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Practical management of acute gastrointestinal bleeding
GASTROENTEROLOGY
1993;105:606-610
BOOK REVIEWS Jonathan E. Clain, M.D. Book Review Editor Mayo Foundation 200 First Street S.W. Rochester, Minnesota 55905
PracticalManagementofAcute Gastkntestinal Bleeding, By R. J. C.
Steele, S. C. S. Chung, and J. W. C. Leung. 148 pp. $115.00. Butterworth-Heinemann, Stoneham, Massachusetts, 1993. ISBN 0-7506-0767-X. This relatively short book is a masterpiece of pragmatic advice from the Combined Medical-Surgical Unit of the Prince of Wales Hospital (Chinese University), Hong Kong. This unit deals with more than 1000 patients with acute bleeding each year. The authors (two surgeons and an endoscopist) have contributed many important studies in the field. In this book they have successfully condensed their wisdom in an intensely practical way. They give details of initial management and patient triage, outline the appropriate preparations and equipment for use during endoscopic investigation, and provide guidance about what to do when endoscopic diagnosis and treatment is unsuccessful. There are chapters concerning acute colonic bleeding, investigation of obscure bleeding, surgical management, and the special problems occurring in children. The authors emphasize repeatedly that patients with acute gastrointestinal bleeding should be managed by a team of physicians and surgeons and that they should be specialists rather than “generalists.” They recognize that these arrangements are sometimes resisted, but, despite the absence of real proof, this type of management is well accepted by all experts in the field, especially for patients judged to be of high risk. The authors do not attempt to provide exhaustive statistics of the results of various diagnostic and therapeutic procedures, recognizing that the spectrum of patients admitted to any institution will differ. As hospitals become more sophisticated and intensive care more widespread, it is clear that many of the most difficult bleeding problems occur in patients who are already acutely ill in hospital. The second edition might provide some guidance about the special problems involved, for instance in dealing with patients who are coagulopathic or have recently undergone other major surgical intervention. The book is well illustrated with simple line drawings and photographs. Each chapter has a short list of recommended reading, and the index is adequate. In their introduction the authors indicate that “the book is intended for all clinicians, both physicians and surgeons, who are actively involved in the treatment of gastrointestinal bleeding.” I recommend it to them, wholeheartedly. PETER
B. COTTON, M.D., F.R.C.P.
Duke Universi~Medical Center Durham, North Carolina
Biopy Diagnosisofthe DigestiveTract (volumes
1 and 2). 845 pp. $160.00 By Heidrum Rotterdam, Daniel G. Sheahan, and Sheldon C. Sommers. Raven Press, New York, New York, 1992. ISBN O-88167-968-2.
The second edition of the biopsy interpretation series dealing with the digestive tract by Rotterdam, Sheahan, and Sommers runs to two volumes and 845 pages. Its primary objective, as with the other volumes in this series, is to provide the practicing surgical pathologist with an overview of the type of lesion they confront in relatively small biopsy specimens acquired by endoscopic technique. In this, they have succeeded quite admirably; in fact, their coverage of the topic is almost encyclopedic and a treasure trove of interesting and informative facts. There are over 1000 references in each of the chapters dealing with the small bowel and large bowel alone. The brief introductory section could perhaps have been expanded to demonstrate by low-power photomicrographs the types of specimens procured by the various techniques and instruments enumerated. Separate chapters are devoted to esophagus, stomach, duodenum, small and large intestine, and anal canal. Many of the disease entities involve two or more of these locations, resulting in some tendency to repetition, although the authors have highlighted those features more distinctive to lesions in each location. In any multiauthorship work of this type, there tends to be some variation in style from chapter to chapter. In this publication, the chapters dealing with the stomach and small intestine are particularly well constructed. Somewhat less satisfactory than the text is the quality of some of the photomicrographs, particularly those in the lower magnification range. However, the illustrative material does include some excellent electron micrographs and even some superb scanning electron micrographs. When pertinent, the importance of immunohistochemical and molecular genetic studies is emphasized. A comprehensive subject index concludes the second volume. Occasional inconsistencies are noted in the text; e.g., in the chapter dealing with the esophagus, adenoacanthoma is defined as an adenocarcinoma with metaplastic squamous epithelium, whereas the gastric adenoacanthoma is said to be a hybrid adenocarcinoma and squamous carcinoma. Erosions in the stomach are said never to extend beyond the muscularis mucosa but in the esophagus may penetrate deeply through the muscularis mucosa. Mitotic counts are widely recognized as being of signal prognostic importance in the evaluation of smooth muscle neoplasms in various parts of the gastrointestinal tract. The discussion dealing with such counts in relation to smooth
1993;105:606-610
BOOK REVIEWS Jonathan E. Clain, M.D. Book Review Editor Mayo Foundation 200 First Street S.W. Rochester, Minnesota 55905
PracticalManagementofAcute Gastkntestinal Bleeding, By R. J. C.
Steele, S. C. S. Chung, and J. W. C. Leung. 148 pp. $115.00. Butterworth-Heinemann, Stoneham, Massachusetts, 1993. ISBN 0-7506-0767-X. This relatively short book is a masterpiece of pragmatic advice from the Combined Medical-Surgical Unit of the Prince of Wales Hospital (Chinese University), Hong Kong. This unit deals with more than 1000 patients with acute bleeding each year. The authors (two surgeons and an endoscopist) have contributed many important studies in the field. In this book they have successfully condensed their wisdom in an intensely practical way. They give details of initial management and patient triage, outline the appropriate preparations and equipment for use during endoscopic investigation, and provide guidance about what to do when endoscopic diagnosis and treatment is unsuccessful. There are chapters concerning acute colonic bleeding, investigation of obscure bleeding, surgical management, and the special problems occurring in children. The authors emphasize repeatedly that patients with acute gastrointestinal bleeding should be managed by a team of physicians and surgeons and that they should be specialists rather than “generalists.” They recognize that these arrangements are sometimes resisted, but, despite the absence of real proof, this type of management is well accepted by all experts in the field, especially for patients judged to be of high risk. The authors do not attempt to provide exhaustive statistics of the results of various diagnostic and therapeutic procedures, recognizing that the spectrum of patients admitted to any institution will differ. As hospitals become more sophisticated and intensive care more widespread, it is clear that many of the most difficult bleeding problems occur in patients who are already acutely ill in hospital. The second edition might provide some guidance about the special problems involved, for instance in dealing with patients who are coagulopathic or have recently undergone other major surgical intervention. The book is well illustrated with simple line drawings and photographs. Each chapter has a short list of recommended reading, and the index is adequate. In their introduction the authors indicate that “the book is intended for all clinicians, both physicians and surgeons, who are actively involved in the treatment of gastrointestinal bleeding.” I recommend it to them, wholeheartedly. PETER
B. COTTON, M.D., F.R.C.P.
Duke Universi~Medical Center Durham, North Carolina
Biopy Diagnosisofthe DigestiveTract (volumes
1 and 2). 845 pp. $160.00 By Heidrum Rotterdam, Daniel G. Sheahan, and Sheldon C. Sommers. Raven Press, New York, New York, 1992. ISBN O-88167-968-2.
The second edition of the biopsy interpretation series dealing with the digestive tract by Rotterdam, Sheahan, and Sommers runs to two volumes and 845 pages. Its primary objective, as with the other volumes in this series, is to provide the practicing surgical pathologist with an overview of the type of lesion they confront in relatively small biopsy specimens acquired by endoscopic technique. In this, they have succeeded quite admirably; in fact, their coverage of the topic is almost encyclopedic and a treasure trove of interesting and informative facts. There are over 1000 references in each of the chapters dealing with the small bowel and large bowel alone. The brief introductory section could perhaps have been expanded to demonstrate by low-power photomicrographs the types of specimens procured by the various techniques and instruments enumerated. Separate chapters are devoted to esophagus, stomach, duodenum, small and large intestine, and anal canal. Many of the disease entities involve two or more of these locations, resulting in some tendency to repetition, although the authors have highlighted those features more distinctive to lesions in each location. In any multiauthorship work of this type, there tends to be some variation in style from chapter to chapter. In this publication, the chapters dealing with the stomach and small intestine are particularly well constructed. Somewhat less satisfactory than the text is the quality of some of the photomicrographs, particularly those in the lower magnification range. However, the illustrative material does include some excellent electron micrographs and even some superb scanning electron micrographs. When pertinent, the importance of immunohistochemical and molecular genetic studies is emphasized. A comprehensive subject index concludes the second volume. Occasional inconsistencies are noted in the text; e.g., in the chapter dealing with the esophagus, adenoacanthoma is defined as an adenocarcinoma with metaplastic squamous epithelium, whereas the gastric adenoacanthoma is said to be a hybrid adenocarcinoma and squamous carcinoma. Erosions in the stomach are said never to extend beyond the muscularis mucosa but in the esophagus may penetrate deeply through the muscularis mucosa. Mitotic counts are widely recognized as being of signal prognostic importance in the evaluation of smooth muscle neoplasms in various parts of the gastrointestinal tract. The discussion dealing with such counts in relation to smooth