Book reviews 751

Dawson’s reference to the problem of ‘symptomless stones’ and ‘stoneless symptoms’ in his chapter on gallstones. It is good to see a reasoned discourse on piles and note the burial of the varicose vein theory and its replacement by the idea of anal cushions. The chapter on the use of radiotherapy for gastrointestinal tumours is illuminating: most clinicians regard radiotherapy for anything other than the lymphomas with suspicion, but perha we need to relook at this field. The section on interventionatngiography is particularly topical and must be essential reading for all fellowship candidates.

Did you know that: 1. Symptoms and complications of varicose veins are

related to the speed of refilling after emptying rather than the size of the veins?

2. Soft tissue radiology of the testicle is of value in the diagnosis of testicular tumours?

3. An operative wedge biopsy of the pancreas is safer than a needle biopsy? *

4. Coronary angiography is possibly safer than intravenous cholangiography?

5. Not only is a thrombosed external pile a misnomer, so also is perianal haematoma? The lesion is really thrombosis in the sacculated venous plexus in the lower pole of an anal cushion.

Perhaps you need to read this book. The time spent will be more profitable than an equivalent time with the journals.

G. W. JOHNSTON

and dental and maxillofacial prosthetic considerations, the subject matter is dealt with on a regional basis. Each group of tumours is treated along similar lines: anatomy, aetiology, classification, surgical pathology, clinical features, treatment and end results. The relative roles of surgery, radiotherapy and, where appropriate, chemotherapy are considered and their combined use outlined in a balanced fashion. Preferred surgical techniques are well described although this is by no means an operative surgical textbook.

The contributors are American with few exceptions: Professor Donald Harrison represents the United Kingdom with a fascinating chapter on unusual tumours, carcinoma of the nasopharynx is written, appropriately, by a surgeon from Hong Kong and lymphomas of the head and neck are dealt with by a team from the Instituto Nazionale of Milan. The overall standard is so good that to single out any contribution for individual mention would fail to do credit to the remainder. Who after all can write with reater authority than Strong and Spiro on oral cancer, Conky and Baker on the salivary glands, John S. Lewis on cancer of the ear and Oliver Beahrs and his group from the Mayo Clinic on thyroid cancer? The chapter on reconstructive procedures by Ballantyne is superb, if marred somewhat by over-dark reproductions of some illustrations. One wonders whether the specialist practitioner requires specific chapters on anaesthesia, medical assessment, nutrition or the care of the incurable patient but the editors have after all sought to be comprehensive and these sections are admirably written.

This book is up-to-date in content and references and is reasonably priced. It can be confidently recommended to all interested in the field of head and neck cancer and is likely to become a standard text.

The Esophagus: Reflux and Primary Motor Disorders R. D. Henderson. 262 x 173mm. Pp. 279+xvi. Illustrated. 1980. Baltimore: Williams and Wilkins. $46.75. THIS volume is an up-dated and extended version of the author’s Motor Disorders of the Oesophagus. It is clear and comprehensive and very well illustrated. The usefulness of this book arises out of its essentially clinical nature. Almost all operative options are covered, and it would be difficult indeed for anyone of Dr Henderson’s experience to be more fair in his assessment of, for example, the many operations for reflux. Reports of his own operative techniques are supported, understandably rather anecdotally, by examples from his own

G . WESTBURY

. . laboratory work.

British surgeons may be surprised at his brief dismissal of guided bougienage of Gricturei The Eder-Puestow technique used so successfully in this country is not even mentioned and conservative treatment of strictures-which occur so often in the elderly-is hardly considered. Indeed, endoscopy itself is ‘reserved for patients with major disease’, and I believe the more aggressive endoscopic attitude in the United Kingdom may be more appropriate.

The book is smartly produced, which makes it a pity that one of several spelling mistakes is in the ‘Forword’! Overall, this is both an excellent reference volume and, at the same time, a useful, practical book for the general surgeon.

Surgical Review 2 Edited J . S . P. Lumley and J. L. Craven. 235 x I55mm. Pp. 435 + vii. Illustrated. 1981. London: Pitman Books. €16.95. THIS second volume in the Surgical Review series covers a wide range of subjects by 23 authors. In these days of super- specialization, this type of volume is invaluable, keeping the busy surgeon informed about advances in surgery and allied specialties. There is a good balance between the management of such common complaints as piles, which affect half the population over 50 years of age, and the less common problems of testicular tumours, leg inequality etc. The in- depth section on inflammatory bowel disease and intestinal stoma is comprehensive. Brendan Devlin’s 77-page section covers everything from psychology to surgical technique, and from the prescribing of appliances to their disposal. I like John

J. SPENCER

Introduction of Abdominal Surgery. Fifty Clinical Studies C. J . Schein. 240 x 168mm. Pp. 521 +xiv. Illustrated. 1981. London: Harper and Row. €19.50. FAIRLY or unfairly, there is a tendency on this side of the Atlantic to view American textbooks with suspicion, especially those for undergraduates-traditionally, they are expected to advocate clever investigations above talking to the patient and to cloud the whole issue in a foreign language.

This book is different. The author has succeeded in producing a magnificent book which encourages an approach to diagnosis that none could fault. Moreover, he transmits his enthusiasm for the subject at every opportunity, surely the prerequisite for any good book aimed at students and junior doctors testing the water in any branch of medicine. He does it mainly through the skilled use of 50 thoughtful, varied case presentations, repeatedly advocating careful history-taking followed by symptom-directed examination and judicious investigation; treatment o tions are then !iscussed. It is always easy to picture t!e patients (i.e. an ill-looking, cooperative, almost deferentially polite man in severe pain’) and almost to hear the careful discussion led by a sympathetic teacher. Each case, spread over 10 pages, is introduced by a symptom complex rather than a diagnosis; alternatively the index can be used to find a case relating to a particular diagnosis. An avuncular preface and sound chapters on the history of abdominal surgery and simulated surgical disorders enhance the volume.

If one can ignore the Americanisms (idiopathicity, emetogenesis, Courvoisier gallbladder etc.) there are few quibbles. The pre-SI units will evoke confusion rather than nostalgia, while the poor MCQs at the end will produce a few smiles (is ‘De Fabnca Humani Corporis’ a ‘14th century quack nostrum’ or perhaps ‘Galen’s case studies’?) and many frowns (does Crohn’s disease recur ‘frequently’ or ‘very often’ after resection? What is the ‘least uncommon’ cause of ‘board- like rigidity of the duodenum’?).

Notwithstanding, students, prospective surgeons and aspiring teachers will find this book very readable; most would be grateful for a cheaper paperback edition.

J. NORTHOVER

Magnesium and Man W. E. C . Wacker. 240x 160mm. Pp. 171. Illustrated. 1980. London: Harvard. E10.50. THE author is long experienced in the field of mineral meta- bolism and is widely known as an expert on magnesium

752 Bookreviews

metabolism. He has produced a monograph which provides a comprehensive review of the features of normal and abnormal states of magnesium metabolism in a style which will be easily understandable by the uninformed reader. One suspects that it was written with the non-expert in mind to prowde detailed information of value to the clinician for reference in times of need, but it is also sufficiently informative to be a standard text in departments with interests in gastrointestinal disease, renal disease and endocrinology.

Being the fourth most abundant cation in the body and the second most abundant within the cells, magnesium clearly deserves a work such as this, covering a wide span of disciplines. The section on biochemistry and physiology out- lines fully but without unimportant detail the function of magnesium in membrane transport and ermeability, protein synthesis, enzymatic processes and in t i e regulation of cell metabolism. The chapters on normal metabolism and mag- nesium deficiency wll provide the major interest for the clinician, brin$ing together the standard information on intake, absorpbon and excretion with the im act of disease to create deficiency states. The discussion on t& importance of parathyroid hormone and the potential links between hypo- magnesaemia and h ocalcaemia is well written and gives a helpful summary o f x e current state of knowledge.

The Immune Consequences of Thermal Injury J . L . Ninnemann.260 x 176mm. Pp.269+xvi. Illustrated. 1981. Baltimore: Williams & Wilkins. THIS is an interesting volume representing the sub’ect discussed at a workshop on the immune consequences of dermal injury in 1979. Despite the delay in publication, the book is remark- ably up to date in its content.

Although the title specifically mentions thermal injur , the book will be of interest to surgeons involved in the probems relating to all injuries since it concerns the effect of trauma on the patient’s immune response and the chances of overcoming serious infection. This particular subject is now central to the thinking of clinicians involved in areas of intensive care medicine and would be well worth buying as a source of new information and pointers to the future. For the general surgeon who does not have an interest in immunology but would like to gain an overview of the subject, the book would be worth reading as it manages to contain the basics of immunological theory without the fre uentconfusion that this topic generates.

The book is d iv idJ into 16 cha ters dealing with different aspects of the immune response in [urn patients, includmg the activity of macrophages, lymphocres and neutrophils. The possible existence of burn toxin is discussed, and alterations in complement are described. There is also an interesting chapter on auto-immune disease in burn patients, and a fascinating chapter on the possibilities of vaccination for control of infection in these difficult subjects. There follows several chapters which look at the various wa s in which the immune response, depressed as it is by thermafinju improved with a view to reducing the mort%z: %:~oE condition. The very last chapter is intriguingly entitled ‘Elephants, bees and immunity in burn patients’. It offers an amusing comparison between the immune system and the workin s of a colony of bees!

This took should certainly be bought by most libraries, and would not be out of place on the book shelf of dpctors involved in the treatment of burned or seriously ill pabents.

R. CLARK

P. BELL

Eme ency-room Care C. E2ert. Fourth Edition. 234 x I56mm. Pp. 514+xviii. Illus- trated. 1981. Boston: Little Brown. t20.75. THE emergency room in the United States differs from the casualty department in the UK. That this is so is clear from the chapters on administration and operation of the department with the introduction highlighting problems associated with the impatient, attention-seeking and angry patient; certainly such problems do exist in this country but, fortunately so far, without the same litigious overtones.

In thisedition, the fourth in 14 years, extra material has been

added on cardiac emergencies, rape and ps chiatric emer- gencies. The latter section is particularly l u c d and succinct.

Of the 31 authors, all but 6 are affiliated to the Albany Medical College of Union University, Albany, New York. Uniformity of style is good and the text is terse and dopa t i c .

The 26 chapters cover a wide field of topics mamly by specialty. Such an ap roach is orderly and, for a multiple- author book, essentiar Nevertheless, it does mean that dis- orders responsible for some common presenting complaints are discussed in more than one chapter. Thus, the causes of abdominal pain appear in no less than 8 chapters, while abdominalemergencies, which include trauma, are dealt with in a mere 13 pages. Such an important aspect ot’ emergency care surely warrants better coverage.

Each section blends practical advice with sufficient patho- physiology for clear understanding. The chapter on the severel In’ured is divided into three parts: injuries that can causedlath in minutes, hoursand days. In the first part we read that ‘the single most important determinant of oxygen delivery to the tissues is the haemoglobin concentration’ (sic); discus- sion of hypovolaemia appears in the second part!

Chapters on maxillofacial and neck injuries, infectious diseases, neurological emergencies and drug abuse are par- ticularl welcome since, for the casualty officer, such informa- tion is hard to come by outside specialist texts.

Given the constraints imposed by North American termino- logy and notwithstanding the above comments, this book is strongly recommended and should find a place in all casualty

Prevention of Venous Thrombosis and Pulmonary Embolism J . G. Sharnof. 223 x 143mm. Pp. 135. 1980. Lancaster: MTP. €8.95. DR SHARNOFF has produced a small book which deals in great detail with the pathology of venous thrombosis, hypercoagula- tion, the pharmacology of platelets and then devotes half of its 130 pages to the prevention of deep venous thrombosis by means of subcutaneous heparin. The book makes little or no mention of other methods of prevention of venous thrombosis and its title is therefore misleading. Nevertheless, it catalogues in great detail the technique used by the author to minimize postoperative venous thrombosis using heparin.

The o inions of the author are not shared by all workers in this fielaand the bibliography used to support his theones IS not always fully balanced. This book, however, is essential reading for anyone with a serious interest in the prevention of dee venous thrombosis. Sharnoffs work has never been stuied in controlled trials, for all the controlled trials pub- lished on the prevention of deep venous thrombosis by the use of subcutaneous heparin, although based upon his work, do not follow his protocol. No attempt has been made in other series, tomonitor the levels of hepann during therapy. Sharnoff makes the point that this is essential if the treatment is to be safe and his claim is valid. Other workers have found that heparin levels are so low using this treatment that monitoring may not be necessary, but the main risk of using subcutaneous heparin is undoubtedly haemorrhage either through intolerance of patients to the prescribed dosage or to accidental overdosa e. Moreover, Sharnoff bases his dosage of heparin very carefufly on the size of the patient which has again been sadly lacking from most controlled trials of subcutaneous heparin. It requires no great effort to modify the dosage in accordance with the size of the patient, but a considerably reater effort to

Sharnoff claims that subcutaneous he arin is not safe unless this precaution ,is taken and a signilcant increased nsk of haemorrhage in most published series strongly supports his contention. We cannot therefore assess the true place of

rophylaxis of deep venous thrombosis using subcutaneous feparin without yet another controlled trial in which prophy- lactic heparin, in pro erly adjusted dosage and properly monitored is cornpardwith other methods of prevention of deep venous thrombosis.

This little book makes this oint very clearly and we must hope that workers in this fiel~will heed its message.

departments. BRIAN W. ELLIS

monitor therapy with regular estimations o P clotting time.

C. JAMIESON

Primed in Greaf Britairl by John Wright and Sons (Printing) Ltd. af The Stonebridge Press, Bristol