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.

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.

Practical, handy and succinct, this full colour pocketbook provides clear-cut clinical guidance to the main symptoms that infants and children commonly present with in both primary and secondary care. Clearly divided into specific sections covering the GI tract, liver and nutrition, Professor Kelly and her team discuss how best to investigate and manage specific clinical problems such as vomiting, abdominal pain, acute diarrhoea, constipation and jaundice using a highly clinical problem-orientated approach. They cover the management of important clinical problems such as chronic liver disease, ascites, malnutrition, obesity, coeliac disease and inflammatory bowel disease, and provide advice on nutritional problems in premature infants and children including weaning and food aversion. Key points, potential pitfalls, and management algorithms allow for rapid-reference, and link with the latest evidence, guidelines and protocols from ESPGHAN and NASPGHAN providing coverage of the major professional society recommendations for clinical practice. Brought to you by the experts, Practical Approach to Gastroenterology, Hepatology and Nutrition is the perfect accompaniment for trainees in gastroenterology, hepatology and pediatrics, as well as nutritionists, GI nurses and GPs.