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Contemporary geriatric medicine. Volume 2
834
GASTKOENTEROLOGY Vol. 92, No. 3
BOOK REVIEWS
Kupffer Cell Foundation, P.O. Box 5815, 2280 HV Rijswijk, The Netherlands, 1986. ISBN 90-800079-l-9.
enterologist. It would medical libraries.
provide
a useful
reference
for larger
JAMES M. ANDERSON. M.D.. Ph.D.
In September 1985 the Third International Kupffer Cell Symposium was held in Strasbourg, France. The organizers, A Kirn, D. L. Knook, and E. Wisse, assembled 187 participants from 22 different countries representing a wide range of current research interests in the nonparenchymal cells of the liver. This book dutifully presents both the great variety and slightly overwhelming aspect of this type of meeting by presenting 132 papers and posters by 357 authors, all in 532 pages. Although wellbound and printed on excellent paper, the text appears unedited and manuscripts are printed in the typeset offered by the individual contributors. A significant portion of the papers are devoted to current topics in Kupffer cell origin, immunology, cell biology, and arachidonoid metabolism. Of special interest are papers providing evidence for local proliferation of the liver’s resident macrophage during liver regeneration and inflammation, a scheme opposed to the past dogma of replacement by monocytes. A fundamental technical theme common to most of the papers is that the nonparenchymal cell types can be isolated and characterized, often in prolonged culture, free of the overwhelming number of hepatocytes in the intact liver. Studies of the other nonparenchymal cells are represented as well, with some of the major topics involving the other immunocompetent cells (B, T, and natural killer cells), and cooperation between hepatocytes and Ito cells in retinoid uptake and metabolism. Numerous electron microscopic studies offer evidence for the fascinating possibility that endothelial cell fenestrations are a potentially regulated size barrier between plasma and the sinusoidal space. A particularly useful discussion is offered by K. Aterman (University of New Brunswick) on the nonmenclature of the parasinusoidal cells. He points out the great confusion in naming the extravascular cells of the Disse space by reference to only limited aspects of their structure or function. For example, we may be describing related cells as stellate cells, Kupffer stellate cells, fatstoring cells, fat-storing cells of Ito, Ito cells, retinoidcontaining cells, or contractile cells. He suggests we refer to them with the noncommital term parasinusoidal cells, appending qualifying terms like connective tissueproducing or fat-storing until we more thoroughly have defined their morphology and functions. Who should buy or read this book? The quality of work presented is good and does offer a collage of the present research techniques and concerns in sinusoidal cell biology and pathology. However, most papers are 1.5-3 pages long and as such cannot be critically reviewed for their scientific merit. All data would be more fairly reviewed elsewhere in the context of the author’s full-length publications. There is no effort at unifying or explaining the themes common to groups of related papers, and short overviews or introductory papers would have been much appreciated. For these reasons this book will be of little value to those not directly involved in related research, and I would see no value at all for the practicing gastro-
New Haven,
Connecticut
Contemporary Geriatric Medicine. Volume 2. Edited by Steven R. Gambert. 537 pp., $49.50. Plenum Medical Book Co., New York, New York 1986. ISBN o-306-42055-4. In the preface, the editor promises this volume to be the second in a series of “easy-to read essays . . designed to keep the nongeriatrician abreast of the current state of the art.” In the chapter on gastrointestinal disorders by Dr. Thomas W. Sheehy (96 pp), an attempt is made to emphasize the organic disorders that afflict the aged digestive tract, rather than to catalogue our advances in understanding the physiology and pathophysiology of senescence. This emphasis is unfortunate because it is in such investigation that the current state of this field will be defined best. Moreover, throughout the chapter, there is not a sufficiently pure focus on digestive disorders and their treatment as they occur in the elderly; middle age continually creeps in. Thus, for example, in the section on esophageal dysphagia, diffuse esophageal spasm and achalasia are the only disorders described. Although neither are particularly considered disorders of the elderly, it would have been of importance to stress the differentiation of the former from cardiac angina and the latter from gastroesophageal carcinoma, i.e., secondary achalasia. The organization is puzzling: a section of the esophagus/ stomach is followed by one on the hepatobiliary tract/pancreas, which in turn is followed by a section on the colon, and thence to gastrointestinal bleeding and cancer. Illustrations are sparse and of poor quality, adding little for the reader. The writing style is easy to read, although in his praiseworthy attempt to be brief and compress the entire field of gerogastroenterology into less than 100 pages, Dr. Sheehy was trapped into making superficial generalizations that do not stand scrutiny. An example, in the section on cricopharyngeal achalasia and myotomy, is the following statement “Formerly, a Zenker’s diverticulum had to be removed surgically. This is no longer necessary. Even in the advanced stage, older patients with severe obstruction respond to myotomy alone.” Woe to the gastroenterologist who assures his patient with a large Zenker’s diverticulum that symptomatic relief will follow cricopharyngeal myotomy! The text seems to be targeted for the average housestaff officer or generalist who in one sitting wishes to peruse the digestive disorders his patients are susceptible to. It is of no value to the consultative gastroenterologist. LAWRENCE J. BRANDT, M.D
Bronx,
New York
Clinical Nutrition. Volume II: Total Parenteral Nutrition. Edited by J. L. Rombeau and M. D. Caldwell. 768 pp., $60.00. W. B. Saunders Co., Philadelphia, Pennsylvania, 1985. ISBNiISSN 7645-6.
GASTKOENTEROLOGY Vol. 92, No. 3
BOOK REVIEWS
Kupffer Cell Foundation, P.O. Box 5815, 2280 HV Rijswijk, The Netherlands, 1986. ISBN 90-800079-l-9.
enterologist. It would medical libraries.
provide
a useful
reference
for larger
JAMES M. ANDERSON. M.D.. Ph.D.
In September 1985 the Third International Kupffer Cell Symposium was held in Strasbourg, France. The organizers, A Kirn, D. L. Knook, and E. Wisse, assembled 187 participants from 22 different countries representing a wide range of current research interests in the nonparenchymal cells of the liver. This book dutifully presents both the great variety and slightly overwhelming aspect of this type of meeting by presenting 132 papers and posters by 357 authors, all in 532 pages. Although wellbound and printed on excellent paper, the text appears unedited and manuscripts are printed in the typeset offered by the individual contributors. A significant portion of the papers are devoted to current topics in Kupffer cell origin, immunology, cell biology, and arachidonoid metabolism. Of special interest are papers providing evidence for local proliferation of the liver’s resident macrophage during liver regeneration and inflammation, a scheme opposed to the past dogma of replacement by monocytes. A fundamental technical theme common to most of the papers is that the nonparenchymal cell types can be isolated and characterized, often in prolonged culture, free of the overwhelming number of hepatocytes in the intact liver. Studies of the other nonparenchymal cells are represented as well, with some of the major topics involving the other immunocompetent cells (B, T, and natural killer cells), and cooperation between hepatocytes and Ito cells in retinoid uptake and metabolism. Numerous electron microscopic studies offer evidence for the fascinating possibility that endothelial cell fenestrations are a potentially regulated size barrier between plasma and the sinusoidal space. A particularly useful discussion is offered by K. Aterman (University of New Brunswick) on the nonmenclature of the parasinusoidal cells. He points out the great confusion in naming the extravascular cells of the Disse space by reference to only limited aspects of their structure or function. For example, we may be describing related cells as stellate cells, Kupffer stellate cells, fatstoring cells, fat-storing cells of Ito, Ito cells, retinoidcontaining cells, or contractile cells. He suggests we refer to them with the noncommital term parasinusoidal cells, appending qualifying terms like connective tissueproducing or fat-storing until we more thoroughly have defined their morphology and functions. Who should buy or read this book? The quality of work presented is good and does offer a collage of the present research techniques and concerns in sinusoidal cell biology and pathology. However, most papers are 1.5-3 pages long and as such cannot be critically reviewed for their scientific merit. All data would be more fairly reviewed elsewhere in the context of the author’s full-length publications. There is no effort at unifying or explaining the themes common to groups of related papers, and short overviews or introductory papers would have been much appreciated. For these reasons this book will be of little value to those not directly involved in related research, and I would see no value at all for the practicing gastro-
New Haven,
Connecticut
Contemporary Geriatric Medicine. Volume 2. Edited by Steven R. Gambert. 537 pp., $49.50. Plenum Medical Book Co., New York, New York 1986. ISBN o-306-42055-4. In the preface, the editor promises this volume to be the second in a series of “easy-to read essays . . designed to keep the nongeriatrician abreast of the current state of the art.” In the chapter on gastrointestinal disorders by Dr. Thomas W. Sheehy (96 pp), an attempt is made to emphasize the organic disorders that afflict the aged digestive tract, rather than to catalogue our advances in understanding the physiology and pathophysiology of senescence. This emphasis is unfortunate because it is in such investigation that the current state of this field will be defined best. Moreover, throughout the chapter, there is not a sufficiently pure focus on digestive disorders and their treatment as they occur in the elderly; middle age continually creeps in. Thus, for example, in the section on esophageal dysphagia, diffuse esophageal spasm and achalasia are the only disorders described. Although neither are particularly considered disorders of the elderly, it would have been of importance to stress the differentiation of the former from cardiac angina and the latter from gastroesophageal carcinoma, i.e., secondary achalasia. The organization is puzzling: a section of the esophagus/ stomach is followed by one on the hepatobiliary tract/pancreas, which in turn is followed by a section on the colon, and thence to gastrointestinal bleeding and cancer. Illustrations are sparse and of poor quality, adding little for the reader. The writing style is easy to read, although in his praiseworthy attempt to be brief and compress the entire field of gerogastroenterology into less than 100 pages, Dr. Sheehy was trapped into making superficial generalizations that do not stand scrutiny. An example, in the section on cricopharyngeal achalasia and myotomy, is the following statement “Formerly, a Zenker’s diverticulum had to be removed surgically. This is no longer necessary. Even in the advanced stage, older patients with severe obstruction respond to myotomy alone.” Woe to the gastroenterologist who assures his patient with a large Zenker’s diverticulum that symptomatic relief will follow cricopharyngeal myotomy! The text seems to be targeted for the average housestaff officer or generalist who in one sitting wishes to peruse the digestive disorders his patients are susceptible to. It is of no value to the consultative gastroenterologist. LAWRENCE J. BRANDT, M.D
Bronx,
New York
Clinical Nutrition. Volume II: Total Parenteral Nutrition. Edited by J. L. Rombeau and M. D. Caldwell. 768 pp., $60.00. W. B. Saunders Co., Philadelphia, Pennsylvania, 1985. ISBNiISSN 7645-6.