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ACHALASIA OF THE ESOPHAGUS
THE BOOKSHELF ACHALASIA O F T H E ESOPHAGUS (Vol IX in the Major Problems in Clinical Surgery Series) F. HENRYELLIS, JR., A N D ARTHUR51. OLSEN,W. B. Saunders, Co., Philadelphia, 1969, 221 pages, illustrated. $9.00 This nlonograph will probably stand out as the most definitive work on achalasia of the esophagus for many years. The authors consider in an orderly, well-written fa!hion the history, pathogenesis, and physiology of this condition in the early chapters of the b w k , followed by a discussion of the clinical feahtres ;lnd roentgen manifestations. The latter part of the text is concerned with nonsurgical and surgical methods of management, ant1 includes their technique of esophagonlyotolny. Best defined as a disease of unknown etiology characterized by absence of ~eristalsisin the body of the esophagus and failure of the inferior sphincter to relax in response to ~wallowing, esophageal achalasia was first described by Thomas Willis in 1674, althor~ghthe term "achalasia" was not coined until 1913 by Sir Cooper Perry. The contributions of Hurst, Plummer, Einhorn, Vinson, Russel, Von Irlikulicz and Heller to the understanding or management of this condition are covered and bring the rcntler to modern times when more refined manometric techniques permit a better appreciation of the altered physiology that exists. A thorough disc~~ssion of the pathogenesis of ;ich;tlasia inclr~desgross and histologic feah~lesof the intrin\ic nerve plexrlses, vagus nerve, central nervous system, and 111usc1eof the esophagus. Some of the methods for experi111entalproduction of esophageal achalasia are reviewed. In qcneral, all of the struchires considered have been demonrtrated to play a role in the production of achalasia, but no sinrle etiolonv , ., has been established. The use of manometric techniques with and without ~~lc>thacholine (Slecholyl) are covered in depth in the chapt c o~ n ~,hvsiolopic studies. This is an excellent discourse with . c.lc*ilr reprotluctions of relevant pressure profiles of the cbsophagus and esophagogastric junction in normal individuals iuitl those with achalasia. The clinical and roentgenographic manifestations are thoro~lghlydiscussed with a~iipleexanlples of patient material. 'I hc authors divide achalasia into three stages: mild, moder. ~ t cand severe, depending on the diameter of the esophagus o n roentgenogram. Colnplications and conditions associated \+ ith achalasia are reviewed and there is a short discussion of .ichalasia in children. In the ch;~ptersdevoted to treatment, the authors discuss t i i t * resrllts of forceful dilatation as well as some of the volnplici~tionsof this methtd. Their general conclusion, how,,\c8r,is that hurgical management consisting of a transthordci c . Heller-typ. of esophagomyotomy is the treatment of lroice. T h r authors feel that reflux esophagitis is less apt to occur if the operation is perfomled through the chest, the c,\tt.nt of the myomotoniy over the stomach limited to only a fc.\v niillilneters, ant1 the esophageal hiatus disturbed as little :I.; possible. The various operations utilized prior to the ~lc,\.cloplnento f the Heller procedure are discussed and I'~~ll)csrly evaluatetl ;IS to their efficacy. It should be ment i ( ~ ~ ~ cthat , t l the type of esophagornyotolny advocated by the .
general agreement with the overall results reported in the literature. They conclude that esophagomyotomy is a safe operation and when properly performed can be expected to relieve symptoms in more than 90 percent of patients. In addition, once a satisfactory result has been achieved, there is little tendency for symptoms to recur later; none of their patients whose status was classified as improved a year after operation had significant difficulty later. They state, because of the excellence of the results, that esophagomyotomy should now be considered the plimary treatment of choice for the symptomatic patient with esophageal achalasia, and it should be done early in the course of the disease. Although niany may take issue with this encompassing statement, none can take issue with the general excellence of this book and the magnificent way in which the material is presented. This is a monograph to be read and used for reference by anyone dealing with or interested in problems of the esophagus. S. Frank Redo, X1.D. New York City PATHOLOGY O F T H E LUNG (EXCLUDING PULMONARY TUBERCULOSIS ) by H. SPENCER ( 2nd e d ) Pergamon Press, Oxford and New York, 1968, 1106 PP, $38.00 Until hlorgagni, pathology was s ~ d i e dalong purely philosophic lines. Lesions were described merely as deviations from the norm, and little attention was paid to the dynamic feahlres associated with them. Morgagni's lead was perfected by the Hunter brothers and by Bichat, who emphasized the etiopathogenetic aspects of what had been formerly designated "morbid" anatomy. There are still, to this day, some authors of pathology textbooks who adopt a purely descriptive format, but the majority prefer to include a reasonable ratlo of clinical backgrnund material. This not only lends a discursive tone to the information presented but makes the latter more meaningful as well. Dr. Spencer's textbwk on lung pathology has long enjoyed a well-deserved reputation for thoroughness which has established it as the standard work of its kind. In this, the second edition, numerous painstaking revisions and expansions are obvious, which are bmmd to make the book even more esteemed than heretofore. There is excellent correlation of pathologic findings with clinical situations, and considerable new information has been incorporated, some of it of fairly recent vintage. In this category may be mentioned the discussions pertaining to pulmonary surfactant and to endocrine manifestations of sundry lung neoplasms. Of the noteworthy additions to the illustrations are the electron photomicrographs. The author's scholarship and discernment are evident in every paragraph. One can only regret that pulmonary tuberculosis is excluded from the vast wealth of educational detail provided. Most British publications favor the citing of authors' names in the text itself, whereas American journals and books prefer the assignment of numerals to refer to specific items in the bibliography. This reviewer has long felt that the fornmr method is wasteful and distracting, and uses this opportunity to suggest that British publishers might find a more receptive audience by converting to the more practical American system. Dr. Spencer's book deserves to be on the reference shelf of everyone concerned with the management of pulmonary diseases-if it does not enjoy a place there already. . M.D. David C h a ~Schechter, New York C i t y
general agreement with the overall results reported in the literature. They conclude that esophagomyotomy is a safe operation and when properly performed can be expected to relieve symptoms in more than 90 percent of patients. In addition, once a satisfactory result has been achieved, there is little tendency for symptoms to recur later; none of their patients whose status was classified as improved a year after operation had significant difficulty later. They state, because of the excellence of the results, that esophagomyotomy should now be considered the plimary treatment of choice for the symptomatic patient with esophageal achalasia, and it should be done early in the course of the disease. Although niany may take issue with this encompassing statement, none can take issue with the general excellence of this book and the magnificent way in which the material is presented. This is a monograph to be read and used for reference by anyone dealing with or interested in problems of the esophagus. S. Frank Redo, X1.D. New York City PATHOLOGY O F T H E LUNG (EXCLUDING PULMONARY TUBERCULOSIS ) by H. SPENCER ( 2nd e d ) Pergamon Press, Oxford and New York, 1968, 1106 PP, $38.00 Until hlorgagni, pathology was s ~ d i e dalong purely philosophic lines. Lesions were described merely as deviations from the norm, and little attention was paid to the dynamic feahlres associated with them. Morgagni's lead was perfected by the Hunter brothers and by Bichat, who emphasized the etiopathogenetic aspects of what had been formerly designated "morbid" anatomy. There are still, to this day, some authors of pathology textbooks who adopt a purely descriptive format, but the majority prefer to include a reasonable ratlo of clinical backgrnund material. This not only lends a discursive tone to the information presented but makes the latter more meaningful as well. Dr. Spencer's textbwk on lung pathology has long enjoyed a well-deserved reputation for thoroughness which has established it as the standard work of its kind. In this, the second edition, numerous painstaking revisions and expansions are obvious, which are bmmd to make the book even more esteemed than heretofore. There is excellent correlation of pathologic findings with clinical situations, and considerable new information has been incorporated, some of it of fairly recent vintage. In this category may be mentioned the discussions pertaining to pulmonary surfactant and to endocrine manifestations of sundry lung neoplasms. Of the noteworthy additions to the illustrations are the electron photomicrographs. The author's scholarship and discernment are evident in every paragraph. One can only regret that pulmonary tuberculosis is excluded from the vast wealth of educational detail provided. Most British publications favor the citing of authors' names in the text itself, whereas American journals and books prefer the assignment of numerals to refer to specific items in the bibliography. This reviewer has long felt that the fornmr method is wasteful and distracting, and uses this opportunity to suggest that British publishers might find a more receptive audience by converting to the more practical American system. Dr. Spencer's book deserves to be on the reference shelf of everyone concerned with the management of pulmonary diseases-if it does not enjoy a place there already. . M.D. David C h a ~Schechter, New York C i t y