historical review of the extensive literature on this topic, citing and discussing approximately 1000 references published in English between 1964 and 1984. This exhaustive task unfortunately makes for exhausting reading. This book must be praised for thoroughness but must be faulted for the cumbersome and confusing way in which the topic is presented. Dr. Feitelson drags the reader through the early literature on hepatitis B on the way to more recent and definitive studies in a somewhat unstructured and uncritical way. The result is a rather confusing picture of the antigenic structure and genetic organization of this virus. Investigators who are knowledgeable about the molecular biology of hepatitis viruses will be confused by some sections in this monograph; newcomers to the field will be baffled. Actually, the replicative cycle, genetic organization, and antigenic structure of the hepatitis B virus have been fairly well defined. Extracting that information from this monograph can be done but is not easy. A major problem with this book is that it has not been adequately edited. Every paragraph of text has numerous grammatical errors; parts of the text are missing; the figures are poorly reproduced (and often outdated and contradictory]; the tables are poorly organized, too large, and inadequately described; the references lack titles and are not in alphabetical order [features that make the reference list almost useless). With suitable editing and rewriting, this book could have been turned into a valuable contribution. The academic gastroenterologist or internist who is looking for an introduction to the molecular biology of hepatitis B virus should avoid this monograph and turn to the elegant and concise, recent summary of this field by Tiollais and coworkers (The hepatitis B virus. Nature 1985;317:489-95). Those who want more, should tackle the original literature or, better still, plan to attend the 1987 International Symposium on Viral Hepatitis and Liver Disease that will be held in the Barbican Centre, London, England on May 26-28, 1987. JAY H. HOOFNAGLE.
Current Hepatology, Volume 5. Edited by G. Gitnick. 545 pp., $65.00. Year Book Medical Publishers, Chicago, Illinois, 1985. The medical literature continues to expand. For the student of the liver, several new journals have recently begun publication, and the number of articles in basic research and general medical journals is growing. In addition to an expanding number of original articles, the student of the liver is confronted with an increasing array of secondary sources that can help to keep his knpwledge current. Among these, I consider the Current Hepatology series to be a useful addition. Like the preceding volumes, the present book is comprised of a series of reviews of major topics in liver disease, concentrating on literature mainly from 1982 and 1983. Enough background information is given about each subject to permit a reader who is not an expert to understand the present status of the field. The chapter titles are similar in all four volumes, and the current text includes papers on acute and chronic hepati-
tis, serology of liver disease, alcoholic liver disease, cirrhosis and its complications, liver tumors, and hepatobiliary surgery. Chapters are also included on druginduced liver injury, cholestasis, radiology of the liver and biliary tract, gallstones, and the metabolism of bilirubin. The book will be most useful for readers who are not experts in the field but who are seeking an in-depth review of recent developments in the subject areas covered. ALFRED L. BAKER, M.D.
Strategies for Reducing Gastroenterologic Testing. By Harold Lazar. 138 pp., $24.95. Precept Press, Inc., Chicago, Illinois, 1986. As a light primer for a medical student or family practice resident beginning an abbreviated rotation on the gastroenterology service, this book may have some usefulness, but at $24.95 is overpriced. A concise discussion of, and suggestions for, winning the DRG required chart “game” is presented in the introduction. This may be the most valuable information provided. The text is divided into 18 chapters each discussing a disease (e.g., esophageal disease, peptic ulcer disease, tumors of the stomach, gallbladder disease, viral hepatitis, alcoholic liver disease.) There is a short, reasonably good bibliography at the end of each chapter with references that are readily obtainable. Gastroenterologists in clinical practice should find the chapter by Richard Gore of some interest. Dr. Gore, Associate Professor of Radiology, Northwestern University Medical School, presents a well-annotated critique of the various radiologic modalities available for abdominal imaging in most hospitals. This chapter includes 11 illustrations and two decision tree analysis diagrams (jaundice and acute cholecystitis.) The book is written in an informal style and provides for easy reading, but there are two major disadvantages: (a) the subject matter is presented as in a mini-textbook and often represents the author’s unsupported opinion, and (b) in most of the chapters, the discussion does not suggest any priority for testing to facilitate cost control. The author’s effort in this text to provide meaningful strategies for reducing gastroenterologic testing falls short of its goal. JAMES L. BORLAND, M.D
Jacksonville. Florida Textbook of Laparoscopy. By J. F. Hulka. 152 pp., 18 color figures, 138 illustrations, $49.50. Grune & Stratton, Inc., Orlando, Florida, 1985. At first glance, I was tempted to return this slim text to the editor as inappropriate for a GI journal review. A closer reading changed my mind. The author is a gynecologist, renowned for inventing a widely used clip for laparoscopic sterilization, and certainly his book is designed primarily for gynecologists. There is much of interest here, however, for those using laparoscopy in gastroenterologic practice. Dr. Hulka distinguishes between gynecologic and “med-
ical” laparoscopy, but inherent similarities are emphasized. Gynecologic indications for laparoscopy are sterilization and investigation of infertility and pelvic pain; gastroenterologists are usually diagnosing liver disease or ascites. Invariably there are overlaps. Good practice dictates that gynecologists take time to look up at the liver, and gastroenterologists examiqe the pelvis. The superb color laparoscopic photographs of the pelvis by themselves justify the price of the book. Most remarkable in this very personal single-authored text is the recurrent tone of tolerance for “variations in technique among skilled and experienced clinicians.” But there is no mistaking the importance Dr. Hulka places on painstaking methodology and intense observation. Of 12 chapters, I found the ones relating to anesthesiology, abdominal entry, special techniques, description of pelvic findings, and patient selection and management to be most valuable. These are just packed with details and clinical pearls. There are more than 120 excellent drawings by John Parker to complement the text. In spite of the technical nature and detail involved, Dr. Hulka’s writing style is lucid, highly readable, and spiced with gentle humor. For example, in the midst of describing alternate abdominal entry methods, he introduces “the teacher’s coronary index, defined as the amount of spasm the teacher’s coronary arteries experience while watching a trainee perform a certain maneuver.” The chapter on biophysics and physiology is apt to seem a bit elementary to most gastroenterologists long involved with fiberoptics and electrocautery, and there are sections that are pretty straight gynecology, e.g., a chapter on sterilization techniques. It may be, however, that GIlaparoscopists, particularly those who share facilities and equipment with gynecologists, could benefit from a more precise idea of just what their colleagues are doing. There are excellent recent texts which are essential to GI-laparoscopy units, most notably Dagnini’s Clinical Laparoscopy and Beck’s Color Atlas of Laparoscopy, and an English edition of Henning’s Laparoskopie, Atlas und Lehrbuch should be available soon. This book certainly replaces none of them, but in emphasizing gynecologic technique and observation wauld make a fine supplement on the reference shelf. CHARLES J. LIGHTDALE, New
York, New York
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Nutrition and Diabetes. Edited by Lois Jovanovic and Charles M. Peterson. 208 pp., $25.50. Contemporary Issues in Clinical Nutrition Series. Alan R. Liss, Inc., New York, New York, 1985. Few current areas of medical management are as controversial as the use of diet for diabetes. This fact is peculiarly puzzling given the unanimous dictum that diet is a “mainstay of therapy” (page 61) for this disease. Although most textbooks try to address this issue with precise directions, the alert reader cannot avoid noticing contradictory advice depending on the source. This book offers an altogether highly satisfying review of the present status of this problem by recognized authorities in this area. Each of the aspects of dietary management in diabetes is covered: the history of nutrition in diabetes; methods in improving glycemic control; artificial sweeteners and total parenteral nutrition in diabetes; kidney disease, pregnancy, and hyperlipidemia. There is a refreshingly perceptive examination of methods of improving dietary adherence by Dr. Wing (a psychologist), confirming the dismal record of long-term adherence to dietary management in diabetes and obesity, and the scarcity of evidence that if adherence is achieved, it relates to metabolic outcome. The author of this chapter chose to disregard her own “disappointing” results of behavioral modification for obesity in type II diabetes, still concluding with a hopeful note for this mode of treatment. Given the generally recognized recommendation of normal to high carbohydrate diets by the American (and other English speaking) Diabetes Associations, it is somewhat surprising that the Editors in their own final chapter seem to support a carbohydrate-restricted diet for both type I and II diabetes. Nonetheless, their selection of topics and authors has been very successful, and hopefully will be updated in future editions [where they might choose to dispense with their “closing comments” to each chapter, which generally add nothing to the contents of the book). C. ABRAIRA.