Kunio Okuda – författare

Primary liver cancer is a rather unusual malignancy in that the incidence varies tremendously from one geographical area to another. While relatively uncom­ mon in Western countries, it is the most prevalent malignant neoplasm in Southeast Asia, South Africa, and many other regions; in all, the countries in which primary liver cancer is very prevalent account for more than two-thirds of the world''s population. In China alone, approximately 100 000 people die every year from primary liver cancer, mostly hepatocellular carcinoma. The incidence is rising in some countries, especially Japan, where it has doubled among males in the past 15 years or so, a staggering and puzzling trend. Since the demonstration of an etiological relationship between hepatitis B virus infection and hepatocellular carcinoma, intensive research has been con­ ducted in an effort to elucidate the role of the virus in hepatocarcinogenesis. Though much progress has been made, a full understanding of the molecular events leading to malignant transformation of the hepatocyte will probably require many more years of rigorous investigation. Chemical carcinogens and several industrial pollutants may also be involved in the etiopathogenesis of neoplastic liver disease.

Primary liver cancer is a rather unusual malignancy in that the incidence varies tremendously from one geographical area to another. While relatively uncom­ mon in Western countries, it is the most prevalent malignant neoplasm in Southeast Asia, South Africa, and many other regions; in all, the countries in which primary liver cancer is very prevalent account for more than two-thirds of the world's population. In China alone, approximately 100 000 people die every year from primary liver cancer, mostly hepatocellular carcinoma. The incidence is rising in some countries, especially Japan, where it has doubled among males in the past 15 years or so, a staggering and puzzling trend. Since the demonstration of an etiological relationship between hepatitis B virus infection and hepatocellular carcinoma, intensive research has been con­ ducted in an effort to elucidate the role of the virus in hepatocarcinogenesis. Though much progress has been made, a full understanding of the molecular events leading to malignant transformation of the hepatocyte will probably require many more years of rigorous investigation. Chemical carcinogens and several industrial pollutants may also be involved in the etiopathogenesis of neoplastic liver disease.

Portal hypertension is the abnormal pathophysiologic state that develops in liver cirrhosis and certain other disorders with characteristic clinical and hemodynamic features. There has been great progress in our under­ standing and management of portal hypertension, particularly in the diagnostic and therapeutic approaches. The so-called Banti''s syndrome, a disorder whose existence had long been questioned, is now a well-defined portal hypertensive disease. The recently introduced Doppler ftowmetry is currently yielding new information on portal hemodynamics. Endoscopic sclerotherapy and beta-blockers have come to be widely used in the man­ agement and prevention of variceal bleeding. In spite of all these advances, a number of unsolved questions remain, such as whether sclerotherapy, pharmacotherapy or surgery is warranted for prevention of bleeding, which is more effective as an elective treatment, the surgical or endoscopic approach, and whether surgical portacaval shunt should be totally replaced by selective shunt operations. These new developments and problems are clearly and comprehensively described and discussed by the foremost authorities in 44 chapters, which are divided into five sections: 1) Patho­ physiology, 2) Hemodynamic Investigations, 3) Imaging Investigations, 4) Clinical and Pathological Features, and 5) Esophageal and Gastrointestinal Bleeding. The primary goal of this monograph, to provide a framework of patho­ physiology of portal hypertension with authoritative descriptions of the clinical and laboratory manifestations of various portal hypertensive dis­ orders, has clearly been achieved by these excellent contributions.