Book Reviews

Wound Healing: Methods and Protocols 
L.A. DiPietro and A.L. Burns (Eds.) 
Humana Press Inc. New Jersey, USA 
ISBN 0896039994 £102.50

Our understanding of the mechanisms involved in tissue repair have under-gone unprecedented expansion in the last decade. From numerous studies at the molecular level to the use of newly developed wound care products, there is excitement about the progress being made in wound healing. Yet much remains to be discovered as the basic mysteries of this complex and dynamic biology are just beginning to yield to myriad new investigative techniques. Therefore, the need for the book, Wound Healing: Methods and Protocols, is high.

The book is well presented and meticulously set in two parts, which are easy to follow. Part I presents model systems for studying wound healing and part II gives methods for analysis. The editors and expert contributors have covered a comprehensive range of topics for the benefit of readers and researchers committed to studying the healing process. Each chapter has a complete and up-to-date list of references. There are three chapters (14, 15 and 16) for extensive reviews of specific conditions, which affect the healing process and their model systems.

The healing process encompasses many overlapping biological phases including the inflammatory response, cytokine production, alteration in cellular activity and migration, epithelial growth and differentiation, fibrous tissue production and modulation and angio-genesis. This book provides models and protocols for many types of wounds in different tissues, and to assist in studying the various aspects of the healing process. Part I includes comprehensive protocols for thirteen in vivo and four in vitro models. The in vivo animal models are carefully designed to assess the molecular and cellular changes not only in a healthy animal but also in models representing acquired or hereditary clinical conditions known to affect the healing process. In addition, chapters 17, 18 and 19 provide protocols to employ humans as in vivo models.

It is well known that extremes of age affect the outcome of the healing process. Therefore, chapter 12 on methods for investigating foetal tissue repair and chapter 16 on wound repair in the elderly will be of interest to many scientists and clinicians.

Part II illustrates multiple methods for quantitative and qualitative analysis of the changes during the healing process. Chapters 33 and 34 evaluate the role of the new bio-technology of microarrays and gene therapy in wound healing.

This book has fulfilled its aim and it will become a valuable reference for both basic and clinical scientists interested in initiating or expanding their studies of wound healing.

One possible criticism of the book is its cost, which could make it less readily available for some young researchers. Costs apart, I recommend this book to be available in the library and in the research laboratory.

Mr M El-Sheemy United Lincolnshire Hospitals NHS Trust and the University of Lincoln, U.K.

Conservative surgery for menorrhagia 
P. O’Donovan, P. McGurgan and W. Prendiville (Eds.) 
Greenwich Medical Media Ltd. London 2003 
ISBN 1841100978 £65

Menorrhagia is a major problem for patients and provides a major work burden for most practising gynaecologists.

This book describes menorrhagia, summarises its pathophysiology and describes the latest methods of treatment available or becoming available to the gynaecologist.

Of interest is the foreward by Loffer and the introduction by Downes. The book starts with chapters on the clinical facets of menorrhagia (epidemiology, diagnosis) and then continues with the various treatment options. It could have benefited from rather tighter editing to reduce the repetition noted in the introductions of most of the chapters.

The book provides a good overview of the second generation treatment techniques (balloon technology, radiofrequency, cryotherapy, interstetial laser, circulating hot saline and microwave ablation). It describes a number of published randomised controlled trials (RCTs) but like a lot of books suffers from a long lead time from writing of the chapters till publication, as several important RCTs have been published in the interim. Their inclusion would have strengthened the book.

There appears to be little to choose between some of the techniques described and, as has been expressed at several international meetings, the most popular technique may ultimately depend on the price set for the disposables and the marketing expertise of the various companies.

David Parkin has expressed an interesting personal view and has provided evidence of RCTs using microwave endometrial ablation (MEA). He comments that apart from MEA, hydrothermablation is a good method as it is performed under direct vision and can also treat an irregular uterine cavity. However, he prefers MEA as he has had much experience with this method.

In summary, this book provides a good overview of the subject but it would have been improved by the inclusion of results of more controlled trials.

Professor D. Abramovich University of Aberdeen

Bioceramics in Joint Arthroplasty 
J.P. Garino & G. Willmann (Eds.) 
Thieme, Stuttgart 2002
ISBN 3131326514 £54.00

This book incorporates the 30 papers presented at the 7th international BIOLOX^® symposium. The contents are not confined to ceramic bearing surfaces. Several chapters are dedicated to metal-on-plastic articulations, and in particular the new highly crosslinked polyethylenes. Polyethylene wear is discussed in some detail, and the important observation is made that all cups with plastic less than 6 mm thick coupled with 32mm heads should be monitored indefinitely. It is also noted that while increased crosslinking is associated with very low wear rates, it contributes to an increase in crack initiation and crack propagation. Its future performance needs to be carefully monitored.

The liberation of trace metal from metal-on-metal bearings is reviewed, and the implications of the systematic dissemination of these trace metals with regard to both hypersensitivity and mutagenesis is discussed.

As suggested by its title the book mainly focuses on ceramic-ceramic couples. Manufacture, composition and in vitro testing are all addressed. It is noted that quality control, including design verification, design transfer and process validation now generates considerable knowledge which contributes to ongoing improvements. New innovations - such as zirconia toughened alumina - may open the door to a wider application of ceramic bearings. Their use, for example, in total knee replacement is discussed in the last few chapters.

Several clinical trials are presented, with both clinical and surrogate outcome measures. This ‘closes the loop’ and transfers the science to the bedside.

The book is somewhat fragmented, and is not reader friendly with small print arranged in two columns on each page. The English would not satisfy a purist. However, the book does contain useful information regarding current opinion on articular couples.

I believe it would make a useful addition to the library of any surgeon with a genuine interest in the science and practice of joint arthroplasty.

Professor I.D. Learmonth University of Bristol, U.K.

Prostate Cancer Diagnosis and Surgical Treatment 
R. Hofmann, A. Heidenreich and J.W. Moul (Eds).
Springer, Berlin 
ISBN 3540420193 £86.95

The management of men with early prostate cancer remains the most major controversy within urological oncology. Epidemiological autopsy based studies have shown that small prostate cancers are found in over 25% of men aged 50 to 65, and it is clear that in many men most of these tumours will not cause significant problems during the patient’s lifetime. The widespread use of measurement of serum prostate specific antigen (PSA) has resulted in marked increases in the diagnosis of prostate cancer in the US and in many countries in Europe. Whilst most of the prostate cancers found by such case-finding efforts are said to be ‘clinically significant’, many are small and the majority are of Gleason Grade 6. It is generally accepted that up to 60% to 70% of such men who have tumours that are unlikely to progress, are over-treated radically by means of surgery or radiotherapy, and as a result suffer significant impairment of quality of life. It is to be hoped that the major research effort that is now underway will identify serum or tissue markers that better stratify tumours into different risk categories.

This book is aimed mainly at the urologist managing men with early prostate cancer, and is surgically oriented. The authors largely come from academic centres within Germany, where there are centres with large experiences of radical prostatectomy. The book includes a CD-ROM with 10 operative video clips. These are of high quality and I thought the CD was a really welcome addition, though some of the videos include rather irritating background music. Many of the difficult steps of radical prostatectomy are well shown, though the clip showing dissection of the seminal vesicle artery, which can be sometimes rather tiresome, was not very clear.

The book includes good chapters on pathology and basic science, though inevitably some of the latter chapters are a bit out of date because of the rapid progress of the field. The book was particularly good in dealing with diagnostic, staging and imaging aspects. Also the operative chapters were well written with some good diagrams. Coupled with the operative videos, I felt that the book would have major appeal to the urooncologist in training, though the experienced surgeon would also find much to learn from reading chapters and watching the video clips. Knowing how long it can take to bring such a book from conception to delivery, I am not too surprised that there was no written section on the evolving role of laparoscopic radical prostatectomy, which was an omission, though the editors have included two videos of the technique.

There were some typographical errors that crept through the copy-editing (brother instead of bother in one of the appendices), but in general the book was well-presented, and well-written. There were two chapters on radiotherapy, which were short, well referenced, but the inclusion of more detailed discussion might have been helpful. The side effects of radical surgery were covered, but a more detailed review of clinical outcomes of radical treatment stratified by tumour stage, grade and pre-operative PSA levels would have been a welcome addition.

In conclusion, for the reader wanting a book which covered the surgical aspects of radical treatment for prostate cancer, the book is good value. There were the omissions that I have alluded to above, but I did feel that the operative sections, the diagrams and the video clips were a real strength. Coupled with the sections on pathology, staging and imaging I think the book is an attractive buy, and occupies a vacant niche in the market.

Professor D. Neal University of Cambridge, U.K.

Female Pelvic Medicine and Reconstructive Pelvic Surgery 
H.P. Drutz, S. Herschorn, and N.E. Diamant (Eds.) 
Springer-Verlag London 2003 
ISBN 1852334797 £120.00

This is the second book on the subject, which I have read in the last six months and reviewed. It is pleasing to see that the whole of the female pelvic floor is being incorporated together now, that is the urology, the gynaecology and the anorectal problems.

In this book the editors are all Canadian, therefore, the contributors are either mostly Canadian and some are Americans. This, in fact, gives us an excellent list of contributors very knowledgeable in their field. There is a good summary of the past and present situation and the future trends in female reconstruction with the urogynae cological pelvic reconstructive surgery specialising in this area. The landmarks of the last century where the development of urogynaecological operative procedures including the Martias graft, Marshall Marchetti Kranz, Burch colposuspension, and the development of urodynamics. The future lies in improvements of imaging, the understanding of pelvic floor anatomy and physiology and specific surgery for pelvic floor defects.

The book gives a good synopsis of anatomy and physiology. There is a chapter on congenital abnormalities and intersex. The investigative chapters included in this book videourodynamics but the traces for both this chapter and the previous chapter on cystometrograms were a bit difficult to interpret, although the instructions were good.There are also chapters on anal physiology, but the authors don’t describe how useful this was or how many patients were undertaking the tests currently.

There is excellent coverage of medical management of stress incontinence and detrusor overactivity with an almost up-to-date resumé of the drugs available at present. It is difficult for text books to be entirely up to date, but the new alpha sympathetico-mimetic drugs are mentioned, these hopefully will be useful in mild to moderate stress incontinence. The drug management of overactive bladders has improved also, with the development of drugs with fewer side effects, but the treatment of this disorder is often worse than the condition itself.

The surgical chapters are well dealt with. There are good diagrams for all the surgical procedures especially the chapter on urethral and vesico-vaginal fistulae. It is nice to see a book which combines all the surgical problems of the pelvis together. This is a well-worthwhile book to have in any hospital library or appropriate department and I would recommend it.

Ms C. Evans Glan Clwyd Hospital Wales, U.K.

The Regius Chair of Military Surgery in the University of Edinburgh, 1806-55 
Mathew H Kaufman 
ISBN 9042012382 £24.00 paperback £51.90 hardback

For almost every decade of the eighteenth and nineteenth centuries Britain could be considered at war somewhere in the world. Its armed forces were being sent to fight with medical support which was unprepared for the unhygienic conditions to which they were exposed and surgically was often less than competent to deal with the casualties inflicted upon them.

To the Edinburgh Medical School came many students who, under the current system of medical education and advancement, were free to take ‘time out’ in the armed forces with their course uncompleted - and did so because of their need for the financial support of an army pay or because they sought additional experience in the services before the completion of their degree.

The hospitals of the city of Edinburgh had a fair proportion of military patients, institutions like the Royal Infirmary derived a part of their income from housing them and their teaching material was incidentally augmented. It was against this background that a debate began about the need for the improvement of the surgical care of military patients. This included a more precise definition of the principles behind military surgery and how it should be taught.

John Bell was among the first to promulgate the need for one great School of Military Surgery; and so Edinburgh became the focal point of what essentially was a short-lived experiment to improve Military Surgery. This is the background outlined by Professor Mathew H. Kaufman, Professor of Anatomy in the University of Edinburgh.

In the opening chapters of his book, The Regius Chair of Military Surgery in the University of Edinburgh, 1806-55 he describes how the chair was created, its rise and fall during the tenure of its two holders and why it was eventually ‘killed off’ after a relatively short life of 49 when the Government withdrew its funding.

The Chair had the great merit of introducing students to military surgery and prepared them for it. Thomson’s course was attended widely and was much valued by the Army, Navy and East India Company personnel. Kaufman demonstrates that is was surgically comprehensive for the trauma of the times. Thomson had come, with many vicissitudes, from the College’s extra-mural Chair of Surgery and had beaten off perhaps the more deserving Bell to aquire the important position of surgeon to the Royal Infirmary. But in the fullness of time he was to move to the Regius Chair of Surgery.

He was succeeded by Sir George Ballingall who should have been more suited to being its occupant.

He had been the amanuensis of the great Edinburgh extra-mural teacher of Anatomy, Barclay, and had a more extensive military experience than his predecessor. But one suspects that he was not a popular figure. He developed the course and extended it in the much needed direction of sanitation and hygiene, neglect of which was contributing greatly to the cost of war. There were, however, critical reports of his lectures and books in the Lancet, which conducted an acrimonious campaign against him. Professor Kaufman leaves one in little doubt that Ballingall’s anonymous critic (Scotus) was none other than James Syme. When Ballingall died suddenly, he took prompt action to ensure that the Chair of Military Surgery came to an end, the consequences of which may have been to set back the development of military surgery until the advancement of the Royal Army Medical Corp in 1898.

Appendices to the book deal with the contemporary Edinburgh M.D. degree, a submission made on Medical Education and Military Surgery to Visiting Royal Commissioners, Ballingall’s museum collection of military surgery, the attendance figures at his classes and his concern about his personal finances. Each chapter is very fully annotated, often with interesting digressions and the bibliography is extensive.

Professor Kaufman portrays, in a well-documented and scholarly text, his surgical ‘dramatis personae’ and their times, when politics, lobbying and animosities, as well as merit, determined the entitlement to Chairs. It is not history as light reading, but will absorb the interest of those who are looking for the real stuff!

Professor A. Smith Edinburgh, U.K.