Three distinct types of contractions perform colonic motility functions. Rhythmic phasic contractions (RPCs) cause slow net distal propulsion with extensive mixing/turning over. Infrequently occurring giant migrating contractions (GMCs) produce mass movements. Tonic contractions aid RPCs in their motor function. The spatiotemporal patterns of these contractions differ markedly. The amplitude and distance of propagation of a GMC are several-fold larger than those of an RPC. The enteric neurons and smooth muscle cells are the core regulators of all three types of contractions. The regulation of contractions by these mechanisms is modifiable by extrinsic factors: CNS, autonomic neurons, hormones, inflammatory mediators, and stress mediators. Only the GMCs produce descending inhibition, which accommodates the large bolus being propelled without increasing muscle tone. The strong compression of the colon wall generates afferent signals that are below nociceptive threshold in healthy subjects. However, these signals become nociceptive; if the amplitudes of GMCs increase, afferent nerves become hypersensitive, or descending inhibition is impaired. The GMCs also provide the force for rapid propulsion of feces and descending inhibition to relax the internal anal sphincter during defecation. The dysregulation of GMCs is a major factor in colonic motility disorders: irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), and diverticular disease (DD). Frequent mass movements by GMCs cause diarrhea in diarrhea predominant IBS, IBD, and DD, while a decrease in the frequency of GMCs causes constipation. The GMCs generate the afferent signals for intermittent short-lived episodes of abdominal cramping in these disorders. Epigenetic dysregulation due to adverse events in early life is one of the major factors in generating the symptoms of IBS in adulthood.

Dr. Norman W. Walker is one of the pioneers of the raw foods movement and is recognized throughout the world as one of the most authoritative voices on life, health and nutrition. Dr. Walker shares his secret to a long, healthy, productive life through his internationally famous books on health and nutrition.

The untold story of the greatest library of the Renaissance and its creator Hernando Colón This engaging book offers the first comprehensive account of the extraordinary projects of Hernando Colón, son of Christopher Columbus, which culminated in the creation of the greatest library of the Renaissance, with ambitions to be universal––that is, to bring together copies of every book, on every subject and in every language. Pérez Fernández and Wilson-Lee situate Hernando’s projects within the rapidly changing landscape of early modern knowledge, providing a concise history of the collection of information and the origins of public libraries, examining the challenges he faced and the solutions he devised. The two authors combine “meticulous research with deep and original thought,” shedding light on the history of libraries and the organization of knowledge. The result is an essential reference text for scholars of the early modern period, and for anyone interested in the expansion and dissemination of information and knowledge.

This third edition text provides a completely revised and updated new version of this unique, modern, practical text that covers the strategic evaluation, specific approaches, and detailed management techniques utilized by expert colorectal surgeons caring for patients with complex problems–whether they result from underlying colorectal disease or from complications arising from previous surgical therapy. The format follows that of both a “how to” manual as well as an algorithm-based guide to allow the reader to understand the thought process behind the proposed treatment strategy. By making use of evidence-based recommendations, each chapter includes not only background information and diagnostic/therapeutic guidelines, but also provides a narrative by the author on his/her operative technical details and perioperative “tips and tricks” that they utilize in the management of these complex surgical challenges. Distinctive to this book, is the reliance on experts in the field including past presidents of the ASCRS, as well as multiple other national and internationally recognized surgeons, to lend their personal insight into situations where data may be more sparse, but individual and collective experience is paramount to making sound decisions and thereby optimizing patient outcomes. The text includes chapters on the assessment of risk and methods utilized to minimize perioperative complications. In addition, it incorporates sections covering the medical and surgical therapies for abdominal, pelvic and anorectal disease. Moreover, the technical challenges of managing complications resulting from the original or subsequent operations is addressed. The underlying focus throughout the text is on providing pragmatic and understandable solutions that can be readily implemented by surgeons of varying experience to successfully treat complex colorectal problems. However, it also goes beyond the technical aspects of colorectal surgery and includes special sections highlighting the essence of a surgeon; covering aspects involving the medical-legal, ethical, and economic challenges confronting surgeons. Throughout the text, each author provides an ongoing narrative of his/her individual surgical techniques along with illustrations and diagrams to “personally” take the reader through the crucial steps of the procedure, and key points of patient care inherent to that topic. Additionally, where appropriate, links to online videos give the reader an up-front look into technical aspects of colorectal surgery.

This thoroughly revised and extended second edition of the book clearly explains the nature of colon polyps and their relationship to colorectal cancer in light of new developments. It discusses in detail new topics, including polyp development, risk factors and prevention measures, and also describes surgical, medical oncology and radiotherapy treatments of colon cancer. In cases of advanced colon cancer, it clearly demonstrates how to perform surgical interventions in the presence of urinary tract metastases and gynecologic organ metastases. The book also includes chapters on medical treatment and radiotherapy in distant metastases of colorectal cancer. Further, it presents resection of liver metastases and transplantation options. Carefully examining the risk factors, and the treatment of colon cancer from the early to the advanced stages, the book is invaluable not only for medical specialists and students, but also for general readers and patients.

"Mysterious illnesses. Freakish injuries. X-rays revealing something weird that got stuck in your foot. These strange but true stories are among the 24 medical tales illustrated in hilarious fashion by New York Times bestselling author/illustrator Nick Seluk"--Page 4 of cover.

Colorectal Cancer Screening provides a complete overview of colorectal cancer screening, from epidemiology and molecular abnormalities, to the latest screening techniques such as stool DNA and FIT, Computerized Tomography (CT) Colonography, High Definition Colonoscopes and Narrow Band Imaging. As the text is devoted entirely to CRC screening, it features many facts, principles, guidelines and figures related to screening in an easy access format. This volume provides a complete guide to colorectal cancer screening which will be informative to the subspecialist as well as the primary care practitioner. It represents the only text that provides this up to date information about a subject that is continually changing. For the primary practitioner, information on the guidelines for screening as well as increasing patient participation is presentedd. For the subspecialist, information regarding the latest imaging techniques as well as flat adenomas and chromoendoscopy are covered. The section on the molecular changes in CRC will appeal to both groups. The text includes up to date information about colorectal screening that encompasses the entire spectrum of the topic and features photographs of polyps as well as diagrams of the morphology of polyps as well as photographs of CT colonography images. Algorithms are presented for all the suggested guidelines. Chapters are devoted to patient participation in screening and risk factors as well as new imaging technology. This useful volume explains the rationale behind screening for CRC. In addition, it covers the different screening options as well as the performance characteristics, when available in the literature, for each test. This volume will be used by the sub specialists who perform screening tests as well as primary care practitioners who refer patients to be screened for colorectal cancer.