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Hepatobiliary, Pancreatic and Splenic Disease in Children. Medical and Surgical Management.
  1. Department of Paediatrics
  2. Sheffield Children’s Hospital, UK

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    Hepatobiliary, Pancreatic and Splenic Disease in Children. Medical and Surgical Management. Edited by W F Balistreri, R Ohi, T Todani, Y Tsuchida. (Pp 605; hardback n/a). Amsterdam: Elsevier Science, 1997. ISBN 0 444 82052 3 .

    When three paediatric hepatobiliary surgeons of the stature of Ohi, Todani, and Tsuchida get together to write about biliary atresia, choledochal cysts, and liver tumours, respectively one can confidently expect an authoritative account of their long experience. Add excellent chapters on portal hypertension (Howard), liver trauma (Garcia), and a series of good chapters on surgical aspects of the pancreas and one has a book which I am pleased to have on my shelf.

    It dropped onto my desk just as I was feeling in need of continuing medical education about Schwachman’s syndrome. How frequently should we do a bone marrow examination to detect early malignancy? I could not find the answer. Indeed, I could not find more than two passing references to Schwachman’s syndrome. This exemplifies the limitation of this book—its coverage is patchy, it is better on the surgical than on the medical, and it cannot be relied upon to help out in an hour of need.

    A particularly galling fact for the editor of a text on paediatric hepatology is that the subject just will not stand still. Between submission to the publisher (1995 perhaps, as judged by the latest references?) and now, paediatric hepatologists have discovered molecular biology. Insight into the mechanisms of Alagille’s syndrome, Byler’s syndrome, and Wilson’s disease have tumbled out but too recently for this book.

    My copy of this book will be annotated before being lent to a trainee. I would not wish that trainee to believe that percutaneous liver biopsy is reliable in diagnosing biliary atresia in 85–95% of cases, that Wilson’s disease is part of the differential diagnosis of neonatal cholestasis, that copper stains will always be positive in Wilson’s disease, or that tyrosinaemia should only be suspected if plasma tyrosine is raised. I will, however, ask my trainee to read Onishi’s chapter on bilirubin metabolism to find out why breast milk jaundice is not, after all, a design fault but really a rather good idea.

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