clinical hepatology, and these changes have generated the motivation for the production of the present book, which attempts to give an account of well-known clinical facts in the light of current thinking. It is the fruit of the coordinated work of experts from different countries in three continents. In a sense, it is a manifestation of the fact that inter national cooperation is becoming increasingly important not only in the expansion of science but also in its exposition. We hope that Hepatobiliary Diseases will be useful to both students and clinicians and that internists, gastroenterologists, and general practitioners will find in its contents a satifactory coverage of their field of interest."

Basic and clinical research have in recent years contributed towards clarifying certain aspects ofthe epidemiology, pathogenesis, prevention, and treatment of liver diseases. New diagnostic techniques have, moreover, facilitated observations on the evolution of such diseases. Nevertheless, a numberofquestions still remain, especially in the assess- ment and management ofliver patients. The hope that such questions can be answered justifies publications like the present one, which provide experts an opportunity to pre- sent the results oftheir research. The papers collected in this volume cover all aspects of the assessment and man- agement of hepatobiliary disease. The focal points are three summaries ofthe state of the art. The first deals with the highly topical problem of liver transplants from the point ofview ofpatient selection. Roger Williams in fact stresses the urgent need to ex- ercise caution in the selection ofsuitable candidates. This is especially true at the pre- sent time when cyclosporin A, a new immunosuppressive drug now available on the market, has significantly changed the natural history ofsurvival after liver transplanta- tion.

Based on the results of the latest congress of the European Association for the Study of the Liver (EASL), this volume makes excellent reading since it explores in detail the role of free radical reactions in liver diseases. Studies in recent years using various methods have shown that free radicals play an important role in toxic liver disorders. For this reason, the current scientific knowledge is presented in this balanced, clinical portrayal. The account refers to the many observations, experiencesand evaluations that have been made both clinically and experimentally. Two major areas discussed concern the pathophysiological changes by free radicals and the therapeutic possibilities that have come to light.

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).

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 book has its roots in a monograph on cancer of the esophagus and gastric cardia edited by us in 1965 and published in Chinese on ly. Along with a number of colleagues in various fields, we summa rized our work in the epidemiology, pathology, diagnosis, radiother apy, and surgery of carcinoma of the esophagus and gastric cardia, carried out chiefly at Peking Union Medical College Hospital, Fu wai Hospital, and the Cancer Institute of the Chinese Academy of Medical Sciences during the 25 years from 1939 to 1964. In the 18 years since the publication of that monograph, further progress has been made in China in various aspects of research and surgical treatment. Abundant material has been accumulated on the long term results of surgery, and a number of newer principles and meth ods for diagnosis and management have been evolved. In order to meet the need for the exchange of scientific and technical informa tion, both domestically and internationally, we have invited a group of our current colleagues working on the different aspects of carci noma of the esophagus and gastric cardia to contribute to the pre sent volume, which is being printed in both Chinese and English. The Chinese edition, like the original monograph, is being publish ed by Shanghai Science and Technology Publishers. Through the kind invitation of Dr. Heinz Gotze, the English text is being publish ed for international circulation by Springer-Verlag.

The development and improvement of new technologies have made pancreatic disease more accessible to diagnosis in the last decade. The cooperation and coordination of experts in the fields of gastro enterology, radiology, biochemistry, immunology, and pathology are necessary if the methods are to be made available and the progress made to be fully exploited. Each of the new methods requires special training, and extensive experience is needed to guarantee high standards in the diagnosis of pancreatic disease. New methods have to be tested carefully against established diagnostic procedures, though at the same time we must be ready to adopt a new approach to diagnosis. The aim of this book is to update the material already published and to focus on the various imaging methods and functional tests currently available, the features specific for each, and their integrative potential in the detection of pancreatic disease. The various pathologic findings are analyzed with reference to the clinical stages of pancreatic disease. As an introduction to the morphological and functional features of acute pancreatitis, chronic pancreatitis, and pancreatic cancer revealed by the different imaging methods and functional tests, basic knowledge of the patho-physiological and pathomorphological events is provided by research workers. This knowledge is essential for the understanding and interpretation of the diagnostic findings recorded in pancreatic diseases.

"...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.

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.

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.

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.

Radioembolization is a widely used treatment for non-resectable primary and secondary liver cancer. This handbook addresses the radiation biology, physics, nuclear medicine, and imaging for radioembolization using Yttrium-90 (90Y) microspheres, in addition to discussing aspects related to interventional radiology. The contents reflect on and off-label treatment indications, dose-response relationships, treatment-planning, therapy optimization, radiation safety, imaging follow-up and many other facets of this therapy necessary for both novice and advanced users alike.

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 atlas describes and illustrates in detail the surgical procedures employed in laparoscopic anatomical liver resection, according to tumor location. The surgical approach and techniques are explained for each type of laparoscopic liver resection based on the involved anatomical segment, section, and hemi-liver. Attention is also drawn to potential complications and the means of preventing and managing them. Beyond anatomical liver resection, guidance is provided on non-anatomical resections that do not pay regard to segmental, sectional, or lobar anatomy. The coverage is completed by the inclusion of useful information on instruments and energy devices as well as the basic skills required for laparoscopic liver resection. In presenting a clear practical approach to each laparoscopic anatomical major and minor resection, the Color Atlas of Laparoscopic Liver Resection will be an invaluable guide for trainees. In addition, it will equip more experienced surgeons with much useful information that will enable them to further improve their technique.

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.