Book reviews 887

There is an extensive review of the pathology of non- endocrine tumours by Dr Patrick Fitzgerald, based on his personal experience of 645 cases at the Sloan Kettering Memorial Hospital from 1949 to 1978. He gives a detailed account of the histopathological variants, and also a particu- larly valuable analysis of the pattern of lymph node metastases from carefully dissected post-mortem and total pancreatec- tomy specimens. This type of analysis is of vital importance for staging and resectability now that total pancreatectomy is a real surgical possibility. The system proposed by the American Joint Committee for Cancer Staging, based on the TNM format, is reviewed. This was designed essentially for surgical staging, but Fitzgerald proposes a more detailed pathological TNM staging based on his own findings. This differs in an important respect from other proposed systems; Fitzgerald's experience suggests that invasion of adjacent organs and vessels is almost invariably associated with distant lymphatic spread. thus casting some doubt on the value of 'regional pancreatectomy' as a cancer operation.

Professor Jan Reddy (Chicago) and Professor James Jamieson (Yale) have both made important contributions to the basic biology of pancreatic tumours. and their respective chapters reflect in considerable depth the debate on the histogenesis of this tumour. Professor Reddy's chapter is a valuable review and source reference on the important subject of the relationship of chemical carcinogens to the initiation of pancreatic cancer. Reddy also gives the evidence for the potential of pancreatic acinar cells to undergo modulation into less differentiated types, and even to morphologically definable 'ductular' cells. Jamieson, on the other hand, pre- sents the histochemical evidence for the ductular origin of most pancreatic tumours. These studies, using surface glyco- protein 'probes', may lead the way to more detailed classifi- cation of the cells of origin of these tumours, and perhaps even serve as markers for screening the serum or pancreaticjuice of high risk populations. Tumour markers are reviewed by Zamcheck (Boston) though the conclusion must be that no single agent has proved of significant value; the combination of CEA and POA remains the most sensitive marker for this tumour available at present.

Jurgen Althoff (Hamburg) reviews extensively the available animal models for pancreatic cancer and also details the pancreatic cancer cell culture lines and transplantable tumours in current use. There is also a comprehensive account by Cesare Bordi of the various endocrine tumours of the pan- creas, based largely on his own work and that of Professor Orci in Italy. lngemar lhse presents his work from Lund on dietary influences on pancreatic exocrine secretion, since the trophic effects of gastrointestinal hormones on the gland may be of importance in sensitizing pancreatic cells to environ- mental carcinogens.

Althou h the workshop was not primarily concerned with therapy. t i e closing chapter from the Hammersmith Hospital addresses the question of selection of therapy for pancreatic cancer, and discusses the way in which new a proaches to preoperative preparation of the patient may affect the out- come of surgical trcatment.

Pancreatic cancer is a tumour of increasing incidence and dismal prognosis, and it is clear that any advances in manage- mcnt of this condition must rely on earlier diagnosis and on a clearer understanding of the basic pathology of the cancer. The proceedings of this workshop should serve as a valuable 'st-;e of the art' review both for established workers and for those about to embark on a programme of research in this area.

1. S. BENJAMIN

Therapeutic Endoscopy and Radiology of the Cut J . R . Bennert. 240 x 160mm. Pp. 271 +xii. Illusrrated. 1981. London: Chapman & Hall. f20.00. I N this handy-sized, well-illustrated book, Dr Bennett has brought together 23 contributors to describe therapeutic procedures using fibreoptic endoscopy or radiolo or both. The preface suggests that it should be used as a g u i g to enable endoscopists and radiologists to undertake the procedures described safely. Some chapters, such as those on endoscopic and radiological placement of tubes, jejunal biopsy and

endoscopic and percutaneous retrieval of gallstones from the common bile duct, attain this standard. Others do not. The section on selective anqiography and embolization is a good 'update' but not a guide on how to do it, nor is that on intubation for oesophageal carcinoma, which contains seven pages of historical introduction but fails to mention the use of X-ray screening during insertion of the tube. The section on lasers and diathermy becomes too technical. The chapter describing research into other endoscopic techniques for dealing with haemorrhage has no clinical application and could be omitted. The book is spoilt by a paragraph number- ing system reminiscent of an administrative document. There are several printer's errors.

These are minor criticisms of an otherwise excellent and up- to-date account which should be on every endoscopist's bookshelf. The very practical chapters on dilatation of benign strictures and retrieval of foreign bodies would justify this alone. It is a pity Dr Bennett did not write more of the book himself.

BRIAN STERRY ASHBY

Surgical Radiology Volume 1 J. G . Teplick and M. E. Haskin. 267x 190mm. Pp. I088 + xix + xxviii. Illustrated. 1981. Eastbourne: Saunders. f40.00. THE authors of this book previously compiled a two-volume radiological companion to the Beeson McDermott Textbook of Medicine. Based on the success of that venture, they have now prepared a three-volume accompaniment to the Davis- Christopher Textbook of Surgery.

In an era in which interventional radiological techniques are encroaching more and more into areas which were once the sole domain of the surgeon, it is interesting to review the first volume of a textbook of radiology designed to complement a major surgical work. Whether or not it achieves its comple- mentary role is a matter for personal opinion. In my view, it does that and more. It is a superbly illustrated book with clear explanation of the important and relevant features. I am sure it will be a valuable source of reference to specialists in radiology and surgery alike.

There are excellent chapters dealing with ultrasound and CAT scanning. By comparison, however, the chapter dealing with radioisotope techniques is disappointing, mainly because of the relative lack of detail in the main sections. More recent techniques, such as HIDA scanning and indium-] 11 colloid labelling, are dismissed in a few lines.

One of the best chapters is that dealing with the radiological si s in the acute abdomen. Very useful tables are provided wEch list the signs to be found in each condition, often distinguishing between common and unusual findings, and comparing them with the relevant anatomical feature. Most surgeons would find this section of considerable interest.

The authors are to be congratulated on their achievement. It is a book that can be recommended to surgeons, and certainly hospital libraries should be advised to have it available for reference.

C. WOOD

Lymph Node Biopsy A. H . T. Robh-Smith and C. R. Taylor. 303 x 215 mm. Pp. 308. Illustrated. 1981. London: Miller Heyden. f36.00. THIsis destined to become a classic work but it is debatable for whom it is really written. There are some technical comments about biopsy but they are comparatively short and insignifi- cant compared with the main message of the book which is expensive and extravagantly pictorial.

Although me title is somewhat misleading, surgeons, and especially those with an interest in oncology, should be grateful to the authors and wish to possess the book them- selves. A minimum of effort is required to turn the pages and familiarize oneself not only with old and established ideas but also with new concepts and developing classifications. The personal discipline of continuing education which a book like this makes so easy (even if somewhat superficial) enables surgeons to lift themselves from the status of technicians and converse on almost equal terms with pathologists and

888 Book reviews

physicians. To this end the book succeeds supremely well. Who else, I wonder, will turn the glossy pages and appreciate the clear tables and typography? Perhaps pathologists them- selves and this would be the true accolade.

There are, however, some defects and omissions. Most are more likely to be apparent to the pathologist, who will not find all the illustrations as satisfying as the sharp clarity and colour of direct vision down a microscope.

As a surgeon 1 was disappointed not to find an account of fatty infiltration of lymph nodes-surprisingly common when vigilant surgeons following malignant cases sample enlarged nodes. There was also a failure to unravel the mysteries of glands infiltrated with naevus cell pigment and how they differ from those with deposits of secondary melanoma.

Let not these small criticisms significantly detract from a work of great competence which many surgeons would enjoy possessing and derive great benefit from having at their elbow before operating and in preparing clinicopatholo 'cal con- ferences. The index makes the book easy to use an t the price will soon be forgotten.

The Management of Acute Vascular Injuries M. 0. Perry. 260x 172mm. Pp, 148+x. Illustrated. 1981. Baltimore: Williams & Wilkins. $27.75. THIS monograph is written by the chief of vascular surgery at Cornell University Medical Center, New York, where the results of 665 vascular injuries treated in the past 18 years are described. In the preBce, we are reminded that each year in the United States trauma causes 50 million injuries and 100 000 deaths. The initial responsibility for resuscitation and care of injured patients rests with surgical residents, to whom this book is directed. The author and his publishers have provided a concise, nicely presented and well-illustrated volume, but it has to compete with Rutherford's Vascular Surgery (in which Dr Perry wrote the section on vascular injuries) and Rich and Spencer's Vascular Trauma, two American surgically heavyweight tomes published within the past 4 years.

The book covers the care of acute arterial and venous injuries of the limbs, neck, thorax and abdomen, with intro- ductory chapters about evaluation of the patient, preparation for operation and the principles of surgical repair. Dr Perry highlights many important topics including pointers to assist in early diagnosis, techniques of arteriography and other investigative methods and the use of interposition vein auto- grafts rather than direct suture to avoid excessive tension at suture lines. He also emphasizes the importance of the repair of venous injury if both artery ind vein are damaged. The high prevalence of acts of civil violence-bullet wounds and stab- bings-has given surgeons in metropolitan areas of the United States u n p a r a ~ ~ e ~ ~ e d experience of vascuiar repair.

Even so, I found a few points of disagreement. which is almost inevitable in a book of this size. For example, in fractures combined with arterial injuries, the bony injury is usually stabilized prior to arterial re air contrary to the advice on page 22 to repair the artery lrst.

Times are changing in Britain, both in our inner city areas and in Ulster. Books like this will become increasingly necessary if the level of violence in our society increases.

HARVEY WHITE

R. BAIRL)

Recent Advances in Urology/Andrology 3 Edited by W. F. Hendry. 240x 160mm. Pp. 361+xii. Illus- trated. 1981. Edinburgh: Churchill Livingslone. f20.00. MR HENDHY has succeeded in getting together a number of experts to write on a wide variety of subjects for this new edition. There are topics that we ought to know more about and 1 am sure there is something in it for everyone.

I t is nice to have consecutive chapters on controversial subjects such as the investigation of upper tract obstruction. Should we go for invasive techniques or esoteric decon- volution analysis? The chapters on the American and British views on combined therapy of urological malignancies are both excellent, but I do not think that we will be, persuaded that radical retroperitoneal lymph node dissection IS essential.

As a new venture, tropical diseases are well covered as is modern management and treatment of bilharzia. Likewise to be recommended are the authoritative accounts of the modern management of tuberculosis, the place of Helmstein's dis- tension in bladder disorders, the treatment of incontinence and impotence, thoughts on urinary diversion and on vesico- ureteric reflux. There is much to be learnt from the chapter on antibiotics. There are three chapters on the prostate- prostatitis, carcinoma and prostatectomy in the 1980s-this last one being nicely provocative.

The addition of andrology to the title reflects the increasing interest in this subject in recent years, and the informative chapter on endocrine function in male gonadal dysfunction with its wealth of references is essential reading for those who have defaulted in their reading.

I can recommend this book and at f20 it should be on !he shelf of every urologist in training or involved in teaching because it contains the sort of information that is dillicult to find so well presented elsewhere.

Recent Advances in Plastic Surgery, 2 Ian T. Jackson. 244 x 160mm. Pp. 266 + viii. Illustrated. 1981. Edinburgh: Churchill Livingstone. f24.00. THE modern general surgeon will probably have completed his training without working for a plastic surgeon. One of the drawbacks of super specialties is that the craft is usually plied in special units whose junior staff are destined for specialized training. Invaluable experience is thus missed by our general surgical trainees and they may only have a sketchy knowledge of the disciplines of plastic surgery.

This book has, therefore, an especially exciting message. Some of the chapters relate to the most esoteric of plastic surgical techniques such as the management of thc microtic ear, cleft palate and infantile craniofacial deformity. There are, however, splendid sections which either outline tech- niques within the capabilities of general surgeons or which serve to tell us about fields that have advanced tremendously in recent years.

For surgeons concerned with the management of cancer, John Bostwick's contribution on breast reconstruction is excellent reading as is that by Dowden and McCraw on myocutaneous fla s The latissimus flap has become a stan- dard method in tRerepertoire of any surgeon who plans to give a comprehensive service to patients with advanced breast cancer. The use of omentum in reconstruction is already widely known and is discussed well by Kiricuta.

Most surgeons will rightly regard the modern techniques in the management of facial palsy as outlined by Anderl and Miihlbauer as being beyond their abilities but they should know that such help can be given. The same applies to those preserves of microvascular surgeons such as digital replanta- tion and free-flap surgery. These things tend to happen only in very specialized units and most surgeons will find something of interest, relevance and clinical excitement in this book. I t is well written by a distinguished international team, wcll edited by Ian Jackson and is outstanding value.

Treatment of Bums J . S. Cason. 244 x 160mm. Pp. 339+ix. Illustratc~d. 1981. London: Chapman and Hall. fl540. THIS is a 'middle of the road' manual on the management of burns, as practised in the Birmingham Accident Hospital where an average of 400 inpatients are treated every year.

Although basically a practical. concisc and yct comprehensive book on the treatment of burns, the author has also included less ambitious chapters on the history, classification, pathology and physiology of burns.

In addition to the general and local treatment of burns, Mr Cason has also incorporated worthwhile chapters on the management of the resultant scars, contracturcs and deformities, as well as the physical and mental rehabilitation of patients. Burns of the eyes and respiratory system are given individual coverage, but regrettably not those of the hands.

The author has obviously aimed at a wide readership, both medical and paramedical. In this he has succeeded.

Y. WORTH

P. S. HOULTER

M. N. SAAD