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Undergraduate teaching project. Unit 4a. Upper GI tract: Pathoclinical aspects
GASTROENTEROLOGY
AUDIOVISUAL
1985;88:2017-9
REVIEWS
Note: From time to time Dr. Marvin M. Schuster readers. A.L.
of Baltimore provides
Undergraduate Teaching project. Unit 15. Splanchnic Circulation EUGENED. JACOBSON,T. E. BYNIIM, JAN WARKEN. Produced
by the American Gastroenterological Association, 1984. Distributed by Milner-Fenwick, Inc., 2125 Greenspring Drive, Timonium, Md., 21903. 46 slides with text. Cost $75.00. The slides cover basic principles of splanchnic vascular and microvascular anatomy, blood flow measurement, control, and distribution. Most of the major concepts and basic principles of splanchnic circulatory physiology are concisely preseqted, including nervous and humoral control, autoregulation, countercurrent exchange, and the relationship of blood flow to organ function. The last 12 slides deal with splanchnic vascular disease, including gastrointestinal bleeding, intestinal ischemia, and portal hypertension. These integrate pathophysiologic principles with these common clinical problems particularly well. Some choices of subjects for inclusion seem questionable. For example, many would now question the choice of the aminopyrine clearance technique over the hydrogen clearance or microsphere methods for measuring gastric mucosal blood flow. Five slides dealing with intestinal ischemia unfortdnately do not mentiop the most common cause, strangulation obstruction. A few slides are not designed for optimal understanding: slides 18 and 19 are confusing and would only complicate understanding the complex interaction of factors regulating splanchnic flow. It is difficult to understand why the authors chose a radiograph of aberrant vascular anatomy to illustrate the normal superior mesenteric artery (slide 3). Although timely in some areas (disc’ussion of free-radical mediated reperfusion injury), it is somewhat out of date in others [the measurement of blood flow, the relationship of gastric mucosal blood flow to acid secretion). Despite these minor flaws, this set of slides provides an excellent and remarkably efficient summary of this field to be used for the instruction of undergraduates by someone already familiar with the subject. GREGORYB. BULKLEY.M.D. Baltimore, Maryland
Undergraduate Teaching Project. Unit 17. Gut Immunology and Ecology JOHNG. BANWELL,ALAN M. LAKE, BARBAKAM. RANKIN.Produced
by the American Gastroenterological Association, 1984. Distributed by Milner-Fenwick, Inc., 2125 Greenspring Drive, Timonium, Md. 21093. 100 slides with text. Cost $135.00. This newly revised component of the popular Undergraduate Teaching Project provides materials for teaching clinically relevant gut immunology and microbial ecology to medical students. The slides and their accompanying text deal comprehensively and skillfully with many topics such as mucosal immunity, the acquisition, location and biology of the enteric microflora, and the influence of these bacteria on intestinal and systemic host physiology. An extensive and thoughtful discussion of most relevant gastrointestinal infections completes the set; the emphasis on
reviews of audiovisual
materials
that might Be useful to our
diarrhea is sufficiently dominant to suggest that the effort be renamed Gut Immunology, Ecology, and Infection. The slides are expertly crafted with only occasional problems, e.g., crowding of words that causes momentary confusion, and a pair on alimentary microflora that I could not differentiate. The photomicrographs are beautiful and the cryptosporidiosis, Whipple’s di’sease, and Giardia entries will immediately replace their faithful worn-out counterparts in my present collection. I will find much use for many of these diagrams in teaching. Immunology is represented by a thin slice of this endeavor, but this is appropriate, given the clinical relevant objectives of the project. The authors are aware of the numerous ambiguities that becloud our full understanding of mucosal defense, and they define clearly where information on this subject is lacking. Although pictures, diagrams, and text are the main teaching tools in this Unit certain of the references cited, although excellent, were from marginally accessible sources, e.g., Bulletins of WHO Working Groups. Several of the references were dated; the authors cite a good immunology resource book (The Immunoglobulin A System, edited by J. Mestecky and A. II. Lawton, Plenum Press, New York, 1974) that is 10 years old, and a similar volume from 1977, but not the most recent book-length proceedings The Secretory Immune System, edited by J. R. McGhee and J. tiestecky, Ann NY Acad Sci. Vol409,1983. Certain other entries from the late 1960s or early 1970s could have been replaced by later reviews. These citations do not teflect what is obvious from the text and diagrams-that the authors are fully aware of the most current work. I recommend the entire set with enthusiasm. It will benefit anyone who is given the happy task of teaching and learning about how the gut and its microbial guests get along. ANDREW G. PLAUT, M.D.
Boston, Massachusetts
Undergraduate Teaching Project. Unit 4A. Upper GI Tract: Pathoclinical Aspkcts JOHN H. YARDLEY and THEODOREM. BAYLESS. Produced by the American Gastroenterological Association, 1983. Distributed by Milner-Fenwick, Inc., 2125 Greenspring Drive, Timonium, Md. 21093. 70 slides, with 37 page text. Cost $95.00. The slides are almost evenly split between light photomicrographs and charts, sketches, and gross photographs, and the major emphasis is on the histologic appearance of common upper gastrointestinal disease, with secondary emphasis on broad overviews of current concepts of pathogenesis of these disprders. The accompanying text consists of concise descriptions of the material presented by each slide and recent references are often given. Many slides contain more than one photomicrograph, for example, comparing normal with diseased tissues, or comparing routine and special stain appearances of diseased mucosa. Photomicrographs of slides prepared by special techniques-such as ah autoradiographic demonstration of basal cell proliferation in esophageal reflux-are useful demonstrations of principles of tissue injury and response. The graphs and micrographs are of good quality and are well and concisely labeled. Potentially
2018
AUDIOVISUAL REVIEWS
controversial points in this work were trivial. This set should easily accomplish its goal of supplying useful and key visual aids to be used by those teaching at the intended level of students and house staff. JAMES L. MADARA.
M.D
Boston, Massachusetts
Undergraduate Teaching Project. Unit 13.A. Nutrition: Energy and Protein DAVIDALPERS. Produced by the American Gastroenterological Association, 1980. Distributed by Milner-Fenwick, Inc., 2125 Greenspring Drive, Timonium, Md. 21093. 68 slides, 35 page text, cost $90.00. This unit is primarily focused on protein and energy metabolism in normal, starved, and diseased human beings. The slides are clearly illustrated and of good quality. The subjects include: body composition; energy intake and utilization; food work equivalents; caloric content of foods; metabolic changes in fasting and in early and prolonged starvation; protein requirements; and protein-calorie malnutrition, The set ends with slides on dietary fiber and obesity, both being treated superficially. Accompanying text is generally clear and well-written. Several important topics are omitted, such as newer methods of measuring energy utilization and body composition. The most unfortunate omission is that of practical material for demonstrating calculation of energy and protein needs in malnourished and well-nourished patients undergoing surgical or traumatic stress. Although there is one page of text on this subject, there are no accompanying slides. Equations for determining protein needs and basal energy expenditure have not been included, which is curious, for these are useful clinical tools. Further, there is no discussion of protein requirements in old age and little treatment of lipoprotein metabolism. In very few instances, the text is either confusing or not congruent with the slide material. For example, the title of one slide is “Protein Feeding Increases Tissue Protein and Fat,” when, in fact, a later slide states that excess protein cannot be retained per se, although the calories from the protein can be retained. Further, a slide on the intraconversion of nutrients is presented incorrectly with a correct relationship indicated in the text. One or two slides are extremely simplistic and should have been omitted, such as a single bar graph illustrating that soft drinks contain only carbohydrates. An example of incongruity between a slide and its text arises when the slide entitled “Basal Energy Use Is Increased by Trauma,” is a component of a discussion centered around nitrogen losses. It is difficult to show metabolic pathways in an interesting way and I think, in general, metabolic pathways are well-illustrated in this set. However, I think the value of the set could have been greatly enhanced by specific case examples and clinical formulas that can be applied to patients. The slide set will increase the students’ knowledge of the pathophysiology of malnutrition, but will probably not serve to increase the quality of care to the patients, for no patient material is given. The level of the text and slides is appropriate for medical students and clinicians, although clinicians could use a bit more basic science review and medical students a bit more on clinical applications. ROBERTRUSSELL, M.D. Boston, Massachusetts
GASTROENTEROLOGY Vol. 88, No. 6
Undergraduate Teaching Project. Unit 16. Exocrine Pancreas: Pancreatitis TRAVISSOLOMON.Produced by the American Gastroenterological Association, 1984. Distributed by Milner-Fenwick, Inc., 2125 Greenspring Drive, Timonium, Md. 21093. 75 slides with text. cost $100.00 This collection depicts the anatomy and exocrine physiology of the pancreas. Each visual aid is supplemented with a brief but adequate text that describes the physiology of the pancreas with clarity, accuracy, and timeliness that exceed many textbooks of physiology; the text consists of precise information and not just generalizations. The object of this collection is to provide the student with sufficient knowledge of the pancreas to understand the normal function of digestion, Its secondary goal is to relate the function of the pancreas to the etiology of pancreatitis and to provide an understanding of the abnormal physiology resulting from acute and chronic pancreatitis. Such knowledge leads to a rational approach to the diagnosis and, we hope, to the treatment of pancreatic disease. The composition of pancreatic juice, the cellular origin of the various components, and the controlling mechanisms for their secretion are described. The relationship between gastric secretion and pancreatic secretion is covered. A discussion is presented of the delicate balance within the duodenum between the secretions from the stomach and pancreas for the pancreatic enzymes to perform optimally in digestion. The effect of duodenal contents on the release of duodenal hormones and the initiation of enteropancreatic reflexes are discussed with regard to their effect on pancreatic secretion. The mechanisms of action of the pancreatic enzymes in digestion of carbohydrates, fats, and proteins are described. The etiologic, pathologic, and clinical findings of acute and chronic pancreatitis are presented and correlated with the deranged physiologic function associated with pancreatitis. How our knowledge of pancreatic physiology contributes to the diagnosis of acute and chronic pancreatic inflammation is included. Because our knowledge is lacking, there is little information as to how normal pancreatic function in humans is altered to produce autodigestion of the pancreas and pancreatitis. Although the set suggests numerous approaches to the treatment of pancreatitis there is little physiologic information that one can use at this time to alter the progress. This material is highly suitable for students receiving their first exposure to the physiology of the pancreas. It is equally suitable for those who wish to review and upgrade their knowledge of pancreatic function, for it contains some of the newest concepts of pancreatic physiology. PAUL JORDAN, JR., M.D. Houston, Texas
A Microscopic
Look at Digestion
JOHNPATTONand KEVINKELLEY.Produced by Bandera Enterprises, Studio City, Calif. 91604. A 20 min, 16 mm film-full color and sound (1 reel). This attractive film uses real-time and time-lapse photography to examine in vitro enzymatic hydrolysis of basic food particles, i.e., fat droplets, starch granules, and meat (protein) fibers, It succeeds, but the yield of knowledge for the time spent was small.
AUDIOVISUAL
1985;88:2017-9
REVIEWS
Note: From time to time Dr. Marvin M. Schuster readers. A.L.
of Baltimore provides
Undergraduate Teaching project. Unit 15. Splanchnic Circulation EUGENED. JACOBSON,T. E. BYNIIM, JAN WARKEN. Produced
by the American Gastroenterological Association, 1984. Distributed by Milner-Fenwick, Inc., 2125 Greenspring Drive, Timonium, Md., 21903. 46 slides with text. Cost $75.00. The slides cover basic principles of splanchnic vascular and microvascular anatomy, blood flow measurement, control, and distribution. Most of the major concepts and basic principles of splanchnic circulatory physiology are concisely preseqted, including nervous and humoral control, autoregulation, countercurrent exchange, and the relationship of blood flow to organ function. The last 12 slides deal with splanchnic vascular disease, including gastrointestinal bleeding, intestinal ischemia, and portal hypertension. These integrate pathophysiologic principles with these common clinical problems particularly well. Some choices of subjects for inclusion seem questionable. For example, many would now question the choice of the aminopyrine clearance technique over the hydrogen clearance or microsphere methods for measuring gastric mucosal blood flow. Five slides dealing with intestinal ischemia unfortdnately do not mentiop the most common cause, strangulation obstruction. A few slides are not designed for optimal understanding: slides 18 and 19 are confusing and would only complicate understanding the complex interaction of factors regulating splanchnic flow. It is difficult to understand why the authors chose a radiograph of aberrant vascular anatomy to illustrate the normal superior mesenteric artery (slide 3). Although timely in some areas (disc’ussion of free-radical mediated reperfusion injury), it is somewhat out of date in others [the measurement of blood flow, the relationship of gastric mucosal blood flow to acid secretion). Despite these minor flaws, this set of slides provides an excellent and remarkably efficient summary of this field to be used for the instruction of undergraduates by someone already familiar with the subject. GREGORYB. BULKLEY.M.D. Baltimore, Maryland
Undergraduate Teaching Project. Unit 17. Gut Immunology and Ecology JOHNG. BANWELL,ALAN M. LAKE, BARBAKAM. RANKIN.Produced
by the American Gastroenterological Association, 1984. Distributed by Milner-Fenwick, Inc., 2125 Greenspring Drive, Timonium, Md. 21093. 100 slides with text. Cost $135.00. This newly revised component of the popular Undergraduate Teaching Project provides materials for teaching clinically relevant gut immunology and microbial ecology to medical students. The slides and their accompanying text deal comprehensively and skillfully with many topics such as mucosal immunity, the acquisition, location and biology of the enteric microflora, and the influence of these bacteria on intestinal and systemic host physiology. An extensive and thoughtful discussion of most relevant gastrointestinal infections completes the set; the emphasis on
reviews of audiovisual
materials
that might Be useful to our
diarrhea is sufficiently dominant to suggest that the effort be renamed Gut Immunology, Ecology, and Infection. The slides are expertly crafted with only occasional problems, e.g., crowding of words that causes momentary confusion, and a pair on alimentary microflora that I could not differentiate. The photomicrographs are beautiful and the cryptosporidiosis, Whipple’s di’sease, and Giardia entries will immediately replace their faithful worn-out counterparts in my present collection. I will find much use for many of these diagrams in teaching. Immunology is represented by a thin slice of this endeavor, but this is appropriate, given the clinical relevant objectives of the project. The authors are aware of the numerous ambiguities that becloud our full understanding of mucosal defense, and they define clearly where information on this subject is lacking. Although pictures, diagrams, and text are the main teaching tools in this Unit certain of the references cited, although excellent, were from marginally accessible sources, e.g., Bulletins of WHO Working Groups. Several of the references were dated; the authors cite a good immunology resource book (The Immunoglobulin A System, edited by J. Mestecky and A. II. Lawton, Plenum Press, New York, 1974) that is 10 years old, and a similar volume from 1977, but not the most recent book-length proceedings The Secretory Immune System, edited by J. R. McGhee and J. tiestecky, Ann NY Acad Sci. Vol409,1983. Certain other entries from the late 1960s or early 1970s could have been replaced by later reviews. These citations do not teflect what is obvious from the text and diagrams-that the authors are fully aware of the most current work. I recommend the entire set with enthusiasm. It will benefit anyone who is given the happy task of teaching and learning about how the gut and its microbial guests get along. ANDREW G. PLAUT, M.D.
Boston, Massachusetts
Undergraduate Teaching Project. Unit 4A. Upper GI Tract: Pathoclinical Aspkcts JOHN H. YARDLEY and THEODOREM. BAYLESS. Produced by the American Gastroenterological Association, 1983. Distributed by Milner-Fenwick, Inc., 2125 Greenspring Drive, Timonium, Md. 21093. 70 slides, with 37 page text. Cost $95.00. The slides are almost evenly split between light photomicrographs and charts, sketches, and gross photographs, and the major emphasis is on the histologic appearance of common upper gastrointestinal disease, with secondary emphasis on broad overviews of current concepts of pathogenesis of these disprders. The accompanying text consists of concise descriptions of the material presented by each slide and recent references are often given. Many slides contain more than one photomicrograph, for example, comparing normal with diseased tissues, or comparing routine and special stain appearances of diseased mucosa. Photomicrographs of slides prepared by special techniques-such as ah autoradiographic demonstration of basal cell proliferation in esophageal reflux-are useful demonstrations of principles of tissue injury and response. The graphs and micrographs are of good quality and are well and concisely labeled. Potentially
2018
AUDIOVISUAL REVIEWS
controversial points in this work were trivial. This set should easily accomplish its goal of supplying useful and key visual aids to be used by those teaching at the intended level of students and house staff. JAMES L. MADARA.
M.D
Boston, Massachusetts
Undergraduate Teaching Project. Unit 13.A. Nutrition: Energy and Protein DAVIDALPERS. Produced by the American Gastroenterological Association, 1980. Distributed by Milner-Fenwick, Inc., 2125 Greenspring Drive, Timonium, Md. 21093. 68 slides, 35 page text, cost $90.00. This unit is primarily focused on protein and energy metabolism in normal, starved, and diseased human beings. The slides are clearly illustrated and of good quality. The subjects include: body composition; energy intake and utilization; food work equivalents; caloric content of foods; metabolic changes in fasting and in early and prolonged starvation; protein requirements; and protein-calorie malnutrition, The set ends with slides on dietary fiber and obesity, both being treated superficially. Accompanying text is generally clear and well-written. Several important topics are omitted, such as newer methods of measuring energy utilization and body composition. The most unfortunate omission is that of practical material for demonstrating calculation of energy and protein needs in malnourished and well-nourished patients undergoing surgical or traumatic stress. Although there is one page of text on this subject, there are no accompanying slides. Equations for determining protein needs and basal energy expenditure have not been included, which is curious, for these are useful clinical tools. Further, there is no discussion of protein requirements in old age and little treatment of lipoprotein metabolism. In very few instances, the text is either confusing or not congruent with the slide material. For example, the title of one slide is “Protein Feeding Increases Tissue Protein and Fat,” when, in fact, a later slide states that excess protein cannot be retained per se, although the calories from the protein can be retained. Further, a slide on the intraconversion of nutrients is presented incorrectly with a correct relationship indicated in the text. One or two slides are extremely simplistic and should have been omitted, such as a single bar graph illustrating that soft drinks contain only carbohydrates. An example of incongruity between a slide and its text arises when the slide entitled “Basal Energy Use Is Increased by Trauma,” is a component of a discussion centered around nitrogen losses. It is difficult to show metabolic pathways in an interesting way and I think, in general, metabolic pathways are well-illustrated in this set. However, I think the value of the set could have been greatly enhanced by specific case examples and clinical formulas that can be applied to patients. The slide set will increase the students’ knowledge of the pathophysiology of malnutrition, but will probably not serve to increase the quality of care to the patients, for no patient material is given. The level of the text and slides is appropriate for medical students and clinicians, although clinicians could use a bit more basic science review and medical students a bit more on clinical applications. ROBERTRUSSELL, M.D. Boston, Massachusetts
GASTROENTEROLOGY Vol. 88, No. 6
Undergraduate Teaching Project. Unit 16. Exocrine Pancreas: Pancreatitis TRAVISSOLOMON.Produced by the American Gastroenterological Association, 1984. Distributed by Milner-Fenwick, Inc., 2125 Greenspring Drive, Timonium, Md. 21093. 75 slides with text. cost $100.00 This collection depicts the anatomy and exocrine physiology of the pancreas. Each visual aid is supplemented with a brief but adequate text that describes the physiology of the pancreas with clarity, accuracy, and timeliness that exceed many textbooks of physiology; the text consists of precise information and not just generalizations. The object of this collection is to provide the student with sufficient knowledge of the pancreas to understand the normal function of digestion, Its secondary goal is to relate the function of the pancreas to the etiology of pancreatitis and to provide an understanding of the abnormal physiology resulting from acute and chronic pancreatitis. Such knowledge leads to a rational approach to the diagnosis and, we hope, to the treatment of pancreatic disease. The composition of pancreatic juice, the cellular origin of the various components, and the controlling mechanisms for their secretion are described. The relationship between gastric secretion and pancreatic secretion is covered. A discussion is presented of the delicate balance within the duodenum between the secretions from the stomach and pancreas for the pancreatic enzymes to perform optimally in digestion. The effect of duodenal contents on the release of duodenal hormones and the initiation of enteropancreatic reflexes are discussed with regard to their effect on pancreatic secretion. The mechanisms of action of the pancreatic enzymes in digestion of carbohydrates, fats, and proteins are described. The etiologic, pathologic, and clinical findings of acute and chronic pancreatitis are presented and correlated with the deranged physiologic function associated with pancreatitis. How our knowledge of pancreatic physiology contributes to the diagnosis of acute and chronic pancreatic inflammation is included. Because our knowledge is lacking, there is little information as to how normal pancreatic function in humans is altered to produce autodigestion of the pancreas and pancreatitis. Although the set suggests numerous approaches to the treatment of pancreatitis there is little physiologic information that one can use at this time to alter the progress. This material is highly suitable for students receiving their first exposure to the physiology of the pancreas. It is equally suitable for those who wish to review and upgrade their knowledge of pancreatic function, for it contains some of the newest concepts of pancreatic physiology. PAUL JORDAN, JR., M.D. Houston, Texas
A Microscopic
Look at Digestion
JOHNPATTONand KEVINKELLEY.Produced by Bandera Enterprises, Studio City, Calif. 91604. A 20 min, 16 mm film-full color and sound (1 reel). This attractive film uses real-time and time-lapse photography to examine in vitro enzymatic hydrolysis of basic food particles, i.e., fat droplets, starch granules, and meat (protein) fibers, It succeeds, but the yield of knowledge for the time spent was small.