Book Review
Multiple Systems Organ Failure: Hepatic Regulation of Systemic Host Defense
N Engl J Med 1994; 330:148January 13, 1994
- Article
Multiple Systems Organ Failure: Hepatic Regulation of Systemic Host Defense
Edited by George M. Matuschak. 411 pp., illustrated. New York, Marcel Dekker, 1993. $150. ISBN: 0-8247-9059-6The theme of this collection of chapters is advertised as “multiple systems organ failure.” The syndrome is described as developing in 15 percent of patients admitted to intensive care units and as having a mortality rate exceeding 50 percent. It is an open question whether the syndrome has become more widely recognized because patients survive longer in intensive care settings as a result of more aggressive treatment of acute problems affecting individual organs. The subtitle of this book -- “Hepatic Regulation of Systemic Host Defense” -- is not entirely accurate or convincing in its implication that there is a sole defect underlying this syndrome.
The majority of the authors are clinicians in the fields of surgery, internal medicine, and hepatology; a minority are basic scientists from physiology and pathology departments. No fewer than eight chapters address bacterial infection, endotoxemia, opsonic fibronectin, leukotriene action, cytokines, and Kupffer-cell function. The chapter on hepatic drug metabolism is somewhat out of place, and the chapters on liver dysoxia and hemostatic abnormalities do not logically blend with the approach of the rest of the book. It is not clear whether these chapters originated as the proceedings of a meeting dedicated to liver pathology and whether the overarching title of the book was chosen in an attempt to relate these diverse subjects to a popular theme. The first five chapters certainly do address the advertised subject in a cohesive fashion; perhaps they could have been expanded and combined as a monograph.
The two chapters dealing with acute-phase protein responses bring excellent new information to the reader. However, it is difficult to envision which group of clinicians or scientists will find this somewhat variable book (in terms of cohesion and quality) up to date and comprehensive enough for their needs at the price of $150.
Julien F. Biebuyck, M.D.
Pennsylvania State University College of Medicine, Hershey, PA 17033
