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Colorectal cancer: From pathogenesis to prevention
GASTROENTEROLOGY
BOOK
1990;99:1536-1537
REVIEWS
Helen M. Shields, M.D. Book Review Editor Beth Israel Hospital 330 Brookline Avenue Boston,
MA 02215
Hepatology for the Clinician: A Problem-Oriented Approach. Edited by Simbn Beker. 369 pp. $96.00. Alan R. Liss, Inc., New York, New York, 1989. ISBN: O-471-56212-2. This multi-authored book is intended for clinicians. It uses the problem-oriented approach to provide practical guidelines for patient management. The first chapter covers assessment procedures, from history and physical examination to immunological, virological, and imaging techniques, and includes liver biopsy. This is followed by specific chapters covering presenting features such as jaundice, gastrointestinal hemorrhage, ascites, and space-occupying lesions. The editor presumably laid down detailed guidelines to each author emphasizing the problemoriented approach. However, the chapters lack consistency. They vary in length and in the number of references. Some include therapy, some have discussions, and some include case discussions. In general, the authors pay only lip service to the problem-oriented approach. The chapters vary in the depth covered. Bruce Runyon, for instance, gives a very valuable and detailed discussion of ascitic fluid analysis in 14 different conditions, from spontaneous bacterial peritonitis to postoperative lymphatic tears. The coverage in other chapters is much more superficial. A very valuable appendix covers new work on the hepatitis C and E viruses. Illustrations are plentiful, particularly scans and cholangiograms. These are of good quality, although to a clinical reader, more arrows and descriptive line keys would have assisted interpretation. Some color might have been useful. Figure 7-1 is clearly misplaced, and I was unable to find the real 7-l. This is a valuable book if regarded as a series of up-to-date articles on various important topics in hepatology. The chapters are written by a first-class team of authors who, in general, live up to their excellent reputations. It does not represent a new method of approach to a patient with liver disease. SHEILA SHERLOCK, M.D.
Department of Surgery The Royal Free Hospital London, England
Colorectal Cancer: From Pathogenesis to Prevention. Edited by H. K. Seitz, U. A. Simonowski, and N. A. Wright. 391 pp. $125.00. Springer-Verlag, New York, New York. ISBN: o-387-50474-55. The true test of the value of a book is whether or not it is useful. This is a well-written, well-edited, and useful book. The stated goal of the editors is to compile “current knowledge and concepts concerning the epidemiology and etiol-
ogy of colorectal cancer from the viewpoint of different scientific methodologies.” The book successfully meets this goal. The book’s 25 chapters are written by experts in their respective fields and are divided into five sections. With few exceptions, the authors review the current status of their subject matter rather than presenting their own data in isolation. The first three sections [“Epidemiology,” “Pathophysiology of Colorectal Cancer,” and “Mechanisms in Colorectal Carcinogenesis”) are particularly well done. The “Epidemiology” section includes a discussion of the geographic epidemiology of colorectal cancer with particular analysis of the hypothesis that dietary fat is important in colorectal cancer risk, chapters on genetic and acquired (inflammatory bowel disease, radiation ureterosigmoidostomy, and others) conditions that predispose to colorectal cancer, and a discussion of the value of biomarkers in the identification of high-risk groups. The “Dietary Factors in the Pathophysiology of Colorectal Cancer” section is probably the best section of the book. It includes six well-referenced chapters covering the major dietary hypotheses [fat, cholesterol, and neutral sterols, bile acids, fiber, ethanol], and it includes a section on the interaction between diet, colonic bacteria, and colon cancer risk. There is no separate chapter on the calcium hypothesis, but it is mentioned briefly in the other chapters. The third section, “Pathophysiologic Mechanisms in Coincludes chapters on potential lorectal Carcinogenesis,” colonic carcinogens and inhibitors of carcinogenesis, chapters on a variety of biochemical (microsomal enzymes, arachidonic acid metabolism, growth factors) and genetic (oncogenes) changes in colorectal carcinogenesis, as well as chapters on animal models of colon cancer and growth regulation in the colon. The oncogene chapter is already outdated because of the rapid advances in this area, but the others are complete. Two short sections on selected aspects of morphology (histogenesis and cell differentiation] and diagnostic and therapeutic approaches (immunoassay for fecal occult blood and experimental models to study new chemotherapeutic agents) are well written but do not cover the entire area as the previous sections did. The book concludes with a chapter of recommendations for dietary prevention of colorectal cancer. Although one might question whether there is adequate evidence for some of the specific recommendations [lower intake of highly fried, broiled, or browned foods], the general recommendations are reasonable and generally consistent with those of the National Cancer Institute, and the rationale for them is given in the chapter. The editors deserve particular credit for organizing these chapters in a consistent style, with a table of contents and an
November
BOOK REVIEWS
1990
introductory section at the beginning of each chapter, a summary or conclusion section at the end of each, and consistently well-referenced chapters. As luck would have it, I was asked to review this book at a time when I was writing a chapter on the etiology of large bowel cancer, and I can say from personal experience that this is a very useful book for anyone interested in the mechanism of colonic carcinogenesis, including epidemiologists, nutritionists, primary care physicians, gastroenterologists, and oncologists. Its clarity makes it useful to those at any level, from student to established investigator. DENNIS 1. AHNEN. M.D.
Veterans Affairs Medical Center Denver, Colorado
Motilin. Edited by Zen Itoh. 264 pp. $59.00. Academic Press, Inc., San Diego, California, 1990. ISBN: O-12-3757304. The editor has attempted to compile a comprehensive review of the literature on the peptide hormone motilin. The audience for which this book is most appropriate includes academic gastroenterologists and physiologists who have interests in gut peptides or in regulation of gastrointestinal motility. This book represents the most complete and readable work on motilin in the literature today. The organization of the book is logical, beginning with descriptions of the discovery, purification, synthesis, and processing of motilin. This is followed by sections on the distribution of motilin and the characteristics of motilin receptors. The greatest portion of the book is reserved for discussions of in vivo effects of motilin on fasting and fed gastrointestinal and biliary motility and on the secretory events of the gut as well as in vitro effects on gastrointestinal smooth muscle preparations. The final sections of the book deal with the associations of abnormal plasma motilin profiles with disease states and the role of erythromycin and its derivatives as motilin-receptor agonists. The information provided in this book is complete and refreshingly unbiased, unlike many reviews on the role of motilin in gut motility. The sections on the morphology of motilin cells, characteristics of motilin receptors, motilin release, and motilin levels in disease states are especially good and provide information that is not routinely offered in reviews on peptide mediation of gut motility. The graphs and figures are of good quality, although the casual reader should have a basic understanding of gastrointestinal manometric tracings before reading this book because both the
1537
text and the figure legends assume the reader’s familiarity with the technique. However, as is often the case with multi-authored books, certain chapters, such as on the role of motilin in duodenal ulcer disease, are unfocused and difficult to understand. Furthermore, there is extensive duplication of information. I found myself reading the same information several times in different chapters. This is especially prominent with respect to in vivo and in vitro effects of motilin on gut motility. I suspect that if all redundant material were removed, this 264-page book could be shortened by 75 pages or more. In addition, some of the chapters are not up-to-date. This is most obvious in the chapters on erythromycin, which does not include important studies from the past 2 years. Despite these shortcomings, I recommend this book with enthusiasm to anyone interested in the field. Though there is little information in this book that cannot be retrieved with a careful literature search, the organization and completeness of this book make such an extensive search unnecessary. Zen Itoh states in the preface that “motilin is a hormone which should never be forgotten.” With the current explosion of investigation into erythromycin as a prokinetic agent, I suspect that motilin will be one of the most publicized gut hormones of the next several years. I look forward to a second edition and hope it will cover these present and future investigations with the same organizational clarity as the current edition. WILLIAM L. HASLER, M.D.
University of Michigan Medical Center Ann Arbor, Michigan NEW
TITLES
1. The Duodenum: Selected Topics. Edited by G. Bertaccini, R. Cheli, G. Dobrilla, A. Gad, A. Giacosa. 314 pp. 1989. $76.50. Cortina International, Verona, Italy/Raven Press, New York, New York (ISBN: 88-7749-052-7). 2. Practical Guide to Anorectal Testing. Edited by L. E. Smith. 258 pp. 1990. $47.50. Igaku-Shoin Medical Publishers, Inc., New York, New York (ISBN: o-89640-185-5). 3. Practical Gastrointestinal Endoscopy, 3rd Edition, P. B. Cotton, C. B. Williams. 289 pp. 1990. $49.95. Blackwell Scientific Publications, Oxford, United Kingdom (ISBN: 0-632-02706-l). 4. Gastrointestinal Endocrinology: Receptors and PostReceptor Mechanisms. Edited by J. C. Thompson. 519 pp. 1990. $45.00. Academic Press, Inc., San Diego, California (ISBN: o-12-689330-6).
BOOK
1990;99:1536-1537
REVIEWS
Helen M. Shields, M.D. Book Review Editor Beth Israel Hospital 330 Brookline Avenue Boston,
MA 02215
Hepatology for the Clinician: A Problem-Oriented Approach. Edited by Simbn Beker. 369 pp. $96.00. Alan R. Liss, Inc., New York, New York, 1989. ISBN: O-471-56212-2. This multi-authored book is intended for clinicians. It uses the problem-oriented approach to provide practical guidelines for patient management. The first chapter covers assessment procedures, from history and physical examination to immunological, virological, and imaging techniques, and includes liver biopsy. This is followed by specific chapters covering presenting features such as jaundice, gastrointestinal hemorrhage, ascites, and space-occupying lesions. The editor presumably laid down detailed guidelines to each author emphasizing the problemoriented approach. However, the chapters lack consistency. They vary in length and in the number of references. Some include therapy, some have discussions, and some include case discussions. In general, the authors pay only lip service to the problem-oriented approach. The chapters vary in the depth covered. Bruce Runyon, for instance, gives a very valuable and detailed discussion of ascitic fluid analysis in 14 different conditions, from spontaneous bacterial peritonitis to postoperative lymphatic tears. The coverage in other chapters is much more superficial. A very valuable appendix covers new work on the hepatitis C and E viruses. Illustrations are plentiful, particularly scans and cholangiograms. These are of good quality, although to a clinical reader, more arrows and descriptive line keys would have assisted interpretation. Some color might have been useful. Figure 7-1 is clearly misplaced, and I was unable to find the real 7-l. This is a valuable book if regarded as a series of up-to-date articles on various important topics in hepatology. The chapters are written by a first-class team of authors who, in general, live up to their excellent reputations. It does not represent a new method of approach to a patient with liver disease. SHEILA SHERLOCK, M.D.
Department of Surgery The Royal Free Hospital London, England
Colorectal Cancer: From Pathogenesis to Prevention. Edited by H. K. Seitz, U. A. Simonowski, and N. A. Wright. 391 pp. $125.00. Springer-Verlag, New York, New York. ISBN: o-387-50474-55. The true test of the value of a book is whether or not it is useful. This is a well-written, well-edited, and useful book. The stated goal of the editors is to compile “current knowledge and concepts concerning the epidemiology and etiol-
ogy of colorectal cancer from the viewpoint of different scientific methodologies.” The book successfully meets this goal. The book’s 25 chapters are written by experts in their respective fields and are divided into five sections. With few exceptions, the authors review the current status of their subject matter rather than presenting their own data in isolation. The first three sections [“Epidemiology,” “Pathophysiology of Colorectal Cancer,” and “Mechanisms in Colorectal Carcinogenesis”) are particularly well done. The “Epidemiology” section includes a discussion of the geographic epidemiology of colorectal cancer with particular analysis of the hypothesis that dietary fat is important in colorectal cancer risk, chapters on genetic and acquired (inflammatory bowel disease, radiation ureterosigmoidostomy, and others) conditions that predispose to colorectal cancer, and a discussion of the value of biomarkers in the identification of high-risk groups. The “Dietary Factors in the Pathophysiology of Colorectal Cancer” section is probably the best section of the book. It includes six well-referenced chapters covering the major dietary hypotheses [fat, cholesterol, and neutral sterols, bile acids, fiber, ethanol], and it includes a section on the interaction between diet, colonic bacteria, and colon cancer risk. There is no separate chapter on the calcium hypothesis, but it is mentioned briefly in the other chapters. The third section, “Pathophysiologic Mechanisms in Coincludes chapters on potential lorectal Carcinogenesis,” colonic carcinogens and inhibitors of carcinogenesis, chapters on a variety of biochemical (microsomal enzymes, arachidonic acid metabolism, growth factors) and genetic (oncogenes) changes in colorectal carcinogenesis, as well as chapters on animal models of colon cancer and growth regulation in the colon. The oncogene chapter is already outdated because of the rapid advances in this area, but the others are complete. Two short sections on selected aspects of morphology (histogenesis and cell differentiation] and diagnostic and therapeutic approaches (immunoassay for fecal occult blood and experimental models to study new chemotherapeutic agents) are well written but do not cover the entire area as the previous sections did. The book concludes with a chapter of recommendations for dietary prevention of colorectal cancer. Although one might question whether there is adequate evidence for some of the specific recommendations [lower intake of highly fried, broiled, or browned foods], the general recommendations are reasonable and generally consistent with those of the National Cancer Institute, and the rationale for them is given in the chapter. The editors deserve particular credit for organizing these chapters in a consistent style, with a table of contents and an
November
BOOK REVIEWS
1990
introductory section at the beginning of each chapter, a summary or conclusion section at the end of each, and consistently well-referenced chapters. As luck would have it, I was asked to review this book at a time when I was writing a chapter on the etiology of large bowel cancer, and I can say from personal experience that this is a very useful book for anyone interested in the mechanism of colonic carcinogenesis, including epidemiologists, nutritionists, primary care physicians, gastroenterologists, and oncologists. Its clarity makes it useful to those at any level, from student to established investigator. DENNIS 1. AHNEN. M.D.
Veterans Affairs Medical Center Denver, Colorado
Motilin. Edited by Zen Itoh. 264 pp. $59.00. Academic Press, Inc., San Diego, California, 1990. ISBN: O-12-3757304. The editor has attempted to compile a comprehensive review of the literature on the peptide hormone motilin. The audience for which this book is most appropriate includes academic gastroenterologists and physiologists who have interests in gut peptides or in regulation of gastrointestinal motility. This book represents the most complete and readable work on motilin in the literature today. The organization of the book is logical, beginning with descriptions of the discovery, purification, synthesis, and processing of motilin. This is followed by sections on the distribution of motilin and the characteristics of motilin receptors. The greatest portion of the book is reserved for discussions of in vivo effects of motilin on fasting and fed gastrointestinal and biliary motility and on the secretory events of the gut as well as in vitro effects on gastrointestinal smooth muscle preparations. The final sections of the book deal with the associations of abnormal plasma motilin profiles with disease states and the role of erythromycin and its derivatives as motilin-receptor agonists. The information provided in this book is complete and refreshingly unbiased, unlike many reviews on the role of motilin in gut motility. The sections on the morphology of motilin cells, characteristics of motilin receptors, motilin release, and motilin levels in disease states are especially good and provide information that is not routinely offered in reviews on peptide mediation of gut motility. The graphs and figures are of good quality, although the casual reader should have a basic understanding of gastrointestinal manometric tracings before reading this book because both the
1537
text and the figure legends assume the reader’s familiarity with the technique. However, as is often the case with multi-authored books, certain chapters, such as on the role of motilin in duodenal ulcer disease, are unfocused and difficult to understand. Furthermore, there is extensive duplication of information. I found myself reading the same information several times in different chapters. This is especially prominent with respect to in vivo and in vitro effects of motilin on gut motility. I suspect that if all redundant material were removed, this 264-page book could be shortened by 75 pages or more. In addition, some of the chapters are not up-to-date. This is most obvious in the chapters on erythromycin, which does not include important studies from the past 2 years. Despite these shortcomings, I recommend this book with enthusiasm to anyone interested in the field. Though there is little information in this book that cannot be retrieved with a careful literature search, the organization and completeness of this book make such an extensive search unnecessary. Zen Itoh states in the preface that “motilin is a hormone which should never be forgotten.” With the current explosion of investigation into erythromycin as a prokinetic agent, I suspect that motilin will be one of the most publicized gut hormones of the next several years. I look forward to a second edition and hope it will cover these present and future investigations with the same organizational clarity as the current edition. WILLIAM L. HASLER, M.D.
University of Michigan Medical Center Ann Arbor, Michigan NEW
TITLES
1. The Duodenum: Selected Topics. Edited by G. Bertaccini, R. Cheli, G. Dobrilla, A. Gad, A. Giacosa. 314 pp. 1989. $76.50. Cortina International, Verona, Italy/Raven Press, New York, New York (ISBN: 88-7749-052-7). 2. Practical Guide to Anorectal Testing. Edited by L. E. Smith. 258 pp. 1990. $47.50. Igaku-Shoin Medical Publishers, Inc., New York, New York (ISBN: o-89640-185-5). 3. Practical Gastrointestinal Endoscopy, 3rd Edition, P. B. Cotton, C. B. Williams. 289 pp. 1990. $49.95. Blackwell Scientific Publications, Oxford, United Kingdom (ISBN: 0-632-02706-l). 4. Gastrointestinal Endocrinology: Receptors and PostReceptor Mechanisms. Edited by J. C. Thompson. 519 pp. 1990. $45.00. Academic Press, Inc., San Diego, California (ISBN: o-12-689330-6).