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Autoimmune Liver Diseases
504
BOOK REVIEWS
Keining and Braun-Falco in 1960. Three editions later in 1984, a Mayo Clinic dermatologist, Richard Winkelmann, joined Braun-Falco and coauthors. The current "four horsemen" have now brought to the English-speaking world a matchless "400-horsepower" text. It has rapidly become the most wanted, most admired, and most consulted book in my extensive library of textbooks on dermatology. In a single day, I have used it to show an internist the best illustrations of Mees' lines associated with arsenic poisoning, to review the treatment of erythrokeratodermia variabilis, and to learn for the first time of paroxysmal hematomas of the fingers. A book like this is published only once in a generation. It should be not only reviewed but also bought, used, and enjoyed.
Mayo Clin Proc, May 1992, Vol 67
The chapter on the pathogenesis of autoimmune chronic active hepatitis is particularly strong and, importantly, details the current animal models of autoimmune hepatitis as well as the immunologic aberrations in patients with this disease. The discussion of the pathogenesis of primary biliary cirrhosis is one ofthe few disappointments. The authors' narrow viewpoint is based on their own hypothesis that, as stated, is simply a summary of what is known and unknown. Nonetheless, the chapter is relatively complete in presenting the known facts about immunologic aberrations in patients with primary biliary cirrhosis. Three chapters focus on autoantibodies and autoimmune liver diseases. The information in each of these chapters is extensive, and each chapter is fairly well written. In particular, the tables in the chapter on autoantibodies and autoimmune chronic hepatitis provide an overview of this Walter B. Shelley, M.D., Ph.D. complex topic. The chapter on autoantibodies in primary biliary cirrhosis is superb; the discussion is thorough and well Division of Dermatology Medical College of Ohio supplemented with tables and illustrations. The authors Toledo, Ohio review the extensive available information on the relationship of immunologic and clinical heterogeneity. A summary of the important aspects of this chapter is included. The chapters that review the clinical aspects of autoimAutoimmune Liver Diseases, edited by Edward L. Krawitt mune liver diseases are well written, complete, and up-toand Russell H. Wiesner, 272 pp, with illus, $89, New York, date, especially the chapter on the clinical aspects of autoimmune chronic hepatitis. Dr. Czaja has done an excellent job Raven Press, 1991 of combining his own vast clinical experience with that of The expressed purpose of this book is to summarize the others to describe thoroughly the clinical manifestations and current knowledge of autoimmune liver diseases. During the response to treatment. My only recommendation for this past 10 years, this area of medicine has experienced numerous chapter would be to include information about the importance advances in the understanding of the pathogenesis and treat- of symptoms in determining what patients should and should ment of such diseases. In that regard, this text will be a timely not be treated. The chapter on primary biliary cirrhosis is addition to the libraries of practicing hepatologists and those predictable but extensive in discussing symptoms and laboratory manifestations; however, the important association of the persons interested in hepatic disease. The book is informally divided into three sections. The CREST syndrome (calcinosis cutis, Raynaud' s phenomenon, first section deals with the basic immunologic factors of esophageal dysfunction, sclerodactyly, and telangiectasia) autoimmunity and autoimmune liver diseases. The second and primary biliary cirrhosis is not included. In addition, the describes the pathogenesis of specific autoimmune liver dis- importance of natural history data in determining the timing of eases, and the final section discusses the clinical aspects. The liver transplantation seems to demand more information about text has 16 chapters, all of which are appropriately narrow in prognostic indicators. The chapter on primary sclerosing focus. Each chapter is written by an internationally known cholangitis is the weakest of the clinical chapters. It lacks a authority in the field. description of the radiographic findings in primary sclerosing The first chapter is on the concept of autoimmunity and cholangitis and only superficially discusses the endoscopic contains an excellent discussion of the current understanding and surgical therapy for this disease, which may be important of immunologic response and what goes awry in autoimmune at least from a historical perspective. The chapter on treatment diseases. Although this chapter is complete, I would have options for primary biliary cirrhosis is extremely well written preferred inclusion of an illustration that would enable readers and complete. It provides an important perspective on the to visualize the immune response clearly and that would also design of future studies. A table that compares the results of delineate what is known and unknown about T- and B-cell selected trials of the various agents that have been used for recognition of self and nonself. This chapter is an excellent primary biliary cirrhosis would have been helpful. The preface to the next several chapters that deal with the patho- material on the role of liver transplantation in the treatment of genesis of autoimmune chronic active hepatitis, primary bil- autoimmune liver disease is useful and comprehensive. The iary cirrhosis, and sclerosing cholangitis. authors effectively combined their experience at King's Col-
Mayo CUn Proc, May 1992, Vol 67
lege Hospital with the information available in the literature to provide an excellent review of the timing of liver transplantation as well as special problems that may develop after transplantation. The book concludes with three chapters on drug-induced chronic hepatitis, the immunologic manifestations of viral hepatitis, and the autoimmune manifestations of hepatic disease from alcoholism. Each of these chapters is well written, exhaustive, and valuable. Overall, this excellent book provides up-to-date information and perspectives on autoimmune liver diseases and is the best available text on this subject. I believe it will be an important reference source for all physicians, especially those involved in the care of patients with liver disease and those in liver research. The book is well indexed, and each chapter contains an extensive bibliography. Finally, I commend the editors for maintaining a consistently high standard; overlap and redundancy have been minimized in this publication. John R. Lake, M.D. Department of Medicine and Liver Transplant Service University of California, San Francisco San Francisco, California
Congenital Heart Disease in Adults, edited by Joseph K. Perloff and John S. Child, 342 pp, with illus, $75, Philadelphia, W. B. Saunders Company, 1991 During the past few decades, increasing numbers of children with congenital heart disease have lived to adulthood because of medical or surgical treatment; thus, congenital heart disease in adults has emerged as a special cardiologic interest. Despite this large group of patients, few centers are equipped to treat them, and most cardiologists know little about these patients and their specific problems. Dr. Perloff is one of the pioneers in this area. His center at the University of California, Los Angeles has fostered a collaborative effort among pediatric and adult cardiologists as well as among cardiac surgeons, nurses, radiologists, and obstetricians. With his colleague Dr. Child, Dr. Perloff has written this 342-page textbook with the following objective: "to excite the interest of a broad range of health professionals-from the neophyte to the expert." The book is almost entirely an effort ofthe University of California, Los Angeles. Dr. Perloff, coauthor of 17 of the 20 chapters, wrote the final version of each chapter; thus, the text resembles a singleauthored book. The 20 chapters are divided into 5 sections. The first section addresses historical perspectives and available special facilities at the University of California, Los Angeles. The second section deals with survival patterns, both natural and
BOOK REVIEWS
505
postoperative. The third section focuses on medical treatments in operative and nonoperative patients and discusses pregnancy, hematologic management, exercise, employability, and insurability. The fourth section reviews surgical considerations, risks of operation and reoperation, prosthetic materials, interventional cardiac catheterization, and noncardiac surgical procedures. The final section covers postoperative residua and sequelae. This book differs from Dr. Perloff's classic textbook, The Clinical Recognition ofCongenital Heart Disease, because it is not organized by anatomic diagnosis. For example, congenitally corrected transposition of the great arteries is referenced in 10 sections, including surgical treatment, survival patterns, electrophysiologic abnormalities, and exercise. Consequently, for readers who want to review the anatomic features, hemodynamics, and management of a patient with such a diagnosis, this text is not an easy-to-use reference source. Nonetheless, these broad sections result in good general reading and contain a vast amount of useful and extremely well-written information. The illustrations, especially the roentgenograms, angiograms, and morphologic pictures, are of excellent quality. This book will undoubtedly improve the understanding of congenital heart disease in adult patients and might motivate some physicians to assist in the care of this important and growing group of patients. Carole A. Warnes, M.D. Division of Cardiology and Internal Medicine
Surviving With AIDS: A Comprehensive Program of Nutritional Co- Therapy, by C. Wayne Callaway (with Catherine Whitney), 192 pp, with illus, $14.95, Boston, Little, Brown and Company, 1991 The following statement is made in the introduction of this text on acquired immunodeficiency syndrome (AIDS): "This book is not about curing AIDS or any direct way about treating the virus. Rather, it is designed as a co-therapy, a nutritional approach that addresses the most debilitating aspect of the disease-the chronic malnutrition that, more than anything else, affects the quality oflife ofPWAs (person with AIDS)." That this publication is designed to present information on nutrition as co-therapy needs to be emphasized. The author's intent is that it should be used hand in hand with established medical treatments. To this end, the text, which consists of 10 chapters plus appendixes (192 pages), ably addresses malnutrition that contributes to the estimated 60 to 80% of deaths from AIDS. It is written for persons with AIDS and their families to help them understand the mechanisms of nutritional problems.
BOOK REVIEWS
Keining and Braun-Falco in 1960. Three editions later in 1984, a Mayo Clinic dermatologist, Richard Winkelmann, joined Braun-Falco and coauthors. The current "four horsemen" have now brought to the English-speaking world a matchless "400-horsepower" text. It has rapidly become the most wanted, most admired, and most consulted book in my extensive library of textbooks on dermatology. In a single day, I have used it to show an internist the best illustrations of Mees' lines associated with arsenic poisoning, to review the treatment of erythrokeratodermia variabilis, and to learn for the first time of paroxysmal hematomas of the fingers. A book like this is published only once in a generation. It should be not only reviewed but also bought, used, and enjoyed.
Mayo Clin Proc, May 1992, Vol 67
The chapter on the pathogenesis of autoimmune chronic active hepatitis is particularly strong and, importantly, details the current animal models of autoimmune hepatitis as well as the immunologic aberrations in patients with this disease. The discussion of the pathogenesis of primary biliary cirrhosis is one ofthe few disappointments. The authors' narrow viewpoint is based on their own hypothesis that, as stated, is simply a summary of what is known and unknown. Nonetheless, the chapter is relatively complete in presenting the known facts about immunologic aberrations in patients with primary biliary cirrhosis. Three chapters focus on autoantibodies and autoimmune liver diseases. The information in each of these chapters is extensive, and each chapter is fairly well written. In particular, the tables in the chapter on autoantibodies and autoimmune chronic hepatitis provide an overview of this Walter B. Shelley, M.D., Ph.D. complex topic. The chapter on autoantibodies in primary biliary cirrhosis is superb; the discussion is thorough and well Division of Dermatology Medical College of Ohio supplemented with tables and illustrations. The authors Toledo, Ohio review the extensive available information on the relationship of immunologic and clinical heterogeneity. A summary of the important aspects of this chapter is included. The chapters that review the clinical aspects of autoimAutoimmune Liver Diseases, edited by Edward L. Krawitt mune liver diseases are well written, complete, and up-toand Russell H. Wiesner, 272 pp, with illus, $89, New York, date, especially the chapter on the clinical aspects of autoimmune chronic hepatitis. Dr. Czaja has done an excellent job Raven Press, 1991 of combining his own vast clinical experience with that of The expressed purpose of this book is to summarize the others to describe thoroughly the clinical manifestations and current knowledge of autoimmune liver diseases. During the response to treatment. My only recommendation for this past 10 years, this area of medicine has experienced numerous chapter would be to include information about the importance advances in the understanding of the pathogenesis and treat- of symptoms in determining what patients should and should ment of such diseases. In that regard, this text will be a timely not be treated. The chapter on primary biliary cirrhosis is addition to the libraries of practicing hepatologists and those predictable but extensive in discussing symptoms and laboratory manifestations; however, the important association of the persons interested in hepatic disease. The book is informally divided into three sections. The CREST syndrome (calcinosis cutis, Raynaud' s phenomenon, first section deals with the basic immunologic factors of esophageal dysfunction, sclerodactyly, and telangiectasia) autoimmunity and autoimmune liver diseases. The second and primary biliary cirrhosis is not included. In addition, the describes the pathogenesis of specific autoimmune liver dis- importance of natural history data in determining the timing of eases, and the final section discusses the clinical aspects. The liver transplantation seems to demand more information about text has 16 chapters, all of which are appropriately narrow in prognostic indicators. The chapter on primary sclerosing focus. Each chapter is written by an internationally known cholangitis is the weakest of the clinical chapters. It lacks a authority in the field. description of the radiographic findings in primary sclerosing The first chapter is on the concept of autoimmunity and cholangitis and only superficially discusses the endoscopic contains an excellent discussion of the current understanding and surgical therapy for this disease, which may be important of immunologic response and what goes awry in autoimmune at least from a historical perspective. The chapter on treatment diseases. Although this chapter is complete, I would have options for primary biliary cirrhosis is extremely well written preferred inclusion of an illustration that would enable readers and complete. It provides an important perspective on the to visualize the immune response clearly and that would also design of future studies. A table that compares the results of delineate what is known and unknown about T- and B-cell selected trials of the various agents that have been used for recognition of self and nonself. This chapter is an excellent primary biliary cirrhosis would have been helpful. The preface to the next several chapters that deal with the patho- material on the role of liver transplantation in the treatment of genesis of autoimmune chronic active hepatitis, primary bil- autoimmune liver disease is useful and comprehensive. The iary cirrhosis, and sclerosing cholangitis. authors effectively combined their experience at King's Col-
Mayo CUn Proc, May 1992, Vol 67
lege Hospital with the information available in the literature to provide an excellent review of the timing of liver transplantation as well as special problems that may develop after transplantation. The book concludes with three chapters on drug-induced chronic hepatitis, the immunologic manifestations of viral hepatitis, and the autoimmune manifestations of hepatic disease from alcoholism. Each of these chapters is well written, exhaustive, and valuable. Overall, this excellent book provides up-to-date information and perspectives on autoimmune liver diseases and is the best available text on this subject. I believe it will be an important reference source for all physicians, especially those involved in the care of patients with liver disease and those in liver research. The book is well indexed, and each chapter contains an extensive bibliography. Finally, I commend the editors for maintaining a consistently high standard; overlap and redundancy have been minimized in this publication. John R. Lake, M.D. Department of Medicine and Liver Transplant Service University of California, San Francisco San Francisco, California
Congenital Heart Disease in Adults, edited by Joseph K. Perloff and John S. Child, 342 pp, with illus, $75, Philadelphia, W. B. Saunders Company, 1991 During the past few decades, increasing numbers of children with congenital heart disease have lived to adulthood because of medical or surgical treatment; thus, congenital heart disease in adults has emerged as a special cardiologic interest. Despite this large group of patients, few centers are equipped to treat them, and most cardiologists know little about these patients and their specific problems. Dr. Perloff is one of the pioneers in this area. His center at the University of California, Los Angeles has fostered a collaborative effort among pediatric and adult cardiologists as well as among cardiac surgeons, nurses, radiologists, and obstetricians. With his colleague Dr. Child, Dr. Perloff has written this 342-page textbook with the following objective: "to excite the interest of a broad range of health professionals-from the neophyte to the expert." The book is almost entirely an effort ofthe University of California, Los Angeles. Dr. Perloff, coauthor of 17 of the 20 chapters, wrote the final version of each chapter; thus, the text resembles a singleauthored book. The 20 chapters are divided into 5 sections. The first section addresses historical perspectives and available special facilities at the University of California, Los Angeles. The second section deals with survival patterns, both natural and
BOOK REVIEWS
505
postoperative. The third section focuses on medical treatments in operative and nonoperative patients and discusses pregnancy, hematologic management, exercise, employability, and insurability. The fourth section reviews surgical considerations, risks of operation and reoperation, prosthetic materials, interventional cardiac catheterization, and noncardiac surgical procedures. The final section covers postoperative residua and sequelae. This book differs from Dr. Perloff's classic textbook, The Clinical Recognition ofCongenital Heart Disease, because it is not organized by anatomic diagnosis. For example, congenitally corrected transposition of the great arteries is referenced in 10 sections, including surgical treatment, survival patterns, electrophysiologic abnormalities, and exercise. Consequently, for readers who want to review the anatomic features, hemodynamics, and management of a patient with such a diagnosis, this text is not an easy-to-use reference source. Nonetheless, these broad sections result in good general reading and contain a vast amount of useful and extremely well-written information. The illustrations, especially the roentgenograms, angiograms, and morphologic pictures, are of excellent quality. This book will undoubtedly improve the understanding of congenital heart disease in adult patients and might motivate some physicians to assist in the care of this important and growing group of patients. Carole A. Warnes, M.D. Division of Cardiology and Internal Medicine
Surviving With AIDS: A Comprehensive Program of Nutritional Co- Therapy, by C. Wayne Callaway (with Catherine Whitney), 192 pp, with illus, $14.95, Boston, Little, Brown and Company, 1991 The following statement is made in the introduction of this text on acquired immunodeficiency syndrome (AIDS): "This book is not about curing AIDS or any direct way about treating the virus. Rather, it is designed as a co-therapy, a nutritional approach that addresses the most debilitating aspect of the disease-the chronic malnutrition that, more than anything else, affects the quality oflife ofPWAs (person with AIDS)." That this publication is designed to present information on nutrition as co-therapy needs to be emphasized. The author's intent is that it should be used hand in hand with established medical treatments. To this end, the text, which consists of 10 chapters plus appendixes (192 pages), ably addresses malnutrition that contributes to the estimated 60 to 80% of deaths from AIDS. It is written for persons with AIDS and their families to help them understand the mechanisms of nutritional problems.