This issue will provide gastroenterologists with the most current information on clinical matters in hepatology and serves as an update to the last issue. Articles address the spectrum of matters involving the liver, including Hepatitis C, Hepatitis B, alcoholic Hepatitis, hemochromatosis, varices, liver transplantation, non-alcoholic fatty liver disease, liver failure, and hepatic fibrosis.

Dr. Adrian Reuben updates one of the most highly requested topics in liver disease by inviting highly distinguished authors to address the important aspects of diagnosis and treatment of hepatocelluar carcinoma. State-of-the-art issues are addressed, including the role of oncogenic viruses, molecular and genetic guidelines, and screening and staging. Dr. Reuben, himself, concludes the issue with an important article on an agorithmic approach to diagnosis and treatment: Resect, Ablate, Replace or Intoxicate?

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.

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.

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.

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.

Cancer is one of the major health problems of our time and liver cancer is responsible for over one million deaths per year world-wide, making it the fourth most common cause of death from cancer. Surgical resection of the tumour(s) is the treatment of choice and offers the only chance of prolonged survival. Yet the best attempts are often frustrated by either advanced or co-existent disease that renders the patient non-respectable. This book tackles the many options available to doctors and patients in an attempt to combat this desperate disease.

A cutting-edge review of the latest findings on key scientific topics and the best strategies for evaluation and management of portal hypertension in the clinic. Writing in an easy-to-read style, the authors review its pathobiology, the progress being made in its experimental understanding, the methodologies to assess it in humans, the treatment of its complications (esophageal varices, ascites, and hepatorenal syndrome), and its treatment in special circumstances (during pregnancy, in children, or when the portal vein is blocked). They also provide in-depth coverage of the pros and cons of the various therapeutic choices available to the clinician managing patients with complicated portal hypertension.

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.

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.

Despite numerous hepatitis C virus infection studies, its pathogenesis and medical treatment have not been fully explained. This comprehensive volume, written by experts in the field, covers the most recent advances in the study of HCV, moving from basic research to clinical applications. The first chapters of this volume analyze the full spectrum of immune responses to HCV. The volume also includes contributions that explain the state of the art in IFN-alpha treatment of HCV patients.

Cell-cell and cell-matrix interactions are of fundamental importance for the development and the maintenance of tissues and organs in multicellular organisms. Adhesive processes are mediated and controlled by an increasingly large and complex number of cell adhesion molecules that are anchored to the cell surface membrane by transmembrane domains. According to their structural and functional features, cell adhesion molecules have been classified into at least four major families: the integrins, selectins, cadherins and members of the immunoglobulin superfamily. Apart from linking cells to each other or to components of the extracellular matrix, cell adhesion molecules function also as receptors that interact via their cytoplasmic domain with numerous signalling molecules including protein kinases and phosphatases, G-proteins, or proteins of the beta-catenin/armadillo family. Cell adhesion molecules can activate various signalling pathways and as a consequence play a crucial role in the regulation of cell differentiation, proliferation, migration and apoptosis. During the last decade it has been recognized that acquired as well as inherited defects of cell adhesion molecules and adhesion-linked signalling molecules are the molecular basis of various types of disease including cancer, infectious and inflammatory disease, connective tissue disorders or blistering disease.
This book is the proceedings of a Falk Workshop held in Berlin, Germany, on January 23-24, 2003, which brought together experts in different fields of research to stimulate the transfer of findings from basic research to clinical application. Section I focuses on cell adhesion molecules of the liver and their role inhepatocarcinogenesis and inflammatory liver disease. Section II deals with infection and fibrosis and with transforming growth factor beta (TGF-beta). Morphogenesis, cell migration and inflammation are the subject of Section III with a focus on the role of integrins in blood cell-endothelial interactions. In Section IV the importance of cell adhesion molecules for cancer and their role as potential target for cancer therapy will be discussed.

The rise in hepatocellular carcinoma (HCC) mortality rates has caused researchers to focus increased attention on liver cirrhosis, a pathological condition known to lead to HCC. If hepatic fibrosis can be controlled, it follows that the risk of HCC among patients with chronic hepatitis can be reduced. In the quest for greater understanding of liver cirrhosis, the 1999 Yamaguchi Symposium on Liver Diseases brought together leading researchers in the field. Guest speakers included Michael J.P. Arthur, on mechanisms of the progression and regression of liver fibrosis; Mark A. Zern, on novel therapeutic modalities for hepatic disease; and Jiro Fujimoto, on gene therapy to inhibit progression to liver cirrhosis. The presentations by these groundbreaking scientists are collected in this volume along with those of other leading researchers in the field of hepatology, creating a valuable source for professionals concerned with hepatic fibrogenesis and hepatocarcinogenesis.

My training started in 1971, when I joined the First Department of Medicine of Chiba University, as Dr. Kunio Okuda became chair ofthe department. To acquire training ingeneralpathology, Iapplied for the Intern MatchingProgram and started as aninternin the DepartmentofPathologyofYale University, in 1973.While Iwas achiefresident, Ispent 10months in Dr. GeraldKlatskin'sofficestudyingthe com plete set of his famous liver biopsy samples (the Klatskin Collection). In 1976, I movedtoJohnWesleyHospital, where therewasagroup from the USC (University ofSouthern California) Liver Unit, to obtain further pathology training under the guidanceofDr. Robert L. Peters. Those experiences have given me ample opportu nity to see the differences between the United States and Japan. Ofcourse, 28 years ago in downtown Los Angeles there were enormous num bers ofpatients suffering from typical alcoholic liver diseases. Now in Japan, in contrast, we have an enormous number ofpatients suffering from hepatocellular carcinoma (HCC), due in particular to hepatitis C viral infection. Last year, in the DepartmentofGastroenterology at the University ofTokyo, we had approximately 500 admissions due to HCC. Thus, we have an urgent need to prevent the develop ment ofHCC and to provide better treatment for such patients through a basic un derstanding ofvirology, clinical features, and treatment modalities. The first single-topic conference on "TherapyofViral Hepatitis and Prevention ofHepatocellular Carcinoma" was organized by the Japan Society ofHepatology (Kiwamu Okita, Director General) and was held November 14-15,2002, near Mt. Fuji. Thisbook, which is asummaryofthe meeting, helps toupdate relevantinforma tion on this vital topic. June 28, 2003 Masao Ornata, M.D."

The application of molecular techniques to gastroenterology continues to yield important advances in the development of drugs to treat gastrointestinal disorders. Important new drugs have emerged through the collaborative and complementary efforts of basic scientists, clinicians, and clinical researchers in academia and the pharmaceutical industry. The challenge has been exciting, with a few surprises along the way. Consider peptic ulcer disease as an example. The discovery of H receptors and the availability of potent and 2 selective H-receptor antagonists signaled the beginning of a new era 2 in the treatment of gastric hypersecretory states and peptic ulcers. Introduction of proton pump inhibitors offered another therapeutic option. Though H-receptor antagonists and proton pump inhibitors 2 are important and useful drugs, the discovery of the link between H. pylori infection and peptic ulcer disease has led to even more effective pharmacotherapeutic regimens. Our intent in Drug Development: Molecular Targets for GI Diseases is to bring together hands-on experts to review promising areas of gastrointestinal pharmacology. The contemporary topics covered, from a mechanistic viewpoint, are relevant to gastrointestinal inflammation and motility disorders. Authoritative opinions are offered on both future research directions and potential applications for new therapies.