Nutrition and metabolism in patient care

BOOK REVIEWS

134

of the Liver,

Neophm

In 1916 Okuda

by Kunio Okuda and Kamal G. Ishak (Eds.), Springer-Verlag,

and Peters edited a monograph

which. despite its title of ‘Hepatocelhdar

Carcino-

Tokyo. 1987.

Eastern experience. particularly but most authors

on the clinical side,

have considered

their

subjects

ma’. actually covered all types of liver tutnours, and

broadly, rather than simply reporting their own expe-

this became the standard text for the next decade.

rience, so that the work will be relevant to all parts of

The

the world. The first part starts with a considemtion of

present

volume,

plasms of the Liver’, mows.

particularly

although

now called

‘Neo-

concentrates on primary

hepatocellular

carcinoma,

tuand

the epidemiology

of HCC.

and is followed by chap-

ters on human hepatoma cell lines, and the molecular

has again been edited by Okuda. this time in collabo-

biology and sequellae of hepatitis B virus infection.

ration with Ishak. Looking at the two books side by

There follow detailed descriptions of the pathology

side it is easy to gain an impression of the excitement

of all the important primary liver tutnwrs

in the field, and the progress that has been made over

mourous lesions in the cirrhotic

and pretu-

liver. The second

the last 10 years. Particularly striking is the explosion

part contains a comprehensive account of serological

of basic and clinical research into the relationship of

and imaging techniques for diagnosis. Of the nine

hepatitis B virus infection to hepatoma. In the 1976

chapters relating to therapy, that on targeting of che-

volume there was a single chapter on ‘Viral Hepatitis

motherapy for HCC by Konno and Maeda was par-

and Hepatocelht!ar

ticularly

outstanding

Carcinoma’ - now there are five

chapters on this subject ranging from

impressive. They

report

using SMANCS

(styrene maleic acid conjugates of neocarzinostatin)

molecular biology to the clinical sequellae of HBV

dissolved in Lipiodol.

infection. Similarly.

have not yet been reported. the consistent reduction

screening programmes to detect

Although

controlled

studies

small hepatomas had only just started in 1976 and the

in turnour size and AFP levels is impressive and the

results of surgical resection were fairly depressing.

survival figures are claimed to be similar to those

This book now documents the 20% 5 yeat survival

from resectton of srxdl turnours. Certainly

experience

tologist wishing to obtain an overview of current hep

for subclinical hepatoma in China after

any hepa-

surgical resection and describes the first stages of

atic oncology or simply requiring an answer to a spe-

mass vaccination programmes against the hepatitis B

cific question could do no better

virus, suggesting that treatment and prevention may

tone. This will be the definitive work in the field of

soon be realities.

human hepatoma for the next decade and is a most

The book is beautifully produced and illustrated and contains 33 chapters divided into two sections.

yolume is dedicnted.

than consult this vol-

fitting tribute to Dr. Robert L. Peters. to whom the

Pttt~tt’ J. JOHNSON

the first on basic and the second on clinical aspects. There is an inevitable slant towards the Japanese and

Nurririon

and Metabolism

(Ed%). W.B. SoundersCo..

in Parim

Cure, by J.M.

Philadelphia.

The editors of this book come front the United States. Canada and New Zealand. They have recruited contributors Europe.

among their compatriots and from

The underlying

Kinney.

K.N.

Jeejeebhoy.

G.L.

Hill

and O.E.

Owen

1988.

philosophy of the boo!. is

metabolic issues. There are four sectiws.

The first describes basic

information concerning the normal elements of nutrilion

and energy

metabolism.

The second section

based on the premise that. more than ever before.

deals with variations occurring in otherwise normal

medical practice must incorporate nutritional consid-

individuals.

erations founded on a knowledge

physical activity. The third section is concerned with

of fundnmental

e g. ageing. pregnancy.

lactation

end

13s acute and chronic medical and surgical conditions. whilst the final section discusses nutritional The

authors do not identify

support.

the intended read-

It is a complex book with no ambitious and exciting opportunity

chapters on pregnancy. lactation and “edema are detailed but physiological in their emphasis rather than nutritional.

ership of this book. remit. The mqority

response and the infected patients are superb. The

The reader with an interest in hepatic medicine wil:

of the authors have ssiled

the

be disappointed.

given to them by their editors. Th*

re-

what with physiology rather than nutrition

sults are in general magnificent. scholarly and of sig-

The

hepatic chapter deals someand me-

tabolism. Whilst the support of renal transplantation

nificance to all clinicians. whether established or in

patients is discussed. the nutritional

training.

atic transplantation patients is not mentioned.

The opening chapters on energy metabo-

lism and regulation establish a ctandard of lucidity and scholarship

which other,

but not all. authors

achieve. Sometimes the authors have misread the instructions

and have written solely of the physiology

of the organ. not on the nutrition

and metabolism in

support of hep-

Overall this should be the second book that a dinician interested

in the nutritional

care of patients

might buy. The first book is necessary to supply tbe nutritional

framework

times provides. This

which this book only some-

book will excite, stimulate and

that organ. Sometimes so little is understood of an or-

educate the majority of. but not all. experienced clin-

gan‘s metabolism that the result is very pedestrian.

ical and research nutritionists.

The chapters on age@. spiratory

exercise. heart disease. re-

medicine. alcohol. pancreas. the immune