Mechanisms in the Pathogenesis of Enteric Diseases

GASTROENTEROLOGY 1998;114:853–855

PRINT AND MEDIA REVIEWS Lawrence S. Friedman, M.D. Print and Media Review Editor Gastrointestinal Unit, Blake 456D Massachusetts General Hospital Boston, Massachusetts 02114

Mechanisms in the Pathogenesis of Enteric Diseases. Edited by Prem S. Paul, David H. Francis, and David A. Benfield. 439 pp. $125.00. Plenum Publishing Corp., New York, New York, 1997. ISBN 0-306-45519-6. This book is the result of the First International Rushmore Conference on Mechanisms in the Pathogenesis of Enteric Diseases, which was held in September 1995. The conference was conceived as a forum for an interdisciplinary discussion of mechanisms of infectious diseases and focused on enteric diseases of animals and humans. The aim of the book is to offer the material presented at the conference, and in literal terms it certainly does that. The book is comprised of 68 separate chapters and covers a variety of topics related to enteric diseases. The keynote presenters have all contributed a chapter and offer current information related to host-pathogen interactions in their various fields of expertise. While the majority of the chapters relating to bacterial infections address various aspects of Escherichia coli pathogenesis, other pathogens are covered as well (e.g., Clostridium difficile, Salmonella enteritidis, Aeromonas caviae, Serpulina hyodysenteriae, and Campylobacter jejuni). Much of the section on viruses deals with rotavirus, and there are several chapters relating to mucosal immunology and vaccines. The chapters are easy to read, and the figures are generally of high quality. There are several disappointing aspects of Mechanisms in the Pathogenesis of Enteric Diseases. There seems to be no structure to the book in terms of dividing it into relevant sections. For example, if one wants to find the work presented on a specific pathogen, various relevant chapters could be anywhere within the 436 pages of the book. The index does help a little, but the lack of subject matter structure makes the index difficult to deal with. Even the chapters by the keynote speakers seem to be randomly distributed and are not followed by other relevant presentations. There is similarly a lack of uniform structure in the way the individual chapters are presented. Some are nicely laid out with multiple subheadings, whereas others are just two or three pages of script with no subheadings. Again, this makes it a difficult book to dip into. Despite these negative criticisms, the individual contributions are some of the latest work in the field of host-enteric pathogen interaction. It is difficult to know just who the anticipated audience for this text will be. It falls between those working on animal pathogens and those working on human pathogens. It is not comprehensive enough to be a reference text for those working on enteric pathogens, yet it does have new information relating to the pathogenesis of a number of enteric pathogens, which will be of interest to those in the field. Bottom Line: This book contains useful information but has a disorganized presentation that will limit its use as a

reference text. It will, however, be of interest to those working in the field of enteric pathogens, if they take the time to go through the book carefully. DAVID W. K. ACHESON, M.D. Division of Geographic Medicine and Infectious Diseases New England Medical Center Boston, Massachusetts

Medical Care of the Liver Transplant Patient. Edited by Paul G. Killenberg and Pierre-Alain Clavien. 409 pp. $75.00. Blackwell Scientific Publications, Cambridge, Massachusetts, 1997. ISBN 0-865425248. Medical Care of the Liver Transplant Patient was written for practicing physicians who care for liver transplant recipients with the goal of reintegrating the care of the liver transplant patient into the community-based practice of medicine. This goal led the editors to focus on common problems that occur frequently in the pretransplant and posttransplant management of liver patients and how to deal with these problems on a practical basis. The authors have achieved these goals by putting together a concise yet complete and readable text addressing all important aspects of the medical care of the liver transplant patient before and after surgery. The editors have divided their book into three larger sections dealing with the selection of potential liver transplant recipients, management of patients in the perioperative period, and management of chronic medical problems in transplant recipients. Two smaller sections deal with medications commonly used by transplant patients, including the important issue of drug interactions, and a single chapter on pediatric liver transplantation. The contributing authors are primarily from Duke University Medical Center and consist of the full complement of individuals involved in the multidisciplinary care of transplant patients, including transplant hepatologists, liver transplant surgeons, transplant psychiatrists, social workers, transplant nurse coordinators, and hospital administrators. The layout of the book, print font, and generous use of tables make this book a particularly readable text. The chapters dealing with the selection and timing of liver transplantation and evaluation of potential liver transplant recipients are quite good. In the section dealing with the management of patients in the perioperative period, I found the chapter outlining what to expect during recovery from liver transplantation very practical and helpful and the chapter on the role of histopathology in the evaluation of liver transplant recipients particularly well done. A unique topic addressed in this book, which I have not seen addressed in other books on liver transplantation, is the role of research in liver transplantation; it provides a perspective for the referring physician regarding careful data

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collection and some understanding of funding sources for clinical research. My only complaints about this practical and useful text are minor and include the somewhat unnecessarily detailed psychiatric flavor to the chapter on liver transplantation for alcoholic liver disease, rather than an emphasis on selection criteria and outcomes. In addition, the criteria for the selection of patients with primary hepatic malignancies and chronic hepatitis B are somewhat conservative. Although some centers only consider patients with hepatic malignancy for transplantation if the tumor size is ,5 cm in diameter and there are no more than three nodules, not all centers adhere to this strict protocol. Also, recent data suggest that hepatitis B immune globulin alone or with lamivudine is quite effective in preventing hepatitis B virus reinfection in patients with active viral replication and detectable hepatitis B e antigen, who are no longer excluded from transplantation at most centers. Finally, the chapter dealing with the management of patients with portal hypertensive bleeding before transplantation does not mention octreotide, which is currently the drug of choice for acute medical therapy, and only mentions endoscopic variceal ligation rather than acknowledging its emerging dominant role over sclerotherapy in the management of patients with esophageal variceal bleeding. These criticisms are minor and do not detract from the value of this particularly readable, comprehensive and concise text outlining key aspects in the medical care of patients after liver transplantation. Bottom Line: General physicians referring patients for liver transplantation will find this book a handy and practical resource, particularly when patients return to their care for long-term medical management in cooperation with the transplant center. EMMET B. KEEFFE, M.D. Division of Gastroenterology Stanford University Medical Center Stanford, California

Highlights in the History of Laparoscopy. By Grzegorz S. Litynski. 367 pp. $249.00. B. Bernert Verlag, Frankfurt, Germany, 1996. ISBN 3-9804740-6-2. This book blends the author’s research from the medical literature and many personal communications with experts in the field to provide a remarkable historical record of the evolution and revolutions in laparoscopy over the past 96 years. The events in European history, especially in Germany and to a lesser degree in the United States, are carefully integrated into the evolution of laparoscopy. The personalities and professional activities related to various medical-technical developments and the interpersonal conflicts make for fascinating reading. The modern era of laparoscopy during the 1930s and 1940s is introduced by the family histories and tragedies, medical training, professional conflicts, and hindrances encountered by Hans Kalk in Germany and John C. Ruddock in the United States. Serendipitous events led to their independent involvement in, and dedication to, establishing diagnostic laparoscopy as a safe and accurate technique.

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Discussions of the development of laparoscopic instruments, color photography, and accessories serve to emphasize the problems encountered in documenting findings and popularizing laparoscopy among clinicians. The invention of the Hopkins lens optic system and ‘‘cold’’ light transmitted via fiberoptic bundles allowed excellent visualization and color photography. The virtual absence of medical communications between Europe and the United States prevented timely exchange of information and severely hindered acceptance of diagnostic laparoscopy. Many anecdotes give the narrative a humanistic flavor. Semm’s invention of an efficient insufflator occurred, surprisingly, without his chief’s knowledge or blessing. Battles over techniques and terminology between gynecologists led Semm to collaborate with Eisenberg, an internist who performed diagnostic laparoscopy. The two of them were caught in the operating room using Semm’s automatic insufflator and chased away by Semm’s chief. Semm was called the ‘‘magician of Kiel,’’ because of the complexity and volume of laparoscopic procedures he was performing. His performance of the first laparoscopic appendectomy in 1980 later created culture shock, angering both general surgeons and gynecologists. The author reviews many of these professional conflicts, some of them representing infantile, nonprofessional behavior that proved to be only temporary hindrances. The antagonism to laparoscopy among gynecologists rapidly faded in the 1970s, but abdominal surgeons persisted in their classic nonbelief until the late 1980s, using as their battle cries, ‘‘why look through the keyhole when you can open the door’’ and ‘‘small incision, small brain.’’ My, how things have changed! Throughout the past two decades, George Bercl is described as the lonesome surgeon in this field who, along with several gastroenterologists, were the true believers and persistent proponents of laparoscopy in the United States. The stories of dedication, frustration, persistence, and technical genius shown by a few forward-thinking surgeons are epitomized by the author’s full chapter on the contributions of Erick Muhre. He performed the first laparoscopic cholecystectomy on September 12, 1985, using his own galloscope and Semm’s automatic insufflator. The chapter entitled ‘‘The American Spirit Awakens’’ chronicles the development of skills necessary for laparoscopic cholecystectomy by surgeons in private practice, who later served as teachers for academic surgeons around this country. Turn about is fair play! This marvelous historical account concludes with a brief review of the revolution in therapeutic laparoscopy, including the numerous new procedures introduced in recent years. The impact of contributions of instrument manufacturers on the evolution of these therapeutic advances, economic factors, and the roles of the mass media and patient demands are given appropriate emphasis. The content justifies the title, and there are only a few significant omissions, primarily in the area of diagnostic laparoscopy as championed by gastroenterologists. Unfortunately, there is no mention of three of the giants of diagnostic laparoscopy in gastroenterology in Germany: Harald Lindner,

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Harald Henning, and Kurt Beck, all of whom made major contributions through their lectures, medical writing, and superb photographic documentation abilities. Henning and Beck, as well as Giorgio Dagnini of Italy, published superb atlases of diagnostic endoscopy. This text’s orientation naturally favors the recent, more exciting developments in therapeutic laparoscopy. It contains numerous color snapshots and formal photographs that strengthen the narrative and add a personal touch. The author has succeeded in providing us with one of the most thorough personal and historical accounts available of any diagnostic or therapeutic technique. He has the novelist’s unique ability to integrate world history, politics, social attitudes and constraints, personalities, professional conflicts, and acts of productive cooperation among practitioners and academicians. Bottom Line: Any physician or surgeon who performs or has an interest in either diagnostic or therapeutic laparoscopy or medical history will surely enjoy this work. It is recommended highly for reading and for the library shelf as a reference. H. WORTH BOYCE, M.D. Division of Digestive Diseases and Nutrition University of South Florida College of Medicine Tampa, Florida

Diseases of the Liver and Biliary System. By Sheila Sherlock and James Dooley. 714 pp. $150.00. Blackwell Science, Oxford, England, 1997. ISBN 0-86542-906-5. This year brings us the occasion of the tenth edition of Sherlock and Dooley’s Diseases of the Liver and Biliary System. The authors of this ‘‘warhorse’’ textbook have strived to integrate the dizzying expansion of knowledge in liver disease over the 4 years since the ninth edition into a format that is, above all, accessible to students, residents, fellows, and generalists. To this end, they have grandly succeeded. The new edition has added more than 1000 new references, 100 new figures, and greatly expanded coverage of the viral hepatitides, liver transplantation, newer interventions for portal hypertension, along with consideration of the discoveries of the genetic basis for hemochromatosis and Wilson’s disease. Incorporation of these and other new developments is accomplished without the need to move into a two-volume set or a bulky single volume. Indeed, this edition is printed with no significant change in length from its predecessor. This fact is attributable in great measure to the deliberately laconic style of the authors that has by now become a familiar hallmark of their work. First-time readers of this textbook should understand that the highly declarative statements that characterize the text are distillations of the authors’ extensive clinical experience and do not attempt to capture the discourse and debate that surround several of the key concepts in liver disease. Put another way, this is not a text for those who seek a comprehensive reference. The organization of the book is for the most part straightfor-

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ward and logical, beginning in its first third with consideration of key pathophysiological processes, followed by a more detailed probing of individual disease entities. The chapter on viral hepatitis is lucid and relevant and includes discussion of the clinical significance of hepatitis B virus mutants as well as discovery of the GBV-C or hepatitis G viral agent. The latter, perhaps, does not warrant the nearly full page that it receives. The only unfortunate chapter division that leaves the reader searching for continuity occurs when the authors separate chronic viral hepatitis and its treatment (including it in a separate chapter on chronic hepatitis) from the chapter on viral hepatitis, which covers the viruses and their more acute manifestations. Nonetheless, the coverage of antiviral therapy is appropriate and current, even discussing the role of combined use of interferon and ribavirin in the management of chronic hepatitis C infection. In an area such as antiviral treatment already congested with seemingly obfuscatory literature, the authors’ succinct style of synthesis is especially refreshing. Other subjects treated with particular clarity include portal hypertension, alcoholic liver disease, primary biliary cirrhosis, nutritional and metabolic liver diseases, and hepatic tumors. The section on liver transplantation deserves special mention for its illumination of both technical aspects of transplant surgery and posttransplant graft complications. As with previous editions (and even more so with this one), the figures and tables are extraordinarily helpful. The color plates are often breathtaking. Schematics of hepatic anatomy, along with simplified algorithms for disease management, are presented clearly and are easy to read. The tables are almost always uncluttered and benefit from parsimony of space. It is clear that great pains were taken to ensure presentability and a basic message at the cost of often unnecessary detail. There are areas where the text could have benefited from more careful editing. For example, among the predisposing factors to Budd–Chiari syndrome is the factor V (rather than factor IV) Leiden mutation. However, these oversights do not significantly detract from accomplishment of the overall mission of the book. This text will not be the first choice for those seeking to understand more fully the basis of individual diseases of the liver. It will, however, be the reference of choice for those who wish to survey subjects in a manner that delivers the bottom line on these diseases. It is sufficiently well-referenced for the reader to seek out the classics in the field. Bottom Line: More than any other text in liver disease, this one provides the best source of synthesized clinical wisdom, a currency in ever increasingly short supply as our fund of factual knowledge burgeons. Indeed, if one demanded that an author confine the breadth of our existing knowledge in liver disease into a readable clinical textbook of less than 700 pages, he or she could do no better than to direct that individual to Sherlock and Dooley’s Diseases of the Liver and Biliary System. RAYMOND T. CHUNG, M.D. Gastrointestinal Unit Massachusetts General Hospital Boston, Massachusetts