Clinical Nutrition: Parenteral Nutrition. Second Edition

the slides are attractive and of high technical quality. Forty-nine single-spaced accompanying pages provide a brief explanation of each slide alongside a black and white copy of the slide. The explanatory notes are supported by 133 up-to-date references. The subject matter of the slides is very comprehensive, covering (1) macroscopic and microscopic anatomy ofthe biliary tree, (2) composition of bile including lipids, electrolytes, and proteins, (3) physiology of bile formation and secretion of lipid and electrolytes, and (4) gallbladder physiology including motor function as well as epithelial transport functions. Appropriately, there is very little clinical information included on the slides. Many concepts are conveyed using more than one slide, often one slide with a word chart and another with a schematic picture or diagram. Although the slides are clear and easy for the eye to follow, they are densely packed with information. Many use detailed diagrams together with verbal information to summarize the complex concepts involved. Most of the slides would require relatively long explanations during a lecture. Presentation of all the slides with appropriate explanations would consume perhaps 3 to 4 hours of lecture time. One's overall sense in reviewing these slides is that they were assembled with a sophisticated fundamental understanding of the subject matter. The authors present a comprehensive, erudite, and detailed account of our current understanding of biliary physiology. Indeed, the slide collection as a whole is probably too much for any but the most precocious medical student. Nevertheless, one could certainly put together an excellent student lecture by selecting 20 or 30 slides. Lectures prepared using the entire slide set would be most appropriate for fellows in gastroenterology preparing either for a career in academics or board examinations. William C. Duane, MD Minneapolis, Minnesota

Clinical Nutrition: Parenteral Nutrition. Second Edition by J. L. Rombeau, M. D. Caldwell W.B. Saunders Co., Philadelphia, 1993, 920 pp., $105.00

Often by default, gastroenterologists with variable degrees of training are called on to treat patients with complex nutritional problems. This makes a comprehensive text necessary. This new edition is extensively revised with new senior authors and meets its major goal "to provide the highest quality clinical and research information concerning parenteral nutrition." Eight new chapters have been added and several outdated topics have been eliminated. The general format, with 140 additional pages, remains similar and is very readable. 90

GASTROINTESTINAL ENDOSCOPY

This book blends the topics with enough basic science background and practical clinical application to be a valued reference. The first eight chapters lay a strong theoretic foundation for the provision of parenteral nutrition. Fluids and electrolytes are thoroughly reviewed. The requirements for vitamins and trace elements are discussed. Appropriately short new chapters introduce the concepts of molecular biology, specific fuels, and the role of growth factors in nutrition support. A new chapter on metabolic assessment falls short when discussing the use of indirect calorimetry in determining a patient's caloric requirements. A chapter on measurement of energy expenditure has been deleted from this edition and, with the wider availability of metabolic carts for indirect calorimetry, represents one of the few shortcomings in this book. Chapters 13 through 20 provide a state-of-the-art approach to nutrition support teams, catheter access and care, complications, parenteral solutions and equipment, and computers in nutrition research and patient care. Cost-effectiveness is also addressed in a revised chapter. The remaining 23 chapters deal with specific diseases and the use of parenteral nutrition. These chapters are concise, well written, and extensively referenced. They have been updated and revised since the last edition. Noteworthy is the welcome addition of chapters on acquired immunodeficiency syndrome and ethical dilemmas in parenteral nutrition therapy. The deletion of the chapter on anorexia nervosa and lack of coverage of the role of parenteral nutrition in eating disorders are omissions that should be reconsidered for the next edition. The text, tables, and photographs are of higher quality than in the first edition. Cost is always an important consideration, and at $105 this book is appropriately priced. Two other books should be mentioned for comparison. Total Parenteral Nutrition, edited by Fischer, is more a "how to" book with fewer pages and references. It was published in 1991 and now costs $85. Parenteral and Enteral Nutrition is a single author work by Silberman. This book is quite readable and covers both enteral and parenteral nutrition fairly well. If it were not for its 1989 publication date in such an evolving field, I would recommend it more highly, and its $75 price makes it a relative bargain. In summary, for those clinicians who require a resource text for parenteral nutrition, this is the best choice. Like a fine wine that has improved with age, aggressive editing skills have polished this text. It is strongly recommended for those clinicians treating patients with nutrition-related problems and should be in the libraries of all gastroenterology training programs. Donald F. Kirby, MD Richmond, Virginia

VOLUME 41, NO.1, 1995