Medicine And Books

Diagnosis and Management of Liver Disease

BMJ 1995; 311 doi: (Published 23 September 1995) Cite this as: BMJ 1995;311:818
  1. I T Gilmore, consultant physician and gastroenterologist
  1. Royal Liverpool and Broadgreen University Hospitals NHS Trust

    Ed Ralph Kirsch, Simon Robson, Charles Trey Chapman and Hall, £29.95, pp 327 ISBN 0412575701

    Patients with liver disease occupy only a small fraction of the working week of a general physician, even one specialising in gastroenterology. This gives limited opportunity for the physician to gain expertise, yet patients often present with compelling and dramatic symptoms, such as variceal haemorrhage, that need rapid and accurate management. As a result, clinicians are often uneasy dealing with liver disease, where there have been rapid advances both in understanding the causes (for instance, hepatitis C) and in treatments on offer (such as liver transplantation and transjugular portosystemic shunts). Diagnosis and Management of Liver Disease aims at making hepatology accessible to those who want a readable overview.

    In truth, it contains little more detail than a major textbook of medicine but it is certainly more portable and digestible. It is also more up to date.

    Three policies adopted by the editors, highlighted in the preface, are unusual and interesting. The first is the use of a “home” author from the Medical Research Council Liver Research Centre in Capetown to draft each chapter and a guest specialist coauthor to revise it. A degree of uniformity of style is achieved by this. The second policy is to donate authors' royalties to allow those disadvantaged by apartheid to study liver disease. The third is to devote two clear chapters at the back of the book to modern immunology and molecular biology.

    The tight editorial rein has not prevented the chapter on porphyria becoming twice the length of that on paediatric liver disease and nearly twice that on viral hepatitis. Also, the suggested further reading list tends to contain landmark historic papers rather than recent detailed reviews. In a short book with a fairly didactic style, I suspect that generalists would prefer more detailed advice on managing specific problems such as hepatorenal syndrome and alcoholic hepatitis. None the less, the editors have succeeded in producing a visually attractive and easy to read paperback that may win the attention of undergraduate and postgraduate students; it may also give practical help to generalists on when to refer patients to centres of expertise.--I T GILMORE, consultant physician and gastroenterologist, Royal Liverpool and Broadgreen University Hospitals NHS Trust


    Contact dermatitis from sun screen in a photosensitive individual, from Photoimmunology, edited by Jean Krutmann and Craig A Elmets (Blackwell Science, £60, ISBN 0865428263), a detailed account of skin and general immunological response to ultraviolet radiation, which will be of interest to those who wish to weigh up the benefits and hazards of sunlight.

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