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Pathology of the esophagus and duodenum. Volume 4 of series “contemporary issues in surgical pathology”
250 BOOK REVIEWS
mend therapy for a patient with an immunodeficiency state and a gastrointestinal problem or a child with peptic ulcer disease? Would you like to know how sclerotherapy of varices is performed in one of the world’s busiest liver centers? If so, you can obtain the information in the usual ways, such as consulting textbooks, reviewing the literature, attending meetings, or asking colleagues. But these require time and access, two commodities you probably have little of as you struggle to keep abreast of managing your patients with gastroesophageal reflux, chronic inflammatory bowel disease, and irritable bowels, just to mention a few of the major categories. Another approach, not mutually exclusive of the others, is to consult this book. You will find 103 topics covered by experts who treat the diseases and conditions they discuss. The management of every significant gastrointestinal and hepatobiliary condition is discussed in sufficient detail to permit the reader to apply the information quickly to the care of patients. Medical and surgical approaches are discussed. A remarkable amount of practical information is supplied. A few of the many examples include the relative cost of nutritional support regimens, names and addresses of suppliers of gluten-free products, reference materials for patients with sprue, and how to guide alcoholic patients through the proliferating treatment programs. “Tricks of the trade” abound and attest to the hands-on experience of the authors. The practical points are not provided at the expense of more sophisticated information, such as the comparative value of drugs for various conditions and what to expect from your treatment. How is it possible to provide both practical and more esoteric information about so many conditions in a volume that is 1 inch thick and set in print of ordinary size? The answer lies in key editorial decisions and style. Diagnosis and pathophysiology have been deemphasized or omitted. It is assumed that the reader will have a diagnosis before consulting this book. Space is saved by the liberal use of tables and by providing few references. Little attention is paid to traditional pharmacologic considerations like bioavailability, pharmacokinetics, and drug metabolism and excretion. The style is a combination of informed opinion and documentation by references to key studies in the text. This also saves space while leaving the reader with a clear understanding of how an expert manages the condition and, to a lesser but not troublesome extent, why he or she does it that way. Another expert might quibble about certain details or make the point in another way, but this should be of little concern to the users of the book. The intended audience is the experienced practitioner who is familiar with digestive diseases. This seems about right, but some not-so-experienced clinicians, such as gastrointestinal fellows, will also find it useful. A new book doesn’t often fit a need as closely as this one does. Its value exceeds its cost by a considerable margin. JAMES W. FRESTON,
M.D.,Ph.D. Farmihgton, Connecticut
Pathology of the Esophhgus and Duodenum. Volume 4 of Series “Contemporary Issues in Surgical Pathology.” Ed-
GASTROENTEROLOGY
Vol. 90, No.
ited by H. Appelman. 296 pp., $49.50. Churchill stone, New York, New York, 1984.
1
Living-
Appelman says in his preface that this book does not attempt to be encyclopedic, but that it does cover the common and many uncommon upper gastrointestinal lesions, along with some “trendy” disorders such as endocrine tumors. His assessment is valid. Each of the eight chapters by seven pathologists gives a detailed overview of the pathology in the author’s assigned area, along with discussions of more unusual aspects that are his special province. The monograph complements an earlier volume on the mid and lower gastrointestinal tract [Pathology of the Colon, Small Intestine and Anus, edited by H.T. Norris, Volume 2 of the series “Contemporary Issues in Surgical Pathology”), so that the two together provide reasonably complete and current coverage of gastrointestinal pathology. Appelman has written a chapter on “Localized and extensive expansions of the gastric mucosa,” turning a confusing area of gastric pathology into a well-organized presentation that is marked by clear definitions and descriptions of what is known and not known about gastric polyps and mucosal hyperplasias. That chapter is virtually worth the price of the book. Appelman’s section on stromal tumors is also,notably clear and well organized. A chapter on inflammatory and neoplastic diseases of the esophagus by Frank Mitros is a balanced, sensible discussion of the pitfalls one encounters when interpreting lower esophageal biopsy in gastroesophageal reflux. Coverage of gastric carcinomas by Donald Antonioli is well organized and well written, although, surprisingly, his section on carcinoma of the cardia makes no mention of overlap with carcinoma arising in Barrett’s esophagus. Ali H. Qizilbash gives a good compendium of the mostly uncommon duodenal and periampullary epithelial neoplasms. There are also useful summations of endocrine pathology by Juan Lechago and of lymphoproliferative lesions, including the difficult area of gastric pseudolymphoma, by Charles E. Platz. The various forms of gastritis and duodenitis are covered by David Owen, in most cases appropriately. But I was disappointed in the author’s approach to ordinary chronic gastritis. Owen begins with the statement that “chronic gastritis is really a single disease.” All such conditions are then lumped together pathologically as rather than by considering purely inflam“nonspecific,” matory gastritis as usefully separable into forms that are distinctive in regard to features such as distribution and intestinal metaplasia. Alterations to the stomach after subtotal gastrectomy are not even mentioned. Epidemiologic, clinical, pathogenetic, and etiologic aspects of ordinary gastritis are discussed in a different part of the chapter, thereby implying to the reader that these aspects are not especially relevant to pathologic assessment. On the contrary, pathologists should be striving to pull together all available information about patients with chronic gastritis. They should not deal with gastritis as though it is a single entity-a condition that an overwhelming amount of evidence tells us it is not. There is no better proof of the need to assess gastritis carefully and
January
BOOK REVIEWS
1986
thoroughly than the recent exciting observation that a campylobacterlike organism may be an important causative factor. This book places particular emphasis on interpretation of endoscopic biopsy specimens, and it could certainly be useful to gastroenterologists who have an interest in and knack for pathology. It is written, however, primarily for surgical pathologists and, along with the book by Norris, is an important addition to the growing library of monographs on gastrointestinal pathology. This conclusion is supported by my personal observation that both the Appelman and Norris books have become popular with pathology house officers and fellows, as well as with more senior pathologists who have a special interest in gastrointestinal disease. JOHN H. YARDLEY,
M.D.
Baltimore, Maryland
251
edly different viewpoints concerning the treatment of gastroesophageal reflux with Nissen fundoplication. One group reported excellent results and another encountered major short- and long-term problems. Which group is correct? What accounts for the difference in results? Are one investigator’s results better because of his technique, or were the other investigator’s results poor because they were the experience of several surgeons at the same hospital? The reader is left with questions and no answers. Similarly, I was consistently bothered by the constant discussion of hiatus hernia in infants and children. In the United States, the percentage of infants and children with reflux who have concurrent hiatus hernia does not exceed 20%; therefore, it is not a major factor. This volume of Progress in Pediatric Surgery is not for the average clinician. Its value lies more in pointing out the current controversies than in giving a clear picture of the pathophysiology and treatment of GER. MARVIN E. AMENT, M.D.
Gastro-esophageal Reflux in Childhood: Problems of Splenit Surgery in Childhood (Progress in Pediatric Surgery, Volume 18). P. Wurnig, Volume Editor, with the cooperation of I. Klos. 193 pp., 75 figures, $46.00. Springer-Verlag, New York, New York, 1985. The first 131 pages of this volume are devoted to GER in childhood, and the remainder to splenic surgery in childhood. There are 16 chapters on GER-one on the physiology and pathophysiology of the esophagus in childhood; six on diagnostic tests; two on the relationship between GER, esophageal dysfunction, and either disturbances of respiratory regulation or bronchial asthma; one on the relationship between GER and severe mental retardation; and six on medical or surgical treatment. Of those chapters dealing with surgery, several are of great interest: “Late results after operations for hiatus hernia”; “To Nissen or not to Nissen”; “Retroesophageal hiatalplasty and gastropexy in the treatment of gastroesophageal reflux with or without hiatus hernia in childhood”; “Small bowel esophagoplasty with vascular microanastomosis in the neck for treatment of esophageal burns in childhood”; and “Followup examinations of conservatively and surgically treated children with hiatus hernia.” The chapters predominantly represent the viewpoints of an Austrian, German, and Swiss experience. Some of the contributors are not familiar to those of us on this side of the Atlantic who do investigation in GER. The chapters vary greatly in their “up-to-datedness.” References in most chapters do not extend beyond 1982, and in some do not go beyond the late 1979s. In a few, the limited experience of the author is stated, and his or her experience is compared with other published experience. Some of the chapters on diagnostic testing are particularly weak. The chapter on 24-hour pH monitoring is particularly lacking because no normal values are established. The reader must be careful in reviewing these chapters because they are not critiqued as in a peer-reviewed journal. I wonder why the editors did not provide a critique, rather than a summary, at the end of each chapter. It would certainly help a reader who is not thoroughly familiar with reflux and its treatment. There were decid-
Los Angeles, California
Comparative Biochemistry and Physiology of Enzymatic Digestion. By H. J. Vonk and J. R. H. Western. 501 pp., $80.00. Academic Press, Inc., Orlando, Florida, 1984. Readers of GASTROENTEROLOGY are familiar with the splendid efflorescence of the sciences underlying their specialty, but they are probably not so well acquainted with work that does not seem to have some remote possibility of clinical application. If they want to know what has happened in a broader field they might consult Vonk and Western’s compilation of results of comparative biochemical and physiological studies of enzymatic digestion in the entire range of metazoans. In three long chapters on proteinases in mammals, submammalian vertebrates, and invertebrates, they will find, for example, a table giving the properties of proteinases in 13 species of bivalves. Data on carbohydrases and lipases are almost equally comprehensive. Presentation of the physiology of enzymatic digestion is less complete, and comparison of Vonk and Western’s description of fat digestion in vertebrates with the corresponding chapter in any current textbook of the physiology of digestion in humans shows how much more thorough and illuminating the work of clinicians and medically oriented biochemists and physiologists has been. The figures are clear and the tables are well-organized. The long bibliographies make the book useful for consultation in the library. H. W. DAVENPORT,
Ph.D
Ann Arbor, Michigan
Intestinal Microbiology (Aspects of Microbiology, Volume 10). By B. S. Drasar and P. A. Barrow. 80 pp., $5.95. Van Norstrand Reinhold (U.K.) Company, Ltd., Wokingham, Berkshire, England. The microbiology of the gastrointestinal tract is indeed a complex subject. This short review is an attempt to pro-
mend therapy for a patient with an immunodeficiency state and a gastrointestinal problem or a child with peptic ulcer disease? Would you like to know how sclerotherapy of varices is performed in one of the world’s busiest liver centers? If so, you can obtain the information in the usual ways, such as consulting textbooks, reviewing the literature, attending meetings, or asking colleagues. But these require time and access, two commodities you probably have little of as you struggle to keep abreast of managing your patients with gastroesophageal reflux, chronic inflammatory bowel disease, and irritable bowels, just to mention a few of the major categories. Another approach, not mutually exclusive of the others, is to consult this book. You will find 103 topics covered by experts who treat the diseases and conditions they discuss. The management of every significant gastrointestinal and hepatobiliary condition is discussed in sufficient detail to permit the reader to apply the information quickly to the care of patients. Medical and surgical approaches are discussed. A remarkable amount of practical information is supplied. A few of the many examples include the relative cost of nutritional support regimens, names and addresses of suppliers of gluten-free products, reference materials for patients with sprue, and how to guide alcoholic patients through the proliferating treatment programs. “Tricks of the trade” abound and attest to the hands-on experience of the authors. The practical points are not provided at the expense of more sophisticated information, such as the comparative value of drugs for various conditions and what to expect from your treatment. How is it possible to provide both practical and more esoteric information about so many conditions in a volume that is 1 inch thick and set in print of ordinary size? The answer lies in key editorial decisions and style. Diagnosis and pathophysiology have been deemphasized or omitted. It is assumed that the reader will have a diagnosis before consulting this book. Space is saved by the liberal use of tables and by providing few references. Little attention is paid to traditional pharmacologic considerations like bioavailability, pharmacokinetics, and drug metabolism and excretion. The style is a combination of informed opinion and documentation by references to key studies in the text. This also saves space while leaving the reader with a clear understanding of how an expert manages the condition and, to a lesser but not troublesome extent, why he or she does it that way. Another expert might quibble about certain details or make the point in another way, but this should be of little concern to the users of the book. The intended audience is the experienced practitioner who is familiar with digestive diseases. This seems about right, but some not-so-experienced clinicians, such as gastrointestinal fellows, will also find it useful. A new book doesn’t often fit a need as closely as this one does. Its value exceeds its cost by a considerable margin. JAMES W. FRESTON,
M.D.,Ph.D. Farmihgton, Connecticut
Pathology of the Esophhgus and Duodenum. Volume 4 of Series “Contemporary Issues in Surgical Pathology.” Ed-
GASTROENTEROLOGY
Vol. 90, No.
ited by H. Appelman. 296 pp., $49.50. Churchill stone, New York, New York, 1984.
1
Living-
Appelman says in his preface that this book does not attempt to be encyclopedic, but that it does cover the common and many uncommon upper gastrointestinal lesions, along with some “trendy” disorders such as endocrine tumors. His assessment is valid. Each of the eight chapters by seven pathologists gives a detailed overview of the pathology in the author’s assigned area, along with discussions of more unusual aspects that are his special province. The monograph complements an earlier volume on the mid and lower gastrointestinal tract [Pathology of the Colon, Small Intestine and Anus, edited by H.T. Norris, Volume 2 of the series “Contemporary Issues in Surgical Pathology”), so that the two together provide reasonably complete and current coverage of gastrointestinal pathology. Appelman has written a chapter on “Localized and extensive expansions of the gastric mucosa,” turning a confusing area of gastric pathology into a well-organized presentation that is marked by clear definitions and descriptions of what is known and not known about gastric polyps and mucosal hyperplasias. That chapter is virtually worth the price of the book. Appelman’s section on stromal tumors is also,notably clear and well organized. A chapter on inflammatory and neoplastic diseases of the esophagus by Frank Mitros is a balanced, sensible discussion of the pitfalls one encounters when interpreting lower esophageal biopsy in gastroesophageal reflux. Coverage of gastric carcinomas by Donald Antonioli is well organized and well written, although, surprisingly, his section on carcinoma of the cardia makes no mention of overlap with carcinoma arising in Barrett’s esophagus. Ali H. Qizilbash gives a good compendium of the mostly uncommon duodenal and periampullary epithelial neoplasms. There are also useful summations of endocrine pathology by Juan Lechago and of lymphoproliferative lesions, including the difficult area of gastric pseudolymphoma, by Charles E. Platz. The various forms of gastritis and duodenitis are covered by David Owen, in most cases appropriately. But I was disappointed in the author’s approach to ordinary chronic gastritis. Owen begins with the statement that “chronic gastritis is really a single disease.” All such conditions are then lumped together pathologically as rather than by considering purely inflam“nonspecific,” matory gastritis as usefully separable into forms that are distinctive in regard to features such as distribution and intestinal metaplasia. Alterations to the stomach after subtotal gastrectomy are not even mentioned. Epidemiologic, clinical, pathogenetic, and etiologic aspects of ordinary gastritis are discussed in a different part of the chapter, thereby implying to the reader that these aspects are not especially relevant to pathologic assessment. On the contrary, pathologists should be striving to pull together all available information about patients with chronic gastritis. They should not deal with gastritis as though it is a single entity-a condition that an overwhelming amount of evidence tells us it is not. There is no better proof of the need to assess gastritis carefully and
January
BOOK REVIEWS
1986
thoroughly than the recent exciting observation that a campylobacterlike organism may be an important causative factor. This book places particular emphasis on interpretation of endoscopic biopsy specimens, and it could certainly be useful to gastroenterologists who have an interest in and knack for pathology. It is written, however, primarily for surgical pathologists and, along with the book by Norris, is an important addition to the growing library of monographs on gastrointestinal pathology. This conclusion is supported by my personal observation that both the Appelman and Norris books have become popular with pathology house officers and fellows, as well as with more senior pathologists who have a special interest in gastrointestinal disease. JOHN H. YARDLEY,
M.D.
Baltimore, Maryland
251
edly different viewpoints concerning the treatment of gastroesophageal reflux with Nissen fundoplication. One group reported excellent results and another encountered major short- and long-term problems. Which group is correct? What accounts for the difference in results? Are one investigator’s results better because of his technique, or were the other investigator’s results poor because they were the experience of several surgeons at the same hospital? The reader is left with questions and no answers. Similarly, I was consistently bothered by the constant discussion of hiatus hernia in infants and children. In the United States, the percentage of infants and children with reflux who have concurrent hiatus hernia does not exceed 20%; therefore, it is not a major factor. This volume of Progress in Pediatric Surgery is not for the average clinician. Its value lies more in pointing out the current controversies than in giving a clear picture of the pathophysiology and treatment of GER. MARVIN E. AMENT, M.D.
Gastro-esophageal Reflux in Childhood: Problems of Splenit Surgery in Childhood (Progress in Pediatric Surgery, Volume 18). P. Wurnig, Volume Editor, with the cooperation of I. Klos. 193 pp., 75 figures, $46.00. Springer-Verlag, New York, New York, 1985. The first 131 pages of this volume are devoted to GER in childhood, and the remainder to splenic surgery in childhood. There are 16 chapters on GER-one on the physiology and pathophysiology of the esophagus in childhood; six on diagnostic tests; two on the relationship between GER, esophageal dysfunction, and either disturbances of respiratory regulation or bronchial asthma; one on the relationship between GER and severe mental retardation; and six on medical or surgical treatment. Of those chapters dealing with surgery, several are of great interest: “Late results after operations for hiatus hernia”; “To Nissen or not to Nissen”; “Retroesophageal hiatalplasty and gastropexy in the treatment of gastroesophageal reflux with or without hiatus hernia in childhood”; “Small bowel esophagoplasty with vascular microanastomosis in the neck for treatment of esophageal burns in childhood”; and “Followup examinations of conservatively and surgically treated children with hiatus hernia.” The chapters predominantly represent the viewpoints of an Austrian, German, and Swiss experience. Some of the contributors are not familiar to those of us on this side of the Atlantic who do investigation in GER. The chapters vary greatly in their “up-to-datedness.” References in most chapters do not extend beyond 1982, and in some do not go beyond the late 1979s. In a few, the limited experience of the author is stated, and his or her experience is compared with other published experience. Some of the chapters on diagnostic testing are particularly weak. The chapter on 24-hour pH monitoring is particularly lacking because no normal values are established. The reader must be careful in reviewing these chapters because they are not critiqued as in a peer-reviewed journal. I wonder why the editors did not provide a critique, rather than a summary, at the end of each chapter. It would certainly help a reader who is not thoroughly familiar with reflux and its treatment. There were decid-
Los Angeles, California
Comparative Biochemistry and Physiology of Enzymatic Digestion. By H. J. Vonk and J. R. H. Western. 501 pp., $80.00. Academic Press, Inc., Orlando, Florida, 1984. Readers of GASTROENTEROLOGY are familiar with the splendid efflorescence of the sciences underlying their specialty, but they are probably not so well acquainted with work that does not seem to have some remote possibility of clinical application. If they want to know what has happened in a broader field they might consult Vonk and Western’s compilation of results of comparative biochemical and physiological studies of enzymatic digestion in the entire range of metazoans. In three long chapters on proteinases in mammals, submammalian vertebrates, and invertebrates, they will find, for example, a table giving the properties of proteinases in 13 species of bivalves. Data on carbohydrases and lipases are almost equally comprehensive. Presentation of the physiology of enzymatic digestion is less complete, and comparison of Vonk and Western’s description of fat digestion in vertebrates with the corresponding chapter in any current textbook of the physiology of digestion in humans shows how much more thorough and illuminating the work of clinicians and medically oriented biochemists and physiologists has been. The figures are clear and the tables are well-organized. The long bibliographies make the book useful for consultation in the library. H. W. DAVENPORT,
Ph.D
Ann Arbor, Michigan
Intestinal Microbiology (Aspects of Microbiology, Volume 10). By B. S. Drasar and P. A. Barrow. 80 pp., $5.95. Van Norstrand Reinhold (U.K.) Company, Ltd., Wokingham, Berkshire, England. The microbiology of the gastrointestinal tract is indeed a complex subject. This short review is an attempt to pro-