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Clinical Pathology of Pancreatic Disorders

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Clinical Pathology of Pancreatic Disorders. Edited by J A Lott. (Pp 218; $99.50.) Totowa, New Jersey: The Humana Press, 1997. ISBN 0-896-03475-5.

Pathologists think themselves very good at classifying things, but they’re not even good at classifying themselves. In the United Kingdom, “pathologist” sometimes means histopathologists only, and sometimes bacteriologists, chemical pathologists and haematologists, too. As a histopathologist, I think that what I do is very clinical, but in many parts of the world, I’d be labelled an “anatomic pathologist”, a “morbid anatomist”, or even both, to distinguish me from “clinical” pathologists. I rather like to label the latter “fluid” pathologists, if only because my discipline becomes, by way of contrast, “solid” pathology. The United Kingdom and continental Europe have contrasting practices, and both differ from North America. The American publishers of this book expect its readers to include “laboratory medicinists”—and I’ve never even heard of them!

You can see, therefore, that I didn’t know what to expect from a book on “clinical pathology”, and my first task was to determine what disciplines it covered. There’s a little immunology, with insights into pancreatic transplantation and the aetiology and pathogenesis of diabetes mellitus. Histopathology is largely ignored, even in the chapter on pancreatic neoplasms, and there is very little discussion of the bacteriological complications of acute pancreatitis or the putative viral triggers of type I diabetes mellitus. However, there is a great wealth of detail on the role of clinical biochemistry in the diagnosis of pancreatic diseases, both exocrine and endocrine, and their complications, together with a more patchy coverage of the biochemical pathogenesis of these conditions. The former component is excellent, the latter focally disappointing: I think—for example, that a book that discusses assays of pancreatitis associated protein in the diagnosis of acute pancreatitis might also clarify recent developments in the role of the closely related lithostathine/stone protein in the pathogenesis of chronic pancreatitis.

This book reads like five long review papers, rather than a single integrated text. This is not a problem if you want to bring yourself up to date on some broad field or other, but it is disconcerting if you simply want to look up a single topic, especially with the brief and unhelpful index. There is no cross-indexing so that, for instance, you’ll only find “alpha-fetoprotein” and “carcinoembryonic antigen” if you look up “tumour markers”, and some of the references to elastase are under “E”, while the remainder reside under “P” (for “pancreatic enzyme”).

So what does this book have to offer the gastroentrologist? It’ll provide a significant amount of irritation and tedium if, like me, you try to read it from cover to cover. It won’t help a lot if you’re hoping for help with the day-to-day investigation of pancreatic disease. It will enable you to seem relatively well-informed if you hope to enter dialogue about future strategies in test selection with your local chemical pathologists (and I think it appropriate and important that you do). While you’re there, ask them to classify themselves.