Since the 1st Yamaguchi Symposium on Liver Diseases in 1989, this series of symposia has provided opportunities for exchanges of information on the topic between leading Japanese hepatologists and internationally renowned scientists. Somewhat unusually for meetings held in Japan, the official language of the symposium is English. The pro ceedings of these symposia are published under the title Frontiers in Hepatology and distributed worldwide. The 12th symposium was held on December 9 and 10,2000, at the ANA Hotel, Ube, Japan. The theme selected by the Organizing Committee was "Growth, Proliferation, and Apoptosis in Hepatocytes;' each of which is important in the understanding of the pathophysiology of intractable liver disease. Nine Japanese hepatologists were invited to give presentations, as was leading u.S. researcher Professor D.A. Brenner, recently elected editor-in-chief of the journal Gastroenterology. The reports given at the two-day meeting were valuable in furthering our under standing of the complicated signaling system involved in hepatocyte differentiation, proliferation, and apoptosis. Progress in this field is rapid, and another symposium on the same theme will be held in the near future. We believe that these proceedings are useful in summarizing current information on this important topic. The Organizing Committee would like to express special thanks to all participants and to the Viral Hepatitis Research Foundation of Japan for its continuing financial support."

The condition of prolonged obstructive jaundice with patent bile ducts was first described in 1851 by Addison and Gull of Guy's Hospital, London. The term primary biliary cirrhosis (PBC) was defined in 1950 by Ahrens and colleagues of the Rockefeller Institute, New York. The condition was considered rare but this changed in 1965 with the discovery of a definitive diagnostic serum mitochondrial antibody test and the recognition that a raised serum alkaline phosphatase value, often discovered incidentally, could be a diagnostic pointer. If the diagnosis is made earlier, the end stages are rarely reached as death is replaced by liver transplantation. On November 6th 1997, in Chicago, an International Faculty discussed in depth the clinical features, pathogenesis and treatment of PBC, no longer considered a rare disease. The course of PBC is long, but some 18 years after the discovery of a positive mitochondrial antibody test in a symptom free patient with normal serum biochemistry, 83% will have developed abnormal tests and 76% will be symptomatic. Identification of those who will progress rapidly is difficult. The serum antimitochondrial profile may be useful but this is a very specialist technique. Mathematical prognostic models are useful in therapeutic trials and in the selection and timing of patients for liver transplantation but have limited value in individual patients. An increasing serum bilirubin level remains the most important indicator of rapid progression. Its value however can be negated by the use of ursodeoxycholic acid which has a bilirubin-lowering effect."

A concise, practical guide to the diagnosis and treatment of liver disease. Authoritative and practical, this important new book not only spells out the advantages and limitations of the latest diagnostic tests, but also provides numerous algorithms for evaluating patients and treating the liver problems commonly encountered by primary care physicians. Here, too, the reader will find described the nuances of serological tests for the detection of viral infections and how best to use invasive and noninvasive radiological tests in specific circumstances. Common complications are fully discussed and detailed practical information is given on how to recognize the patient's immediate problems and deal with them effectively. This book's numerous diagrams, clinical "pearls", and cost comparisons will clarify the often complex and bewildering array of conditions associated with liver disease and make it a definitive and indispensable guide for primary care physicians, medical students, and residents.

This book intends to provide a comprehensive and up-to-date description of the newest techniques in minimally invasive liver surgery. The treatment of liver diseases comprises a significant component of the practice of any general surgeon working either in the academic, general and community hospitals. With the rapid expansion of knowledge and technology also the liver has been approached laparoscopically in a few specialized centers with well recognized advantages for the patients. Now this large amount of experience will be made universally available through this book. After a concise description of the main tools and technology necessary to carry out a safe laparoscopic and/or robot-assisted liver surgery, details of operative techniques will be illustrated. Each chapter will consist of an introduction, a summary of the indications and contraindications of specific operative procedures and a detailed description of each surgical procedure, including the potential complications of both the surgery and the postoperative care. A special effort will be done to provide informative and accurate illustrations and pictures, that will be completed by the DVD containing the movies illustrating the technical procedures performed by the leading European liver surgeons.

This book is directed towards post-graduates who have passed Part I of the examination for Membership of the Royal College of Physicians and are preparing for Part II. However, it is hoped that physicians at all stages of their careers will find some parts that interest them. Most of the material has appeared in the Hospital Update series, 'Preparation for MRCP', but this has been modified and expanded; many useful points arising from correspondence relating to the series have been included, and the authors would like to express their thanks to those who have written. It is not intended that this should be used as a work of reference, although there is detailed discussion of some subjects. Only the written part of the examination is dealt with in detail, but the introduction contains hints on tackling the clinical sections which the authors hope the candidates will find valuable. There is, however, no substitute for clinical practice under supervision. The questions in Vll PREFACE the written section of the examination require short answers so that marking may be easy and objective. This book contains questions similar to those that may be encountered in the examination, but the answers have been expanded as a basis for discussion. It is hoped that this will encourage the candidate to read around the subjects covered, and the authors recommend that the questions are used as a basis for group discussion, as answers other than those in the text may be considered.

In 1983 and 1984, I had the pleasure of being invited to Europe for the Cour- se of Hepatobiliary Surgery started by Professor Hepp and continued by Pro- fessor Bismuth. In these courses, I demonstrated many slides and movies of intraoperative echography that Makuuchi, one of my staff members, had made using the transducer that he was the first to develop. The topic of Intraoperative Echography had an enormous impact on the audience, and its use has since spread rapidly over the European countries, by virtue of the first Italian edition of Professor Gozzetti's book on Intra- operative Echography and Professor Bismuth's monograph on the same top- ic. I had been, therefore, unwittingly a very fortunate transmitter of intra- operative echography to Europe by means of Makuuchi's slide file. I am extremely honoured that the Italian Edition written by Gozzetti, Maz- ziotti and Bolondi has been dedicated to me. Also in this English Edition, Professor Gozzetti very kindly asked me to write a few words. It is an extra- ordinary pleasure for me to emphasize how this book is easy to read and understand, maybe by virtue of the profound Italian tradition of artistic expression since the Renaissance. On the other hand, a variety of series of intraoperative echographic images as well as resected specimens are arranged in an excellent manner.

A series of international symposia on viral hepatitis and liver disease has been held triannially, and called the "Olympics" of this research field. Our book presents the results of the eighth of these "Olympiads" which for the first time, was held in Asia (May 1993, Tokyo). Due to the rapid progress in research on both basic and clinical aspects of viral hepatitis and liver disease, the state of the art in this field is continually being updated, and our book provides a broad and in-depth survey of current work. The major topics in our book include molecular biology of the five known hepatitis viruses (HAV, HBV, HCV, HDV, and HEV), clinical implications of genetic variants of HBV and HCV, interferon treatment of HCV-related liver disease, and worldwide epidemiology and control of viral hepatitis. New subjects not seen in previous books, such as genotypes of HCV, are also covered. Expanding knowledge about the heterogeneity of the HCV genome has revealed a great variety of genotypes as well as their association with host pathogenesis and their varying responsiveness to interferon therapy. The first promising results of efforts to develop a hepatitis C vaccine are also presented. Finally, compared with its predecessors, our book contains many more papers from Asian countries, where the prevalence of viral hepatitis and liver disease is the highest in the world.

"This attractive, compact handbook offers highly practical, to-the-point guidance to residents and students. The Handbook gives equal weight to both diagnosis and therapy, includes an easy-to-reference emergency section, and maintains a focus on practical disease management. The book's anatomically organized sections are supplemented by special sections on management of GI emergencies and the Top 10 GI Problems, including pertinent algorithms and practice guidelines from the American Gastroenterology Association. Useful appendices provide CT images of common GI problems, normal laboratory ranges, and links to useful websites"--Provided by publisher.

Acute liver failure (ALF), or fulminant hepatic failure, is a distinct clinical syndrome which crosses medical disciplines. A relatively rare condition, ALF remains a major focus of clinical and research attention and with the advent of transplantation, the importance of understanding management of ALF has taken on a new urgency. In this 1997 volume, the editors bring together a distinguished team of contributors to describe the aetiology, pathology and treatment of this important syndrome. Also covered are consensus techniques in liver transplantation for ALF patients, as well as descriptions of artificial and bioartificial liver assist devices. A section on future treatments includes hepatocyte transplantation, auxiliary grafts and other temporary liver support. Notable for the high level of authors' expertise, this comprehensive volume should prove invaluable to internists, gastroenterologists, surgeons, and intensive care providers.

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.

- 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.

During his years at Memorial Sloan Kettering Cancer Center, Dr. Leslie H. Blumgart developed an extensive video library of high-quality, narrated and captioned video of his personal techniques used to train surgeons worldwide. These videos present history, radiologic evidence, and operative procedures - from major and minor resectional procedures to biliary and pancreatic anastomotic techniques. Blumgart's Video Atlas: Liver, Biliary & Pancreatic Surgery, 2nd Edition, compiles these outstanding videos, along with laparoscopic alternatives to these landmark surgeries from Dr. Carlos U. Corvera, into one outstanding multimedia resource that brings you fully up to date with innovative and advanced techniques in hepatobiliary and pancreatic surgery. Covers diseases of the liver, biliary tract, and pancreas, both in print and on more than 120 videos. Offers step-by-step discussion of open surgical procedures by world renowned surgeon Dr. Les Blumgart, allowing you to see clearly how an expert handles a difficult case. Includes an expanded number of minimally invasive laparoscopic techniques for the management of liver disease and pancreatic tumors, contributed by Dr. Carlos Corvera. Features a new chapter on laparoscopic hepatectomy techniques, as well as several new videos that showcase totally laparoscopic approaches to major hepatectomy, and the benefits of a hand-assisted laparoscopic approach. Details recent advances in laparoscopic liver and pancreatic surgery, modifications to open right hepatectomy (a "bottom-up" approach), right hepatectomy for donor liver transplant, and management of rare complications of gallstones disease. Includes both conceptual and imaging anatomy in print, including new cadaver dissections, allowing you to better understand surgeries preoperatively and consider the impact of anatomy and disease on the surgical procedure. Enhanced eBook version included with purchase. Your enhanced eBook allows you to access all of the text, figures, and references from the book on a variety of devices.

An essential resource for the day-to-day management of patients with liver disease and its complications. Covering conditions commonly seen in practice, such as hepatitis, nonalcoholic fatty liver disease, auto-immune disease, and a host of other hepatic problems, this book provides a practical reference for clinicians and trainees involved in the care of patients with diseases of the liver. Each chapter is written by an international expert in the field of hepatology and presents an evidence-based review of the disease or problem with a systematic approach to diagnosis and management. It provides clear illustrations, algorithms, and tables for easy access to key information. Practical Management of Liver Diseases will help to ensure that healthcare professionals are up to date on recent advances to detect and treat these diseases rapidly and efficiently for maximum patient benefit.

Acute liver failure (ALF), or fulminant hepatic failure, is a distinct clinical syndrome which crosses medical disciplines. A relatively rare condition, ALF remains a major focus of clinical and research attention and with the advent of transplantation, the importance of understanding management of ALF has taken on a new urgency. In this 1997 volume, the editors bring together a distinguished team of contributors to describe the aetiology, pathology and treatment of this important syndrome. Also covered are consensus techniques in liver transplantation for ALF patients, as well as descriptions of artificial and bioartificial liver assist devices. A section on future treatments includes hepatocyte transplantation, auxiliary grafts and other temporary liver support. Notable for the high level of authors' expertise, this comprehensive volume should prove invaluable to internists, gastroenterologists, surgeons, and intensive care providers.

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.

Nonalcoholic fatty liver disease is one of the most common liver diseases worldwide affecting patients from all ages, races, and ethnic backgrounds. It comprises a spectrum of hepatic pathology ranging from simple steatosis, in which there is an increase of fat accumulation in hepatocytes, to nonalcoholic steatohepatitis and cirrhosis. The significant prevalence of this disease-between 15 and 45 percent of the general population-means that it contributes to an increased burden of ill health both today and in the future. Liver Metabolism and Fatty Liver Disease addresses the current understanding of the development of nonalcoholic fatty liver disease as well as the clinical aspects of the disease by examining the current knowledge surrounding metabolism in the liver. The book discusses various topics including the involvement of oxidative stress, metabolic effects, and inflammation as well as the effect of nutrition on the development and progression of the disease.

Liver Anesthesiology and Critical Care Medicine emphasizes all aspects of this broad and important area and is the definitive textbook for anybody involved in the perioperative care of liver patients. The book is divided into three sections: Physiology and Pathophysiology, Anesthesiology, and Critical Care Medicine. The anesthesiology section contains information about liver transplantation and other liver surgeries and provides detailed practical direction and concise background information of all aspects of the anesthetic management of these patients based on the most recent evidence. The critical care section describes basic critical care management as it relates to liver surgical patients and addresses specific postoperative issues relevant for liver resection and liver transplant patients. The book combines practical guidance to the perioperative management with extensive background and clinical evidence to allow the reader gain an in -depth understanding of this complex and fascinating topic.

Liver disease in children is increasing in prevalence, placing a huge burden on healthcare systems and often requiring long-term management. Offering an integrative approach to the science and clinical practice of pediatric hepatology, this is the definitive reference text for improved diagnosis and treatment strategies. In the new edition of this authoritative text, chapters have been thoroughly revised in line with major advances in the field, such as recognizing the increased frequency of fatty liver disease, and how genetic testing has the potential to establish earlier diagnoses for a variety of diseases. Disorders covered include cholestasis, metabolic disorders and hepatitis, with their presentation across the spectrum of infancy, childhood and adolescence discussed. The indications and surgical aspects of liver transplant are explained and post-transplant care is described in detail. This is a valuable resource for pediatricians, hepatologists, gastroenterologists and all clinicians involved in the care of children with liver diseases.

Based around the core curriculum for specialist trainees in gastroenterology and hepatology, this book contains 50 well-structured, peer-reviewed cases gathered from the Oxford Hospitals, comprehensively covering the various disorders of the gastrointestinal system.
Each case comprises a brief clinical history and relevant examination findings, details of investigations including examples of medical imaging, followed by questions on differential diagnosis and management and detailed answers and discussion. The text is complemented by numerous black and white illustrations, including radiographic images, and 24 colour images. The question-and-answer format is designed to enhance the reader's diagnostic ability and clinical understanding.

Proceedings of the European Association for the Study of the Liver, Paris, September 1993. This conference was attended by leading world specialists, who gave papers on the advances made in the treatment of hepatitis B and C, benign tumours of the liver, lesions produced by medical treatment, and liver transplants. This book, which has a strong clinical focus, gives hepatologists and gastroenterologists the opportunity to provide a rapid overview of the most innovative work described by the major international research teams.

Vor mehr als 12 Jahren wurden die H -Rezeptor-Antagonisten - 2 als Ergebnis induktiver Forschung - in die Therapie des peptischen Ulkusleidens eingefUhrt. JAMES W. BLACK, dem wir die Entdek- kung dieser neuen Stoffgruppe verdanken, wurde 1988 mit dem Nobelpreis fUr Medizin ausgezeichnet. Mit den Hz-Rezeptor-Antagonisten begann eine neue Ara der Ulkustherapie. Die Patienten werden unter H -Rezeptor-Anta- 2 gonisten in der Regel in wenigen Tagen beschwerdefrei, Ulzera im Duodenum und Magen heilen zu einem hohen Prozentsatz in vier bis sechs Wochen; selbst eine Rezidivprophylaxe gelingt mit dies en Substanzen in hohem MaBe. Die Konsequenz der erstaun- lichen Wirkqualitaten der H2-Rezeptor-Antagonisten war ein Rilckgang der operativen Eingriffe wegen eines Ulkusleidens. Operationen sind heute nur noch bei Auftreten von Komplikatio- nen oder bei fehlender Compliance angezeigt. Inzwischen wurden mehrere H -Rezeptor-Antagonisten unter- 2 schiedlicher Struktur entwickelt, die sich insbesondere bezilglich ihrer Affinitat zu den H -Rezeptoren unterscheiden. Die zunachst 2 eingefilhrten Imidazol-haltigen Substanzen besitzen eine relativ geringe derartige Affinitat, die bei den Aminomethylfuranen deutlich haher liegt. Die hOchste Affinitat und Selektivitat zu Hz- Rezeptoren weist Famotidin auf, ein Guanidinothiazol. Die lange Wirkdauer und die bemerkenswert gute Vertraglichkeit sind dar- auf zurilckzufUhren. Die hohe Selektivitat der Bindung an Hz-Rezeptoren und die vergleichsweise niedrige Dosierung von Famotidin lieBen diese Substanz zu einem H -Rezeptor-Antagonisten der ersten Wahl 2 werden. AIle klinischen Studien, die in den letzten Jahren mit Famotidin durchgefUhrt wurden, haben eine den bisher verfilg- baren Hz-Rezeptor-Antagonisten vergleichbare Wirkung bezilg- lich der Ulkusheilung und der Rezidivprophylaxe bei Duodena- lulzera aufgezeigt.

Lehrbiicher werden fUr Studenten geschrieben. Sie miissen daher nicht nur hohen Anspriichen an den Inhalt, sondern auch in puncto didakti- scher QualiHit geniigen. Kann ein auch noch so kenntnisreicher Autor diese beiden Forderungen erfUllen? Kann er, wohl ausgestattet mit den theoretischen Kenntnissen des Forschers an der Universitatsklinik und den praktischen Erfahrungen einer mehrjahrigen Tatigkeit, einen Lehrbuchtext iiber so unterschiedliche Gegenstande, wie das peptische Ulkus, die infektiose Enterokolitis und den Morbus Wilson auf einem konstant hohen Niveau halten? Halt das vorgelegte Werk den Ver- gleich mit sogenannten Vielmannerbiichern aus? Diese und andere Fragen bewegen den Leser, wenn er die ersten Seiten aufschIagt. Man findet ein gut organisiertes Werk mit klarer Gliederung vor. Moderne diagnostische Methoden und therapeutische MaBnahmen werden liickenlos dargestellt und den entsprechenden Krankheitsbil- dern zugeordnet. Der Inhalt wirkt sehr konzentriert, Wiederholungen und Oberschneidungen fehlen. Die Grundlagen der Physiologie, Bio- chemie, Pathologie werden sorgfaltig dargestellt, soweit sie zur Losung eines klinischen Problems benotigt werden. Besonders wohltuend ist die ausfUhrliche Wiirdigung des arztlichen Gesprachs und die Einord- nung technischer Methoden an adaquater Stelle. Der Patient und seine Krankheit finden Beriicksichtigung. Wenngleich das Buch in erster Linie fUr Studenten geschrieben wurde, werden es doch auch Arzte in der Weiterbildung oder Kollegen auBerhalb des Teilgebiets Gastro- enterologie gem in die Hand nehmen.

Die Bedeutung des morphologischen - makroskopischen wie mikroskopischen - Befundes fur die Diagnostik ist trotz im- mer subtilerer Funktionsprufungen, sowie verbesserter che- mischer und immunologischer Untersuchungsmethoden keines- wegs geringer geworden, man hat eher den gegenteiligen Ein- druck: dass dieser Zweig der Diagnostik heute wieder eine Re- naissance erlebt. Das ist wohl in erster Linie die Folge des raschen technischen Fortschrittes nach dem 2. Weltkrieg. Vor allem die Entwicklung von flexiblen faseroptischen Endoskopen mit Kaltlichtquellen, sowie verbesserten Geraten zur Entnahme von Gewebsproben hat in der gastroenterologischen Diagnostik die endoskopischen Untersuchungsverfahren immer mehr in den Vordergrund geruckt. Die Rectoskopie - heute erganzt und erweitert durch die eo- loskopie - ist eine der altesten, aber nach wie vor der wichtig- sten endoskopischen Untersuchungsmethoden, die keineswegs der Klinik vorbehalten ist, sondern - mit Ausnahme der ho- hen eoloskopie - in jeder internistischen und auch in man- chen Allgemeinpraxen durchgefuhrt werden kann. Sorgfaltige Vorbereitung des Patienten vorausgesetzt, liefert sie, vor allem in Verbindung mit der histologischen Untersuchung dabei ent- nommener Gewebsproben eindeutige Ergebnisse, die ebenso wie bei anderen bioptischen Untersuchungsmethoden in der uber- wiegenden Mehrzahl der Falle die Ursache von Beschwerden oder objektiven Krankheitszeichen zu klaren vermoegen.

Die groBte arztliche Herausforderung ist die Konfrontation mit einer den Patienten vital gefahrdenden NotfaIlsituation. Hier gilt es, moglichst effektive therapeutische MaBnahmen in ktirzester Zeit zu ergreifen. Gerade in Anbetracht der drangenden Zeit ist es von besonderer Be deutung zu wissen, welche der theoretisch moglichen Therapieverfahren von belegter Effektivitat sind, welche nur spekulativen Nutzen fUr den Patienten haben. Wichtigste Aufgabe der hier vorliegenden Monographie ist es deshalb, die vorhandenen therapeutischen Prinzipien unter diesen Gesichtspunkten zu sichten und zu gewichten. Voraussetzung fUr ein gezieltes therapeutisches Handeln ist auch unter NotfaIlbedingungen die Kenntnis der Diagnose. Deswegen kann auch ein "Therapiebuch" nicht ohne SteIlungnahme zur notwendigen ad aquaten Diagnostik in dieser spezieIlen Situation auskommen. 1m hier vorliegenden Buch werden nur "gastroenterologische Notfalle" aufgearbeitet. Dies ist, wie es dem Stil der "Interdisziplinaren Gastro enterologie" entspricht, im gemeinsamen Gesprach zwischen Internisten, Chirurgen und Theoretikern erfolgt. Besonderer Wert wurde auf die Er arbeitung von Richtlinien fUr die praktische Therapie gelegt. In diesem Sinne wurden aIle Abschnitte mit Empfehlungen zur Indikationsstellung und zur Verfahrenswahl beendet, tiber die im Kreise aIler an diesem Seminar teilnehmenden Sachkenner ein Consensus erzielt werden konnte. Die dem groBen Thema angepaBte vergroBerte Herausgeberschaft hofft, daB es auch diesmal wieder wie in den vorausgegangenen Banden der "Interdisziplinaren Gastroenterologie" gelungen ist, einen fUr den praktisch tatigen Arzt ntitzlichen Ratgeber zu schaff en."