Book Reviews

Diseases of the Lymphatics
Sir Norman Browse, Kevin G. Burnand and Peter Mortimer
Arnold Publishers 2003
ISBN 0340762039

This excellent text is in my opinion the current ‘state of the art’ textbook for lymphatic disease. This work comes from a centre of excellence for the management of lymphatic disease in these islands. In fact, the Vascular Unit at St. Thomas’ Hospital is one of the few worldwide centres of excellence with regard to lymphatic disease.

This text is indeed ‘everything to all men’. The text is divided into two parts. Part I discusses the physiology, pathology and investigation of the lymphatic system and the subsequent principles underlying medical and surgical treatment and is an excellent text for the trainee. The second part of the book, discusses the management of specific clinical conditions and is in my opinion a vital text for the personal library of every Consultant encountering diseases of the lymphatics. This textbook is a very readable with a mere 324 pages, which are extensively illustrated. The illustrations are tremendously useful, particularly for those of us who only see occasional cases of lymphatic disease. Undoubtedly, after reading this text every reader will feel significantly more confident in their knowledge and understanding of lymphatic disease.

Every chapter contains excellent illustrations and enlightening text allowing diseases of the lymphatics to become an engaging and stimulating aspect of the management of vascular disease. Perhaps one of the most important messages from this text relates to the aetiology and classification of lymphoedema. We are all aware of the variety of different classification systems, which indicates just how much uncertainty remains about the exact pathophysiology of the spectrum of lymphoedema that we see. The point is made in the text that the classification system is likely to change in the light of steadily increasing knowledge, particularly in the field of genetics. The stature of this text is such that there are no significant deficiencies that I could find.

The authors have undoubtedly achieved their aim of producing a comprehensive authoritative text on what remains a complex disease process. This books essential reading and in my opinion currently the text on diseases of the lymphatics.

KS Cross
Senior Lecturer in Surgery,
Royal College of Surgeons in Ireland

Maggot Therapy, A Handbook of Maggot-Assisted Wound Healing
Win Fleishchmann, Martin Grassberger and Ronald Sherman
Thieme £29.00 £145.00 HB
ISBN 313136811X

This book is an authorised and revised translation of the German edition published and copyrighted 2002 by TRIAS Overflag, Stuttgart, Germany. The title of the German edition is Erfolgreiche Wundheilung durch Maden-Therapie, Biochirugrgie: Die weider entdeckte Behandlungsmethode bei diabetischem Fuß und anderen schlecht heilenden Wunden. For centuries fly larvae have been used successfully to treat wounds. But with the modernisation of medicine and introduction of antibiotic therapy world wide, maggot therapy became obsolete and rarely employed. However, micro-organisms are becoming increasingly resistant to modern antibiotics, and maggot therapy is experiencing a renaissance. Therefore, there is need for a comprehensive book on this topic.

In chapter two, the book gives a broad background on the origin of the maggot with detailed external morphology, internal anatomy and the life cycle of some classes. The history of using maggots is well documented, in chapter three encompassing the era of the Old Testament until its revival in the 1980s. This chapter includes the mechanisms and mode of action of maggot in wound debridement, antimicrobial action and their role in stimulating wound healing. I strongly support the authors’ statement “ In patients with chronic wounds, the cause of the underlying disease must always be treated”. In chapter four, in addition to detailed descriptions of the clinical problems for which maggots can be utilised and forms of maggot preparations, it also reports on many case studies. The authors have not forgotten the adverse effects of maggot therapy. Moreover, in chapter 5 the book provides the answer to many questions, that are frequently asked on this therapy.

I believe this book has been written for everyone interested or involved in the healing process. The criticism I have of this book is the lack of a background scientific knowledge on the healing processes.

I agree with the authors and the publishers in advising every user of maggot’s therapy in respect to any dosage instructions or forms of applications stated in the book without examining carefully the manufacturers’ instructions and consulting clinicians or specialists.

The book is clearly written and provides a comprehensive review on the growing interest in maggot therapy and its use in biodebridement, to aid in the care and healing of wounds which have not responded to the conventional therapies.

M. El-Sheemy
Lincoln County Hospital & University of Lincoln,
Lincoln, UK

A Dictionary of Bookplates of Irish Medical Doctors with short biographies
De Búrca 2003 €36.00
ISBN 0946130396

A bookplate belonging to Sir Walter Scott apparently read: “Please return this book; I find that though many of my friends are poor mathematicians, they are nearly all good bookkeepers.” A bookplate, or ex-libris refers to a label or a stamp usually placed on the inside front cover of a book. Its primary purpose is to indicate ownership as a safeguard against loss or, more often, book-borrowers’ forgetfulness. Bookplates originated shortly after the invention of printing in Germany in the 15th century. The first bookplate was published around 1450, but the first dated bookplate was 1516 and was designed by Albrecht D¸rer. However, like medical eponyms that celebrate the doctor who discovered some illness and not the patient who suffered from it, bookplates record the person for whom the plate was made and not the artist who created it.

The use of bookplates spread from Germany to France, to England, the Low Countries and North America. As with stamp and coin collecting, bookplate collecting came into vogue in the latter half of the 19th century. The Ex-libris Society was founded in England in 1891 and interest in collecting peaked at the turn of the 20th century. Today, bookplates are of interest to a small number of bookowners, historians and collectors. 

A Dictionary of Bookplates of Irish Medical Doctors is a very narrowly focused work and its writing was obviously a labour of love for the author, Dr Edward Martin, a retired Dublin neurologist. He attempted to locate and illustrate as far as possible the bookplates of Irish doctors through the centuries, starting with Sir Thomas Molyneaux (1661-1733), who may have possessed the earliest bookplate of any kind in Ireland. He supplies a short biography of each bookplate owner, which makes the book more interesting.

Most of the bookplates are heraldic in nature and of limited artistic interest. The pictorial-allegorical bookplates are much more attractive such as the large reproduction of Geoffrey Bewley’s bookplate of grasses and a poppy drawn by a Dublin medical student, Earle Hackett, presented at the front of the book. I was somewhat surprised to find Lord Moynihan of Leeds listed as an Irish medical doctor but his motto (not translated) is in Irish script (griandacht tareis néill = sunshine after cloud) and his grandfather came from Ireland. Surprisingly, in a dictionary of bookplates, some entries have no illustration of the bookplate to which they refer, while others have several different bookplates for the same entry e.g. Ephraim MacDowel Cosgrave (1853-1925) has no less than six different bookplates illustrated.

The book is nicely presented with a good introduction on the topic of bookplates and their collection. It is a scholarly work, of which Dr Martin can be justifiably proud. The book will be of interest to those who like history and books and the often-eccentric Irish doctors whose stories are told therein.

P. Grace
Professor of Surgical Science
University of Limerick, Ireland

Surgical Oncology - An Algorithmic Approach
Theodore J. Saclarides, Keith W. Millikan, Constantine V. Godellas 
Springer Verlag £82.00
ISBN 0387952012

This is a hard backed book of 743 pages and 80 chapters of an algorithmic approach to surgical oncology. This edition is a systemsbased approach with chapters on all organ systems in the body ranging from head and neck cancer, skin cancers, lung cancers, intra-abdominal organ cancers, gynaecological cancers, and sarcoma and bone tumours. In addition, there are chapters on haematological malignancies and a discussion of common oncological emergencies and the nutritional support of the oncological patient.

The editors have succeeded in trying to ensure uniformity in the approach to each chapter. Perhaps this was easier to achieve in that the three editors and the majority of the contributors come from Chicago, with there being only one author from outside North America. As would be expected, therefore, it reflects American practice. The text is clearly written, easy to follow and is well illustrated with many algorithms for each chapter but little in the way of other illustrations or figures. The algorithms do help in that they provide an easy to follow visual pathway of the multi-disciplinary management of the patient with malignancy. They are a starting point for the reader. This should not be considered a comprehensive text because there are many omissions and limitations in this approach and we could debate many of the algorithms. For example, in the sections discussing breast cancer there is nothing regarding the management of lobular carcinoma in situ, very little on the key area of adjuvant treatments (important to the surgical oncologist).

Whilst it gives a broad overview of malignancies in all systems I am not sure who this book is intended for? I do not think that it is suitable for undergraduate students. It may provide a broad overview for the postgraduate trainee. However, I think that the wide variety of systems covered limits its value for the surgical trainee in a specific discipline and there are alternative texts that are specifically written and are of more use. What about the surgical oncological specialist? Unfortunately, in view of the subspecialisation in surgery that has occurred, the information in the text is too general and lacks adequate detail for specialist surgical oncological practice in the UK, as it exists at present.

I would not recommend this book for an individual to buy as a reference in the library it would prove an useful addition.

SD Heys
University of Aberdeen
Aberdeen, UK

Surgical Pathology Dissection - An Illustrated Guide
William H. Westra, Ralph H. Hruban, Timothy H. Pelps and Christina Isacson
Springer Verlag £61.50
ISBN 0387955593

This is a very comprehensive book about the dissection of surgical pathology specimens. There are a large number of contributors and it is divided in to forty five chapters focusing not just on the commonly encountered specimens, but specimens that are rarely seen by the general pathologist; an example of this is in chapter 19, a section on heart, heart valves and vessels, in which there is even an account of the examination of mechanical heart valves and five such types are illustrated. This is an example of the detail in this book.

The first four chapters deal with the general approach to surgical pathology specimens, laboratory techniques, including comments on the various fixatives, tissue collection for molecular genetic analysis (which is increasingly occurring) and the techniques of specimen photography. The other chapters are on the various sub specialities and the layout is similar in each chapter there being a discussion of the clinically important features of the various types of specimens and an indication of the important issues to address in the surgical pathology report. The text is very detailed and in each chapter there are extremely good illustrations drawn by a medical artist. Included in these illustrations are the important areas to sample histologically and I can think of no other book that illustrates these surgical specimens so realistically. These illustrations are accompanied by a list of key points so that the pathologist can rapidly assimilate the techniques required.

The second edition of this book includes updated chapters on the digestive system, heart and breast and also new chapters including transplantation specimens and sentinel lymph nodes, which are included to reflect the emerging changes in clinical practice. My own subspecialty interests are in breast and gynaecological pathology, and the breast chapter is excellent and mention is made of the need for optimal fixation, a problem which all breast pathologists are familiar with.

The chapters on the female genital system are also very comprehensive and up to date and cover both neoplastic and non-neoplastic resections.

The last chapter is interesting as it is titled “Common uncomplicated specimens” and types of specimens included are tonsils and adenoids, hernia sacs, intervertebral disc material and amputations for gangrene. I think that this type of chapter is useful as these specimens are quite common and yet there are few guidelines as to how best to examine these specimens.

This is a very practical book for both the general pathologist and the specialist pathologist. The book finishes with some closing comments regarding the necessity to understand the patients clinical history prior to the dissection of the specimen, the need to approach each dissection in a systematic and orderly fashion, the documentation of important findings, gross discretion and photography, the thorough but selective sampling for histology and the role of ancillary studies including cytogenetics and hormone receptor analysis.

In conclusion, this is by far the best book I have encountered on surgical pathology dissection and I would certainly recommend it for pathology departments and both trainee and more experienced pathologists will find it useful in day to day practice. The book will also be useful for surgeons in training as it will give them an insight in to the detailed examination and care of the specimens which they will often have spent many hours removing.

I.D. Miller
Aberdeen Royal Infirmary
Aberdeen, UK

Surgical Anatomy of the Hand
Hans-Martin Schmidt and Ulrich Lanz
Thieme 2004 £159.00
ISBN 3131252618

I was delighted to have been given the opportunity of reviewing a copy of this book. As the authors have emphasised in their preface, it is essential that hand surgeons possess a thorough knowledge of the normal anatomy of this region, as well as the common anatomical variants, when they are involved in the management or treatment of this critical component of the body. In this volume, the close relationship that has clearly existed between the two authors, one of whom is a Professor of Anatomy while the other is a Professor of Hand Surgery, has been indispensable in producing such a high quality end product. Furthermore, the illustrations prepared by Gerhard Kohnle are of the highest possible standard. This reader would certainly agree with them that, for most purposes diagrams and drawings tend to be of far greater value than photographs of anatomical preparations. While the availability of a single print colour, in addition to black and white may be less flexible than offering multiple colours, it is more than adequate for the principal purpose of this book. This is to describe the normal anatomy and the variations likely to be encountered in the clinical management of the hand both for surgeons and for other health professionals specialising in this area. While extremely impressed with the first english edition of this book, I strongly suspect that it is likely to go into a second or possible other editions. It is for this reason than I believe that it is reasonable to make a few suggestions for the consideration of these authors and those others who have been involved in its production.

As an anatomist, rather than a surgeon, I was extremely impressed with this book. As with all books of this type, it is easy for specialists to criticise those aspects of the text where their own particular knowledge is only briefly covered. The question arises, how much should a professional anatomist know, and how much should they be expected to impart to their students. Clearly, this depends on the level of knowledge required by the latter, whether a medical student, a postgraduate surgeon-intraining, or a specialist hand surgeon. For most purposes no academic teacher of anatomy would be expected to have at their immediate disposal more than a fraction of the information available in this book. As a reference work, however, it is invaluable, principally because it covers in enormous detail the normal anatomy of the hand and most of the variations seen in clinical practice. If the authors have not covered a particular subject in what is considered appropriate detail, then they have generally provided an adequate number of references for the reader who may wish to pursue the topic further than is available in the text. It has to be emphasised that this book contains far more information than most teachers would consider adequate for both undergraduates and surgeons-in-training.

For most purposes the information that a professional anatomist would need to convey on this topic to either undergraduates or surgeons-in-training is more than adequately covered in most simple text-books of anatomy. In most British universities, few if any “anatomists” are these days likely to be appointed to academic posts if they do not have other skills than simply teaching gross anatomy. They are, these days, expected to undertake research or at least to teach other related disciplines, such as clinical embryology. If academic anatomists attempted to teach their students even a relatively small proportion of the information provided in this book, complaints would soon be made because of their perceived over-enthusiasm for their specific discipline. There is simply insufficient time in the curriculum these days to cover the entire body in this degree of detail. Even those who may wish to specialise in hand surgery would be better advised to have a profound overview of the topic obtained from scanning the relevant section of something like Jamieson’s Plates, rather than attempting to read and thoroughly learn all of the material covered in this book.

It is unlikely that many hand surgeons would be required to dip into this book on more than a few occasions during their career. When this arises, I have little doubt that they will gain immensely from the experience. When talking to hand surgeons-in-training, it would be wise to recommend this an invaluable work of reference. When they are presented with injured or diseased or even congenitally deformed hands, they would be wise to try, where at all possible, to attempt to re-establish normality of function, rather than attempt anything more heroic. Indeed, there must be few occasions when it makes much difference what the detailed blood or nerve supply to a particular territory really is, as long as an attempt is made to re-establish some form of blood or nerve supply which is adequate for the needs of the individual concerned. I would certainly feel happy to recommend that this book should be purchased by appropriate libraries, as I strongly suspect that it would be rather too expensive for either individual anatomists or hand surgeons to purchase for their own personal use.

M.H. Kaufman
University of Edinburgh
Edinburgh, UK