Book Reviews
David Wheatley has edited an excellent compilation of chapters, encompassing the many aspects of coronary artery surgery. The text is fluid and most understandable, and each chapter is followed by a few choice references. So much has transpired since the first edition in 1986, that a second treatment was mandatory. Each topic has the benefit of a world class author, and the illustrations are of the highest quality.
The interventional cardiologists have been moving their field in competition with surgery. First, there was coronary angioplasty; next came various atherectomy devices and pressure to find some use for lasers. Stents followed, and now we have irradiating stents and drug-eluting stents. The interventional cardiology community continues to take advantage of the fact that no one wants an operation. This book, however, introduces minimal surgical approaches to offset the argument. In the final analysis, whenever that will be, very few patients coming to direct coronary artery surgery will have escaped the cardiologist’s table. So far, perhaps the best thing about the use of stents in coronary artery disease is to make it relatively easy for the surgeon to identify the appropriate artery.
This book covers the complete field of coronary artery disease and treatment. It should find a place in the library of cardiologists and cardiac surgeons alike.
Professor N.E. Shumway
Stanford University
California, USA
History of the Treatment of Spinal Injuries
John Russell Silver
ISBN 0306480328
£76.00
In a two volume report to Congress following the First World War, Harvey Cushing devoted only two small paragraphs to spinal injuries and concluded ‘.....they did badly throughout, as was anticipated’. In spite of that sad comment the knowledge gained in that war was to be the basis for care of such injuries in the subsequent conflict.
In contrast, Dr Silver has provided a well balance review of this topic starting with a historical survey and then continuing with chapters based on activities and people by geographical or national borders. This presentation derives from an MD thesis and, as might be expected from the author who has made a significant personal contribution to the subject, the reader is given a review in depth and detail including a splendid bibliography. This makes the book an invaluable resource for the medical historian and an essential reference volume for medical and political libraries.
Although Guttman deserves world fame for his advocacy, Dr Silver correctly gives credit to Donald Monro who in Boston developed the first unit for the treatment of spinal injuries and who pioneered modern holistic care with all its physical and socio-economic benefits.
The author almost strays from his subject in the chapter on the Germanspeaking world but may be forgiven since Nazi ideology destroyed the pre-eminence of German neurology, which existed prior to 1918 and the lessons learned from the First World War were lost in a society that did not favour rehabilitation. Anti-semitism, however, did result in a significant shift of intellect and knowledge to the West from which we continue to benefit.
Sadly, but for different reasons, in the United Kingdom the subject also was neglected and the lessons had to be relearned in the specialist units opened after 1940. Guttman did not arrive at Stoke Mandeville until 1944, towards the end of World War Two, and then effectively revolutionised care of the spinal injured in the United Kingdom.
The advantages of early admission to a system of comprehensive care, with the avoidance of complications associated with paralysis and loss of sensation has been established now for half a century but yet, even in England today, such facilities still are not available to a large proportion of patients. This is almost the same situation as in 1945 when half of spinal injury patients never reached a spinal facility. The creation of the unit at Stoke Mandeville, followed four years of administrative wrangles about the release of orthopaedic beds. History does repeat itself!
This book is a valuable addition to the literature, not only for the specialty of spinal injury, but for the wider account of how personalities and cataclysmic events, especially wars, can influence the creation and development of a service. As with the story of secondary suture the requirement to relearn the lessons of history is a demonstrable and universal medical weakness. This book deserves a wide readership.
Mr P. Edmond
Pickering, North Yorkshire, UK
Minimally Invasive Cardiac Surgery
Second Edition, Edited by Daniel J
Goldstein and Mehmet C Oz
ISBN 1588291707
Over 70 contributors from around the world, with recognised expertise in minimally invasive cardiac surgery, make this volume a comprehensive
and authoritative source of information about this expanding aspect of cardiac surgery. Minimally invasive cardiac surgery most commonly implies techniques that dispense with the traditional extracorporeal pump, oxygenator and tubing circuit. It also encompasses limitation of injury of access to the heart by using small incisions, often with the aid of video assistance or robotic manipulators.
Though notable historical precedents are described in this book, the rise in minimally invasive cardiac surgical practice is largely a feature of the past decade, facilitated by improved devices and perioperative management, spurred on by the hope of keeping ahead of competing non-surgical, catheter-based interventions. The pathophysiology of cardiopulmonary bypass, and the mechanisms and consequences of endothelial injury are described - highly relevant to minimally invasive cardiac surgical practice.
The largest section of the book describes the techniques of coronary surgery with the beating heart maintaining the circulation, using a variety of stabilising devices. The techniques, problems and pitfalls are well covered. Several contributors present evidence that beating heart coronary surgery has greater relative benefit for the elderly and those with serious co-morbidity than conventional cardiopulmonary bypass assisted coronary surgery.
Minimally invasive approaches for valvular heart surgery are less widely practised, and the need for expensive robotic equipment is part of the explanation for this. The contributors to this section highlight the pitfalls of being dependant on multiple devices and manoeuvres to achieve minimal access valve surgery.
The book also gives a good overview of the outcome of minimally invasive cardiac surgery in terms of quality of life and economic impact. It does not entirely explain the differing current practice of coronary surgery where beating-heart revascularisation surgery varies from having very little, to an almost exclusive role for different surgeons. The 20 year experience of coronary surgery of the Brazilian contributors, which has culminated in about 50% of their coronary practice being “off-pump” is probably a reasonable figure for rational application of this technique.
A further benefit of minimal access cardiac surgery is the influence it has on conventional techniques. Many techniques, to mitigate the adverse effects of cardiopulmonary bypass, athero-embolism, sternotomy and wide surgical exposure, have application to conventional surgery.
The book lacks truly objective evaluation of the role of minimally invasive techniques. Significant randomised trials are in their infancy, and the enthusiasts will be most likely to get best results from the technique. Further outcome studies will be necessary to fully evaluate the role of this surgery. Nevertheless, the authors have produced an excellent review of the state of the art in this field and the book can be well recommended to all practising cardiac surgeons.
Professor D. Wheatly
University of Glasgow,
Glasgow, UK
Laparoscopic
Hernia Surgery, an
Operative Guide
Edited by Karl A
Leblanc.
Arnold Publishers
2003
ISBN 034080940X
Price £125.00 (HB)
Hernia surgery has probably seen more advances in the past decade than took place in the previous century. Yet while minimally invasive surgery is established as mainstream treatment for many procedures, hernia repair is not among them, and Dr Leblanc fully acknowledges this in his foreword. The book, as the name suggests, is an operative guide to all aspects to laparoscopic hernia repair and includes accounts of groin hernia, ventral hernia and diaphragmatic hernia repair, but also the laparoscopic treatment of gastro oesophageal reflux. There are chapters on laparoscopic treatment of paediatric hernias and the book ends with a short chapter on socio-economic issues.
The book has much to commend it. The quality of the illustrations, both photographs and line drawings, is superb. The chapters are short, sub-headings are used to advantage, and each chapter is well referenced. Each section begins with a very balanced account of the history of the procedure.
Most of the authors are from the United States and inevitably the style of the book reflects this, which at times is frustrating for non-American readers. Descriptions and trade names of materials for example may be familiar to American readers but not to those outside the United States where some of the materials described may not be available. I wasn’t sure what the chapter entitled “Laparoscopic Repair in the Emergent Setting” was about. My dictionary described emergent as ”emerging; coming into being in the course of evolution”. It was about ventral hernias and the second sentence advised us that “while these hernias may incarcerate, it is usually over a long period of time and they become what should be called chronically incarcerated”. I still wasn’t much the wiser but reading on it became apparent that the chapter was about the emergency treatment of such hernias.
The final chapter, whose authors include Andrew Kingsnorth, concluded that laparoscopic repair of inguinal hernias is likely to remain limited, but that the clinical and economic benefits are clearer with the laparoscopic repair of incisional and ventral hernias. At 125 pounds, the book seems more likely to find a place as a departmental reference book for practising laparoscopic surgeons wishing to revise, develop or improve their techniques of laparoscopic hernia repair.
Mr I.M.C. Macintyre
Vice President, RCSEd
Cultured Human Keratinocytes and Tissue
Engineered Skin Substitutes
R.E. Horch, A.M. Munster and B.M. Achauer
Thieme
ISBN 3131301619
These articles deal with the development and delivering modalities for cultured human keratinocytes and describe basic research as well as experiences of many distinguished clinicians. A number of problems still exist including the high cost of production and delivery which probably at present means considerable limitation in widespread usage clinically in the real economic world, especially the UK. Durability and long term cosmetic appearances seem still to be an unresolved problem and it is clear that the better results require considerable preparation, meticulous attention to details and are expensive. We may not yet be at the stage to say that the complete user friendly manufactured skin substitute exists. A combination of meshed autograft and autologous cultured epithelial keratinocytes used in a French study in children seems to give excellent results but even the authors acknowledge that it is difficult to perform randomised studies to prove efficacy. A comparative study (Shriners, Galveston) suggests that in severely burned children patients treatment with cultured epidermal autografts (CEA) had a significantly longer hospital stay than those conventionally treated with meshed autografts. A better quality of scars resulted from the former method. It is acknowledged that balancing possible advantages of CEA with disadvantages means that usage should be restricted to "defined situation" and "wound areas".
The readers of this excellent book have the opportunity, therefore, of obtaining an up-to-date balanced review of the current situation. While a definitive solution has not yet been arrived at, it is obvious that further research and discussion will be generated. I thoroughly recommend it for both the research oriented and those involved in the clinical management of severe skin loss surgery.
J.C. McGregor
Regional Plastic Surgery and Burns Unit
St John's Hospital, Livingston, West Lothian, UK