Book reviews Gallstones Discussions in Surgical Management J. A. Caprini. J . P. Fotopoulos. M. A. Oviedo and D. Paloyan. 212 x 135 nun. Pp. 148. Illustrated. 1979. New York: Medical Examination Publishing Co. $9.50. THIS small paperback is written by three surgeons and a

liologist. Over one-third of the ages are taken up by Awgraphs and diagrams. Perhaps t i e most useful section is

me g F o n radiological assessment of the biliary tree which is in ’-he e n clear and instructive. There is, however, very little c:rit.cism of the accuracy of intravenous cholangiography in :,s&ssing the presence or absence ofstones in the biliary system.

Some of the more controversial aspects of clinical diagnosis are scantly discussed, e.g. the significance of dyspepsia or the problem of biliary tract pain without obvious stones: whereas such topics as disorders of haemostasis, postoperative shock and pulmonary embolism are allotted an inordinate amount of space. No mention is made of transhepatic drainage of the biliary tree as a valuable adjunct in the preparation of the patient with obstructive jaundice.

The operative treatment is described in detail with the aid of diagrams which are clear (except for the one on page 72 which is printed upside down). There is little to quarrel with in the advice which is given except perhaps the statement that the stoma of a choledochoduodenostomy need only be 1 cm in diameter.

Although references are made in the text not all of these appear in the reference list at the end of the volume: this is somewhat irritating if the reader wishes to pursue a particular point.

Overall, the approach to clinical diagnosis and treatment is orthodox and sensible. Most surgeons will find something of interest in browsing through the text.

1. DAWSON

Microsurgery Practice Manual R. D. Acland. 156 x 178 mm. Pp. 106 + ix. Illustrated. 1980. London: Year Book Medical Publishers. €8 75. A most useful step-by-step guide for surgeons wishing to learn microsurgical techniques has been created from the practice manual written by Dr Acland of Louisville, Kentucky, for his microsurgery trainees. He emphasizes the importance of constant laboratory practice as a prelude to clinical microsur- ery, and the ring-binding format of this book is ideal for the aboratory bench.

The manual begins with a description of the use of the operating microscope and gives advice regarding the choice of microsurgical instruments. Rats are most commonly used for microvascular practice and the techniques of anaesthesia and preparation are described. The descriptions of preliminary suturing exercises and arterial and venous anastomotic tech- niqpe are excellent. A most useful feature at the end of each section is a list of faults that can occur at the anastomosis and how to avoid them. There is an appendix which contains a list of microsurgery supplies and suppliers.

This practical microsurgical manual fills a gap in the present range of standard texts. For surgeons wishing to learn the techniques of microsurgery, the book is highly recommended.

f

RODNEY J . CROFT

Outpatient Surgery G . J. Hill 11. Second edition. 255 x 174 mm. Pp. 1475 + xxv. Illustrated. 1980. Eastbourne: Holt-Saunders. €28.75. FIMT published in 1973, the second edition of this book has been fully revised. The scope, as outlined in the preface to the first editlon, is ‘the diagnosls and treatment of surgical patients in the outpatient clinic, emergency room and overnight ward’. Thus the definition of outpatient is somewhat elastic on the

very reasonable grounds that many hospitals have a small overnight ward adjacent to the outpatient facility. The size of the book raised the question in this reviewer’s mind as to whether it was a good idea to try to subserve these several functions in one volume. But the result is successful as a wide- ranging, comprehensive and detailed reference textbook, omit- ting only the techniques and perioperative care of big oper- ations. The sections on recent developments, economics, planning and administration are geared to the American Scene and, in contrast to articles on this topic in the UK, there is scant reference to the involvement of community health services in surgical aftercare.

In connection with the economics of outpatient care, it is interesting to read the comment that ‘ambulatory surgery can decrease occupancy and thus create an adverse financial impact on some hospitals. For this and other reasons only 45 per cent of hospitals in the United States had ambulatory care pro- grammes in 1977’ des ite the fact that it is calculated that 30 per cent of surgery in tEe United States could be done on an outpatient basis. If general surgical practice in the UK is typical of surgery in general, this figure is a conservative estimate.

The scope of the book is illustrated by the fact that, as well as covering conventional areas of general surgery and ortho- paedics, there are chapters on the organization, planning, design and administration of emergency departments’ out- patients clinics and office premises.

The book is well laid out. Most of the chapters are lucidly written, although some are a trifle discursive. It is illustrated with excellent line drawings, particularly in the ortho aedic sections. The text is supplemented with many useful tab]P,. At €28.75 this book is good value. If it reminds us how much of our practicecan and should be managed on an outpatient basis it will have served its purpose. It is recommended to all surgeons interested in Outpatient surgery-and should not that be all of us?

C. V. RUCKLEY

Management of Acute Trauma H. J. Proctor. 236 x I58 mm. Pp. 290 -+ xv -+ xix. Illustrated. 1979. London: Year Book. €2825. THIS book is published under the auspices of the American Trauma Society and is quite naturally orientated towards the American rather than the British situation. The book is more concerned with general problems such as training programmes, le I implications and the initial assessment and resuscitation oRhe patient than with a detailed consideration of specific clinical problems. The role of the EMT (emergency medical technician) is considered and it is useful to obtain information on this topic from a textbook rather than from television fiction. This book would be a useful addition to the library of an accident and emergency department, bearing in mind the obvious transatlantic differences.

COLIN MACKAY

Cewnl Opbthalmdogy D. Vaughan and T. Asbury. Ninth edition. 262 x 180 mm. Pp. 410. Illustrated. 1980. Los Altos. California: Lunge. $1540. THIS book was first produced in 1958 and now appears in its ninth edition; it has proved to be very popular with many established the trainee ophthalmolo ‘sts and to medical stu- dents. It has been translated into Itafan, Spanish, Polish and Portuguese. This attractive book presents a comprehensive and easily

readable, well-illustrated account of ophthalmology in its ialist aspects and in its general implications in relation to

E a s e s of other systems. Potentially urgent ocular problems such as the differential diagnosis of the parnful red eye (a simple