This state-of-the-art book concentrates in one volume our current knowledge on the cardiovascular complications of liver disease. This easy-to-read work provides a better understanding of the pathogenesis and consequences of portal hypertension and establishes a physiological basis for its pharmacological treatment. It examines the effect of liver disease on volume regulation, the activity of the sympathetic nervous system, and the processes involved in capillary fluid exchange. It includes a discussion on volume and sodium regulation, as well as atrial natriuretic peptide. It also covers the effects of different classes of drugs such as alcohol, sympathomimetics, diuretics, and hormones on the cardiovascular system in liver disease. This reference manual is an absolute must for all clinicians and researchers with an interest in the cardiovascular system in liver disease.

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.

"Vascular Liver Disease: Mechanisms and Management" covers all of the disease entities that stem from abnormalities that affect the hepatic vasculature. This multi-authored text includes the mechanisms and management of intrahepatic vascular disease, including the most common cause of vascular disease of the liver, cirrhosis. Other less common diseases of the liver vasculature are also covered such as sinusoidal obstruction syndrome (previously known as veno-occlusive disease), portal vein thrombosis, the Budd-Chiari syndrome and congenital vascular malformations. These entities, although rare, are a challenge to physicians and physician scientists. Although many textbooks have been written on the consequences of cirrhosis on the liver vasculature, this is the only volume that focuses on the liver vasculature as a separate entity, providing an innovative approach to liver disease management. "Vascular Liver Disease: Mechanisms and Management" will be of great value to clinical investigators and basic scientists interested in the liver circulation as well as clinical gastroenterologists and hepatologists, hepatobiliary surgeons and transplant surgeons, and to interventional radiologists with a particular interest in the liver.

Since the last International Bile Acid Meeting in Freiburg in 1996, considerable progress has been made in several areas of bile acid research. The different pathways of bile acid synthesis and their regulation have been further characterized. The molecular mechanisms for biliary secretion of bile acids have been elucidated and genetic defects of bile acid transport have been defined. Injurious as well as protective effects of different bile acids on the liver have been further studied. Finally, the beneficial effects of ursodeoxycholic acid in cholestatic liver diseases have been substantiated and the potential mechanisms of action have been explored. This book, the proceedings of the Falk Symposium No. 108 (XV International Bile Acid Meeting), held in Titisee, Germany, October 12-13, 1998, is dedicated to both basic and clinical aspects of bile acid research with a focus on bile acids and cholestasis.

Autoimmune processes in the liver can cause severe damage and destruction leading to cirrhosis and liver failure. The clinical spectrum of autoimmune liver disease is very wide, and diagnostic difficulties often stand at the beginning of the patient 's medical career. While in autoimmune hepatitis immunosuppressive therapy has long been shown to be life-saving, therapeutic progress is small in primary biliary cirrhosis and questionable in primary sclerosing cholangitis. New approaches to treatment will be needed in the future, but require better understanding of the pathogenesis of the underlying disease process.

This book, the proceedings of Falk Symposium 142 on 'Autoimmune Liver Disease held in Freiburg, Germany, on 12 13 October 2004 (Part I of the Gastroenterology Week Freiburg), describes possible mechanisms of pathogenesis, discusses diagnostic criteria and takes up controversies concerning treatment options. In view of the relatively frequent manifestation of autoimmune hepatitis in childhood in particular, paediatric aspects of autoimmune liver disease, and the role of liver transplantation, are given prominence.

This volume is an account of scientific discovery related to the hepatitis E virus (HEV). HEV was first identified in Afghanistan in 1982 by a remarkably courageous act of self-experimentation by a Russian scientist. Following this, it was found that, in some developing countries in Asia and Africa, HEV was the cause of enormous outbreaks of hepatitis spread by infected drinking water, with a 25% death rate in pregnant women. For many years, HEV was thought not to be an issue in high-income countries and was only seen in travellers returning from high risk areas: it was considered a "back-packers'" disease. We now know that this was hopelessly wrong as HEV is very common in developed countries, with currently over 2 million infections per year in Europe. Here, HEV is found in pigs and spread mainly via consumption of contaminated pork meat. There has been a major increase in cases of HEV in many developed countries, including patients who have suffered liver failure, some of whom have died. We now know that HEV can also cause severe damage to the nervous system.This book describes an English doctor's contribution to the discovery of the impact of HEV in humans. Recent cases in the UK appear to have originated from pigs in Continental Europe and HEV was, as a consequence, dubbed by the international press as the `Brexit Virus'; perhaps an early leaving present from our friends in the EU. Accessible to lay readers, the text includes case histories and stories from a health service increasingly under pressure and given context by examples of medical discoveries from the past. The role of the meat production industry, including questionable on-going high-risk virological practices, is put under the spotlight, leading to inevitable comparisons with the BSE crisis of the 1980s. HEV continues to exact a heavy toll in some low-income countries, most notably with multiple large outbreaks in African refugee camps. Despite the best efforts of organisations such as Medecins Sans Frontieres, each year, pregnant women continue to die by the score. This is particularly poignant as these deaths may be avoidable, as there is a safe and effective vaccine. However, the HEV vaccine is only licensed for use in China, and, so far, efforts to introduce it to Africa have hit a brick wall of politics and red tape.

Our knowledge and understanding of pancreatic diseases has advanced tremendously in the past decade. Clinical and laboratory diagnosis has become increasingly sophisticated, the array of new radiologic and endoscopic mo dalities is vast, and the effectiveness of medical and surgical management of pancreatic diseases has greatly improved. The impetus for these advances has arisen in part from an increasing awareness of the prevalence of acute and chronic pancreatitis, and perhaps more importantly from the steadily increasing incidence of pancreatic carcinoma. Radiology has emerged from this spectrum as a keystone of diagnostic evaluation. Interventional radiology, an important nonsurgical alternative for patient management, has become almost a field unto itself. The wide variety of available diagnostic and interventional radiologic techniques has made the radiologist an important member of the phYSician team managing patients with pancreatic disease. Consequently, the radiologist must be familiar not only with his own specialty, but also with those of his medical and surgical colleagues. For this reason, and because there is a need for a current text presenting the state-of-the-art of pancreatic radiology, this book was conceived. Radiology of the Pancreas is more than just a monograph of imaging techniques. Its goal is to provide a comprehensive understanding of each facet of pancreatic disease for radiologists, clinicians, and surgeons so that they may interact in appropriate and meaningful ways in the evaluation of their patients.

In the last few years, the development of sonographic contrast agents - or "microbubbles" - has stimulated increasingly intensive studies on the rela tionships between ultrasound and contrast media. As a result, "contrast -spe cific" hardware and software systems have been introduced by different ultra sound manufacturers with impressive speed. This has finally led to the birth of a very new imaging modality -"contrast-enhanced sonography" (CEUS). Since 1999, the introduction of second-generation contrast agents has represented a decisive step towards the extensive clinical use of CEUS and has simultaneously made obsolete most, if not all, scientific publications available so far. This book is, to our knowledge, the first to deal entirely with second generation contrast agents and the most updated contrast-specific software for noncardiologic uses. The reasons why the liver has been chosen as the only "target" of the book are easily understandable by radiologists and hepatologists alike. The study of vascularity is the only purpose of CEUS, and the liver has a unique vascular system, with two different inflow systems resulting in a single outflow. Furthermore, the pathologically different focal liver lesions (FLLs) are mostly characterized by different "models" of vascularity: CEUS can mimic contrast enhanced computed tomography and magnetic resonance imaging, basing differential diagnosis on the morphological and temporal characteristics of enhancement, but with the additional unique advantage of the study being done in real-time.

The liver blood flow disorders are usually described under the term 'portal hypertension', which is a well known syndrome since it has been widely studied for years from a clinical, radiological and therapeutic point of view. In fact, portal hypertension is only the result of an obstacle to the portal flow, the clinical manifestations of which often occur at a late stage of the disease: bleeding esophageal varices, splenomegaly, ascites. In addition, it is well known that there is not always a precise relationship between the degree of the obstruction, i.e. the decrease of the portal inflow and the level of the portal hypertension. A severe obstruction to the portal flow may therefore sometimes remain clinically inconspicuous for a long time. For this reason improvement of our knowledge of portal hypertension mainly relies on angiographic investigations. Thus, splenoportography permits the discovery of prehepatic obstructions whereas hepa tic venography permitted the recognition of two different types of intrahepatic obstruction according to the pre-sinusoidal or post -sinusoidal site of the obstacle. More recently, arterial hepatic changes could be evidenced through arteriography. However, these angiographic investigations have not yet allowed for all the problems about portal hypertension to be clearly identified.

The Manual of Upper Gastrointestinal Surgery was compiled as an aid to surgeons, residents, and students who want to acquire a broader knowl edge of the surgical techniques used in the upper gastrointestinal area. Of necessity, a considerable amount of the work of a general surgeon will be confined to this region. The techniques described herein are those preferred by the authors and most, but not all, of their colleagues at the Mayo Clinic. No attempt has been made to include all of the available possibilities and technical varia tions. Likewise, no attempt has been made to include many of the stapling techniques. Although they are good and quite useful, their inclusion would require a complete and separate volume. The omission of an accepted procedure is not meant as a criticism; our aim was to emphasize only the techniques that are most commonly used in day-to-day practice. Gains in knowledge about the anatomy and physiology of the esopha gus, stomach, and duodenum have been highly instrumental in the devel opment of surgical procedures in these areas, particularly the techniques for benign diseases (for example, ulcer, gastritis, and esophagitis).

The third triennial congress of the International Society for Diseases of the Esophagus (lSDE) was held in Munich in September 1986 under the presidency of J. Rudiger Siewert. The very well organized and epoch-making meeting was part of the International Esophageal Week and was held in conjunction with the International Conference of Esophageal Diseases, the European Study Group of Diseases of the Esophagus (GEEMO), and International Organization for Statistical Studies of Esophageal Diseases (OESO). I am very pleased that it has been possible to publish the proceedings of the congress so rapidly. The problems associated with diseases of the esophagus are multifaceted, varying considerably according to locality; their study thus neces sitates a large international forum, which is one of the founding aims of the ISDE. We hope that this volume, by virtue of the in-depth and up-dated reports it contains, can playa role in advancing the work being done in this field. Finally I should like to express my heartfelt appreciation to Professor Siewert and Dr. Holscher for their contribution toward the success of the congress. Kiyoshi Inokuchi, M.D., F.A.C.S. President of the ISDE Preface The scientific knowledge about esophageal diseases and their treatment has rapidly developed and increased within the last 10 years. The present book reproduces for 1987 the topical state of the art about pathology, pathophysiology, diagnostic, and therapy of benign and malignant diseases of the esophagus.