Lecture notes on gastroenterology

Lecture notes on gastroenterology

252 GASTROENTEROLOGY Vol. 90, No. BOOK REVIEWS vide an overview for microbiologists and gastroenterologists. The scope of this book is broad in tha...

325KB Sizes 3 Downloads 374 Views




vide an overview for microbiologists and gastroenterologists. The scope of this book is broad in that both human and animal hosts are considered in each of the discussions. The first chapter deals with the conceptual and technical problems involved with the study of intestinal microflora. The authors correctly point out the difficulties involved in the study of the microflora of the gastrointestinal tract when viewed as an ecosystem. The second chapter is an overview of the bacterial flora of the normal intestinal tract and the important factors that affect both the numbers and types of bacteria at various sites. The third chapter is concerned with the role of intestinal microflora in malabsorption and diarrhea. This may be the weakest part of the book because the description of bacterial enteropathogens is somewhat out of date, and viral enteropathogens are almost completely ignored. The final chapter is an interesting discussion of both the benefits and harm that the intestinal microflora can cause. This short volume is well written and the illustrations, though simple, are well done. I would recommend it as an introduction to intestinal microbiology for students in gastroenterology or microbiology, and for anyone else who would like a short review. JOHN J. MATHEWSON,


Houston, Texas

Giardia and Giardiasis: Biology, Pathogenesis, and Epidemiology. Edited by S. L. Erlandsen and E. A. Meyer. 407 pp., $65.00. Plenum Publishing Company, New York, New York, 1984. Written to celebrate the tricentennial discovery of Giardia by Leeuwenhoek, this book reviews advances in our knowledge of the organization and function of this parasitic protozoan and its interaction with its host. It is divided into three sections. The dominant theme of the first section is the biology of the organism and the correlation of structure-function relationships. The second section deals with the diagnosis and treatment of giardiasis and the immunologic reactions within the host. The third section relates recent studies on the epidemiology of giardiasis. In general, the book is well written, well organized, well illustrated, and well referenced. The first two chapters, on the structure of the trophozoite and cyst and on motility and the mechanism of attachment of trophozoites, are particularly well illustrated, with magnificent electron micrographs. The high-voltage electron micrographs present the parasite in intimate detail, and the scanning electron micrographs and microcinematographic photographs make it almost come alive. The chapters on metabolism of the trophozoite and Giardia isozymes contain much new and useful information. It was news to me, for example, that examination of various isozymes of Giardia has aided in distinguishing its various species which are so similar morphologically. Chapters dealing with methods of isolating trophozoites and cysts and on cultivating Giardia trophozoites should be very useful to scientists working with this organism.


The chapter on symptomatology, diagnosis, and treatment of giardiasis by Martin Wolfe is a good review. The chapter by Gillon and Ferguson on the small intestinal mucosa in giardiasis is disappointing in that it does not contain any photomicrographs, especially of the dramatic abnormalities that may be present in infected hypogammaglobulinemic patients. Two chapters deal with immune responses in giardiasis. The second, by Philip Smith, which deals with human immune responses, is especially good. Unfortunately, there is considerable redundancy of content in these two chapters, as well as in a following chapter on serologic diagnosis. The chapters on epidemiology contain useful and up-to-date information. Some of the subjects covered are waterborne outbreaks of giardiasis, detection of Giardia cysts in drinking water, resistance of cysts to disinfection agents, and fecal-oral transmission of giardiasis. Giardia and Giardiasis is recommended to anyone looking for a comprehensive, easy-to-read update on this important organism and disease. WILLIAM R. BROWN, M.D.

Denver. Colorado

Chemotherapy of Gastrointestinal Helminths. By H. Vanden Bossche, D. Thienpont, and P. G. Janssens. 719 pp., 62 figures, $198.00. Springer-Verlag, New York, New York, 1985. The title is deceptive, for this book contains extensive information over and above the in-depth discussion of chemotherapy of helminths. Pathogenic mechanisms, modes of transmission, life cycles, and epidemiologies are covered by international experts in human and animal parasitology. Chapters include the helminths of man, domestic animals, ruminants, equines, pigs, and carnivorous mammals and birds, which ensures that the book will have widespread veterinary and medical use. Preparation of the work has been careful with fewer than the usual typographic errors. Certain sections are redundant as contributors discuss the same subject from different viewpoints: however, the reader benefits from this diversity. The following chapters are of particular value to gastroenterologists: “Pharmacology of anthelmintics,” “Chemotherapy of gastrointestinal nematodiasis in man,” “Chemotherapy of intestinal trematodiasis in man,” and “Chemotherapy of tapeworm infections in man.” Importantly, there are discussions of such unusual infections as anisakiasis, oesophagostomiasis, and intestinal angiostrongyliasis, among others-infections which can be encountered by the endoscopist, who may appreciate such a reference. The book is too detailed and costly for the average practicing physician but he should know that it is available in a convenient library. LEE S. MONROE, M.D. San Diego, California

Lecture Notes on Gastroenterology. By E. Elias and C. Hawkins. 383 pp., $12.50. Blackwell Scientific Publications, Boston, Massachusetts, 1985.

January 1986

“All you really need to know about clinical gastroenterology” might be the subtitle of this pithy little paperback. It covers most subjects that large texts encompass but does so in a very limited fashion, using a pleasant, conversational tone that reflects the title of “Lecture Notes.” The famous British wit provides occasional humorous relief, sentinel of such as “. . . an efficient anal sphincter-the social security.” The book is arranged in three parts, titled “I-The clinical approach, ” “II-Investigations,” and “III-Essential background information.” Only part III covers specific diseases but omits detailed discussions of pathogenesis or pathophysiology, and sometimes mentions them only in passing or not at all. Occasionally the description of the disease is even omitted (for example, primary sclerosing cholangitis, p. 202), the authors apparently deciding that the name alone was descriptive enough. The most space is devoted to clinical features and treatment. The down-toearth, reasonable approach to diagnostic procedures is refreshing and all too unusual. Parts I and II are clearly the most valuable portions, and the writing clearly conveys the pragmatic approach of two very knowledgeable and widely experienced clinicians. I was most impressed with their discussion of the practical methods of managing the psychological aspects of gastrointestinal non-disease; their discussion of chronic abdominal pain in chapter 8 should be required reading for every student-and again just before entering practice. This book suffers from all the objections that can be leveled at a synopsis of a very broad field. The material in part III is too brief for anything other than an introduction for students or a brief review for others. The material consists of opinions with no documentation; only nine references and five suggestions for further reading are provided for the whole book. On the other hand, although one may argue with details, such as the apparent assumption [in part I but not so clearly put in part III) that hiatal hernia and reflux esophagitis are nearly synonymous, I found no opinion taken in context with which I could seriously disagree. Use of some peculiarly British terms, such as “liquid parafin” for mineral oil might give some pause. The illustrations are of good quality; tables and the few diagrams follow the same abbreviated style of the text. The first 125 pages are valuable and recommended to less experienced physicians; they alone easily justify the remarkably cheap price. The remainder of the book might supplement other reading in much the same way that lectures supplement, but will not stand alone (nor are apparently intended to). I found this volume an enjoyable experience in the first 125 pages and thoroughly appreciated the efforts of the authors, but I doubt that it will have much use in a library. Students will find it useful as a brief introduction to practical clinical gastroenterology. JAMES L. ACHORD, M.D.

Jackson, Mississippi

Maingot’s Abdominal Operations. Eighth ed. Volumes 1 and 2. By S. I. Schwartz and H. Ellis. 2289 pp., $195.00 per set. Appleton-Century-Crofts, Norwalk, Connecticut, 1985.



Maingot’s Abdominal Operations was first published in 1949. With the exception of two chapters by internists, the remaining chapters of the first edition were the single effort of Rodney Maingot. This new work is the continuation of eight editions and still reflects the compulsion for excellence initiated by Rodney Maingot, even though there are now 78 senior consultants and two new editors, Seymour I. Schwartz and Harold Ellis, both known throughout the world for their major contributions to surgery. The book has been totally revised but maintains its original emphasis on the practical approach to surgical problems as well as the selection of operative procedure based on scientific merit. In the introduction to the first edition, Maingot said that his book was intended to present a detailed consideration of the techniques of modern abdominal operations. The new editors and their coauthors have fulfilled this objective better than any text that I am familiar with. Pediatric and vascular surgery, but not gynecologic surgery, are included, and there are only tangential references to urologic surgery. The book is primarily oriented toward students of general surgery-those studying to be surgeons as well as those exerting efforts to remain good surgeons. Even so, there is plenty for gastroenterologists. Some chapters are strictly technical and would be of little interest to anyone other than surgeons. Although many chapters are technically oriented, they give gastroenterologists a better understanding of what their patients are to undergo if they accept the recommendation for operation. Perhaps few gastroenterologists will purchase this set, but these books should be in every major library and available for reference by all physicians. This text is remarkable for consistent clear writing and superb illustrations. Overlap and repetition between chapters are minimal and that which does occur only strengthens the text by giving the reader a second opinion. The text is not limited to operative technique; the background, physiology, medical and surgical considerations, and preoperative, perioperative, and postoperative management are presented for each subject considered. Although this is not an exhaustive operative atlas it does give sufficient detail to provide the serious reader with technical details, options, and hints to make the operations easier and safer. While the authors give you their opinions, they also provide the evidence and, when available, present the prospective randomized studies that have an important bearing on operative management. All of this is presented succinctly and with great clarity. The first section, nearly 250 pages, covers radiology, ultrasonography, computer tomography, nuclear magnetic resonance, nuclear medicine, angiography, endoscopy, and laparoscopy. Each of these chapters is superb, describing the principles, methods, indications, complications, and limitations of these techniques, emphasizing where they are most appropriately applied, and the reliability and value of the information obtained. The illustrative material is outstanding and the text is clear and explicit. This exuberance is not meant in any way to downgrade the succeeding chapters, which are all excellent. The chapters on management of wounds and gastrointestinal fistulas are outstanding. I wish more had been devoted to drainage of