third chapter provides an excellent review by Arthur Cooper of ammonia metabolism in both liver and extrahepatic mammalian tissues. The fourth chapter is a succinct review of the clinical manifestations and management of hepatic encephalopathy. In the fifth chapter, the authors report their experience on the nutritional support of the encephalopathy-prone patient; several combinations of enteral and parenteral diets with branched chain amino acids (BCAA) are discussed. The sixth chapter provides an in-depth review of the role of the GABAhenzodiazepine receptor complex and the response of hepatic encephalopathy to flumazenil in humans and in animal models as well. In the seventh chapter, Dr W. Raabe describes the major effects of hyperammonemia on the function of neurons and their consequences. In a very charismatic manner, he demystifies difficult and complex terminology for the clinician, such as "inhibitory postsynaptic potential (IPSP)," "chloride-extrusion," and so on. References in this chapter are just superb! The eighth chapter, written by the Valencia group headed by Dr Grisolia, deals with the effects of hyperammonemia on brain microtubules. The authors present data to support their hypothesis that ammonia toxicity is mediated by the activation of the N-Methyl-D-Aspartate (NMDA) receptor. The last four chapters are devoted to the study of mechanisms that control the release of glutamate and cerebral protein breakdown and the properties of NMDA receptors that mediate glutamate toxicity, as well as the mechanism(s) of the protective effects of gangliosides against glutamate toxicity.
Cirrhosis, Hyperammonemia and Hepatic Encephalopathy provides an accessible account of the state of knowledge of the role of hyperammonemia in hepatic encephalopathy in 1992. Because of the brevity of the volume, some of the subjects are not dealt with in extensive detail, but, in general, the topics are adequately covered. Overall, this is an attractive book, well-referenced, easy to read, and reasonably priced.