Book Reviews

Essential Guide to Acute Care Nicola Cooper and Paul Cramp BMJ Books 2003 £19.95 PB ISBN 0727916483

This is a handy sized paperback of 217 pages including a comprehensive index. It would probably just about fit into the white coat pocket but I doubt that it would be at home here. On the back cover it advertises the book as being written with trainees in medicine, surgery, emergency medicine, anaesthesia and critical care, as well as final year medical students in mind. It also states that it ‘contains everything you really need to know about acute care that you can’t find in a standard textbook and have probably never been taught before.’

This is a bit of a tall order and I would be pretty sure that you could find most things contained within the book in the standard textbooks - albeit not as easily. The facts contained within the book are certainly compacted and it is also comprehensive in its coverage. I think it is quite a dry read although the authors have tried to add interest by including illustrations, wherever possible, and purple boxes of useful facts and tables. There are also mini-tutorials in many of the chapters - in purple. At the end of each chapter there is a selfassessment in the form of brief clinical cases along with the answers - again in purple. The self-assessment case histories are by and large useful illustrations of the points made in each chapter and allow the reader to assess their assimilation and understanding of the subject. I am not so convinced about the mini-tutorials - these are again purple boxes.

In some ways, the contents are a strange mix of facts which I assume is needed to comprehensively encompass the range of patients encountered in acute care. However, I am not sure that a relatively detailed description of ventilators, inotropes, vasoconstrictors and pulmonary artery catheters would be useful to anyone who is not planning to work in intensive care.

Probably the most useful chapter is the first one which details how to identify the at risk patient. This is often the most difficult task and it only requires the presence of a small derangement in several of the body systems to occur simultaneously to render the patient liable to a cardiac arrest. This is often called the backdoor way into intensive care and the patients usually benefit from being more actively managed before the onset of this obvious sign that not all is well. One particular point which is very well made and that is the work in intensive care. It is well emphasised in this book that many patients with respiratory failure and carbon dioxide retention would benefit from receiving higher inspired oxygen tensions. Most practioners erroneously believe that increases in inspired oxygen will result in further increases in carbon dioxide, as a result of the loss of ventilatory response to hypoxia. Doctors often forget that hypoxaemia can also be fatal.

I do not foresee medical students reading this book. I do think that it would be useful for anyone starting a spell of being responsible for patients either in intensive care or high dependency. In which case I would guess that each will have to buy their own copy because I doubt it will survive on the shelves of the average intensive care unit very long.

N Webster Professor, Intensive Care Aberdeen

Recent Advances in Surgery Colin Johnson and Irving Taylor (eds.) The Royal Society of Medicine Press Limited 2004 £35.00 ISBN 1853155713

Any advance is always exciting for Surgeons and a book entitled ‘Recent Advances in Surgery’ particularly so. It was with considerable anticipation that I opened this book. I was surprised to find that there was no introduction written by the Editors indicating the aims of the book and the intended readership. Many of the chapters are a restatement of known facts and there is relatively little new and exciting material. That is not to say that the chapters are not informative but they do not entirely agree with the book’s title. Many of the quoted references relate to established knowledge and relatively few to recent advances in the subjects. The definite exception to this general comment is the chapter on Laparoscopic Colorectal Surgery written by Robin Kennedy and his colleagues: the current status of new techniques and management are clearly described. The chapter on Laparoscopic Abdominal Wall Hernias is good but presents what is now outdated advice from NICE who have now approved laparoscopic repair of inguinal hernias without reservation.

This book is worthwhile for the trainee, as it is informative, but for those truly seeking recent advances it will generally be a disappointment.

Michael Bailey Professor of Surgery The Royal Surrey County Hospital, Guildford

The Evidence for Cardiothoracic Surgery Tom Treasure, Ian Hunt, Bruce Keogh and Domenico Pagano (eds.) tfm Publishing 2004 £40.00 ISBN 1903378206

It has become axiomatic that “evidence-based medicine” is desirable. For the cardiothoracic surgeon, whose actions in the operating room frequently result in immediate and obvious effects there may be a temptation to think that “evidence-based medicine” is for others. Many operative procedures are the result of intuitive, pioneering initiatives where an evidence base did not exist. A potential concern is that unthinking adherence to practising “evidence-based medicine” will inhibit innovation. Indeed, in the first chapter the point is well made that evidence has often followed innovation.

However, studies of the outcome of surgery and related management, provide essential evidence for selection of optimal treatment regime for all the major conditions encountered in cardiothoracic surgery. Surgical intuition cannot substitute for this evidence.

The chapter on screening for lung cancer shows just how wrong “intuition” can be - there can still be no recommendation for routine screening for lung cancer.

Chapters dealing with lung cancer staging and resection are exemplary. The same rigor is applied to assessment of the role of video-assisted lobectomy, demonstrating the need for knowing more than just “how to do it” but also being able to assess the role of a new surgical technique.

Most of the commonly encountered thoracic conditions are dealt with in a thorough fashion, from the complex, such as mesothelioma, to the apparently simple, such as spontaneous pneumothorax.

The management of empyema has been curiously understudied, reflecting no doubt the varied nature of the condition and the long-standing, differing established practices in many parts of the world. By contrast, there is a wealth of information to guide practice in two much more recent thoracic surgical procedures - lung reduction surgery and pulmonary transplantation.

The commonest cardiac surgical practice, that of coronary bypass surgery, has a large evidence base, well reviewed in this book. The striking change in the use of the internal thoracic artery as the preferred conduit for bypassing the anterior descending artery following the landmark 1986 article from the Cleveland Clinic epitomises the triumph of “evidence-based practice” over intuitive practice - the advocates of the internal thoracic artery from the early 1970s had little impact until this publication provided highly persuasive evidence of its beneficial properties.

The choice of cardiac valve substitutes is similarly well described and commendably well-illustrated. Mitral valve surgery, thoracic aortic disease and cardiac transplantation are dealt with in detail, providing excellent source material for further reading.

Anti-coagulation, blood conservation and avoidance of atrial fibrillation are important ancillary aspects to cardiothoracic surgical procedures and are well covered. It is perhaps surprising that “beating heart surgery for coronary disease” is allocated only a short section in a well-produced chapter on interventions aimed at reducing cognitive decline.

Despite its inelegant cover, this is a serious, comprehensive book. It should be essential reading for all cardiothoracic surgical trainees, and is an important source of reference material for all surgeons in the specialty. It brings together in one book, in an organised fashion, the evidence underlying cardiothoracic surgical practice, and can be highly recommended.

David J. Wheatley British Heart Foundation Professor of Cardiac Surgery University of Glasgow, Scotland

Surgical Critical Care Vivas Mazyar Kanani (ed.) Greenwich Medical Media Limited 2003 £25.50 ISBN 1841101311

This small book is a useful adjunct for trainees about to sit the MRCS exam. It covers basic sciences relating to surgical critical care and also some clinical aspects. The book is well laid out with different sections focusing on the MCQ sections and on the viva sections. It should be emphasised that this is a revision book and is not designed to be comprehensive. Candidates should not expect it to be so! The answer sections have clear cross references to the textbook which this question book is designed to accompany. There are selected comments on which to expand upon the answers. Some of these are quite comprehensive but others are rather scanty. Nevertheless, the book will be a valuable adjunct to candidates about to sit the MRCS but it should be used as one facet of a comprehensive revision programme. At £25.50 it may be priced rather highly.

Iain D. Anderson Consultant Surgeon Salford Royal Hospitals, UK