Book Reviews

HEPATOLOGY welcomes books for review and in- vites its readers both to identify books of hepatological interest and to serve as book reviewers. Books of note should be called to the attention of the Book Editor, and potential reviewers should indicate their areas of in- terest. The Book Editor nonetheless reserves the right to select appropriate reviews for publication on these pages.

Hepatotoxicology. Edited by R.G. Meeks, S.D. Har- rison and R.J. Bull, 640 pp. Boca Raton: CRC Press, 1991. $95. This multicontributor volume is devoted to the science

of the hepatotoxicity of environmental chemicals in experimental animals. It is a well-illustrated and well- referenced work that has been thoughtfully constructed. A large portion of the book is focused on introducing the reader to the structure and function of the liver and the processes of biotransformation. Excellent contributions include the pathology of hepatotoxicity, methods of assessing toxicity and species-specific issues. The con- tributions on fatty liver, free radical mechanisms and abnormalities of heme biosynthesis were extremely well done, and the information presented in these chapters is not readily available in textbooks of hepatology . Chapters on the toxic chlorinated ethylenes and per- oxisomal proliferators are of value to those interested in the toxicology of these agents. My favorite chapter, written by Marzella and Trump, was devoted to the functional and structural alterations of hepatocyte organelles induced by cell injury. This treatise is the most coherent that I have ever read on the subject of liver cell death. This chapter should be read by all investigators in the field of hepatotoxicity.

Overall, this is an up-to-date book that would be of value to toxicologists and hepatologists performing experimental studies in hepatotoxicity in laboratory animals. Much of the book will be redundant for hepatologists possessing other standard textbooks of liver disease in their personal libraries. The book will be of little interest to clinicians. Also, it was somewhat disappointing not to see more coverage of human hepatotoxicology as it relates to environmental and natural chemicals in the industrial workplace. In ad- dition, be aware that this book does not deal with drug-induced liver disease and therefore has a very

RAYMOND S. KOFF, BOOK EDITOR Department of Medicine

MetroWest Medical Center Framingham Union Campus

115 Lincoln Street Framingham, Massachusetts 01701

include this book in their collections. I am pleased to have it in mine.

NEIL KAPLOWITZ, M.D. Los Angeles County-University of Southern California Medical Center Los Angeles, California 90033

Complications of Chronic Liver Disease. Edited by William G. Rector, Jr., 383 pp. St. Louis: Mosby-Year Book, 1992. $65. Twenty-two contributors have written 15 chapters in

this relatively short text dealing with the pathophysi- ology, presentation and clinical management of chronic liver diseases. The volume is designed to supply useful, accessible information and is written by respected, young investigators. The information included is well organized and well referenced. The content is topical, and in most areas citations are current.

The first chapter deals with the general approach to patients with liver disease and succinctly touches on the common modalities of evaluation including liver biopsy and biochemical testing. The inclusion of newer tests of hepatic metabolism is a welcome addition to this area and shows the progressive thinking of these authors. This chapter gives a balanced presentation evaluating the limitations of proposed tests of liver function and hepatic fibrosis, and it reviews predictors of variceal bleeding from endoscopic data and supports use of disease-specific indexes to assess patient survival.

The chapter on portal hypertension draws heavily upon observations from animal experiments to portray the pathobiology of this condition. The scope of treatment options discussed is selective, and the thera- peutic use of nitrates is discouraged. The treatment of acute variceal bleeding is well presented with infor- mation on pharmacological therapy, balloon tamponade and sclerotherapy. The discussion excludes surgical options or consideration of the transjugular intrahepatic portacaval shunt procedure. Therapeutic advice is well substantiated and lapses in available data are pointed out. An asset of this chapter is the compilation of comparable clinical trials into summary tables to present clinical data on topics such as the utility of B-blockers and endoscopic sclerotherapy. The chapter on

- portal hypertension is complemented by the sedion on 1.- #. 1 rr n* 9 - 1 1 r n.1 1 * I 3 1 1

Vol. 16, No. 5, 1992 BOOK REVIEWS 1309

Dr. Runyon has written a succinct, well-referenced chapter on spontaneous bacterial peritonitis, which serves as an excellent review of the pathogenesis of and the rationale for the management of patients with ascites-associated infection.

Sections on hepatorenal syndrome and hepatic en- cephalopathy review several hypotheses of pathogenesis and serve as excellent, concise synopses. HCC is dis- cussed in relation not only to hepatitis B but also to genetic liver disease and cirrhosis per se. However, the impact of hepatitis C cirrhosis on this condition is mentioned only a little.

The difficult task of presenting available data on disorders of nutrition in cirrhotic patients is tackled by Dr. Arthur McCullough. He focuses this chapter on protein malnutrition and explains the limitations of experimental measures before presenting a summary of the available literature. The accurate presentation por- trays the lack of consensus on aggressive nutritional intervention in the cirrhotic patient. Chapters on more specialized areas, such as hormonal abnormalities, pulmonary function, hematological disorders and gas- trointestinal complications, complete the curriculum for the text and are well referenced. The chapter on metabolic bone disease supplies an overview of this problem, which selected patients with chronic liver disease face.

The &ion on drug disposition is particularly useful. The initial pages outline basic pharmacological prin- ciples for those of us who may benefit from a review. This introduction is followed by discussion of the disposition of antibiotics, diuretics and antiinflammatory and car- diovascular drugs. This practical application of basic principles is a welcome addition to this volume.

The final chapter is, appropriately, devoted to liver transplantation and serves as a well-organized summary of the issues involved in the management of patients who undergo liver transplantation. Adequate discussion is included on operative indications and prognosis, on newer immunosuppressive drugs (such as FK506) and on postoperative complications (such as rejection and infection).

The style of the authors is easy to read, and the outline of the book is sufficiently consistent from author to author to assist the reader in finding desired infor- mation. The references are generally current with some inclusions up to 1991. Tables and diagrams are used advantageously to supplement the text.

This volume will be of particular value to students and clinicians who want to combine an understanding of basic pathophysiology with clinical medicine in the management of patient with chronic liver disease. Gastroenterologists and hepatologists will welcome the concise review of principles accompanied by up-to-date references. The authors and the editor can be proud of their work.

HENRY C. BODENHEIMER, M.D. Mt. Sinai Medical Center New York, New York 10029

Guide to Liver Transplantation. Edited by T.L. Fabry and F.M. Klion, 352 pp. New York: Igaku- Shoin, 1992. $98.50.

Selection of this book for review represents a personal paradox, Yes, I fully accept the notion that liver transplantation is lifesaving and represents an appro- priate use of current technology, skills, resources and finances in the United States. It is, as Drs. Fabry and Klion indicate in the preface, the ultimate treatment of end-stage liver disease. I do refer patients to our local transplantation centers, and I am pleased that we have learned so much about end-stage liver disease and its systemic effects through careful study of patients undergoing liver replacement. The liver transplantation experience also has provided an enormous amount of information about hepatic physiology, hepatic immu- nology and transplantation biology. However, I take no comfort from my personal acceptance of this mode of therapy. In fact, my view, which some may consider harsh, can be simply stated as follows: every liver transplantation is a failure. It is a failure because it reflects our imperfect understanding of the pathogenesis of hepatobiliary disease, our inability to interrupt disease progression and our inability to prevent pre- sumably preventable liver diseases. If our knowledge base were greater, our therapeutic tools more powerful and our application of our collective wisdom more judicious and widespread, the need for this ultimate therapy would diminish over time.

Drs. Fabry and Klion have ignored my concerns. They have provided a comprehensive overview of liver trans- plantation as undertaken at the Mt. Sinai Medical Center in New York, where a liver transplantation program was initiated in 1984 and the first patient underwent transplantation in 1988. The contributors, all of whom have been associated with the Mt. Sinai program, lucidly discuss a range of important issues, beginning with organ procurement, allocation systems and assessment of the potential donor. A concise review of transplantation biology also covers immunosup- pressive therapy. The role of available immunosup- pressive agents in the induction and maintenance of immunosuppression and the treatment of rejection is presented in a subsequent chapter on the clinical practice of immunosuppression after liver transplan- tation. The transplantation process, including medical and surgical management of the transplant candidate, operative techniques and early postoperative evaluation and management, is well described in three successive chapters. A separate chapter defines and details the functions of the transplant coordinator, who serves as the liaison between transplant team members, as pa- tient advocate and as clinician-educator, to name but a few of the typical roles played by these key personnel. Fabry and Klion have written three chapters-one on the selection of patients for referral, one on the medical evaluation of the prospective recipient and one on the management of the recipient after discharge from the transplantation center and referral to a local physician.