Hepatology – serie

Alcohol abuse is this culture's most important drug problem. Statistics indicate that it is exacting a great and relentlessly increasing toll of human suffering. It is clear that the problem is not being dealt with in any effective manner. At the invitation of the. Canadian Hepatic Foundation, many of the world's experts gathered in Toronto, May 14-15 1976, to focus attention on one of the most important aspects of the alcohol problem -alcohol induced liver damage. The epidemiology of alcohol induced liver disease was discussed and current views on the pathogenesis of the problem were reviewed. New insight into the pathological alterations of the liver was presented and some of our current therapeutic capabilities were discussed. Dr. Hans Popper summarized the Symposium and presented some of his views on those aspects of the problem which will require early attention by the research community. The Symposium achieved its immediate objective -that of bringing together the committed experts of various disciplines for an updating of our understanding of alcohol and the liver and for a discussion of new approaches to the problem. As a backdrop to the Symposium, however, was large writing on the wall to the effect that we are expending our research talents and efforts on a totally unnecessary problem. Right now we probably know enough and have sufficient resources at our disposal to solve the problem.

Gallstone disease has afflicted man since antiquity, but only in the past decade has it been recognized as a major health problem and been the subject of widespread investigation. This investiga­ tion, initiated by the definition of the limits of cholesterol solubility in bile, has led to our current understanding of the pathogenesis of gallstone formation and has provided the hasis for a rational approach to the in situ dissolution and prevention of cholesterol gallstones. This volume comprises the papers and discussion which formed the Fourth International Syrnposium of the Canadian Foundation for Diseases of the Liver. The Syrnposiurn, held in Montreal on May 12 and 13, 1978, was designed to bring together investigators from various disciplines and to review the current status of cholesterol gallstone disease. The Editors wish to thank these experts for their lucid and important contributions. We also wish to thank Valerie M. Price and Dianne McFee, of the Canadian Foundation for Diseases of the Liver, for their considerable and expert help in organizing the meeting, and preparing this volume for publication.

Jaundice is much more than a clinical sign of liver disease. It is also a pathophysiological disorder. Through studying it we have come to a much better understanding of how the liver functions under normal and abnormal circumstances. In spite of several important advances in this field, it has not recently been the subject of a comprehensive and interdisciplinary review. This Symposium was held in Montreal on May 31 and June 1, 1974, and the experts who participated in it came together for the purpose of reviewing the current status of Jaundice. The Editors sincerely appreciate the outstanding contribution which these experts made to the Second International Symposium of the Canadian Hepatic Foundation. They are also particularly indebted to Valerie M. Price, Executive Director, Canadian Hepatic Foundation, for her invaluable role in the preparation of this publication. Carl A. Goresky Murray M. Fisher v Contents BILIRUBIN CHEMISTRY An Overview of Bilirubin Chemistry 1 A. F. McDonagh The Conjugates of Bilirubin 19 E. R. Gordon Discussion Period. • • 39 R. Schmid, Char:imm BILIRUBIN PRODUCITON 43 Bilirubin Metabolism: An Overview • • • R. Schmid Bilirubin Production fram Non-Erythroid SoUI"Ces • • • • • • • • • • • • • • • • 57 S. H. Robinson Bilirubin Production fram Erythroid Sources 69 U. Muller-Eberhard and E. F. Johnson Induction Mechanisms for Bile Pigment Formation 85 B. A.