Pancreatic diseases in English

The second edition of Diseases of the Pancreas is a completely revised and updated English translation of the popular German text Pankreaserkrankungen. The book is designed to digest the vast and rapidly evolving body of information on pancreatic diseases, form clinical presentation to basic mechanisms, and from technical imaging to surgical interventions for life-threatening complications.Diseases of the Pancreas is organized into three sections: Acute Pancreatitis, Chronic Pancreatitis, and Pancreatic Cancer. Each section follows standard sequence of chapters that begins with three characteristic cases and an atypical case and progresses to their definition and classification, epidemiology, etiology, pathogenesis and pathophysiology, pathology, clinical aspects, complications, diagnosis, and prognosis and treatment. The chapters are concise and well written, so they can be used by medical students but they still remain relevant for practicing physicians interested in pancreatic diseases.The clinical case presentations of acute pancreatitis, chronic pancreatitis and pancreatic cancer are well-selected teaching cases. The cases are designed to illustrate the spectrum of disease, however, the management style tends to reflect European practices rather than typical American standards of care in terms of length of admission for an uncomplicated case (10-12 days compared with 3–4 days in the USA) and the early use of diagnostic endoscopic retrograde cholangiopancreatography in suspected alcoholic acute pancreatitis.The presentation of each of the chapters is precise and authoritative, illustrating the basic standard pathophysological understanding, the diagnostic strategies and the management of common pancreatic problems. In this regard, the reader is not distracted by long discussions of rare or controversial issues. The text is also supported by many illustrations and tables that reinforce these concepts. However, the chapters contain no references (suggested reading is at the back of the book), so the reader can not always be certain of the origin of a specific statement.There are several important areas where only one side of current debate is presented. For example: controversies about the role of early nutritional intervention in acute pancreatitis; the value of enteral versus parenteral feeding; and the management of pseudocysts and pancreatic necrosis are not fully developed. In the discussions of acute pancreatitis, the terms necrotizing pancreatitis and pancreatic necrosis are sometimes use interchangeably, which can be confusing for many students. Because of this, other authors have abandoned the term necrotizing pancreatitis in favor of severe pancreatitis (to reflect the magnitude of the inflammatory response) and fluid collections and/or phlegmon (to refer to local or regional complications), and reserve the term pancreatic necrosis to describe pancreatic infarctions. Hypertriglyceridemia is only presented as a complication of acute pancreatitis rather than a potential cause. In addition, each of the major complications of acute pancreatitis is generally linked to the action of a single enzyme, and the systemic immune response syndrome (SIRS) is less prominently featured in the book.The section on chronic pancreatitis relies heavily on some relatively old perspectives, for example, the calcium-precipitation protein-plug (i.e. lithostathin) hypothesis. In addition, it omits the sentinel acute pancreatitis event (SAPE) hypothesis, updated discussions of autoimmune pancreatitis and classification systems that recognize chronic pancreatitis as requiring multiple etiological risks.The pancreatic cancer section covers ampulary cancers, ductal adenocarcinomas and neruoendocrine tumors. The discussion begins with treatment of adenocarcinoma, which remains dismal. The other types of pancreatic cancer are then presented in order of increasingly better prognoses. Thus, the book ends with discussion of pancreatic cancers that have high hope of treatment. The pancreatic cancer section could have been strengthened by discussion of the premalignant lesions, now referred to as pancreatic intraductal neoplasia (PanIN), and intraductal mucinus neoplasia (IPMN).Despite several areas that could be updated and strengthened, the clear presentation of fundamental concepts and the consistency in focusing mainly on the primary points, helps to explain why the earlier German version of Diseases of the Pancreas has been so successful. A concise and authoritative text on the major pancreatic disease has certainly been needed, and this book fills that need.