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Hepatology Principles and Practice
  1. S D Taylor-Robinson

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“You have a very large parcel”, Zeinab, my secretary said breathlessly as she struggled up from the post room with a copy of this enormous book. It seemed all the heavier as I lugged it around the London bus network from the wilds of East Acton on my way home and then back to work several times. Contained in a reinforced Harrod’s bag, which was the only thing I could find that was strong enough to hold it while I elbowed my way through the myriads of commuters that were forced to travel by bus in lieu of the non-existent Central line, I felt my back pain had returned with a vengeance and did not know whether to take up weight training (where the book would come in handy) or admit defeat and sue the authors for damages. However, sanity soon prevailed and I soon became engrossed in this weighty tome.

At first glance, one could say that another comprehensive book on hepatology is really not needed, given all the other titles on the market place, but it turns out that this 2002 English edition of the original German “Praktische Hepatologie”, published in 1998, has been updated and was a labour of love by Erwin Kuntz whose son, Hans-Dieter, died before the book could be finished. My schoolboy German is not up to the original edition but this has become a bible in Germany and the current version is welcome, despite the fact that a lot of the English is somewhat awkward with curious turns of phrase. Examples of this include “MRT”, rather than MRI, which is irritating, and “lethality”, rather than mortality, which interrupts one’s reading pattern. However, there are some very nice things about the book. It has an interesting section on the history of hepatology, perhaps written from a German perspective, since the late Dame Sheila Sherlock may have had a different take on events. Otherwise, there are 40 chapters, which are essentially written as a “hairdresser’s guide” to being a hepatologist, with nicely illustrated sections on anatomy (termed “morphology”) and biochemistry, before launching into sections on clinical findings and laboratory tests which are comprehensive and well written. There are unusually detailed sections on how to perform liver biopsies and a practical manual on ultrasound (termed “sonography”), the likes of which I have not found in books from the English speaking world, probably because ultrasound is the domain of gastroenterologists in Germany but the preserve of radiologists in the UK. Nevertheless, this level of detail is useful for hepatology/gastroenterology SpRs who would like to interpret scans better but feel inhibited asking their local x ray department for fear of looking stupid. However, the section on CT is scanty and on MRI (“MRT”) is almost non- existent by comparison. It is a shame that the chapter on cognitive testing and the investigations of the neurological sequela of liver disease does not contain detail on newer psychometric tests and technology such as MR spectroscopy, given the wealth of expertise on hepatic encephalopathy that currently exists in Germany. Chapters on the complications of chronic liver disease are well set out and those on liver abscesses, bacterial, parasitic, and fungal (“mycotic”) liver disease are useful.

The question of who may actually buy this book looms large. It is too big and too costly for any individual junior doctor who might be interested in this “user’s guide” approach that the book adopts. However, I would have thought given the fact that the format of its main competitor, the Sherlock book, is looking dated by comparison and that other books are not as visually inviting, the Kuntz tome would find a home in most hospital libraries, or if the local gastroenterology department is feeling flush, then on the shelf of the departmental secretary for reference use by all who pass by. For what it is worth, Zeinab has decided to check the strength of her newly reinforced shelves by clearing a space in anticipation of her copy.

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