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编号:11333526
Portal Hypertension: Pathobiology, Evaluation, and Treatment
http://www.100md.com 《新英格兰医药杂志》
     Drawings in the Lascaux Cave in France show that the liver was known to be a vascular organ more than 30,000 years ago, during Paleolithic times. Ancient Egyptians observed migratory birds and envisioned that the liver was a source of energy, leading them to overfeed captive geese and eat their fatty livers. At around the same time, Egyptians also tasted a new beverage — beer — and linked it to the development of ascites. The ancient Greeks made the connection between jaundice and bleeding in the digestive tract. All of these events suggest that portal hypertension has been known for several millennia.

    Despite its long history, knowledge about and treatment of portal hypertension continue to evolve. International meetings and consensus conferences about the disease are held regularly. Thus, a new book on portal hypertension has long been anticipated. The two editors of Portal Hypertension are recognized experts in the field, and 51 other well-known international experts have contributed. The book is organized into six sections, covering the history of portal hypertension, pathobiology, assessment, varices, ascites and hepatorenal syndrome, and special circumstances (such as portal hypertension during pregnancy or childhood). There is no chapter on hepatic encephalopathy, despite the role of portal hypertension in this condition. The section on pathobiology mirrors the rapidly increasing knowledge of vascular pathology, including the pivotal role of nitric oxide and hepatic stellate cells. These cells, lying between the endothelial cells of the hepatic sinusoids and hepatocytes, have interesting morphologic properties and receptors. Recent advances in angiogenesis and vascular remodeling are described in another chapter in the same section. The reporting of these basic aspects of portal hypertension makes for a concise review that is useful for researchers and clinicians.

    The sections of greatest interest to clinicians concern the description and treatment of varices and portal hypertension gastropathy. The treatment includes nonselective beta-blockers for primary and secondary prevention of variceal bleeding and newer treatments such as transjugular intrahepatic portosystemic shunts. The book also describes new therapeutic targets, such as coagulation disorders. The chapter on bacterial infection clearly shows the important role that infection plays in portal hypertension — and in variceal bleeding especially.

    The most useful part of this book for the reader is the 11-page index, which is presented clearly and can be consulted easily. One surprise is that, despite the many chapters and thorough documentation in the book, the chapter on the anatomy of the portal circulation contains no illustrations. Also, certain points could have been clarified further, such as the distinction between the bleeding phase and the prevention phase in endoscopic treatment of portal hypertension. This concise book, written by a large panel of experts, is a useful and up-to-date summary of knowledge of this fascinating syndrome.

    Paul Calès, M.D.

    Angers University

    49933 Angers, France

    paul.cales@univ-angers.fr((Clinical Gastroenterolog)