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WHIPPLE disease is multisystemic and diagnosed more frequently now because of the availability of peroral small-bowel biopsy techniques. Symptoms of arthritis and polyserositis often precede the more familiar manifestations of diarrhea, malabsorption, weight loss, abdominal pain, and skin hyperpigmentation. The primary disease may not be considered in patients first seen with arthritic symptoms and without diarrhea. Report of a Case A 76-year-old white retired farmer entered the Miami Veterans Administration Hospital complaining of intermittent foul-smelling watery stools, mild hypogastric pain, and a 25-kg (56-lb) weight loss over nine months. The patient had a 20-year history of intermittent, migratory, seronegative, non-deforming arthritis involving hips, back, knees, and wrists. For the last 15 years he had been attending the Rheumatology Clinic at the Miami Veterans Hospital. Roentgenograms of large and small joints had shown only minimal osteoporotic changes. A diagnosis of palindromic rheumatism was made. The arthritis did not respond to treatment

Malabsorption was induced in two adult patients by the prolonged oral administration of neomycin sulfate. Histopathologic small-bowel changes and altered chemical indices of absorption characterized the malabsorptive state. A defect in the hydrolysis of a long-chain unsaturated fat (triolein) was demonstrated by analysis of fat meals aspirated from the duodenojejunal junction. The pathogenesis of the hydrolytic defect is unknown but, theoretically, is related to either the absorptive defect imposed by the associated intestinal cellular damage or a direct inhibition of lipase action by neomycin.

In 83 patients with liver cirrhosis, an esophagogram after administration of barium sulfate, an endoscopic examination of the esophagus, and a portogram after percutaneous injection of an opaque material into the spleen were compared for diagnostic value in demonstrating esophageal varices. The diagnosis was established by esophagoscopy in 81, by splenoportography in 61, and by barium esophagogram in 55. Large varices were frequently missed by barium esophagograms as well as by splenoportograms. The mean splenic-pulp pressure was similar when patients with endoscopically demonstrated varices and normal portograms were compared with those whose portogram showed varices. Moreover, there was no apparent relation between portal pressure and variceal size. A time lapse between studies of as long as two months had no apparent influence on the incidence of positive diagnoses obtained.

Having read V. Tuchel's Non-Specific Mesentericc Lymphadenitis , I have an expanded awareness of this interesting and possibly "commonplace" entity, its diverse forms and clinical manifestations, its masquerading personality and potential role in the etiopathogenesis of a number of poorly understood disorders of bowel, mesentery, omentum, and lymph nodes such as terminal ileitis, panniculitis, and retractile mesenteritis. Its potential for expanding clinical awareness, an interesting and thorough historical account, and a bibliography of more than 400 references are the book's strongest features. The major deficiencies of the 140-page monograph that discusses historical aspects of the entity; anatomy and physiopathology of the mesentery, its nodes and ganglia; the epidemiology, pathology, etiology, clinical manifestations, diagnosis, and treatment of non-specific mesenteric lymphadenitis is in its literary style, overlapping and unbalanced content, degree of disorganization, and unnecessary repetition. More than a third of the text details excessively the anatomic aspects of normal and diseased mesenteric