826 BOOK REVIEWS

The contributors were allowed considerable latitude in style andformat, factors that lead to an interesting but sometimes disparatemode of presentation. A minor criticism is that a greater degree ofuniformity might have produced a more cohesive volume. Simi­larly, the disparity is noticeable in graphs, charts, and flow dia­grams, as well as in graphics in which line drawings, wash draw­ings, photographs, and radiographic reproductions do not followspecific or consistent guidelines.

Those few remarks are not major criticisms of this excellent textbut probably reflect my compulsive organizational character. Thispublication is a major contribution, current and correct to the extentof available knowledge, an accurate reflection ofthe best of today'sinformation, and a credit to the expertise of the contributors, theeditors, and the publishers. This work should be on the desks-noton the shelves---of everyone who is involved in pediatric urology.It is an invaluable reference resource for medical students, practic­ing physicians in various specialties, and libraries accessible toevery resident attending urologic training programs.

James F. Glenn, M.D.Division of Urologic SurgeryUniversity of Kentucky Medical CenterLexington, Kentucky

Clinical Anesthesiology, by G. Edward Morgan and Maged S.Mikhail, 747 pp, with illus, $39.95, Norwalk, Connecticut,Appleton & Lange, 1992

This comprehensive handbook of anesthesiology covers allsubspecialties. Of the 48 chapters, all but 3 are written by twoauthors. This consistency makes the book flow; it is easy to readand nonrepetitive.

The text is divided into five sections. The first section addressesanesthesia equipment and monitoring. A thorough and well-orga­nized discussion of physical and mathematical principles relative toanesthesia is included. The numerous diagrams of anesthesiaequipment are easy to comprehend. The section on airway manage­ment is well written and has accompanying illustrations.

In the second section, the authors cover clinical pharmacologyin a detailed but readable and coherent fashion. Whenever possible,mechanisms of action are pointed out for readers. Similar catego­ries of drugs are compared and contrasted. This up-to-date sectionaddresses the new anesthetic agents and neuromuscular blockingdrugs. The third section-the only section not written by the mainauthors-is devoted to regional anesthesia and management ofpain. Numerous anatomic diagrams enhance this easy-to-read sec­tion. Some diagrams, however, are reproduced poorly in black andwhite.

The bulk of the book is the fourth section, which addressesphysiologic features, pathophysiologic findings, and anestheticmanagement of patients who are undergoing a specific operation.This section is concise yet thorough. Where relevant, mathematicalformulas are presented. The information is conveyed in practicaland clinically oriented fashion. The case discussions at the end ofeach chapter are excellent and welcome additions. The last section,entitled "Special Problems," covers relevant topics, such as car-

Mayo Clio Proc, August 1993, Vol 68

diopulmonary resuscitation, that are not addressed elsewhere in thispublication. This section also includes an overview of critical-caremedicine.

I believe that this text equals the quality of Basics ofAnesthesiaby Stoelting and Miller. It is longer but presents more informa­tion-for example, respiratory physiology and anesthesia equip­ment. It will be an excellent addition to any anesthesia library anduseful for medical students, beginning residents, and candidateswho are preparing for the written board examination.

Brian A. Hall, M.D.Department of Anesthesiology

The Adrenal Medulla, 1989-1991, by Stephen W. Carmichael andSusan L. Stoddard, 646 pp, $89.95, Boca Raton, Florida, CRCPress, 1993

The adrenal medulla is described as "the Rosetta stone of neurobi­ology" on the jacket of this volume by Carmichael and Stoddard.Adrenal chromaffin cells are protypical neuroendocrine cells de­rived from the neural crest. During embryologic development, theycan differentiate as either endocrine cells or sympathetic neurons inresponse to cues from hormones and neurotrophic factors in theirenvironment. In adult life, their endocrine function is regulatedboth by hormones and by neurally derived signals through synapsesoriginating in the central and peripheral nervous systems. Theyalso give rise to pheochromocytomas. These characteristics, to­gether with the accessibility and the relatively simple organizationof the adrenal medulla, have led ever-increasing numbers of inves­tigators to believe that the analogy of the Rosetta stone may beappropriate.

Carmichael and Stoddard are the chroniclers of the adrenalmedulla, and this volume is the sixth in a series, which began in1979, that records the progress of chromaffin cell research. Itattempts to summarize and organize all articles published from1989 to 1991 that deal with the adrenal medulla in vivo or in vitro.More than 2,000 citations reflect the converging interests of embry­ologists, physiologists, biochemists, pharmacologists, endocrinolo­gists, and tumor biologists in the adrenal medulla as an experimen­tal model. Reports that focus on clinical considerations ofpheochromocytomas and other types of adrenal medullary diseaseare also compiled, and one section addresses adrenal medullarytransplantation.

Overall, the effort is a substantial success. The first chapter,entitled "Overview," offers a rapid assessment of what Carmichaeland Stoddard consider the major advances during the 3 years that

.are reviewed. This chapter is particularly helpful because reportselsewhere in the text are summarized without editorial commentabout importance or validity. The essence of the book is in its all­encompassing bibliography, author index, and subject index. Thebibliography is more convenient to use in this volume in compari­son with that of its predecessors because of cross-referencing of thepages in the text on which each article is described. An additionaldeparture from previous volumes is the inclusion of a chapter by aninvited contributor. The chapter entitled "Stimulus-Secretion Cou­pling: Other Second Messengers" is well written by Jack C.

Mayo Clin Proc, August 1993, Vol68

Brooks, professor of physiology at Marquette University. It fitswel1with the style and objectives of the book as a whole and signalsan intention to involve additional experts to write selected chaptersin future volumes in the series.

One minor criticism is that the subject index is actually a wordand phrase index and is somewhat quirky. It includes a few itemsthat are too terse and not particularly informative per se (for ex­ample, silver, Southern blot, and spleen) and inexplicably omitsothers (a listing is included for PCl2h cells but not for PCl2 cells).A more detailed index with subheadings and internal cross-refer­encing would have been helpful.

In summary, I highly recommend this book as a convenient andcomprehensive reference source, both for researchers currentlyworking with chromaffin cells and for those unfamiliar with thefield. The authors' efforts should be appreciated for helping tomake rapidly accumulating and diversifying data accessible andamenable to decipherment.

Arthur S. Tischler, M.D.Department of PathologyTufts University School of MedicineBoston, Massachusetts

The Esophagus, edited by Donald O. Castell, 842 pp, with illus,$150, Boston, Little, Brown and Company, 1992

To some people, the esophagus may seem a simple and ratheruninteresting tube through which food and drink pass on their wayto the stomach. Of note, however, the reflux of gastric acid andpepsin into the esophagus causes daily heartburn in almost 10% ofthe general population, and reflux symptoms account for some 80%of the large market for over-the-counter antacids. Patients withchest pain natural1y worry about heart disease, but establishing anesophageal cause is sometimes possible and will allay their anxiety.About 10,000 Americans die each year of esophageal carcinoma.Recently, knowledge about the esophagus in health and disease hasexpanded substantially, primarily because of the development ofimproved measuring systems for physiologic pressure and pH andthe invention of fiberoptic and videoscopic imaging.

Dr. Castell has enlisted the help of 48 contributors to provide adetailed review of the esophagus in health and disease. The initialchapters cover anatomic and physiologic characteristics, symptomassessment, radiology, endoscopy, manometry, and pH and pres­sure monitoring. One chapter addresses cytologic findings, buthistopathologic features receive less attention. No less than 10chapters are devoted to reflux disease. Separate chapters coversubjects such as oropharyngeal dysphagia, achalasia, rings andwebs, diverticula, foreign bodies, pill-induced injury, caustic inges­tion, esophageal perforation, hiatal hernia, varices, and esophagitisin the immunocompromised host. Surgical treatment of esophagealcancer, motor disorders, and esophageal reflux are described withdetailed operative drawings by DeMeester and Stein. The book hasnumerous diagrams and black-and-white and color illustrations.The opinions of the contributors are reinforced with a mean ofmorethan 100 up-to-date references per chapter, and important articlesare often discussed in detail.

BOOK REVIEWS 827

I enjoyed reading this generally well-written book; it is anexcellent review of the subject. It will be an invaluable source forany physician with a special interest in the esophagus and should bein the library of departments of gastroenterology. For gastroenter­ologists and internists, the depth of information is greater than thatin general textbooks.

Alan J. Cameron, M.D.Division of Gastroenterology

and Internal Medicine

Pediatric Rheumatology for the Practitioner, 2nd ed, by Jerry C.Jacobs, 714 pp, with illus, $98, New York, Springer-Verlag,1993

This second edition of a single-authored text has been substantiallyupdated in comparison with the first edition, which was publishedin 1982. The bibliography at the end of each chapter is extensiveand current.

The textbook begins with a chapter on clinical techniques inpediatric rheumatology and ends with a chapter that discusses thepositive approach to the care of chronically ill children. The otherchapters cover the differential diagnosis of arthritis in children,juvenile rheumatoid arthritis, the HLA-B27-associated spondylo­arthropathies, systemic lupus erythematosus, dermatomyositis, sys­temic vasculitis syndromes, and scleroderma.

The book is designed to be a clinical guide for practitioners whoare responsible for the care of children with rheumatic disease, andthat is its strength. Basic science subjects are only briefly men­tioned. The 205-page chapter that reviews the differential diagno­sis of arthritis in children is the most valuable chapter. It capsulizesthe principal features of approximately 170 entities that range frominflammatory conditions such as Henoch-Schonlein purpura andacute rheumatic fever to noninflammatory conditions such asfibromyalgia and chronic fatigue syndrome. In addition, varioustypes of infectious and viral conditions are addressed as well asmetabolic diseases, heritable diseases, and unusual types of trauma.The 581 references listed at the conclusion ofthe chapter provide acomprehensive resource for readers to pursue a syndrome further.For clinicians who are seeking the cause of unusual rheumaticsymptoms, a table entitled "Clues to Some Unusual Causes ofArthritis in Children" lists the salient clinical clues, the diagnosis,and the appropriate diagnostic procedure.

The chapters on the specific rheumatic diseases are well pre­sented for clinicians to use in diagnosis and treatment. Dr. Jacobs'recommendations on therapy are from his extensive clinical experi­ence and from information in the literature.

Some entities that are covered in the text have not been de­scribed in the pediatric population. Usually, this factor is pointedout, although occasionally it is unclear whether the informationbeing presented is based on pediatric experience or solely on adultliterature. Another confusing part of the book is the chapter onscleroderma that intertwines manifestations of progressive sys­temic sclerosis with those of the localized scleroderma syndromes,such as morphea. Because progressive systemic sclerosis andlocalized scleroderma are different entities with a substantially