This issue of Critical Care Nursing Clinics, guest edited by Sarah Saxer, PharmD, Dinesh Yogaratnam, PharmD, BCPS, and Tenita Foston, NP, on the topic of Liver Failure, will include the following article subjects: Drug-Induced Liver Failure: A Focus on Acetaminophen Overdose; Current and Emerging Strategies for Treating Hepatic Encephalopathy; Drug Dosing Considerations for the Critically Ill Patient with Liver Disease; Critical Care Therapies for Bleeding Esophogeal Varices; Treating Coagulopathies in Fulminant Hepatic Failure; Treating HCV; Management HBV; Hepatorenal Syndrome; Hepatopulmonary Syndrome; Live Transplant Considerations for Evaluation; Hepatocellular Carcinoma; Cholestatic Live Disease; Nutrition in ESLD; Infectious Issues in Patients with Liver Disease; and Management Ascites, TIPS/Shunts.

In this issue, Dr. Hu provides comprehensive coverage of disease states that cause abnormal liver function. The authors focus articles on the presentation and diagnosis, with treatment of the liver concurrent to treatment of the disease. Disease states covered include pulmonary, cardiovascular, renal, endocrine, hematologic/oncologic, gastroenterologic, and rheumatologic, and dermatologic.

Dr. Lefkowitch is one the most well known experts on liver pathology and has updated the topic since it last published over 5 years ago. Important topics updated include benign liver tumor, vascular disorders of the liver, autoimmune hepatitis, and non-alcoholic fatty liver disease. Special emphasis is given to articles devoted to immunochemistry in liver tumors, hepatic granulomas, and diagnostic pitfalls in liver transplantation.

A recent Institute of Medicine report has concluded that "there is a lack of knowledge and awareness about chronic viral hepatitis on the part of health-care and social-service providers, as well as among at-risk populations, members of the public, and policy-makers. Due to the insufficient understanding about the extent and seriousness of this public-health problem, inadequate public resources are being allocated to prevention, control, and surveillance programs." It is with these concerns in mind that Dr. Tsai assembled a group of experts in this field to present their expertise in such a level, where the practicing clinicians who deal with this disease in their daily practice can understand thereby implement this knowledge into their own practice. Dr. Brian McMahon discusses the natural history of chronic hepatitis B with his vast knowledge and experience working with the high endemic population of Inuit in Alaska; Drs. Marc Ghany and Ed provide a very easy-to-understand description of HBV virology; Dr. Kyon-Mi Chang contributes an article on HBV immunology, which is the least understood area of this disease but has the most potential to improve our knowledge in the management of chronic hepatitis B; Dr. Anna Lok provides an authoritative review on the current issues and controversies of treatment of chronic hepatitis B; Dr. Stephen Locarnini, who has extensive experience in anti-viral resistance and its management, presents important issues in the usage of currently available anti-viral oral agents; Dr. Myron Tong discusses the current understanding of HBV carcinogenesis and updates HCC surveillance and treatment-- the most dreadful outcome of this disease; Dr. Paul Martin discusses management of end- stage chronic hepatitis B -anti-viral therapy, montherapy vs combo.therapy, choice of agent, when to start therapy and post-transplant patients including duration of HBIG therapy, HBcAb(+)only recipient) and Occult HBV infection; Dr. Tram Tran discuss the treatment in reproductive women, during pregnancy, and prevention of vertical transmission in third trimester with antiviral agents-- an area with significant lack of good clinical evidence; Dr. Steve Han discuss management of patients with acute hepatitis B, co-infection with HDV/HCV/HIV, pre-immuno-suppressive therapy, and management of renal and heart transplant patients with HBV infection; Dr. Mei Huei Chang discusses Taiwanese success in implementing universal vaccination leading to a remarkable reduction in both prevalence of chronic hepatitis B and incidence of hepatocellular carcinoma; and finally Drs. Michelle Lai and Yun Fan Liaw provide a rundown of what we have accomplished and the hope for the future in our fight to control this disease.

Gastrointestinal endoscopy plays an essential role in the management of patients with liver disease. This issue reviews the standard of care in the endoscopic management of portal hypertension and biliary disease before and after liver transplantation. A thorough knowledge of the available endoscopic diagnostic and therapeutic methods is essential for the practicing hepatologist. Emphasis is placed on recent advances in imaging techniques such as the application of capsule endoscopy and endoscopic ultrasound in the evaluation of portal hypertension and recent advances in cholangioscopy and biliary tissue sampling. Additionally new information regarding the endoscopic management of esophageal and gastric varices is reviewed. Finally, the current role of ERCP in the diagnosis and staging of cholangiocarcinoma before liver transplantation and the endoscopic management of biliary complications after liver transplantation is discussed.

This issue offers the latest information regarding the transmission of hepatitis viruses in various healthcare settings.? It delves with a very timely and interesting patient safety subject that specifically targets healthcare professionals, gastroenterologists, hepatologists, oncologists, dentists and all healthcare workers to adopt and share a variety of best practices to prevent this adverse event. Well known faculty in liver disease, infection control as well as a medical practice in a legal setting have been assembled to produce a comprehensive and concise edition that highlights the latest information regarding hepatitis B and C transmission in healthcare.? It aims to provide an overview on the molecular epidemiology, the outbreak reports, the transmission in hemodialysis, endoscopy, dental, oncology, management, legal aspects and the infection prevention measures to reduce the risk of needless exposure of patients to these blood borne pathogens.

This issue presents the views of internationally renowned experts on current findings concerning the epidemiology, natural history, diagnosis, pathogenesis, and treatment of non-alcoholic steatohepatitis. Articles are included on bariatric surgery, liver transplantation, cytokines and apoptosis, as well as insulin resistence and lipotoxicity, to name a few. The Guest Editor himself ends the issue with an article giving his overall perspective on the current clinical management of NASH and future directions.

This issue of the Medical Clinics of North America brings the practicing clinician up to date on best practices of caring for the cirrhotic patient. Topics covered include diagnosis and epidemiology of cirrhosis; ascites: diagnosis and management; encephalopathy: pathophysiology and emerging therapies; portal hypertensive bleeding; renal failure: differential diagnosis and management; pulmonary complications; hepatocellular carcinoma: current state of treatment; preventative health issues; pre-operative risk assessment; and liver transplantation: from Child's to MELD.

The Guest Editor presents state-of-the-art articles devoted to therapies for treatment of HCV. The novel therapies addressed in this issue include interferons, viral kinetics and anti-viral resistence, anti-fibrotics, immunotherapeutics, hepatoprotectants and caspace inhibitors, and cyclosporine analogues, to name a few.

Often the hepatologist sees patients in consultation, and this issue focuses on how to deal with diagnosing, treating, and managing patients in the hospital on a consultation basis. The Guest Editor has assembled top experts to present articles on the asymptomatic outpatient with abnormal LFTs, surgery in the patient with liver disease, issues in long-term care of liver transplant recipients, management of autoimmune cholestatic liver disease, and current status of hepatitis vaccination and prophylaxis, to name a few.

Intraductal papillary mucinous neoplasms (IPMNs) represent an opportunity to treat pancreatic tumors before they develop into aggressive, hard-to-treat cancers. Beginning with morphological classification and its clinical significance, natural history, and malignant change of both main duct and branch duct IPMNs, this book covers the whole field of IPMNs of the pancreas. It reviews the various methods of investigation: imaging, diagnostic investigation of cyst fluid, and those using pancreatic juice; and also examines aspects ranging from the development of malignancy to the timing and method of resection, focusing on both main duct and branch duct IPMNs.

Aimed at residents, clinical fellows, and pancreatologists who treat patients with this common disease of the pancreas, this book is a landmark in the current understanding and future perspectives of IPMNs of the pancreas.

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The authors explore the history of man's thoughts about hepatic structure, function, and disorders, both chronologically and thematically. The first two chapters present the anatomy and physiology of the liver as explained through the ages. Subsequent chapters deal with hepatic function and disorders and therapies used to treat liver disease. The text is enhanced by chronological tables, extensive notes, and a bibliographic essay.

Hepatology and Transplant Hepatology: A Case Based Approach presents a collection of interesting cases in liver disease seen at a very busy and large liver transplant center in the United States. These cases cover the full range of pathology that an internist or gastroenterologist may expect to see in a lifetime of taking care of patients with acute or chronic liver disease, before or after liver transplant. Each case is presented as you would see it in a clinical situation where a patient presents a complaint or something is noted on exam or blood work. The question/answer format will help one through the problem of making a diagnosis or in considering a differential diagnosis and also point to the best way to manage each condition. The volume is divided into pre-transplant and post-transplant hepatology. Each case is 3 pages with the first page presenting the case and pertinent lab data and 3-4 questions (i.e. differential diagnosis, tests to order, x-rays/CT required).The second page illustrates the tests, scans, biopsies and asks for the pertinent findings. The third page provides the diagnosis and what may have been expected with other diagnoses. Here is a single source dealing with questions specific for patients with complications of advanced liver disease and also clinical situations seen in transplant hepatology. Hepatology and Transplant Hepatology: A Case Based Approach will have great appeal to anyone in hepatology/transplant hepatology and also to residents/fellows and internists interested in gastroenterology.

In this issue, the Guest Editors have focused on recent advances in liver disease related to disturbances in hemostasis and coagulation. The work emphasizes the multifaceted aspects of coagulation disorders in liver disease from hypo-coagulable to hyper-coagulable states and the limitations of conventional tests such as the INR to shed light on relative bleeding risk or on underlying pathophysiology in a given patient. Articles are written by leaders in the field from multiple disciplines and from around the world. In each article, the state of the art is discussed along with its limitations. The issue sheds light on recent advances, explores areas of controversy, and thus, addresses the need of combined clinical and laboratory investigation.

Portal hypertension is the most important complication of a great variety of both acute and chronic liver diseases. Nevertheless, hepatic cirrhosis is the most frequent cause of portal hypertension. Gastrointestinal bleeding due to rupture of oesophageal varices is, without doubt, the most severe complication of portal hypertension. At present, great advances are being made in the pathophysiology and in the development of new therapeutic tools for controlling and preventing this severe clinical event.

This book contains the papers presented and discussed during the Symposium on 'Portal Hypertension in the 21st Century', held in Montreal, Canada, in April 2004, and sponsored by Axcan Pharma Inc. and NicOx S.A. There are eight sections covering basic mechanisms, new drugs, prevention and current treatment of variceal bleeding, prevention of recurrent bleeding and hepatic hemodynamic monitoring.

An international faculty of authors have contributed chapters at an outstanding scientific level which will be vital reading for scientists and clinicians alike."

With a focus on practical patient related issues, Autoimmune Hepatitis: A Guide for Practicing Clinicians serves as a useful practical, and much needed, resource for all those physicians presented with managing patients diagnosed with autoimmune hepatitis, both acutely and over the long term. It provides a basis for clinicians to understand the etiology of the disease, as well as special circumstances where management dilemmas often arise. Emphasis is given to providing management advice of immediate use to clinicians, something not presently offered by other larger general texts. The chapters are written by those with an expertise and training in this field and include the most up to date information. The book will be of great value to Gastroenterologists, Hepatologists, and Internists at all levels who see patients presenting with autoimmune hepatitis.

Acute and chronic viral hepatitis infections are serious public health threats around the world. The different infections have different epidemiology and natural his- ries, and children play important roles in each of these. For example, children are important reservoirs for acute hepatitis A, childhood infections are responsible for most of the global morbidity associated with chronic hepatitis B, and perinatal transmission of hepatitis C continues to occur, even as the overall incidence of new infections wanes. Some non-A through E viral hepatitis infections are seen p- dominantly in infants and young children, while others have specific implications for this population. Therapeutic options for children with chronic viral hepatitis are limited when compared to those available for adults, especially for hepatitis B, and considerations given to long-term therapy have dramatic implications when dealing with the long life expectancy of these young patients. With these issues in mind, this unique volume has been created to address the special considerations regarding viral hepatitis in children. It includes the latest information and recommendations specifically directed at the pediatric population, and highlights the knowledge gaps which will need to be filled to improve our understanding of these infections and treatment of this special group. Experienced practitioners from around the world have contributed these reviews, incorporating the latest studies, the current recommendations, and the distinctive pediatric issues that shape clinical care, and will determine the research agenda for this field going forward.

In several liver diseases, the underlying cause cannot always be eliminated, i.e. the progression of liver disease cannot be prevented. This is particularly true for non-responders to the treatment of chronic hepatitis C (HCV). It is relevant for more than 40 per cent of patients with HCV genotype 1 and up to 20 per cent of patients with genotype 2 or 3. Several approaches are now underway to prevent or ameliorate mechanisms of disease progression. In Asia, and particularly in Japan, Glycyrrhizine-SNMC has been widely used for this purpose. At present, SNMC is under clinical evaluation in Europe.

This book is the proceedings of the Falk Symposium No. 137 on "Liver Diseases: Advances in Treatment and Prevention" (part of the XII International Falk Liver Week 2003 in honour of Hans Poppera (TM)s 100th birthday, held on October 17-19, 2003). It covers our present knowledge of the diagnosis, treatment and prevention of liver diseases, including hepatitis B, hepatitis C and delta hepatitis as well as alcoholic liver diseases, non-alcoholic steatohepatitis and the hereditary liver diseases haemochromatosis, Wilsona (TM)s disease and alpha-1-antitrypsin deficiency. In addition to these clinical entities, the sequelae of liver cirrhosis and its complications, including the clinical management of ascites, the hepatorenal as well as the hepato- and porto-pulmonary hypertension syndrome are discussed. New developments with respect to liver support systems and liver transplantation are further highlights of the proceedings.

The main topics mentioned above are complemented by state-of-the-art chapters on "Hepatocellular Carcinoma," "Emerging Hepatitis Viruses" and "Fulminant Liver Failure" that are of interest to both basic scientists as well as clinicians. A special section is devoted to "Liver Histology" as a tribute to Hans Popper who contributed eminently to the basic and clinical aspects of hepatology.

All in all, Liver Diseases: Advances in Treatment and Prevention provides an exciting overview of the current developments in the treatment and prevention of viral, alcoholic, non-alcoholic and hereditary liver diseases, presented by an international faculty of outstanding scientists and clinicians.

Primary Liver Cancer: Surveillance, Diagnosis and Treatment focuses on the many therapies rapidly evolving to assist with controlling hepatocellular carcinoma as well as emerging technologies to assist in early diagnosis as well as prevention. All chapters are written by experts in their fields and include the most up to date information for diagnosis, treatment, surveillance, epidemiology, staging, recurrence and prevention. This volume will serve as a useful resource for clinical gastroenterologists, hepatologists, oncologists, pathologists, and physicians who treat patients with chronic liver disease and hepatocellular carcinoma.

"Frontiers in Viral Hepatitis" provides a compilation of the research from over 40 key opinion leaders in the field of Hepatitis. The book focuses on the latest advances in the search for new, more effective therapeutic options and related topics in viral hepatitis. These include regulatory issues, epidemiology, and emerging viruses; immunology and vaccines; viral hepatitis B and C infections in children; genetics pathology and viral diagnosis; cell systems and animal models; novel therapeutics for hepatitis B and C; resistance and therapeutic strategies in humans; and prevention and treatment options for hepatocellular carcinoma.

The breadth of information published in this volume provides insight into current prevention and treatment options. Recent advances in our understanding of the molecular biology, immunology and pathogenesis of hepatitis viruses have accelerated at a remarkable rate, offering a more comprehensive perspective on hepatitis.

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.

This book, the proceedings of a Falk Workshop on `Topical Steroids in Gastroenterology and Hepatology', held in Berlin, Germany, on 14 June 2003, critically discusses the current role of budesonide in gastroenterology, hepatology, surgery and oncology and focuses especially on potential new indications for the use of budesonide. A number of smaller clinical studies and anecdotal case reports with impressive clinical effects are reported in patients with gastrointestinal, hepatic, oncological and surgical problems. In addition, the use of budesonide for the treatment of distal ulcerative colitis and ileocolonic Crohn's disease is evaluated with respect to its role in an evidence-based management of IBD. Finally, as clinical experience with the use of budesonide is increasing, safety issues and the side-effect profile of budesonide is addressed.