Book Reviews
It was a pleasure to review Pathology for Surgeons in Training: An A-Z revision text. This book by Professor Gardner and Mr Tweedle is now in its third edition, the first edition having been published 17 years ago. Perhaps the change in title from Pathology for the Primary FRCS, along with the inclusion of Internet based resources, highlights the evolution in surgical education. The book is now two and a half times more expensive than when I bought the original for my primary, but it has increased in size, number of pages and content. In fact, the title is a misnomer as it is not just pathology that this book covers but also immunology, pathological biochemistry, microbiology, virology, haematology and clinical genetics.
I am probably biased having used this book successfully, others may not like the format. It is not a read from cover to cover book, but a dip in and dip out text, perhaps even ideal for a PDA format.
The content and depth of cover have been well thought out, no doubt, as the first edition states, from long experience as Fellowship examiners. However, the change in title is more than window dressing, training and development are lifelong processes and reading this edition, rekindled some unpleasant and long forgotten memories of pre-clinical biochemistry!
Of the new or enhanced material the diversity is huge, AIDS, CJD, telepathology, hospital acquired infections and oxygen, excess or deficiency. I particularly enjoyed the brief biographies of people like Burkitt, Hodgkin and Kaposi, though I think Fleming was an Ayrshire man, born in Darvel.
Of course when looked at critically, in your own area of interest, eyebrows may be raised. For instance, I would take issue with the five-year survival from cancer of the tongue being “no more than 25%”.
This, and I am sure other minor quibbles, in specialist areas should not detract form a book which, if not on every official MRCS reading list, should be, and one in which both something of relevance and interest. Twelve years after buying the 1st edition I would have no hesitation in recommending this book, to medical undergraduates, trainee surgeons preparing for both the MRCS and Intercollegiate FRCS and even those beyond that stage in life.
R. Currie
Crosshouse Hospital
Kilmarnock, UK
Venous
Catheters. A
practical manual
P.C. Pieters, J., Tisnado and M.A Mauro
Thieme 2003
ISBN 3131248211 £46.00
The authors of this book are radiologists from Virginia and NorthCarolina. They have produced a high quality book which is clearly written and beautifully illustrated with line drawings, radiographs and photographs. It runs to 316 pages and has a comprehensive index.
This book is essentially a practical manual on how to insert and care for central venous catheters. In the Preface the authors state “This book will, hopefully, provide most of the information needed for the reader to become an expert”. This is absolutely correct in that even the detail of skin preparation, catheter selection, practical procedure instructions and potential pitfalls is comprehensive.
I can see this book sitting on the reference shelves of radiology departments, parenteral nutrition units and some vascular surgical offices. The book is not appropriate for most surgeons but would be a useful reference in a hospital library.
T.R. Magee
London Road
Reading, UK
Cataract Surgery
Edited by A. Coombes and
D. Gartry
BMJ
Books 2003
ISBN 0727912011 £125.00
This book is one of a series of monographs on Fundamentals of Clinical Ophthalmology produced by BMJ Books.
It is aimed at ophthalmic surgeons in training and general ophthalmologists wishing to update their specialist knowledge.
Most of the 14 contributing authors are based in Southern England, but Europe and America are also represented.
The book’s special strength lies in the clear way that the basics of cataract surgery (which are often poorly understood by trainees) are described.
It starts with chapters on teaching and learning phaco-emulsification, incision construction and planning for phaco-emulsification and capsulorhexis, and these are all very clear and well written.
The chapter on capsulorhexis would benefit for a drawing of the insertion pattern of the anterior zonules.
Throughout the whole volume, the illustrations, particularly the line drawings, are excellent.
The chapters on phacoemulsification equipment, technique, applied phocodynamics and biometry and lens implant power calculations are particularly good.
Cataract surgery in complex eyes and post-operative complications are well covered, but the chapter on anaesthesia is disappointingly short and really needs more detail about the practical details of the specific techniques currently in use.
Similarly, the chapter on nonphacoemulsification cataract surgery is too brief to be of much value, and would benefit from some discussion of Blumenthal’s small incision surgery techniques, including the benefits of the anterior chamber maintainer.
The Chapter on cataract surgery in the third world is rather vaguely written and really adds nothing to what is otherwise a well-written and useful book.
I would have no hesitation in recommending this book to all grades of ophthalmic trainees. However, established cataract surgeons would probably require more detail than is provided in this volume.
A. Adams
Edinburgh, UK
Fundamentals
of Clinical
Ophthalmology
Strabismus
F. Billson
BMJ Books 2003
ISBN 0727915622
This book is one of a series of monographs covering the main speciality areas of Ophthalmology. Strabismus is traditionally a difficult clinical area to break down into a simple reasoned discussion. The evidence base remains relatively weak and diverging opinions on management strategies persist in a number of areas.
The book is divided into three main sections: the neurophysiological substrate for binocular vision and strabismus, strabismus in the decades of life, and management of strabismus. The concept of the book is sound, an attempt has been made to give a straightforward account of current principles and practice related to strabismus. Unfortunately, the quality of execution is patchy. While the personal views of a single author expert provide some very lucid explanations, and many clinical pearls, the finished result is quirky at times. There is a number of irritating errors in the text, and referencing is not always accurate. There are some areas of duplication, and some statements are excessively concise for the inexperienced reader.
Section 1 on the neuropsychological foundations of strabismus management has some very clear explanations. The chapter title “A simple Reflex Model of Normal Binocular Vision” is particularly helpful. However, there is some duplication within the three chapters which make up this section, a rather more basic and simple approach, with clear definitions, would have been more appropriate.
Section 2 has two chapters, one which covers childhood strabismus and the other adult strabismus. The approach is straightforward, although there is once again some duplication with areas covered in Section 1. The concepts presented for the management of congenital esotropia are now somewhat out of date; they have been superseded by recent research findings.
Section 3 describes the management of strabismus. Chapter 5, titled “Assessment of Strabismus”, is particularly helpful in providing useful tips on clinical examination techniques. The final chapter titled “Therapy of Strabismus”, once again contains some duplication from previous chapters. In some areas, the personalised view approach results in the failure to discuss other common approaches to management. The section of surgical technique is disappointingly brief. Trainee ophthalmologists want to learn how to perform strabismus operations and there is surprisingly little information about this in the book.
Experienced strabismus surgeons will find the book an interesting read, as it contains accumulated clinical pearls of an experienced strabismus surgeon. However, trainee ophthalmologists may struggle at times as some descriptions are excessively concise.
Despite these criticisms, I think this will prove to be a popular book. The concept is good and fills a gap in the market. Provided the rough edges are dealt with in the second edition, I think it is likely that this will become a well established text.
B.W. Fleck
Princess Alexandra Eye Pavillion
Edinburgh, UK
An Internist’s
Illustrated
Guide to
Gastrointestinal
Surgery
Edited by G.Y.
Wu, K. Aziz, G.F.Whalen
Humana
Press 2003
ISBN
1588290239
This textbook is written for primary care physicians, general internists and gastroenterologists. The authors also regard the text as suitable for medical students, residents, nurses, nurse practitioners etc. The book has 27 chapters with 10 sections, each dealing with a major aspect of the gastrointestinal tract.
The first section on the oesophagus covers both benign and malignant conditions of this organ and includes endoscopic and laparoscopic management of these conditions. Illustrations on laparoscopic surgery are almost non-existent and there are numerous spelling and reference errors, particularly in the first chapter. The section on gastric surgery is somewhat better but again lacks good illustrations of laparoscopic and endoscopic techniques in this area. The third section deals with small bowel surgery and includes urinary diversion surgery. Here the authors illustrate a stapled rather than a hand-sewn anostomosis of the small bowel as they claim a handsewn anastomosis may comprise the bowel lumen. The fourth section deals with colorectal surgery and many of the illustrations in this section are poor and inaccurate.
The final sections deal with hepatobiliary and pancreatic surgery and for some strange reason the authors place two chapters on aortic aneurysm surgery between this and the management of oesphageal varices and a chapter on hernias between the latter and peritoneal shunts. Notwithstanding this, these are probably the best written and illustrated chapters in the book apart form those on hernia and cholecystectomy, which are poor.
Each chapter deals with the hospital charges for the procedures and has a bullet point summary of the chapter. The hospital charges are interesting, particularly as they relates to some of the interventional radiology costs. This book, I have no doubt, is written for an American audience and would not be of good value to our gastroenterologists.
P.J. O’Dwyer
University of Glasgow
UK
Middle Ear
and Mastoid
Microsurgery
M. Sanna, H.
Sunrose, F.
Mancini, A.
Russo and A.Taibah
Thieme
Publishing
2003
ISBN 3131320915
Middle ear and mastoid microsurgery is an excellent otological surgical textbook. With 433 pages and 1240 illustrations its precise text is generously augmented with both schematic diagrams and operative photographs.
The topics covered are comprehensive for all aspects of middle ear surgery. In particular, there are some excellent chapters on temporal bone anatomy, the operativeroom set-up, aspects of anaesthesia, and a section on general technical considerations. All of these chapters are well illustrated and would be of particular benefit to the more junior surgeon at the beginning of his/her training.
The chapters that deal with external canal surgery, ossiculoplasty, stapes surgery, and both canal wall up and down tympanoplasty are well written. Each chapter has a clear straightforward approach to its topic. Each operation is explained in a clear step by step fashion, while, at the same time the need for an individual assessment of each operation is well emphasised. In addition to the description of operations, most chapters have some very helpful additional sections including: Hints and Pitfalls, Rules and Hints, Problems and Evaluations, and The Decision Making Process. However, the chapters on mastoid obliteration, cochlear implantation, and the management of iatrogenic injuries provide a brief overview rather than a comprehensive review of the particular topics.
This text is written with a very uncomplicated approach to middle ear surgery. Its stated objectives are to teach the basic concepts well and give the reader some introduction to the more complex and controversial issues. To this end the book is very successful. Its particular, strength is the excellent combination of schematic illustrations and extensive operative photographs helping to clearly explain both the anatomy and individual steps of the more common middle ear procedures. Any book this size is clearly not meant to be an exhaustive reference text. However, it would serve as a very useful addition to the library of any otologist at the beginning or middle of his/her training.
C. Timon and M. Rafferty
St. James’s Hospital
Dublin, Ireland.
The Memoirs of
Allen Oldfather
Whipple. The
man behind
the Whipple
operation
Edited
by S. Johna and
M. Schein
tfm Publishing Ltd
ISBN 1903378141
£25.00
These memoirs are an edited account of the life of Dr Whipple, written by him during the late 1950s and early 1960s, when he was in his seventies, mainly for the members of his family. The editors trimmed the original manuscript and divided it into chronological chapters. They have not sought to provide comment nor attempt to place Dr Whipple’s significant contributions in an historical context. However, the valuable footnotes give us some idea of the contemporary scene in which he grew up and became one of America’s most distinguished surgeons.
The surgical reader is inevitably interested in the contributions for which Dr Whipple is eponymously famous - the Whipple’s operation for carcinoma of the Ampulla of Vater and the Whipple’s triad of symptoms that suggest insulinoma of the pancreas. Yet the only description of these is contained in two pages of a brief chapter halfway through the book. Dr Whipple may have done this out of a sense of modesty. This is very disappointing to the surgical historian, for there are several stories to be told concerning these contributions (indeed his son-in-law’s Foreword hints to this) but it does indicate that the book is, at best, directed to the general reader who will find it an interesting account of a surgeon’s life in late 19th and early-tomid-20th century in America.
A child of missionaries, whose ancestors emigrated from Bocking in Essex, he spent much of his early life in Persia (Iran). He had to work his way through college (Princeton) for, in his freshman year, his father died of typhoid fever in Persia. Thereafter, he was a medical student at the College of Physicians and Surgeons in New York. His descriptions of his internship and residency training take us back to an era of great men and great developments in American surgery. As director of the surgical service at the Prebyterian and professor of surgery at Columbia from 1921 to his retirement in 1945, he developed a surgical training programme that attracted bright young trainees from all over the States and, with them, he set up one of the most important departments of surgery. In retirement he played a key role in the setting up of the Pahlavi University Medical school in Iran.
Whipple obviously liked people whom he assessed with a sharp eye. He travelled extensively and describes vividly the people, surgeons and dignitaries whom he met. Of interest to the British reader is a penetrating and sympathetic picture of war-time Britain, particularly of the immediate post-war period when people were tired and drab after six years of war. There are also amusing anecdotes of his visits to London, Oxford, Edinburgh and Glasgow.
Inevitably, some errors have escaped the editors. The Isle of Skye is on the west, not east, coast of Scotland. ‘Ampulla of Voter’ (page 125) should be ‘Ampulla of Vater’. On page 146, ‘burns’ has been given an unfortunate misspelling.
In the blurb at the back of the book, the editors claim that the book will reveal to the reader what kind of man Whipple was and how he arrived at his achievements. These memoirs give an account of his early life; where, and with whom, he worked; his travels and his hobbies. The book lacks the self-awareness that we expect from an autobiography or the historical interpretation that we look for in a biography. Whipple emerges as a talented and focussed man, but on account of his modesty we do not receive any insight into the strategy and philosophy that were responsible for him becoming one of the leaders of American surgery in the inter-war years. A classmate and lifelong colleague and friend of Whipple was Evarts Graham. Both greatly influenced American surgical training and education in the mid twentieth century, but Graham is better served in the excellent biography by Barber Mueller than Whipple has been in these edited memoirs, which do not do him justice.
Sir Robert Shields
Royal College of Surgeons of Edinburgh
UK
Surgical Techniques for the Spine
T.R. Haher and A.A. Merola
Theime Publishing 2003
ISBN 3131247614
This multi-author atlas of Surgical Techniques for the Spine, is edited by two North American orthopaedic surgeons.
The contributors are essentially from the USA but 20% are from around the world including Switzerland, Japan, Germany and North Korea.
The book is really an atlas supported with text; which lists the indications and contraindications for each technique; outlines the operations; and then gives the pitfalls and complications for the procedure.
There are images of the conditions being discussed, and there are illustrations of how the operation is to be performed, mainly in black and white with a few colour plates.
This book does attempt to be all-inclusive, and indeed there are complex procedures side by side with the more common ones.
There is heavy emphasis on scoliosis surgery with far less detail on lumbar spine surgery. Indeed, there is nothing on nerve root decompression in the lumbar spine, or a description of lateral mass fusion, as so clearly outlined by Wiltse. Nor are there references to newer techniques in the lumbar spine, such as soft fusions of the Dynesys or Wallis type.
Is this book worth owning? I think it is comprehensive in many areas and can easily be dipped into. It seems that for publishing costs, the text has been placed close together and the illustrations are rather “fussy” in most parts.
The book is helpful for trainees assisting at surgery; especially to know what is actually going on, and also to have an idea of the complications of the procedure that can occur.
Hence in my view, there is a place for this book in departmental libraries but I believe the book is relatively expensive for personal purchase.
The authors though are to be congratulated on producing a book that contains a great deal of information on spinal surgery, and I fully agree with Dr DeWald’s forward that
“Spine surgery needs to continue to differentiate itself from general neurosurgery and orthopaedic surgery as its own speciality”.
This book may achieve that goal and I believe this book should be available to trainees and spinal surgeons wishing to learn about, or refresh their approach to, the surgery of the spine.
S.P.F. Hughes
Imperial College London, UK
Laparoscopic
Urologic
Oncology
Edited by J.A.
Cadeddu
Humana Press
2003
ISBN 1588292037
$135.00
Endoscopic surgery has always defined urology. Transurethral resection of the prostate (TURP) is the archetypal minimally invasive operation. Open surgery for stones has almost been consigned to the history books. Yet, urologists have been slow to espouse laparoscopic surgery, perhaps just because their endoscopic prowess left them with only complex open abdominal procedures which were hardly good starting points for learning laparoscopy. Our general surgical colleagues, with laparoscopic cholecystectomy as their jumping off point, were more favourably placed, and are now doing laparoscopic procedures, comparable complexity to major urological operations.
So urologists are now able to catch up. This book provides us with a comprehensible “state of the art” review from the USA, and emphasises that in Britain, with some notable exceptions, we may be lagging behind our transatlantic colleagues. It is not surprising that nephrectomy, which does not involve complicated reconstruction, is presently the main territory for the laparoscopic urological oncologist. Thus, in a book of some 320 pages, only 50 are devoted to laparoscopic radical prostatectomy, cystectomy and urinary diversion. Will laparoscopic radical prostatectomy for cancer ever become the gold standard, like TURP for benign disease?
What is the practical value of a volume like this? All forms of surgery, but particularly laparoscopic surgery, cannot be learned from a book. How valuable are the detailed operative descriptions in the chapters on renal surgery, when on the other hand, the much more complicated procedure of laparoscopic radical cystectomy, is dealt with in a couple of pages?
More interesting, perhaps, than the operative details are the background discussions. There is a chapter on the management of complex renal cysts, which includes a substantial review of the current classification of, and thinking on the significance of renal cystic disease. However, the reader may wonder whether the statement “The majority of renal cysts are benign, simple cysts and require no surgical intervention when asymptomatic”, is confirmed by what follows - is this a case of an intervention looking for an indication? In the management of testicular cancer the main role for laparoscopic surgery currently is as a staging operation in patients with clinical Stage 1 disease, a procedure not practiced in the United Kingdom. If those who do staging lymphadenectomy suggest a limited role in patients with established metastasis, how much more is this the case where the simpler operation is not available to provide the experience?
Regarding the book itself, there is evidence of inadequate proof reading, and the reviewer felt that some of the illustrations did not necessarily demonstrate what they were supposed to portray. It is very much an American book, and the idiom in places may jar with the UK speaker of English. Principally, however, this book is a challenge to British urologists. Transurethral resection of the prostrate was developed in the United States and previous generations of British urologists used to cross the Atlantic to learn the technique. It is hoped the British endourologists will ensure that history does not repeat itself.
D. Kirk
University of Glasgow, UK
Preference will be given to candidates whose surgical research has been carried out wholly or in part in Ireland. The subject chosen should be of clinical interest embodying original research.
Further particulars may be obtained from:
Ms G. Conroy
Office of the Director of Surgical Affairs
Royal College of Surgeons in Ireland
123 St Stephen’s Green
Dublin 2.
Telephone: 00 353 1 4022187
Email: gconroy@rcsi.ac.uk
http://www.rcsi.ie
Intensive revision courses suitable for candidates preparing for Parts A and B MFDS/MFD will be held on Saturday
17th and Sunday 18th July 2004 at The Royal College of Surgeons of Edinburgh. The Part B course is also suitable
for candidates preparing for the International Qualifying Examination.
Each course will run for two full days simultaneously at a cost of £230.00, inclusive of coffee, lunch, and tea.
For further information and application form please contact:
Miss Donna Watters
Dental Secretary
The Royal College of Surgeons of Edinburgh
10 Hill Square
Edinburgh EH8 9DW
Tel: 0131 527 1608
Fax: 0131 527 1669
Email: dental@rcsed.ac.uk
CME/CPE This activity is recognised for 14 units.
Further information may be obtained from the Secretary, Royal College of Surgeons of Edinburgh, 10 Hill Square, Edinburgh EH8 9DW.
Telephone +44 (0) 131 527 1608 Fax +44 (0) 131 527 1669 Email dental@rcsed.ac.uk