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Books > Medicine > Clinical & internal medicine > Hepatology
This book contains the 17 lectures given at the International
Symposium on Liver Cells and Drugs held in Rennes on 7 to 10 July
1987 as well as 50 communications presented at the poster sessions.
The topic of alcohol and the liver is long overdue for
re-evaluation. The authors of this book have clearly taken up this
challenge. Human interest in alcohol dates back to the Neolithic
period (circa 10,000 BC). Only a small amount of alcohol is found
naturally in food. Therefore, humans have yet to adapt to the high
quantities of alcohol consumed daily by alcohol abusers. Alcohol is
a simple carbohydrate and is metabolised as a fuel. However, unlike
more naturally occurring carbohydrates such as glucose, the
pathways for its metabolism are not subject to the same checks and
balances. Ethanol oxidation reduces NAD+, which starves reactions
that depend on this substrate. This accounts for the accumulation
of fat in alcoholic steatosis. Alcohol metabolism generates
significant amounts of reactive oxygen species (ROS), which damages
mtDNA and subsequently mitochondrial integrity. The authors provide
several lines of evidence that link the clinical picture of
alcoholic liver disease with mitochondrial damage. Other important
topics highlighted in this book include histo-pathological aspects
of the disease. Clinical assessment of nutrition and vitamin
supplementation is addressed as well. The book concludes with the
highly topical and controversial aspect of liver transplantation in
patients with alcoholic liver disease.
Non-alcoholic fatty liver disease, or NAFLD, represents a spectrum
of pathologic liver histologic findings ranging from the simple
accumulation of fat, known as steatosis, to nonalcoholic
steatohepatitis and cirrhosis. It is estimated that NAFLD in all of
its forms would have a 20% prevalence worldwide, but the evidence
suggests a higher rate for developed countries, exceeding 30% for
the US general population. Major risk factors for NAFLD, such as
ageing, obesity and insulin resistance, are projected to increase
in the following decades, causing the prevalence and relevance of
NAFLD to rise in the future. In obese populations and type 2
diabetes patients, the prevalence of this disease exceeds 70%.
NAFLD has been called the "silent epidemic" for its lack of
symptoms, relatively complex diagnosis and its deleterious effects.
The association between NAFLD with cardiovascular diseases, energy
metabolism disorders and polycystic ovarian syndrome has promoted
the inclusion of this liver pathology within the metabolic
syndrome. From a biochemical point of view, current evidence
suggests the existence of a bidirectional causal relationship
between NAFLD and oxidative stress, where various alterations
energy metabolism and important inflammatory components are
involved. An abnormal glucose and fatty acid metabolism lead to
glucotoxicity and lipotoxicity, respectively, which promote
oxidative stress through different pathways. Oxidative stress
induces the expression of pro-inflammatory mediators, including
transcription factors and cytokines, which trigger an immune
activation, a key step in the transition from simple steatosis to
steatohepatitis. An early diagnosis and optimal therapy are
essential for NAFLD treatment. First-line treatment of NAFLD
focuses on lifestyle changes. Weight reduction through an increase
in physical activity and/or nutritional management is considered
safe and effective, but pharmacological management of common
comorbidities such as hyperglycemia, dyslipidemias and hypertension
are also essential. The key role of oxidative stress in NAFLD
pathophysiology suggests that antioxidant interventions based in
natural substances such as polyphenols would be effective.
Recently, it was shown that the antioxidant properties of these
compounds are beyond their free radical scavenging. This book
presents an update of research advances contributing to a better
understanding of relevant clinical models of NAFLD, particularly,
the disorder in energy metabolism and the role of oxidative stress.
It also highlights the clinical and pathophysiological association
between NAFLD and the metabolic syndrome, and presents an overview
of current diagnosis and treatment and the future avenues for the
management of this disease.
Over the past few years, epidemiological studies have revealed that
there is an increase of life threatening liver diseases worldwide.
It becomes increasingly clear that developments in this field are
moving so rapidly toward the creation of new drugs against these
maladies. Numerous research articles and books have been published
on various aspects of toxicities, symptoms, managements and health
implications of the liver. Consequently, a catalogue of collective
information of toxicities, various features of natural products,
and remedies for the prevention of toxicities is needed. This book
deals with the toxicities in organs like the liver and the role
natural products have in the preventing these ailments. It also
analyses trends in the processing of natural products by using
nanotechnology and their health implications. The main purpose of
this book is to exhibit relevant, modern information on
hepatotoxicity, its symptoms, and treatments presented by
internationally recognised experts in the field. Therefore, it is
our belief that this book has covered some of the most interesting
aspects of research in liver diseases and provides a trustworthy
source of current information in this area of research which should
prove useful to the scientists interested in this discipline
throughout the world. This collection will interest a variety of
other scientific disciplines including toxicology, genetics,
medicine and pharmacology, as well as drug and food sciences. We
hope that our readers will find this volume to be a delightful
addition to their personal libraries, laboratories and offices.
Additionally, it can be used as a required or recommended text for
related courses taught at colleges and universities levels.
The treatment of bile duct benign pathology demands a
multidisciplinary approach, involving a team of both specialised
physicians and solid infrastructure. Radiologists, endoscopists,
and surgeons are all involved in the treatment of these kinds of
patients. This statement is also true for the diagnosis and
treatment of the catastrophic results of bile duct injury.
Cholecystectomy is one of the most common surgical procedures done
either openly or through laparoscopy. The presence of bile duct
injury is one of its most severe complications. The solution for
this unfortunate event poses a technically demanding approach that
involves an array of alternatives comprising surgical and
radio-interventional procedures. This book focuses on benign bile
duct diseases, mainly related to iatrogenic bile duct injury. The
reader will find a complete and profound review of bile duct
anatomy and function, a thorough explanation about the type of bile
duct injuries and how to approach them, beautiful descriptions of
both the surgical and radiological techniques used in the
management of bile duct injuries, a compilation of the experience
of a high-yield centre of this kind of diseases, and logical
techniques to lower the incidence of these injuries. This text is
aimed at an audience composed of health care professionals involved
in the integrative treatment of iatrogenic bile duct injuries. In a
world where the best medical evidence defines the most effective
therapeutic alternative, this book focuses on giving a solid and
broad enough basis upon which medical teams can approach this
disease.
Dx/Rx: Liver Cancer is a quick and practical reference guide
containing all aspects of the diagnosis and therapy of
hepatocellular carcinoma (HCC), prognostic and staging systems,
clinical management, molecular biology, current controversies, and
future insights. Organized into a condensed, bulleted format, this
concise reference offers precise and up-to-date information on the
epidemiology, classification, diagnosis, treatment, and risk
factors for cancers of the liver. Presented in a handy,
easy-to-read format, Dx/Rx: Liver Cancer is a must-have resource
for oncologists, internists, primary care physicians, and other
health care professionals on the ward or in the clinic.
In the last few years, human metabolic disorders have become some
of the most prevalent and prejudicial diseases worldwide. Hepatic
steatosis, among many health problems, has several risk factors
related to the disease prognosis such as obesity, nutritional
problems, diabetes, hypertension, hyperuricemia, and even sleep
apnea. Alcohol abuse also can lead to a severe liver-steatosis
state. The progression of hepatic steatosis can lead to
complications such as cryptogenic cirrhosis and hepatocellular
carcinoma. Drug therapy has instead been focused on the mitigation
of risk factors, however new potential therapeutic perspectives are
being discussed. This book presents the origins, diagnosis and
epidemiology of hepatic steatosis with new perceptions. The authors
also aimed to show the molecular basis and signaling involved in
liver disorders, discussing the inflammatory process, lipid
metabolism and angiogenesis mechanisms. The role of nutrition in
the treatment and development of steatosis was also presented and
new advances were highlighted. Recent studies revealed the need for
the use of bariatric surgery, functional foods and the modulation
of endogenous systems, such as the sirtuins and renin-angiotensin
systems, to treat liver disease. In this context, we aimed to
introduce, review and discusses one of the most widespread
metabolic disorders in the world: hepatic steatosis and its
repercussions.
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