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Intestinal Failure
  1. S Gabe

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Intestinal failure is the newest of the failures. It is so new that many doctors do not know of its existence. And yet it was first described 31 years ago. The timing of this book is therefore important. Many of the chapters are written by clinicians and researchers who have developed the specialty, in many respects written by one generation for the next. The first book dedicated to cardiac failure was published in 1851 (Wardrop J. On the Nature and Treatment of Diseases of the Heart: Containing also an Account of the Musculo-Cardiac, the Pulmo-Cardiac and the Veno-Pulmonary Functions. London: Churchill, 1851), so why has it taken so long for this specialty to emerge? Because it is so complex—definitely not. The reason is given by JE Leonnard-Jones in his opening chapter. This specialty has depended on parallel developments in other specialties: gastrointestinal surgery, physiology, pathology, as well as nutrition and its subspecialties.

The book itself is structured in a logical manner, opening with a new definition of intestinal failure and a proposed classification. This in itself is courageous, as if incorrect the book would loose credibility. However, it stands solid. Following a historical overview by JE Leonard-Jones, a respected voice in intestinal failure, and a description of the normal anatomy and physiology of the intestinal tract, intestinal failure is divided into acute and chronic. The consequences, treatment, outcome, and problems of treatment are addressed in separate sections. I was pleased to see that a broad spectrum was covered, with chapters on intestinal adaptation, developing an intestinal failure unit, small intestinal transplantation, surgical treatments, stoma care, and so on. Initially, I wondered whether it was necessary to devote entire chapters to gall stones and renal stones but these are well written and appropriately placed. The chapter on designing a parenteral and enteral regimen is excellent, giving both practical advice as well as presenting useful reference data.

My criticisms are relatively minor, with little mention of the psychological issues for patients with intestinal failure as well as recognising the contents of a couple of authors' chapters from their previous work.

It is worth mentioning that this is not a book by doctors for doctors. This is a multidisciplinary book (like a nutrition team) brought together by Jeremy Nightingale. Contributors include nurses, dietitians, pharmacists, surgeons, physicians, stoma care nurses and, importantly, patients. The involvement of patients in their own care is of prime importance in nutrition, and this is also seen in this book with a chapter on the patient's perspective by Carolyn Wheatley.

Finally, it is worth looking at the back of the first page (unnumbered). Easily missed is a health worker's oath. A touch which highlights the quality of the man that brought this book together. My only real criticism is that this should have been in a more prominent place. This is an important publication that should be on the shelves of all nutrition teams.

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