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Diagnostic imaging methods in hepatology
GASTROENTEROLOGY
BOOK
1985;89:1443-7
REVIEWS
Armand I.ittrnan. M.D. Book fh,iwv I:ditor
Veterans Administration Hines, Illinois Ii0141
Hosl)ital
Alcohol Related Diseases in Gastroenterology. By H.K. Seitz and B. Kommerell. 71 figures, 38 tables, 423 pp., $72.00. Springer-Verlag, New York, New York, 1985. Ranging from updated versions of multipublished reviews to critically analyzed state-of-the-art presentations, this book consists of 21 monographs by North American, European, and Japanese authors. Some chapters make this an exciting book to discover. A chapter by W.K. Lelbach on epidemiology of alcohol use and its GI complications adds to his well-known reviews on the liver a comparable analysis on pancreatib disease. A review of the toxicity of acetaldehyde (M. Salaspuro and K. Lindros) and a review of ethanol and fibrogenesis in the liver (E.G. Hahn and D. Schuppan) are extremely well done. Chapters on the cytoskeleton of hepatocytes and the interaction of ethanol (H. Denk), on the interaction of ethanol with xenobiotics (C. Sato, Y. Hasumura, and J. Takeuchi), and on ethanol and cancer (H.K. Seitz) are also critically and thoroughly done. The most provocative chapter to me was a speculative review of ethanol and biological membranes (T.F. Taraschi and E. Rubin) and the many implications of these studies. Other subjects covered in depth in reviews that are not widely available include ethanol interacting with lipids, porphyrins, intestinal morphology, and pancreatic secretion. Chapters on markers for alcoholism and treatment of alcoholic hepatitis seemed much more limited in scope than the titles would imply. At least 11 chapters are as good as anything in print, only two or three are poor, and about eight are updates of what the authors have published previously. The importance of alcoholism in producing disease makes this an excellent source for bringing oneself up to date with what is available. All chapters have an extensive bibliography, averaging over 100 papers emphasizing current material; anyone not working in these fields would be assisted by these fine reviews. The photomicrographs are clear and of reasonable size and there are many charts and line drawings. The index is excellent. The book is recommended for all gastrointestinal collections aimed at the general reader, for training programs in family and internal medicine and pathology, and as a source for up-to-date reading by the practicing physician. FRANK L. IB!ZR,M.1) Baltimore, Maryland Liver Biopsy Diagnosis and Reports: SNOMED Codes, ICDg-CM Codes, Nomenclature and Terminology. By J. Ludwig. 156 pp, $34.74. S. Karger AG, Basel, Switzerland and New York, New York, 1984. This-manual is intended to facilitate coding of the diagnosis of liver biopsy specimens. It furnishes a model for encoding liver biopsy reports with a synopsis of
frequently used SNOMED codes and definitions, excluding diseases of the gallbladder. As resources, the author used publications of
1444
BOOK
GASTROENTEROLOGY
REVIEWS
England (distributed in U.S. by Kluwer ers, Hingham, Massachusetts), 1984.
Academic
Publish-
A clear and concise overview of the many diagnostic imaging tests available for examination of the hepatobiliary tree is certainly appropriate, and this short book covers the entire armamentarium, including recent advances in nuclear medicine imaging and magnetic resonance imaging. The book is based on papers given at the Falk Symposium held in Basel, Switzerland in 1983 by authors with very different points of view, depending upon their training and expertise. There is no introduction to tell of the goals of this publication. It is rather a list of methods, each author putting forth the advantages and disadvantages of his own technique. There are, therefore, many controversies on the usefulness and accuracy of various methods. What is lacking is an overview chapter or a series of chapters in which the various imaging methods are weighed against each other. For example, the chapter on laparoscopy states that laparoscopy is indicated in the primary diagnosis of all chronic liver conditions and other conditions, such as the search for tumors and liver metastasis. On the other hand, the chapters on computed tomography [CT) and ultrasound, coupled with liver biopsy, all indicate that much less invasive techniques can provide all the information that might be gained by laparoscopy and even more (i.e., deeply seated tumors). The chapters on endoscopic retrograde cholangiopancreatography (ERCP), both diagnostic and therapeutic, are well balanced, although there is failure to mention when ERCP draining with endoprosthesis should be performed versus when PTC endoprosthesis placement should be utilized. Likewise, the chapter on PTC diagnostics with the use of ultrasound and therapeutics is well presented, but no clear mention is made of when the percutaneous approach should be used versus the endoscopic approach for drainage. The chapter on ultrasound in hepatic disease is perhaps dealt with too lightly, whereas much weight is given to endoscopic and operative cholangiography and computeraided ultrasonography. As put forth here, the case for cholecystography and intravenous cholangiography is too strong. Comparison of these techniques with ultrasound, while perhaps reflecting one author’s own experience, does not mirror the experience of others in the literature. And the statement “once a stone has been detected by ultrasonography, subsequent cholecystography will thus be inevitable anyway” is certainly overstating the case for cholecystography. The exalted role of intravenous cholangiography has a distinctly European flavor here. In the CT section, the scans are adequate but do not represent the high-resolution scans that are currently available. Thus the statement that extrahepatic bile ducts dilated to 1 cm can be seen in 25%-60% does not reflect current high-resolution CT imaging. The radionuclide section is strong and complete. On the other hand, the section on nuclear magnetic resonance is very weak. Both articles are incomplete, and the one on differential diagnosis of liver diseases presents very poor image quality. Statements made about spin echo detection of fatty liver and cirrhosis, even of quantitating cirrhosis,
Vol. 89, No. 6
have no documented background or data. In fact, erroneous statements are made about the magnetic resonance detection of hemochromatosis, which has a reduced Tl relaxation time rather than a prolonged Tl stated here. In general, the illustrations in this book are of uneven quality, too small, and with too much contrast. This book might be of use to general internists and surgeons who want to look up the various diagnostic tests, but it will not guide readers in the selection of which test to use. HENRY I. GOLDBERG. M.D.
San Francisco,
California
Cancer of the Esophagus. Levin. 288 pp., $34.50. Florida, 1985.
Edited by T. R. DeMeester and B. Grune & Stratton, Inc., Orlando,
Although the outlook for patients with cancer of the esophagus has always been bleak, a faint ray of hope is beginning to appear. Epidemiologic factors and cytologic markers have been defined that may help to identify cases earlier; multidisciplinary primary treatment with both initial radiation and chemotherapy may be enhancing curative management. It is timely, therefore, that current knowledge about this tumor be brought together in a single volume, and the editors have succeeded admirably. Authors from the United States, Canada, and Europe address every aspect of this problem in 14 chapters, which include discussions of epidemiology, anatomy, pathology, diagnosis, imaging, and both curative and palliative management. The strategies and tactics of endoscopy and surgery are presented in detail. Color photographs amplify discussions of endoscopic and cytologic features. The informative text is reinforced by figures and tables representing the authors’ own observations. Several topics are of particular current interest. Sections on the epidemiology, histopathology, and cytopathology of esophageal dysplasia are thoroughly developed. It appears that combined preoperative chemotherapy with multiple agents, including bleomycin and cisplatin, improves resectability rates and may improve cure rates: indeed, many patients given this treatment are without identifiable tumor at the time of an attempt at curative resection. An entire chapter is usefully devoted to nutritional therapy, which can be a factor in the safety of operative resection and may also prove to be a factor in the effectiveness of other treatment modalities. Additional areas of interest not readily available in the literature include experimental carcinogenesis in the esophagus, the details of staging, and palliative techniques of perbral dilatation. As one might expect in a volume with 22 authors, there is redundancy. Most of the duplication is useful educational reinforcement, but two chapters on nursing care seem to be one too many. Stapling techniques, which have become popular, are not discussed. But these are small matters. I have no doubt that adherence to the practices and principles set forth in this text can lead to an increase in the rate of cure for patients with cancer of the esophagus,
BOOK
1985;89:1443-7
REVIEWS
Armand I.ittrnan. M.D. Book fh,iwv I:ditor
Veterans Administration Hines, Illinois Ii0141
Hosl)ital
Alcohol Related Diseases in Gastroenterology. By H.K. Seitz and B. Kommerell. 71 figures, 38 tables, 423 pp., $72.00. Springer-Verlag, New York, New York, 1985. Ranging from updated versions of multipublished reviews to critically analyzed state-of-the-art presentations, this book consists of 21 monographs by North American, European, and Japanese authors. Some chapters make this an exciting book to discover. A chapter by W.K. Lelbach on epidemiology of alcohol use and its GI complications adds to his well-known reviews on the liver a comparable analysis on pancreatib disease. A review of the toxicity of acetaldehyde (M. Salaspuro and K. Lindros) and a review of ethanol and fibrogenesis in the liver (E.G. Hahn and D. Schuppan) are extremely well done. Chapters on the cytoskeleton of hepatocytes and the interaction of ethanol (H. Denk), on the interaction of ethanol with xenobiotics (C. Sato, Y. Hasumura, and J. Takeuchi), and on ethanol and cancer (H.K. Seitz) are also critically and thoroughly done. The most provocative chapter to me was a speculative review of ethanol and biological membranes (T.F. Taraschi and E. Rubin) and the many implications of these studies. Other subjects covered in depth in reviews that are not widely available include ethanol interacting with lipids, porphyrins, intestinal morphology, and pancreatic secretion. Chapters on markers for alcoholism and treatment of alcoholic hepatitis seemed much more limited in scope than the titles would imply. At least 11 chapters are as good as anything in print, only two or three are poor, and about eight are updates of what the authors have published previously. The importance of alcoholism in producing disease makes this an excellent source for bringing oneself up to date with what is available. All chapters have an extensive bibliography, averaging over 100 papers emphasizing current material; anyone not working in these fields would be assisted by these fine reviews. The photomicrographs are clear and of reasonable size and there are many charts and line drawings. The index is excellent. The book is recommended for all gastrointestinal collections aimed at the general reader, for training programs in family and internal medicine and pathology, and as a source for up-to-date reading by the practicing physician. FRANK L. IB!ZR,M.1) Baltimore, Maryland Liver Biopsy Diagnosis and Reports: SNOMED Codes, ICDg-CM Codes, Nomenclature and Terminology. By J. Ludwig. 156 pp, $34.74. S. Karger AG, Basel, Switzerland and New York, New York, 1984. This-manual is intended to facilitate coding of the diagnosis of liver biopsy specimens. It furnishes a model for encoding liver biopsy reports with a synopsis of
frequently used SNOMED codes and definitions, excluding diseases of the gallbladder. As resources, the author used publications of
1444
BOOK
GASTROENTEROLOGY
REVIEWS
England (distributed in U.S. by Kluwer ers, Hingham, Massachusetts), 1984.
Academic
Publish-
A clear and concise overview of the many diagnostic imaging tests available for examination of the hepatobiliary tree is certainly appropriate, and this short book covers the entire armamentarium, including recent advances in nuclear medicine imaging and magnetic resonance imaging. The book is based on papers given at the Falk Symposium held in Basel, Switzerland in 1983 by authors with very different points of view, depending upon their training and expertise. There is no introduction to tell of the goals of this publication. It is rather a list of methods, each author putting forth the advantages and disadvantages of his own technique. There are, therefore, many controversies on the usefulness and accuracy of various methods. What is lacking is an overview chapter or a series of chapters in which the various imaging methods are weighed against each other. For example, the chapter on laparoscopy states that laparoscopy is indicated in the primary diagnosis of all chronic liver conditions and other conditions, such as the search for tumors and liver metastasis. On the other hand, the chapters on computed tomography [CT) and ultrasound, coupled with liver biopsy, all indicate that much less invasive techniques can provide all the information that might be gained by laparoscopy and even more (i.e., deeply seated tumors). The chapters on endoscopic retrograde cholangiopancreatography (ERCP), both diagnostic and therapeutic, are well balanced, although there is failure to mention when ERCP draining with endoprosthesis should be performed versus when PTC endoprosthesis placement should be utilized. Likewise, the chapter on PTC diagnostics with the use of ultrasound and therapeutics is well presented, but no clear mention is made of when the percutaneous approach should be used versus the endoscopic approach for drainage. The chapter on ultrasound in hepatic disease is perhaps dealt with too lightly, whereas much weight is given to endoscopic and operative cholangiography and computeraided ultrasonography. As put forth here, the case for cholecystography and intravenous cholangiography is too strong. Comparison of these techniques with ultrasound, while perhaps reflecting one author’s own experience, does not mirror the experience of others in the literature. And the statement “once a stone has been detected by ultrasonography, subsequent cholecystography will thus be inevitable anyway” is certainly overstating the case for cholecystography. The exalted role of intravenous cholangiography has a distinctly European flavor here. In the CT section, the scans are adequate but do not represent the high-resolution scans that are currently available. Thus the statement that extrahepatic bile ducts dilated to 1 cm can be seen in 25%-60% does not reflect current high-resolution CT imaging. The radionuclide section is strong and complete. On the other hand, the section on nuclear magnetic resonance is very weak. Both articles are incomplete, and the one on differential diagnosis of liver diseases presents very poor image quality. Statements made about spin echo detection of fatty liver and cirrhosis, even of quantitating cirrhosis,
Vol. 89, No. 6
have no documented background or data. In fact, erroneous statements are made about the magnetic resonance detection of hemochromatosis, which has a reduced Tl relaxation time rather than a prolonged Tl stated here. In general, the illustrations in this book are of uneven quality, too small, and with too much contrast. This book might be of use to general internists and surgeons who want to look up the various diagnostic tests, but it will not guide readers in the selection of which test to use. HENRY I. GOLDBERG. M.D.
San Francisco,
California
Cancer of the Esophagus. Levin. 288 pp., $34.50. Florida, 1985.
Edited by T. R. DeMeester and B. Grune & Stratton, Inc., Orlando,
Although the outlook for patients with cancer of the esophagus has always been bleak, a faint ray of hope is beginning to appear. Epidemiologic factors and cytologic markers have been defined that may help to identify cases earlier; multidisciplinary primary treatment with both initial radiation and chemotherapy may be enhancing curative management. It is timely, therefore, that current knowledge about this tumor be brought together in a single volume, and the editors have succeeded admirably. Authors from the United States, Canada, and Europe address every aspect of this problem in 14 chapters, which include discussions of epidemiology, anatomy, pathology, diagnosis, imaging, and both curative and palliative management. The strategies and tactics of endoscopy and surgery are presented in detail. Color photographs amplify discussions of endoscopic and cytologic features. The informative text is reinforced by figures and tables representing the authors’ own observations. Several topics are of particular current interest. Sections on the epidemiology, histopathology, and cytopathology of esophageal dysplasia are thoroughly developed. It appears that combined preoperative chemotherapy with multiple agents, including bleomycin and cisplatin, improves resectability rates and may improve cure rates: indeed, many patients given this treatment are without identifiable tumor at the time of an attempt at curative resection. An entire chapter is usefully devoted to nutritional therapy, which can be a factor in the safety of operative resection and may also prove to be a factor in the effectiveness of other treatment modalities. Additional areas of interest not readily available in the literature include experimental carcinogenesis in the esophagus, the details of staging, and palliative techniques of perbral dilatation. As one might expect in a volume with 22 authors, there is redundancy. Most of the duplication is useful educational reinforcement, but two chapters on nursing care seem to be one too many. Stapling techniques, which have become popular, are not discussed. But these are small matters. I have no doubt that adherence to the practices and principles set forth in this text can lead to an increase in the rate of cure for patients with cancer of the esophagus,