- Email: [email protected]
Advances in hepatic encephalopathy and metabolic nitrogen exchange
Book Reviews LAWRENCE S. FRIEDMAN, BOOK EDITOR Gastrointestinal Unit Bullfinch 127 Massachusetts General Hospital Boston, MA 02114
HEPATOLOGY welcomes books for review and invites its readers both to identify books of hepatological interest and to serve as book reviewers. Books of note should be called to the attention of the Book Editor, and potential reviewers should indicate their areas of interest. The Book Editor nonetheless reserves the right to select appropriate reviews for publication on these pages.
This month is my swan song as Book Editor. I've had enormous fun during the past 5 years but I promised myself that I would step down at this juncture and I'm keeping my word. I thank Paul Berk, the Associate Editors, and the Editorial Office for their support and kindness to me during this period. I am most grateful to the many reviewers who were willing to review books, many on more than one occasion, and who did so with elegance and ~lan. I am delighted that Larry Friedman has graciously agreed to replace me. He loves books as much as I do; I know that the reviews will be in superb hands. RAYMOND S. KOFF, MD
Advances in Hepatic Encephalopathy and Metabolic Nitrogen Exchange. Edited by Livio Capocaccia, Manuela Merli, and Oliviero Riggio, 630 pp. Boca Raton: CRC Press, 1995. $199.95. Every 3 years in a different European location, the "encephalopathy community," constituted by hepatologists, neuroscientists, and individuals interested in nitrogen metabolism, gather for the "International Symposium on Ammonia." The proceedings of the VIII meeting, edited by the organizers from the University of Rome, are published in this volume. Like its counterparts in previous years, the edition is well composed and reflects the abundant material presented at the 1993 meeting. The book is divided into 14 sections. Most of them begin with a review of the topic, a mini "state of the art," including contributions such as "Muscle in Protein Turnover in Patients With Liver Disease," "Neurobiology and Neuropharmacology of Hepatic Encephalopathy," and "Optimal Animal Models for the Study of Hepatic Encephalopathy and Nitrogen Metabolism." Five of the sections cover protein and nitrogen metabo-
lism in both physiological and pathological states. Eight of the sections are devoted to the neurochemistry and clinical research in hepatic encephalopathy. A round table on the therapy of hepatic encephalopathy also transcribes the discussion, including the results of an informal polling of the audience on controversial decisions. We learn that 10% of the "experts" often use benzodiazepine antagonists in the treatment of their patients, whereas 58% of them never use intravenous branched-chain amino acids in therapy. Such controversy extends to what can be termed "conventional" measures; the few studies comparing nonabsorbable disaccharides and neomycin to placebo are not truly convincing of their superiority over the control of the precipitating factor(s). Throughout the years, theories of the pathogenesis of hepatic encephalopathy have been intensely debated. In 88 published papers in this symposium, studies of the neurochemical effects of ammonia predominate. Alterations in multiple neurotransmitter systems, including glutamatergic, serotoninergic, and dopaminergic pathways, can be viewed as a cascade of changes that arise from the entry of this "time-honored" toxin into the brain. It is clear that different abnormalities may be expressed to a different degree in different patients, including a role for the elusive "endogenous" benzodiazepines, whose source and characterization remains uncertain. Four presentations cover magnetic resonance-spectroscopy, a window to human studies that has shed further light on this controversial area of research. Five of the sections deal with neuropsychological and neurophysiological testing because of the increasing interest in subclinical encephalopathy. Newer therapeutic modalities, such as zinc, ornithinaspartate, and benzoate, are also discussed. The book is published 2 years after the symposium was held, and some of the material has been published as full articles. Another drawback is its cost. On the other hand, the text of almost all of the presentations is short, allowing a quick update of an area of hepatology that is vibrant with new ideas and new therapeutic approaches. There is food for thought for the many disciplines whose research intersects with that of hepatic encephalopathy and nitrogen metabolism.
1891
ANDRES T. BLEI, MD
Division of Gastroenterology and Hepatology Northwestern Memorial Hospital Chicago, IL
HEPATOLOGY welcomes books for review and invites its readers both to identify books of hepatological interest and to serve as book reviewers. Books of note should be called to the attention of the Book Editor, and potential reviewers should indicate their areas of interest. The Book Editor nonetheless reserves the right to select appropriate reviews for publication on these pages.
This month is my swan song as Book Editor. I've had enormous fun during the past 5 years but I promised myself that I would step down at this juncture and I'm keeping my word. I thank Paul Berk, the Associate Editors, and the Editorial Office for their support and kindness to me during this period. I am most grateful to the many reviewers who were willing to review books, many on more than one occasion, and who did so with elegance and ~lan. I am delighted that Larry Friedman has graciously agreed to replace me. He loves books as much as I do; I know that the reviews will be in superb hands. RAYMOND S. KOFF, MD
Advances in Hepatic Encephalopathy and Metabolic Nitrogen Exchange. Edited by Livio Capocaccia, Manuela Merli, and Oliviero Riggio, 630 pp. Boca Raton: CRC Press, 1995. $199.95. Every 3 years in a different European location, the "encephalopathy community," constituted by hepatologists, neuroscientists, and individuals interested in nitrogen metabolism, gather for the "International Symposium on Ammonia." The proceedings of the VIII meeting, edited by the organizers from the University of Rome, are published in this volume. Like its counterparts in previous years, the edition is well composed and reflects the abundant material presented at the 1993 meeting. The book is divided into 14 sections. Most of them begin with a review of the topic, a mini "state of the art," including contributions such as "Muscle in Protein Turnover in Patients With Liver Disease," "Neurobiology and Neuropharmacology of Hepatic Encephalopathy," and "Optimal Animal Models for the Study of Hepatic Encephalopathy and Nitrogen Metabolism." Five of the sections cover protein and nitrogen metabo-
lism in both physiological and pathological states. Eight of the sections are devoted to the neurochemistry and clinical research in hepatic encephalopathy. A round table on the therapy of hepatic encephalopathy also transcribes the discussion, including the results of an informal polling of the audience on controversial decisions. We learn that 10% of the "experts" often use benzodiazepine antagonists in the treatment of their patients, whereas 58% of them never use intravenous branched-chain amino acids in therapy. Such controversy extends to what can be termed "conventional" measures; the few studies comparing nonabsorbable disaccharides and neomycin to placebo are not truly convincing of their superiority over the control of the precipitating factor(s). Throughout the years, theories of the pathogenesis of hepatic encephalopathy have been intensely debated. In 88 published papers in this symposium, studies of the neurochemical effects of ammonia predominate. Alterations in multiple neurotransmitter systems, including glutamatergic, serotoninergic, and dopaminergic pathways, can be viewed as a cascade of changes that arise from the entry of this "time-honored" toxin into the brain. It is clear that different abnormalities may be expressed to a different degree in different patients, including a role for the elusive "endogenous" benzodiazepines, whose source and characterization remains uncertain. Four presentations cover magnetic resonance-spectroscopy, a window to human studies that has shed further light on this controversial area of research. Five of the sections deal with neuropsychological and neurophysiological testing because of the increasing interest in subclinical encephalopathy. Newer therapeutic modalities, such as zinc, ornithinaspartate, and benzoate, are also discussed. The book is published 2 years after the symposium was held, and some of the material has been published as full articles. Another drawback is its cost. On the other hand, the text of almost all of the presentations is short, allowing a quick update of an area of hepatology that is vibrant with new ideas and new therapeutic approaches. There is food for thought for the many disciplines whose research intersects with that of hepatic encephalopathy and nitrogen metabolism.
1891
ANDRES T. BLEI, MD
Division of Gastroenterology and Hepatology Northwestern Memorial Hospital Chicago, IL