- Email: [email protected]
Computer tomography of the gastrointestinal tract
2048 BOOK REVIEWS
study of gastric and smal1 intestinal motility and this volume, based on over 800 manometric studies carried on there over the last 5 yr in patients and in healthy volunteers, admirably fulfills its purpose “to produce a diagnostic manual to help both the uninitiated and the experienced manometrist in performing gastrointestinal manometry and interpreting the results.” The normal and abnormal manometric patterns presented, together with their careful interpretations and clinical correlations, constitute the matrix of the book. After a consideration of the physiologic basis of gastric and smal1 intestinal motility disorders and a careful review of the literature, the authors take up in a nuts and bolts chapter how to go about performing gastrointestinal manometry. There follow chapters on normal manometric patterns and on a systematic approach to analyzing manometric tracings. The remainder of the book is devoted to the presentation and interpretation of individual manometric patterns derived from patients with a broad spectrum of gastric or smal1 intestinal motility disorders, or both. This wel1 thought out and designed volume represents the state of the art in an area that almost certainly wil1 become clinically much more important in the next few years. Its price is reasonable. Its appeal wil1 be primarily to those with an interest in basic gastrointestinal tract motility who are already experienced in esophageal manometry.
GASTROENTEROLOGYVol. 92, No. 6
quencies of enteric pathogens in humans and animals with diarrheal disease. Rotavirus is repeatedly documented as the most common pathogen in infantile diarrhea. The infectieus problems of newborn calves and piglets are stressed because of their importante to the economy of developing countries and their utility in studying mechanisms of diarrhea, improving diagnostic tools for identifying pathogens, and initiating preventive (vaccine) trials. In addition to the epidemiologic and microbiologie aspects described above, there are extensive reviews concerning mechanisms of diarrhea, molecular approaches to diagnosis, gut immunology, and prevention of diarrheal disease. The potential use of the attenuated strain of Salmonella typhi (Ty2la) that invades the mucosa to stimulate local antibody production without causing clinical disease is of particular interest, as plasmids of Shigella sonnei and Flexneri may be transferred to it resulting in host protection against these organisms. The information is consistently presented in depth and wil1 be of interest to physicians seeklng an unusually broad discussion of infectieus diarrhea. Tables are used liberally to summarize the data provided. This up-to-date review of the worldwide problem of diarrheal disease, newer diagnostic methods, and vaccine development was extremely interesting to this reviewer. This book should be a part of medical school libraries for students, housestaff, and faculty.
PAUL MANDELSTAM
BARBARA S. KIRSCHNER, M.D.
Lexington, Kentucky
Chicago, Illinois
Infectieus Diarrhoea in the Young: Strategies for Control in Humans and Animals. Edited by S. Tzipori. 514 pp., $123.00. Elsevier Science Publishers B.V., Amsterdam, The Netherlands, 1985. IBSN 0-444-80-720-9.
Computer Tomography of the Gastrointestinal Tract. Edited by Alec J. Megibow and Emil J. Balthazar. 464 pp., 672 figures, $67.50. The C.V. Mosby Company, St. Louis, Missouri, 1986.ISBN 0-8016-3376-1.
An International Seminar on Diarrhoeal Disease in South East Asia and the Western Pacific Region was held in Geelong, Australia in February 1985.This publication is a compilation of papers presented at that meeting. The importante of infant diarrhea is established by citing that approximately one billion episodes of diarrhea occur annually in children <5 yr of age, which contribute to almost 5 million deaths, most secondary to dehydration. The recent effectiveness of ORT (oral rehydration therapy) in decreasing hospitalization and death by 50% is documented. The range of topics covered is extensive and discussed in depth, The important relationship between diarrhea and malnutrition is emphasized in several reports. For example, undernutrition was observed in 30%--50~h of children wjth diarrhea in Indonesia. In New Guinea, the lower prevalente of malnutrition in breast-fed infants with diarrhea (26%) compared with 69% in artificially fed infants resulted in the Baby Food Supplies Act (1977) which permits commercial formulas by prescription only from registsred health workers. In addition to supporting breast feedipg, the necessity of programs that improve water sanit&on and personal hygiene are emphasized. Participants included both medical and veterinary scientists. Much data is provided regarding the relative fre-
When this book arrived on my desk, 1 selected it to review myself because 1 have been convinced that barium radiology was about ready to be outmoded by computer tomography and that we gastroenterologists had to prepare ourselves to grasp what goes on in a film made by CT as readily as we do films made in more familiar ways. Maintaining that “pattern recognition” is what counts for a clinician, 1 try to get those who work with me to learn to walk rapidly by a viewbox and find the pathology at a glance. It obviously takes hard work to whip the neurobiologic network into shape. In any event, 1 thought that this new book would be my chance to get myself to be able to read gut CT on my own. Alas, it did not prepare me for that adventure, which mdy be my fault, although this review wil1 suggest that it is the authors’. A major reason for my failure is a regrettable lack of diagrammatic cross-sections of the gut and what 1 can only take to be a contemptuous neglect to put arrows in many of the illustrations, notably those of the stomach and duodenum. A book like this, replete with pictures, which purports to be for “the student in radiology. . . . the clinic genera1 practiradjologist, and . . . the gastroenterologist, tioner and genera1 surgeon” should have aimed at that audience. We stil1 need diagrams and arrows, not just pictures. If we grasped the pictures, we would be bored by
BOOKREVIEWS
June 1987
the book. Instead, 1 think the material in this volume wil1 prove niore useful for the person who is already an expert in computer tomography, but it would not be a book that 1 can advise most of the readers of GASTROENTEROLOGY to buy. That is not to say that once you have mastered the field, you wil1 not enjoy looking at the pictures in this book and testing yourself against the experts. That also is not to say that there are not many valuable comparisons between barium studies and CT studies, but the book is not the vade mecum that 1 had anticipated. 1 should point out, however, that the section on the colon notably and that on the smal1 intestine to a somewhat lesser extent, do provide the requisite arrows and that there is a fine, but too brief chapter of 30 pages giving radiologie-pathologie correlations. 1 was less interested in the text than in the pictures, but 1 am sure that someone interested in doing CT wil1 probably find the techniques in the discussion useful. 1 found that a little boring. Al1 in all, the reader wil1 gather that the high expectations with which 1 approached this book were disappointed. 1 may be too harsh, but 1 hope that in a second edition the authors wil1 provide careful cross-sectional diagrams of what they are showing, and wil1 sit down with a clinical GI fellow (if any stil1 exist a few years from now) to ask him or her to teil, them what needs to be labeled. Then they wil1 provide the book worthy of their consummate clinical skills and diagnostic acumen. HOWARD SPIRO, M.D. New
Haven. Connecticut
Digestion and the Structtire and Function of the Gut. Karger Continuing Education Series-Volume 8. By D. F. McGee, et al. 360 pp., 124 figures, 8 tables, $63.00. S. Karger AG, Basel, Switzerland, 1986. ISBN 3-8055-4204-6. 1 gave this book to a physiologically minded colleague and when he had not reviewed it 6 months later, 1 asked him to review or return it. The book arrived back on my desk with a terse “sorry.” 1 recount this not to malign my colleague so much as to h8pe that he had the same reservations that 1 had about what could be a fine and mature view of physiology, but which instead is probably too nostalgie a view of physiology as it was in the 1950s and 60s. The publishers have a good idea, to provide in one volume “compact instructive texts . . as convenient teaching and training tools.” The authors sound like my kind of people: they want’ to look at the process of digestion in animals and in humans from the standpoint of the whole animal, deemphasizing function at cellular and
2049
subcellular levels and emphasizing the variables of digestion. “We look askance at interpretations of activities elicited from isolated preparations in response only to astronomical concentrations of drugs or homones,” they write in their introduction. They recognize the fads and fashions of physiology and their wise comments in their introduction about physiologists can be extrapolated to most of US clinicians: in pursuing a phenomenon we choose the object in which it is seen best and then generalize to things in general. The book begins very well, indeed, for someone like me who learned his physiology in the 1940s and who tries to keep up, but despairs at how much more than 1 each new crop of medical students knows. But to discount the new, you must first know it, even if you believe, as the authors (and 1) do, that much that was known and studied in Europe in the hundred years preceding the Nazi depredations has been forgotten. You really cannot ignore what has happened over the past 20 years. That is what 1 think is wrong with this book. For the authors the studies that are the most alive for them are those of the 1950s. To be sure, they provide many references from the 1970s and even 1980s in some of the chapters (notably that of the esophagus), but the chapter on gastric motility, for example, does not even mention modern studies of gastric emptying, by radionuclide methods, for good or for bad. That certainly is something that anyone interested ifi the whole animal would have to know about in the 1980s. 1 wanted to like this book because there is so much to like about the approach that these distinguished investigators take. Each must be the characteristic wise man, but as a whole their book fails. 1 found lots of references to “the greatest nían who ever lived,” Walter C. Alvarez; but when 1 looked at the references for somatostatin, alas, 1 came up empty-handed, and the encephalins and endorphins are covered in seven lines. 1 would have wanted to have some notion of what these authors really think about such matters. Their comments on page 203 describe what they should have done: “It wil1 clearly require some Herculean intellectual and organizational effort before the disparate work of the polypeptide specialists, the microelectrical people and the pharmacologists can offer a coherent explanation for the physiological activity of the gut so beautifully observed and described by the early observers.” They could have begun the task. The view from the present into the past is a blurred one and 1 am sorry that the authors did not live up to their original intent. 1 hope that in another edition they wil1 give US the spectacular long view that we clinicians crave. HOWARD SPIRO, M.D. New
Haven,
Connecticut
study of gastric and smal1 intestinal motility and this volume, based on over 800 manometric studies carried on there over the last 5 yr in patients and in healthy volunteers, admirably fulfills its purpose “to produce a diagnostic manual to help both the uninitiated and the experienced manometrist in performing gastrointestinal manometry and interpreting the results.” The normal and abnormal manometric patterns presented, together with their careful interpretations and clinical correlations, constitute the matrix of the book. After a consideration of the physiologic basis of gastric and smal1 intestinal motility disorders and a careful review of the literature, the authors take up in a nuts and bolts chapter how to go about performing gastrointestinal manometry. There follow chapters on normal manometric patterns and on a systematic approach to analyzing manometric tracings. The remainder of the book is devoted to the presentation and interpretation of individual manometric patterns derived from patients with a broad spectrum of gastric or smal1 intestinal motility disorders, or both. This wel1 thought out and designed volume represents the state of the art in an area that almost certainly wil1 become clinically much more important in the next few years. Its price is reasonable. Its appeal wil1 be primarily to those with an interest in basic gastrointestinal tract motility who are already experienced in esophageal manometry.
GASTROENTEROLOGYVol. 92, No. 6
quencies of enteric pathogens in humans and animals with diarrheal disease. Rotavirus is repeatedly documented as the most common pathogen in infantile diarrhea. The infectieus problems of newborn calves and piglets are stressed because of their importante to the economy of developing countries and their utility in studying mechanisms of diarrhea, improving diagnostic tools for identifying pathogens, and initiating preventive (vaccine) trials. In addition to the epidemiologic and microbiologie aspects described above, there are extensive reviews concerning mechanisms of diarrhea, molecular approaches to diagnosis, gut immunology, and prevention of diarrheal disease. The potential use of the attenuated strain of Salmonella typhi (Ty2la) that invades the mucosa to stimulate local antibody production without causing clinical disease is of particular interest, as plasmids of Shigella sonnei and Flexneri may be transferred to it resulting in host protection against these organisms. The information is consistently presented in depth and wil1 be of interest to physicians seeklng an unusually broad discussion of infectieus diarrhea. Tables are used liberally to summarize the data provided. This up-to-date review of the worldwide problem of diarrheal disease, newer diagnostic methods, and vaccine development was extremely interesting to this reviewer. This book should be a part of medical school libraries for students, housestaff, and faculty.
PAUL MANDELSTAM
BARBARA S. KIRSCHNER, M.D.
Lexington, Kentucky
Chicago, Illinois
Infectieus Diarrhoea in the Young: Strategies for Control in Humans and Animals. Edited by S. Tzipori. 514 pp., $123.00. Elsevier Science Publishers B.V., Amsterdam, The Netherlands, 1985. IBSN 0-444-80-720-9.
Computer Tomography of the Gastrointestinal Tract. Edited by Alec J. Megibow and Emil J. Balthazar. 464 pp., 672 figures, $67.50. The C.V. Mosby Company, St. Louis, Missouri, 1986.ISBN 0-8016-3376-1.
An International Seminar on Diarrhoeal Disease in South East Asia and the Western Pacific Region was held in Geelong, Australia in February 1985.This publication is a compilation of papers presented at that meeting. The importante of infant diarrhea is established by citing that approximately one billion episodes of diarrhea occur annually in children <5 yr of age, which contribute to almost 5 million deaths, most secondary to dehydration. The recent effectiveness of ORT (oral rehydration therapy) in decreasing hospitalization and death by 50% is documented. The range of topics covered is extensive and discussed in depth, The important relationship between diarrhea and malnutrition is emphasized in several reports. For example, undernutrition was observed in 30%--50~h of children wjth diarrhea in Indonesia. In New Guinea, the lower prevalente of malnutrition in breast-fed infants with diarrhea (26%) compared with 69% in artificially fed infants resulted in the Baby Food Supplies Act (1977) which permits commercial formulas by prescription only from registsred health workers. In addition to supporting breast feedipg, the necessity of programs that improve water sanit&on and personal hygiene are emphasized. Participants included both medical and veterinary scientists. Much data is provided regarding the relative fre-
When this book arrived on my desk, 1 selected it to review myself because 1 have been convinced that barium radiology was about ready to be outmoded by computer tomography and that we gastroenterologists had to prepare ourselves to grasp what goes on in a film made by CT as readily as we do films made in more familiar ways. Maintaining that “pattern recognition” is what counts for a clinician, 1 try to get those who work with me to learn to walk rapidly by a viewbox and find the pathology at a glance. It obviously takes hard work to whip the neurobiologic network into shape. In any event, 1 thought that this new book would be my chance to get myself to be able to read gut CT on my own. Alas, it did not prepare me for that adventure, which mdy be my fault, although this review wil1 suggest that it is the authors’. A major reason for my failure is a regrettable lack of diagrammatic cross-sections of the gut and what 1 can only take to be a contemptuous neglect to put arrows in many of the illustrations, notably those of the stomach and duodenum. A book like this, replete with pictures, which purports to be for “the student in radiology. . . . the clinic genera1 practiradjologist, and . . . the gastroenterologist, tioner and genera1 surgeon” should have aimed at that audience. We stil1 need diagrams and arrows, not just pictures. If we grasped the pictures, we would be bored by
BOOKREVIEWS
June 1987
the book. Instead, 1 think the material in this volume wil1 prove niore useful for the person who is already an expert in computer tomography, but it would not be a book that 1 can advise most of the readers of GASTROENTEROLOGY to buy. That is not to say that once you have mastered the field, you wil1 not enjoy looking at the pictures in this book and testing yourself against the experts. That also is not to say that there are not many valuable comparisons between barium studies and CT studies, but the book is not the vade mecum that 1 had anticipated. 1 should point out, however, that the section on the colon notably and that on the smal1 intestine to a somewhat lesser extent, do provide the requisite arrows and that there is a fine, but too brief chapter of 30 pages giving radiologie-pathologie correlations. 1 was less interested in the text than in the pictures, but 1 am sure that someone interested in doing CT wil1 probably find the techniques in the discussion useful. 1 found that a little boring. Al1 in all, the reader wil1 gather that the high expectations with which 1 approached this book were disappointed. 1 may be too harsh, but 1 hope that in a second edition the authors wil1 provide careful cross-sectional diagrams of what they are showing, and wil1 sit down with a clinical GI fellow (if any stil1 exist a few years from now) to ask him or her to teil, them what needs to be labeled. Then they wil1 provide the book worthy of their consummate clinical skills and diagnostic acumen. HOWARD SPIRO, M.D. New
Haven. Connecticut
Digestion and the Structtire and Function of the Gut. Karger Continuing Education Series-Volume 8. By D. F. McGee, et al. 360 pp., 124 figures, 8 tables, $63.00. S. Karger AG, Basel, Switzerland, 1986. ISBN 3-8055-4204-6. 1 gave this book to a physiologically minded colleague and when he had not reviewed it 6 months later, 1 asked him to review or return it. The book arrived back on my desk with a terse “sorry.” 1 recount this not to malign my colleague so much as to h8pe that he had the same reservations that 1 had about what could be a fine and mature view of physiology, but which instead is probably too nostalgie a view of physiology as it was in the 1950s and 60s. The publishers have a good idea, to provide in one volume “compact instructive texts . . as convenient teaching and training tools.” The authors sound like my kind of people: they want’ to look at the process of digestion in animals and in humans from the standpoint of the whole animal, deemphasizing function at cellular and
2049
subcellular levels and emphasizing the variables of digestion. “We look askance at interpretations of activities elicited from isolated preparations in response only to astronomical concentrations of drugs or homones,” they write in their introduction. They recognize the fads and fashions of physiology and their wise comments in their introduction about physiologists can be extrapolated to most of US clinicians: in pursuing a phenomenon we choose the object in which it is seen best and then generalize to things in general. The book begins very well, indeed, for someone like me who learned his physiology in the 1940s and who tries to keep up, but despairs at how much more than 1 each new crop of medical students knows. But to discount the new, you must first know it, even if you believe, as the authors (and 1) do, that much that was known and studied in Europe in the hundred years preceding the Nazi depredations has been forgotten. You really cannot ignore what has happened over the past 20 years. That is what 1 think is wrong with this book. For the authors the studies that are the most alive for them are those of the 1950s. To be sure, they provide many references from the 1970s and even 1980s in some of the chapters (notably that of the esophagus), but the chapter on gastric motility, for example, does not even mention modern studies of gastric emptying, by radionuclide methods, for good or for bad. That certainly is something that anyone interested ifi the whole animal would have to know about in the 1980s. 1 wanted to like this book because there is so much to like about the approach that these distinguished investigators take. Each must be the characteristic wise man, but as a whole their book fails. 1 found lots of references to “the greatest nían who ever lived,” Walter C. Alvarez; but when 1 looked at the references for somatostatin, alas, 1 came up empty-handed, and the encephalins and endorphins are covered in seven lines. 1 would have wanted to have some notion of what these authors really think about such matters. Their comments on page 203 describe what they should have done: “It wil1 clearly require some Herculean intellectual and organizational effort before the disparate work of the polypeptide specialists, the microelectrical people and the pharmacologists can offer a coherent explanation for the physiological activity of the gut so beautifully observed and described by the early observers.” They could have begun the task. The view from the present into the past is a blurred one and 1 am sorry that the authors did not live up to their original intent. 1 hope that in another edition they wil1 give US the spectacular long view that we clinicians crave. HOWARD SPIRO, M.D. New
Haven,
Connecticut