Pediatric Gastroenterology and Hepatology, 3rd ed

Pediatric Gastroenterology and Hepatology, 3rd ed

recent being 1990 publications. It is particularly surprising that the important work of Chung, Leung, and others from Hong Kong on epinephrine inject...

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recent being 1990 publications. It is particularly surprising that the important work of Chung, Leung, and others from Hong Kong on epinephrine injection for ulcer bleeding was not mentioned. The authors found that a nonbleeding visible vessel, associated with hypovolemic shock, had a 40% rebleeding rate. If hypovolemic shock was absent, the rebleeding rate fell to 25%. An adherent clot associated with hypovolemic shock had a 50% rebleeding rate; without the shock, the rebleeding rate fell to 17%. Hypovolemic shock appears to be an important predictor of rebleeding, at least in their study. The authors found that by 48 hours, a patient with active bleeding on admission faced a 4.9% risk of rebleeding; this risk was less than 1 % by 96 hours. In addition, all rebleeding episodes associated with hypovolemic shock, need for surgery, and death occurred within 96 hours. Therefore, the authors suggest that observation for 96 hours "is sufficient for detecting most episodes of rebleeding." However, they wisely refrain from suggesting that all patients with bleeding ulcers be hospitalized for a minimum of 96 hours, recognizing that multiple factors affect this decision. Is this Asian experience of bleeding ulcers undertaken in one center equivalent to an American or European one? That is hard to say. As the authors state, prospective studies in different populations are needed to establish the best and most cost-effective management. As America moves towards a capitated health care system, compelling data will be needed to justify a 4-day hospitalization after ulcer hemorrhage. The authors of this study kept their high-risk patients in the hospital and repeatedly endoscoped them to monitor the resolution of bleeding stigmata. I cannot see any U.S. health insurer paying for such intensive surveillance. Nonetheless, the risk factors for rebleeding that they identified are useful and probably applicable in most populations. JOHN BAILLIE

Durham, North Carolina

Book Reviews Pediatric Gastroenterology and Hepatology, 3rd ed. edited by M. Gracey, V. Burke Blackwell Scientific Publications, Cambridge, Massachusetts, 1993, 1110 pages, $225.00 Since the 1970s and early 1980s a large number of textbooks have been written dealing with the topics of pediatric gastroenterology, hepatology, and nutrition. The numbers have increased in proportion to the knowledge and to the number of people practicing this subspecialty. In 1975, Charlotte Anderson and her two VOLUME 40, NO.5, 1994

students, Gracey and Burke, produced the first edition of Pediatric Gastroenterology. The focus of that textbook was to help students of pediatric gastroenterology develop an understanding of the physiologic and biochemical phenomena of a child's gastrointestinal tract. They developed a reference book with an extensive bibliography as a single source of pertinent literature, opinions, and references. They hoped that their text would be used by pediatricians and pediatric and adult gastroenterologists. In this third edition, the authors have added topics dealing with the advances in molecular biology within pediatric gastroenterology. They have stressed newer technologic advances dealing with endoscopy, radiology, and noninvasive imaging procedures. A new chapter on food-borne diseases was added, as were some algorithms in dealing with diarrheal problems in children. An entirely new section on liver diseases, written by Dr. J. Rainer Poley, has been added. This large text is divided into 12 sections. Because each section is authored by a different person, the continuity in writing styles tends to be somewhat variable. However, the text reads easily and has clear diagrams. One of the weaknesses in the text is the radiographic examples. Some have poor clarity, and others would have benefited by the addition of arrows on the radiographs to locate the abnormality that is being discussed. Although the tables presented in the text are quite complete, they are written more in the European (or in this case, Australian) style, with the references written in the tables. This makes them difficult to follow. The textbook's strengths are exactly as stated in the author's preface: its emphasis on the physiological and biochemical aspects of each topic and the extensive and complete bibliography for each chapter. In itself, the textbook is extremely complete. The weakness of the text is in its discussion of the more practical clinical topics. The treatment sections for many of the topics are quite weak and sometimes anecdotal. More space should have been allotted to practical treatments and evaluation of common disorders, such as functional abdominal pain and other functional disorders. The surgical section could benefit from more diagrams and photographs. The section on intestinal digestion and absorption was extremely well written and helpful. The section on liver disease was also well written; however, Dr. Poley tended to present his algorithm for working up biliary atresia as the correct method without presenting other possible evaluations. He stressed utilizing lipoprotein X as a screening test for biliary atresia, whereas most pediatric gastroenterologists in the United States are not using this test. The section on bile salts written by Drs. Piccoli, Maller, and Watkins was presented extremely well. GASTROINTESTINAL ENDOSCOPY 657

This textbook is an excellent reference source for pediatric gastroenterologists and students of gastroenterology in children. Its cost may make it prohibitive for anyone not having an intense interest in this topic. Because it contains such an excellent index and bibliographies, it will be a valuable source for students of the subject. Phillip M. Kibort, MD Minneapolis, Minnesota

Clinical Radiology and Endoscopy of the Colon by J. Reeders, G. Rosenbusch, in collaboration with G. Tytgat and A. Bosma; forewards by G.W. Stevenson, B.I. Hirschowitz. Thieme Medical Publishers, New York, 1993, 582 pp., 500 illus., $199.00

In recent years, colonoscopy has become the gold standard for diagnosis and management of many large-bowel problems. Gastroenterologists tend to focus solely on colonoscopy, to the exclusion of radiologic techniques, in the evaluation ofthe colon. In their text, Reeders and Rosenbusch clearly demonstrate that this approach is short sighted. In preparing this book, they have collaborated with Dr. Tytgat (gastroenterology) and Dr. Bosma (pathology) to produce an exceptionally well-done single-volume text that will serve as a resource for clinicians treating diseases that involve the colon. The authors present a beautifully illustrated text that is much more than an endoscopic and radiologic review of colonic disease. The initial chapters are devoted to anatomy, physiology, and pharmacology of the colon as well as methods and techniques of radiologic examination of the colon. These are quite good, but the really exciting part of this text is when specific colonic diseases are reviewed. Each clinical problem is fully illustrated with both x-ray and endoscopic views that demonstrate the complementary nature of the different techniques. The chapter on ulcerative colitis demonstrates this as well as any in the text. Multiple areas of the diseased colon are illustrated by high-quality films of air contrast barium enemas and are also pictured endoscopically. This is an impressive effect. Concise, clear algorithms fill out the chapters, as do color prints of gross and microscopic pathology. Common and esoteric clinical problems are handled equally well. Separate diagrams that point out important features of the pathology and radiology, along with endoscopic photographs, aid in interpretation of these illustrations. The authors do not stop with barium enema examinations, but explore the utility of ultrasonography, computerized tomography, and magnetic resonance imaging as well. 658 GASTROINTESTINAL ENDOSCOPY

This volume is difficult to put down once one starts reading. It is easy to skip from section to section even though the book is comprehensive in its scope. The text is well referenced, although the references are all in the back, grouped in appropriate sections, instead of following each chapter. In summary, this is an excellent and well-done text that will be useful to all clinical gastroenterologists, gastrointestinal surgeons, radiologists, and pathologists. Anyone interested in diseases of the colon will find this text most enjoyable. Robert C. Kurtz, MD New York, New York

The Pyloric Sphincter in Health and Disease by A.D. Keet Springer Verlag, Heidelberg, Germany, 1993,413 pp., $198.00

Dr. Keet, a practicing radiologist with endless curiosity, has reviewed the literature to an extraordinary degree. He employed the methods of anatomy, pathology, endoscopy, ultrasonography, and electrical and motility recording to give us greatly improved understanding of the antrum and pylorus of the human stomach and provide the concept of the "pyloric sphincteric cylinder." The logic of the book builds through 39 chapters with the first 11 critically examining concepts and anatomy. The next 8 chapters examine the movements of the pyloric region during normal function. The final 18 chapters cover human anatomic and functional changes in this region. Each chapter is extremely well organized with a pithy presentation of the key issues up front. The old and recent literature are reviewed with pertinent observations made by the author, either clinically or in human or animal experiments, followed by conclusions. The next chapter usually builds on the logic of the preceding one. There are about 100 illustrations, mostly radiographs clipped and selected to clearly demonstrate his point, and there are 10 to 50 citations at the end of each chapter. Clearly, Keet has been curious about the function and actions of this region for several decades. This monograph has a depth that is seldom seen in clinical medicine because of the decades of study required, which are limited to a narrow anatomic region. The detailed familiarity and the appropriate utilization of motility, neuroendocrine, electrical, and pathologic information to further his comprehension of the function of this area is unique. The book is a model of clinical science at its best. For anyone interested in stomach function, whatever the discipline, this book provides major enlightenment as to how the stomach functions, and at all times VOLUME 40, NO.5, 1994