Liver and Biliary Diseases, 2nd edition

Liver and Biliary Diseases, 2nd edition

Book reviews include a page in Portuguese as well as a Brazilian editor to process our papers. Last, but not least, the editorial commission publishe...

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Book reviews

include a page in Portuguese as well as a Brazilian editor to process our papers. Last, but not least, the editorial commission publishes two biannual reviews by skilled endoscopists. Since the introduction of videoendoscopy, the directories have been gathering videotapes on endoscopic subjects, so that today there is a video library with more than 30 titles for sale and to help in the instruction of trainees. In 1984 and 1994, SOBED edited and published two books with Brazilian authors alone; the last one, Digestive Endoscopy, is a bestseller (516 pages including color illustrations). The society is also pledged to write an expanded third edition in Spanish for distribution to Hispanic countries. In 1!)96, the first Atlas of Colonoscopy on CD-ROM, edited by Artur P a r a d a (SP), was introduced into the marketplace; another CD-ROM on general endoscopy is in the end stages of editing by the editorial commission. SOBED, by delegation of the Brazilian Medical Association (AMB), is responsible for organizing and administering competitive examinations for the title of specialist in digestive endoscopy. This concourse now takes place at the annual meetings and there are m a n y candidates. For the successful candidate, a diploma establishes his or her professional qualifications in hospitals and with insurance companies. Satisfactory performance is also necessary to move up from aspirant to titular member of the society. Each candidate chooses the area of evaluation: general endoscopy, colonoscopy, or laparoscopic surgery. Last year, there were nearly 400 candidates. The examination is divided into three parts: (1) curriculum vitae analysis, (2) a written test (multiple choice questions), and (3) a practical test in which the candidate performs endoscopic procedures in front of an examining board of four members. The written test is a video quiz, using interactive participation, that provides fbr secure immediate results. Only those candidates who have passed the theoretic examination are admitted to the practical examination. The practical examination board is composed of experts who visit main cities throughout the country. It is sometimes impossible to keep the same group together because of long distances and high cost. Other local specialists are then invited to participate. Candidates who do not pass the written or practical examinations can retake the same test the following year. Other activities of SOBED are open and close oversight of learning centers, monitoring the ethical behavior of members, and defending the interests of members in their relationships with government and insurance companies. Brazilian endoscopists have a special characteristic: they buy their own V O L U M E 46, NO. 2~ 1997

equipment (endoscopes and all accessories). This is very different from our colleagues in the northern hemisphere where nearly all endoscopic equipment belongs to hospitals and can be used freely by gastroenterologists. In Brazil, only some public hospitals and a few private hospitals have their own endoscopic equipment. However, these instruments are reserved for use by their doctors. SOBED has a commission to identify, gather, and preserve the most important documents of the society's history--photographs, newspaper articles, videotapes, minutes of meetings, and testimonies--to build a historical archive for future generations. To this end, Martins Job is writing a book about the society's history with the support of the commission. CLEBERVARGAS,MD Past Secretary Rio de Janeiro

ARNALDOJOSE~GANC, MD President Sdo Paulo

Comment. "Perspectives" is devoted in this issue of the journal to a single contribution--the description of the formation and activities of the Brazilian Society of Digestive Endoscopy. Future issues will include similar contributions from other societies throughout the world with emphasis on their unique characteristics and challenges. PETERB. COTTON,MD, FRCP Charleston, South Carolina

Liver and Biliary Diseases, 2nd edition edited by N. Kaplowitz Williams and Wilkins, Baltimore, 1996, 752 pp., 12 additional pages of color plates, $139.00 This second edition of Liver and Biliary Diseases was published in 1996, 4 years after its inaugural edition. The current volume is 769 pages long and contains 44 chapters, as well as 12 pages of color plate photographs and photomicrographs. The authors have been carefully selected and represent true experts in their fields. New authors have been chosen for 10% of the chapters. The remaining chapters have, in general, undergone extensive updating, with most chapters containing a significant number of new sections that reflect advances in pathophysiology, diagnosis, and t r e a t m e n t of liver GASTROINTESTINAL ENDOSCOPY


Book reviews

and biliary disease. A large number of references published since 1992 have been added to the annotated bibliographies. In the preface to the first edition of this text, Dr. Kaplowitz describes the goal of his book as the creation of a " . . . useful, portable educational tool on hepatobiliary disease, for students, housestaff, family physicians, internists, and gastroenterologists." I believe that the current edition of the text clearly meets this goal. The chapters in Sections I and II, which cover the structure and function of the liver as well as pathophysiology, will serve both students and practicing physicians well. These chapters are written in a style that is easily understandable to the clinician and are accompanied by numerous excellent diagrams to lead the reader through potentially complex concepts. The coverage of these subjects is by no means superficial, and the reader who desires a thorough understanding of these topics will be well satisfied. As noted in t h e preface, Dr. Kaplowitz has apparently found that some have criticized the extent of pathophysiology covered within these detailed sections; I would applaud their continued inclusion, and found these chapters to be truly enjoyable reading. Similarly, the chapters devoted to clinical care and decision making should easily meet the needs of the intended audience. These chapters are rich with tables, photomicrographs, radiographs, diagrams, and flow charts that help the reader sort through the care of a multitude of clinical problems. The chapters contain specific recommendations for therapy, as well as appropriate coverage of alternative treatment choices where such choices exist. Practitioners of general medicine and gastroenterology will be well served by the contents of these clinical chapters. For those individuals whose practice focuses on the more esoteric aspects of liver disease, the depth of the material presented m a y occasionally fall short of that required and necessitate the use of multivolume text books or electronic search techniques. From a structural perspective, Dr. Kaplowitz is to be congratulated on the visual m a t e r i a l distributed liberally throughout the book. He has obviously emphasized the importance of this to his contributors and they have responded with first-class material. In those chapters where the annotated bibliography is fully annotated, a wealth of useful information m a y be gleaned from the references. An occasional chapter bibliography merits improvement with regard to annotation, and the use of other textbook chapters as annotated references should be kept to a minimum inasmuch as these sources of information m a y not be readily available to the reader. Last, the index bears some enhancement in 204


the next edition; the term primary biliary cirrhosis leads the reader to the chapter on the pathophysiology of cholestasis b u t completely ignores the chapter entitled "Primary Biliary Cirrhosis," which is found under biliary cirrhosis, primary. These minor deficiencies, however, are easily outweighed by the richness of the material presented throughout the book. Dr. Kaplowitz's intended audience will be well served by the second edition of his textbook, and I am sure that those who purchase it will find the pages well worn over the years.

Carl L. Berg, MD Boston, Massachusetts

Evolving C o n c e p t s in Gastrointestinal Motility edited by M. C. Champion, W. C. Orr Blackwell Science Ltd, Cambridge, Massachusetts, 1996, 344 pp., 120 illustrations, $85.00 In 14 chapters and 344 pages, Malcolm C. Champion and William Orr have described the recent changes in the field of gastrointestinal motility. This is not a book of techniques and there is little attention focused on the w a y in which motility studies are conducted or interpreted. Rather, this is a book that assesses the state of the art. Several of the chapters are outstanding as they dispassionately present an excellent, balanced, and articulate s u m m a r y of an enormous amount of information while stimulating thought about the controversies in the field. Peter Kahrilas's chapter entitled "Esophageal Motility Disorders: Pathogenesis, Diagnosis, Treatment" is one example of a careful and thorough review of the state of the art and the challenges we face in evaluating and managing patients with esophageal motor disturbances. Grant Thompson's review of irritable bowel syndrome (IBS) is particularly valuable because it gives a well-organized outline of the debates that make our understanding of the area of IBS so confusing. Another interesting and unique chapter, by Dr. Orr, one of the co-editors, concerns the influence of sleep on gastrointestinal physiology. I found this particularly interesting inasmuch as I personally had ignored this important area of motility as a separate concept area in gastrointestinal motility. The definite strength of this book is with the upper gastrointestinal disorders; however, the dyspepsia chapter is weak, with little new information, organization that is difficult to follow, poor delineation of current issues in this area, and failure to define the future prime targets for investigation. The section on the colon and anorectum is covered in V O L U M E 46, NO. 2, 1997