- Email: [email protected]
Molecular Pathogenesis of Cholestasis
1642
PRINT AND MEDIA REVIEWS
Bottom Line: A useful book with many excellent chapters appropriate for health professionals, policy makers, and others interested in disease prevention or in care of older patients.
WILLIAM D. HEIZER, M.D. Division of Gastroenterology and Hepatology University of North Carolina at Chapel Hill Chapel Hill, North Carolina Diet and Human Immune Function.Edited by David A. Hughes, L. Gail Darlington, Adrianne Bendich. 488 pp. $145.00. Totowa, New Jersey, Humana Press, 2003. ISBN 1-58829206-1. Web address for ordering: www.humanpress.com This book provides an excellent overview of the complicated field of nutrition and immune function. The primary audience for this book would be nutritionists interested in the area of immunology. Written at a basic level, scientists trained in immunology might find the book too superficial, although it would provide a good starting point from which immunologists might gain insights into how to incorporate host nutritional status into their studies. The book begins with an overview on the basics of immunology, followed by a chapter discussing the methods used to assess the human immune response. This is important information for the non-immunologist to have to understand the later chapters that delve into the specifics of nutritional effects on the immune response. Although these chapters are easily understood, it would have been helpful for the authors to include diagrams/figures that would help orient the novice to the complexity of the immune response. Following the general introduction chapters, 3 additional overview chapters are provided to discuss the effects of infection on nutrition and immune status, and the effects of nutrition on the immune status of the neonate and the elderly. These are important chapters, for they remind the reader that the results of nutritional studies utilizing adult populations may not translate into younger or older populations. Following the overview, the book is organized into 4 sections: vitamins and immune responses, minerals and immune responses, nutrition, immunity and disease, and environmental stressors. Both the vitamin and mineral sections are well described. Particularly nice are the chapters that include diagrams of immune function that help to explain the nutritionalimmune interactions (e.g., Figure 1 in the Iron chapter). The inclusion of a chapter on the effects of multivitamin supplementation was an excellent idea. Many studies report single nutrient interactions with the immune response, but clearly multiple vitamin (and mineral) interactions are closer to the real world, where individuals often take multivitamin and mineral supplements. In the Nutrition, Immunity and Disease section, the editors chose to focus on rheumatoid arthritis, osteoporosis, HIV, probiotics, and dietary fat and cancer. Although the editors clearly had to limit the amount of material they could include, perhaps selection of additional models might have more inter-
GASTROENTEROLOGY Vol. 127, No. 5
esting and illustrative. For example, inflammatory bowel disease is an area of high research interest with regard to nutritional effects on immune modulation of this disease. In addition, the chapter on dietary fat should have included a discussion of the role of lipid rafts and their modulation by dietary fat. This is in area of intense research interest, particularly because many immune receptors require lipid rafts for their function. The final section, Environmental Stressors, includes chapters on the effects of exercise, air pollution, drugs, and undernutrition in the context of military training. These sections add a unique component to this book, and demonstrate that the effects of nutrition on the immune response may be different in the context of these other stressors. All of the chapters in this book, with the exception of the introductory one, have a “take-home message” section that provides key points delivered in short bullet summaries. This is quite helpful in summarizing the overall intent and highlights of the chapter. Although a different author(s) wrote each chapter, in general, the writing style is easy to read and comprehend. The tables and figures provided are helpful, although as mentioned previously, more descriptive figures would have increased the usefulness of this book. Overall, this book does a good job of reaching its target audience, and will be useful both for nutritionists, physicians who are interested in understanding the relationship between diet and immune function, as well as immunologists who want to delve into the area of nutrition. It provides enough detail for researchers to get a handle on the field, but provides the information in a clear and easily understandable way. The influence of diet on immune function is a rapidly expanding field as more and more research is carried out in this area. Because nutritionists do not often learn immunology, and because immunologists and infectious disease specialists do not often study nutrition, Diet and Human Immune Function serves a basic primer in this area and provides both specific references and related books and websites for the reader who wishes to study further. Bottom Line: A basic primer on diet and immunity.
MELINDA A. BECK, Ph.D. School of Medicine University of North Carolina at Chapel Hill Chapel Hill, North Carolina Molecular Pathogenesis of Cholestasis.Edited by Michael Trauner and Peter L.M. Jansen. 379 pp. €135.00. Dordrecht, The Netherlands: Kluwer, 2003. 2ISBN 0-3064-8240-1. Web address for ordering: www.wkap.nl This book has the stated aim “to provide a cutting-edge overview on the molecular pathogenesis of cholestasis.” To achieve this aim, the editors solicited 25 chapters from colleagues who have contributed to the explosion of new information and concepts in hepatocellular and cholangiocytic transport and their impairment in cholestatic disease.
November 2004
The present volume begins with an overview of bile formation by Jim Boyer, whose laboratory has contributed greatly to our understanding of bile flow. Crawford provides a thoughtful overview of the pathology of cholestasis; in my judgment, this chapter should have been placed among the opening chapters. A series of chapters deal with the pathobiology of hepatocellular transport. The remarkable process in understanding basolateral transporters is reviewed by Hagenbuch and Meier. Insertion of canalicular transporters is discussed by Kipp and Arias, and properties of ABC transporters in general and canalicular transporters in particular are tabulated by Hooiveld and Müller. Echeverria and Nathanson summarize the role of gap junctions in bile formation. The recent advances in characterizing cholangiocyte structure and function are summarized by Le Sage and Alpini and other members of their research group. Intracellular events relating to bile flow are summarized in a chapter on signal transduction in bile formation and cholestasis by Anwer and Webster. Karpen introduces the key role of transcription factors and how they act to regulate the transcription of individual transporters. Now, illustrations of hepatocellular transport must not only find a place for the increasing number of transporters, but must also show a nucleus! An overview of hepatic drug metabolism is provided by Suzuki and Sugiyama. This chapter provides a background for emerging information about the transcriptional regulation of P450 enzymes by bile acids. Hamza and Gitlin review the hepatocellular transport of copper, as well as areas of ignorance relating to canalicular secretion of copper and the mechanism by which retained copper causes liver injury. A chapter by Bull provides a readable discussion of methods for localizing genes involved in disease, and classifies the types of mutations that occur. Her chapter provides a background for several chapters focused on monogenetic defects. Nies and Keppler and their colleagues review bilirubin uptake and secretion and its alteration in the Dubin-Johnson syndrome. Jansen, Sturm, and Muller offer an authoritative review on disorders of bile acid transport. Oude Elferink ably describes biliary lipid secretion (phospholipid and cholesterol) and also reviews the enigma of primary familial intrahepatic cholestasis type I (PFIC I). The very recent discovery that biliary cholesterol secretion is mediated by two half transporters ABCG5 and ABCG8 was made after this chapter was written. Higuchi and Gores summarize their emerging views on the complex pathway of bile acid mediated apoptosis in cholestatic liver disease. The effect of cholestasis on changes in transporter expression and function in experimental cholestasis (in animals) and in human cholestatic disease is summarized by Trauner, Fickert, and Zollner who have made major contributions in this area. The final chapters are more clinically oriented. KullakUblick reviews drug-induced cholestatic liver disease with particular emphasis on drugs that interfere with transporter function. Bassendine provides a scholarly review of the molecular basis of primary biliary cirrhosis, and a similar chapter on primary sclerosing cholangitis is authored by Björnsson and
PRINT AND MEDIA REVIEWS
1643
Chapman. Other chapters review cholestatic pruritus and fatigue, as well as bone disease. In cholestasis, and Dobnig and Fahrleitner discuss bone disease. Verkade, Kuipers, and Werner review the perturbations in fat absorption and lipid metabolism in cholestasis. The last 2 chapters deal with therapy. Rust and Beuers summarize the rationale and efficacy of ursodiol. A recent discovery is that that ursodiol up-regulates mrp2, the transporter mediating conjugated bilirubin secretion, as well as having antiapoptic properties. A final chapter from the Einstein group reviews the promise of hepatocyte transplantation and gene therapy for liver disease in general. The book achieves its aim of assembling the newer knowledge of cholestatic liver disease. The book is as “cutting-edge” as any book can be in a field that is moving extremely rapidly. The book also has the intrinsic limitations of a multiauthored collection of chapters with occasional duplication of topics, figures, and tables. Chapters are well written and I found only 2 typographical errors. The only topic that was not included and should have been, in my opinion, is the use of extracorporeal albumin dialysis (MARS) in the treatment of cholestasis. (The chapter on gene therapy is an overview and does not address specific cholestatic defects). Another chapter that might have been included would have dealt with defects in bile acid synthesis that present as cholestatic disease. One unfortunate aspect of the book’s production is the absence of color in its illustrations. This defect is especially obvious when histology is shown. Some figures are too small for easy comprehension. However, most illustrations are block diagrams and the book is a valuable source for finding schematic illustrations of hepatocellular and chololangiocytic transport. If one thinks that the canaliculus is the power plant for bile formation, the clinical hepatologist must wonder with some trepidation how many transporter pumps will eventually be localized to this tiny domain of the hepatocyte. At present the number of canalicular transporters (all stimulated by ATP) to be remembered is 8. We need one transporter for each of the major biliary constituents (bile acids, phospholipids, bilirubin diglucuronide, and cholesterol. Because cholesterol uses 2 halftransporters, that makes 5. Then we have mdr1 (ABCB1) and ABCG2, whose endogenous substrates have not yet been identified. Finally, there is likely to be at least one heavy metal transporter. This book provides abundant information on each of these transporters, and is certainly one of the most convenient sources currently available. A second problem is what to call the transporters. Nomenclature has become very complicated. This book provides tabulated information on the current nomenclature recommendations. Probably some day, intrahepatic cholestasis will be divided into at least 3 types. There is precanalicular cholestasis as occurs in defective bile acid biosynthesis; there is canalicular disease where the canaliculus is defective or inhibited; and there is postcanalicular disease such as occurs in PBC, PSC, and other cholangiopathies. This book summarizes the experimental work leading to such a classification. Michael Trauner and
1644
PRINT AND MEDIA REVIEWS
Peter Jansen have done both the clinician and the basic scientist a great service in organizing this collection of chapters that summarize the spectacular advances in our knowledge of transport by the hepatocyte and bile duct epithelial cells, as it relates to canalicular bile formation and its subsequent modification in the biliary ductules. The clinician who cares for patients with cholestatic liver disease will find this book a valuable source for comprehending the pathobiological problems in his or her patient. Biliary secretion has at last developed a firm foundation in cell biology and this book provides the evidence for this sea change. Two giants of hepatology, Hans Popper (in the U.S.) and Jacques Caroli (in France), now no longer with us, spent much of their lives thinking about cholestatic liver disease. They would be thrilled to see the great progress that has been made as evidenced by this book. Bottom Line: A cutting-edge overview on the molecular pathogenesis of cholestasis.
ALAN F. HOFMANN, M.D. Department of Medicine University of California, San Diego San Diego, California The Requisites in Gastroenterology. Editor in Chief, Dr. Anil K. Rustgi. Esophagus and Stomach. Volume I. 200 pp. ISBN 0-32301886-6; Small Intestine and Large Intestine. Volume II. 364 pp. ISBN 0-3230-1895-5; Hepatobiliary Tract and Pancreas. Volume III. 400 pp, ISBN 0-32301-837-8; Endoscopy and Gastrointestinal Radiology. Volume IV. 220 pp. ISBN 0-3230-1885-8. $95.00 each. Four Volume set: $269.00. Philadelphia, Pennsylvania: Mosby, 2003. Web address for ordering: www.us.elsevierhealth. com Editor’s note: The first book in this series, Esophagus and Stomach, was reviewed in the May 2004 issue of Gastroenterology. The Requisites in Gastroenterology is the apt title of a new, 4 volume series of textbooks including volume 1, “Esophagus and Stomach” (edited by David A. Katzka and David C. Metz, 205 pages), volume 2, “Small Intestine and Large Intestine” (edited by Gary R. Lichtenstein and Gary D. Wu, 299 pages), volume 3, “Hepatobilliary Tract and Pancreas (edited by K. Rajender Reddy and William B. Long, 337 pages), and volume 4, “Endoscopy and Gastrointestinal Radiology” (edited by Gregory G. Ginsberg and Michael L. Kochman, 200 pages). Dr. Anil K. Rustgi is the editor in chief of the series, no small task considering the breadth of material covered and the oversight of nearly 80 contributing authors from a variety of disciplines and academic institutions.
GASTROENTEROLOGY Vol. 127, No. 5
If at first glance, the series stands out as a colorful addition to the medical bookshelf, a more thorough review reveals that the appealing design is not simply superficial or limited to cover art. In each individual volume, the radiographs, histological images, figures, and tables all serve to illustrate salient disease features, highlight the important points of text discussions, or summarize key points; all are excellently reproduced. In addition to these features, the text, despite the wide variety of authors, is concise and easily read, with a remarkable uniformity of style, stressing the essentials of basic pathology, pathophysiology, and bedside management. Moreover, each chapter concludes with a short but thorough list of landmark references, instead of an exhaustive bibliography that is not well suited to a study of the fundamentals. The combination of an inviting text, superb illustrations, and useful reading recommendations makes each volume remarkably user-friendly and resourceful. A fair question then, is why publish 4 volumes instead of consolidating the work into 1 or 2 volumes? While arguments can be made both for and against consolidating the text into fewer volumes, it is clear that by presenting the requisites of gastroenterology in a series of 4 books, the material becomes less intimidating and more manageable. A reader can focus on diseases affecting the small and large intestines in a single portable book, for instance, and actually succeed in reading the text in its entirety; then move on to another manageable volume. This kind of versatility, in turn, might even prove economical: one need not buy a several-hundred dollar text that may strain the eyes as much as the arms, only to make use of several focused chapters. Clearly, these 4 volumes contain little information that cannot be found in other, more formidable, encyclopedic reference texts. However, an exhaustive completeness is not the intent of the series. Instead, these manageable volumes are organized to meet the needs of its target audience, a goal that it succeeds in achieving better than most similar review books. Thus, for the intended audience of gastroenterology fellows, medical residents, and proverbially precocious and inquisitive medical students, in that order, looking for a concise resource or review text, The Requisites in Gastroenterology is a worthwhile, if piecemeal investment. Bottom Line: Aptly named, inviting, and highly readable.
DAVID H. WEINSTEIN, MD IAN GRIMM, MD Division of Gastroenterology and Hepatology University of North Carolina at Chapel Hill Chapel Hill, North Carolina
PRINT AND MEDIA REVIEWS
Bottom Line: A useful book with many excellent chapters appropriate for health professionals, policy makers, and others interested in disease prevention or in care of older patients.
WILLIAM D. HEIZER, M.D. Division of Gastroenterology and Hepatology University of North Carolina at Chapel Hill Chapel Hill, North Carolina Diet and Human Immune Function.Edited by David A. Hughes, L. Gail Darlington, Adrianne Bendich. 488 pp. $145.00. Totowa, New Jersey, Humana Press, 2003. ISBN 1-58829206-1. Web address for ordering: www.humanpress.com This book provides an excellent overview of the complicated field of nutrition and immune function. The primary audience for this book would be nutritionists interested in the area of immunology. Written at a basic level, scientists trained in immunology might find the book too superficial, although it would provide a good starting point from which immunologists might gain insights into how to incorporate host nutritional status into their studies. The book begins with an overview on the basics of immunology, followed by a chapter discussing the methods used to assess the human immune response. This is important information for the non-immunologist to have to understand the later chapters that delve into the specifics of nutritional effects on the immune response. Although these chapters are easily understood, it would have been helpful for the authors to include diagrams/figures that would help orient the novice to the complexity of the immune response. Following the general introduction chapters, 3 additional overview chapters are provided to discuss the effects of infection on nutrition and immune status, and the effects of nutrition on the immune status of the neonate and the elderly. These are important chapters, for they remind the reader that the results of nutritional studies utilizing adult populations may not translate into younger or older populations. Following the overview, the book is organized into 4 sections: vitamins and immune responses, minerals and immune responses, nutrition, immunity and disease, and environmental stressors. Both the vitamin and mineral sections are well described. Particularly nice are the chapters that include diagrams of immune function that help to explain the nutritionalimmune interactions (e.g., Figure 1 in the Iron chapter). The inclusion of a chapter on the effects of multivitamin supplementation was an excellent idea. Many studies report single nutrient interactions with the immune response, but clearly multiple vitamin (and mineral) interactions are closer to the real world, where individuals often take multivitamin and mineral supplements. In the Nutrition, Immunity and Disease section, the editors chose to focus on rheumatoid arthritis, osteoporosis, HIV, probiotics, and dietary fat and cancer. Although the editors clearly had to limit the amount of material they could include, perhaps selection of additional models might have more inter-
GASTROENTEROLOGY Vol. 127, No. 5
esting and illustrative. For example, inflammatory bowel disease is an area of high research interest with regard to nutritional effects on immune modulation of this disease. In addition, the chapter on dietary fat should have included a discussion of the role of lipid rafts and their modulation by dietary fat. This is in area of intense research interest, particularly because many immune receptors require lipid rafts for their function. The final section, Environmental Stressors, includes chapters on the effects of exercise, air pollution, drugs, and undernutrition in the context of military training. These sections add a unique component to this book, and demonstrate that the effects of nutrition on the immune response may be different in the context of these other stressors. All of the chapters in this book, with the exception of the introductory one, have a “take-home message” section that provides key points delivered in short bullet summaries. This is quite helpful in summarizing the overall intent and highlights of the chapter. Although a different author(s) wrote each chapter, in general, the writing style is easy to read and comprehend. The tables and figures provided are helpful, although as mentioned previously, more descriptive figures would have increased the usefulness of this book. Overall, this book does a good job of reaching its target audience, and will be useful both for nutritionists, physicians who are interested in understanding the relationship between diet and immune function, as well as immunologists who want to delve into the area of nutrition. It provides enough detail for researchers to get a handle on the field, but provides the information in a clear and easily understandable way. The influence of diet on immune function is a rapidly expanding field as more and more research is carried out in this area. Because nutritionists do not often learn immunology, and because immunologists and infectious disease specialists do not often study nutrition, Diet and Human Immune Function serves a basic primer in this area and provides both specific references and related books and websites for the reader who wishes to study further. Bottom Line: A basic primer on diet and immunity.
MELINDA A. BECK, Ph.D. School of Medicine University of North Carolina at Chapel Hill Chapel Hill, North Carolina Molecular Pathogenesis of Cholestasis.Edited by Michael Trauner and Peter L.M. Jansen. 379 pp. €135.00. Dordrecht, The Netherlands: Kluwer, 2003. 2ISBN 0-3064-8240-1. Web address for ordering: www.wkap.nl This book has the stated aim “to provide a cutting-edge overview on the molecular pathogenesis of cholestasis.” To achieve this aim, the editors solicited 25 chapters from colleagues who have contributed to the explosion of new information and concepts in hepatocellular and cholangiocytic transport and their impairment in cholestatic disease.
November 2004
The present volume begins with an overview of bile formation by Jim Boyer, whose laboratory has contributed greatly to our understanding of bile flow. Crawford provides a thoughtful overview of the pathology of cholestasis; in my judgment, this chapter should have been placed among the opening chapters. A series of chapters deal with the pathobiology of hepatocellular transport. The remarkable process in understanding basolateral transporters is reviewed by Hagenbuch and Meier. Insertion of canalicular transporters is discussed by Kipp and Arias, and properties of ABC transporters in general and canalicular transporters in particular are tabulated by Hooiveld and Müller. Echeverria and Nathanson summarize the role of gap junctions in bile formation. The recent advances in characterizing cholangiocyte structure and function are summarized by Le Sage and Alpini and other members of their research group. Intracellular events relating to bile flow are summarized in a chapter on signal transduction in bile formation and cholestasis by Anwer and Webster. Karpen introduces the key role of transcription factors and how they act to regulate the transcription of individual transporters. Now, illustrations of hepatocellular transport must not only find a place for the increasing number of transporters, but must also show a nucleus! An overview of hepatic drug metabolism is provided by Suzuki and Sugiyama. This chapter provides a background for emerging information about the transcriptional regulation of P450 enzymes by bile acids. Hamza and Gitlin review the hepatocellular transport of copper, as well as areas of ignorance relating to canalicular secretion of copper and the mechanism by which retained copper causes liver injury. A chapter by Bull provides a readable discussion of methods for localizing genes involved in disease, and classifies the types of mutations that occur. Her chapter provides a background for several chapters focused on monogenetic defects. Nies and Keppler and their colleagues review bilirubin uptake and secretion and its alteration in the Dubin-Johnson syndrome. Jansen, Sturm, and Muller offer an authoritative review on disorders of bile acid transport. Oude Elferink ably describes biliary lipid secretion (phospholipid and cholesterol) and also reviews the enigma of primary familial intrahepatic cholestasis type I (PFIC I). The very recent discovery that biliary cholesterol secretion is mediated by two half transporters ABCG5 and ABCG8 was made after this chapter was written. Higuchi and Gores summarize their emerging views on the complex pathway of bile acid mediated apoptosis in cholestatic liver disease. The effect of cholestasis on changes in transporter expression and function in experimental cholestasis (in animals) and in human cholestatic disease is summarized by Trauner, Fickert, and Zollner who have made major contributions in this area. The final chapters are more clinically oriented. KullakUblick reviews drug-induced cholestatic liver disease with particular emphasis on drugs that interfere with transporter function. Bassendine provides a scholarly review of the molecular basis of primary biliary cirrhosis, and a similar chapter on primary sclerosing cholangitis is authored by Björnsson and
PRINT AND MEDIA REVIEWS
1643
Chapman. Other chapters review cholestatic pruritus and fatigue, as well as bone disease. In cholestasis, and Dobnig and Fahrleitner discuss bone disease. Verkade, Kuipers, and Werner review the perturbations in fat absorption and lipid metabolism in cholestasis. The last 2 chapters deal with therapy. Rust and Beuers summarize the rationale and efficacy of ursodiol. A recent discovery is that that ursodiol up-regulates mrp2, the transporter mediating conjugated bilirubin secretion, as well as having antiapoptic properties. A final chapter from the Einstein group reviews the promise of hepatocyte transplantation and gene therapy for liver disease in general. The book achieves its aim of assembling the newer knowledge of cholestatic liver disease. The book is as “cutting-edge” as any book can be in a field that is moving extremely rapidly. The book also has the intrinsic limitations of a multiauthored collection of chapters with occasional duplication of topics, figures, and tables. Chapters are well written and I found only 2 typographical errors. The only topic that was not included and should have been, in my opinion, is the use of extracorporeal albumin dialysis (MARS) in the treatment of cholestasis. (The chapter on gene therapy is an overview and does not address specific cholestatic defects). Another chapter that might have been included would have dealt with defects in bile acid synthesis that present as cholestatic disease. One unfortunate aspect of the book’s production is the absence of color in its illustrations. This defect is especially obvious when histology is shown. Some figures are too small for easy comprehension. However, most illustrations are block diagrams and the book is a valuable source for finding schematic illustrations of hepatocellular and chololangiocytic transport. If one thinks that the canaliculus is the power plant for bile formation, the clinical hepatologist must wonder with some trepidation how many transporter pumps will eventually be localized to this tiny domain of the hepatocyte. At present the number of canalicular transporters (all stimulated by ATP) to be remembered is 8. We need one transporter for each of the major biliary constituents (bile acids, phospholipids, bilirubin diglucuronide, and cholesterol. Because cholesterol uses 2 halftransporters, that makes 5. Then we have mdr1 (ABCB1) and ABCG2, whose endogenous substrates have not yet been identified. Finally, there is likely to be at least one heavy metal transporter. This book provides abundant information on each of these transporters, and is certainly one of the most convenient sources currently available. A second problem is what to call the transporters. Nomenclature has become very complicated. This book provides tabulated information on the current nomenclature recommendations. Probably some day, intrahepatic cholestasis will be divided into at least 3 types. There is precanalicular cholestasis as occurs in defective bile acid biosynthesis; there is canalicular disease where the canaliculus is defective or inhibited; and there is postcanalicular disease such as occurs in PBC, PSC, and other cholangiopathies. This book summarizes the experimental work leading to such a classification. Michael Trauner and
1644
PRINT AND MEDIA REVIEWS
Peter Jansen have done both the clinician and the basic scientist a great service in organizing this collection of chapters that summarize the spectacular advances in our knowledge of transport by the hepatocyte and bile duct epithelial cells, as it relates to canalicular bile formation and its subsequent modification in the biliary ductules. The clinician who cares for patients with cholestatic liver disease will find this book a valuable source for comprehending the pathobiological problems in his or her patient. Biliary secretion has at last developed a firm foundation in cell biology and this book provides the evidence for this sea change. Two giants of hepatology, Hans Popper (in the U.S.) and Jacques Caroli (in France), now no longer with us, spent much of their lives thinking about cholestatic liver disease. They would be thrilled to see the great progress that has been made as evidenced by this book. Bottom Line: A cutting-edge overview on the molecular pathogenesis of cholestasis.
ALAN F. HOFMANN, M.D. Department of Medicine University of California, San Diego San Diego, California The Requisites in Gastroenterology. Editor in Chief, Dr. Anil K. Rustgi. Esophagus and Stomach. Volume I. 200 pp. ISBN 0-32301886-6; Small Intestine and Large Intestine. Volume II. 364 pp. ISBN 0-3230-1895-5; Hepatobiliary Tract and Pancreas. Volume III. 400 pp, ISBN 0-32301-837-8; Endoscopy and Gastrointestinal Radiology. Volume IV. 220 pp. ISBN 0-3230-1885-8. $95.00 each. Four Volume set: $269.00. Philadelphia, Pennsylvania: Mosby, 2003. Web address for ordering: www.us.elsevierhealth. com Editor’s note: The first book in this series, Esophagus and Stomach, was reviewed in the May 2004 issue of Gastroenterology. The Requisites in Gastroenterology is the apt title of a new, 4 volume series of textbooks including volume 1, “Esophagus and Stomach” (edited by David A. Katzka and David C. Metz, 205 pages), volume 2, “Small Intestine and Large Intestine” (edited by Gary R. Lichtenstein and Gary D. Wu, 299 pages), volume 3, “Hepatobilliary Tract and Pancreas (edited by K. Rajender Reddy and William B. Long, 337 pages), and volume 4, “Endoscopy and Gastrointestinal Radiology” (edited by Gregory G. Ginsberg and Michael L. Kochman, 200 pages). Dr. Anil K. Rustgi is the editor in chief of the series, no small task considering the breadth of material covered and the oversight of nearly 80 contributing authors from a variety of disciplines and academic institutions.
GASTROENTEROLOGY Vol. 127, No. 5
If at first glance, the series stands out as a colorful addition to the medical bookshelf, a more thorough review reveals that the appealing design is not simply superficial or limited to cover art. In each individual volume, the radiographs, histological images, figures, and tables all serve to illustrate salient disease features, highlight the important points of text discussions, or summarize key points; all are excellently reproduced. In addition to these features, the text, despite the wide variety of authors, is concise and easily read, with a remarkable uniformity of style, stressing the essentials of basic pathology, pathophysiology, and bedside management. Moreover, each chapter concludes with a short but thorough list of landmark references, instead of an exhaustive bibliography that is not well suited to a study of the fundamentals. The combination of an inviting text, superb illustrations, and useful reading recommendations makes each volume remarkably user-friendly and resourceful. A fair question then, is why publish 4 volumes instead of consolidating the work into 1 or 2 volumes? While arguments can be made both for and against consolidating the text into fewer volumes, it is clear that by presenting the requisites of gastroenterology in a series of 4 books, the material becomes less intimidating and more manageable. A reader can focus on diseases affecting the small and large intestines in a single portable book, for instance, and actually succeed in reading the text in its entirety; then move on to another manageable volume. This kind of versatility, in turn, might even prove economical: one need not buy a several-hundred dollar text that may strain the eyes as much as the arms, only to make use of several focused chapters. Clearly, these 4 volumes contain little information that cannot be found in other, more formidable, encyclopedic reference texts. However, an exhaustive completeness is not the intent of the series. Instead, these manageable volumes are organized to meet the needs of its target audience, a goal that it succeeds in achieving better than most similar review books. Thus, for the intended audience of gastroenterology fellows, medical residents, and proverbially precocious and inquisitive medical students, in that order, looking for a concise resource or review text, The Requisites in Gastroenterology is a worthwhile, if piecemeal investment. Bottom Line: Aptly named, inviting, and highly readable.
DAVID H. WEINSTEIN, MD IAN GRIMM, MD Division of Gastroenterology and Hepatology University of North Carolina at Chapel Hill Chapel Hill, North Carolina