ABC of Nutrition, Third Edition Essential Surgical Practice 14th Edition Advanced Surgical Navigation Multiple Choice Questions on Surgical Diagnosis |
Instant Anatomy Second Edition Robert H Whitaker and Neil R Borley Thyroid cancer: a comprehensive guide to clinical
management Port-site wound recurrences in cancer surgery |
ABC of Nutrition, Third Edition
A Stewart Truswell
BMJ Books
£16.9, ISBN 072791233X5
This book was written for the general practitioner who, like most medical students, had been taught little, if any, nutrition in their undergraduate courses yet are increasingly being asked questions about nutrition and health by their patients who are becoming increasingly aware of the implications of good nutrition through media coverage of the topic. Consequently, the book focuses only on aspects of human nutrition, which are likely to be relevant to the medical practitioner. Because of the time constraints on general practitioners the remit had to be for practical relevance, conciseness and clarity in both text and diagrams.
With minor exceptions the book more than meets its prescribed remit. It presents the reader with a "potted" version of practical nutrition covering most of the nutrition-related diseases, therapeutic diets, advantages and disadvantages of certain nutrition-lifestyle choices. In addition it deals with the "hot topics" in modern nutrition including genetically modified foods and food safety, both of which are high in the publics awareness at present. It is replete with sound factual information ranging from basic biochemistry to specific applied nutrition pertaining to patients of all ages; "nutrition from the womb to the tomb." The concepts that early nutrition deficiencies could result in later ill health and that an adequate nutrition in old age could reduce hospitalisation and health care costs are extremely apposite and a focus for research.
Of particular interest was the highlighting of the benefits that can be derived from good pre-operative and post-operative nutrition in hospitals, both from the patient perspective and the cost to the Health Service. This should be standard practice in all hospitals but is often neglected because of antediluvian prejudices against the perceived value of good nutrition when compared with drugs. The author of this book clearly advocates the sensible option of using good nutrition (or therapeutic diets) and the necessary drugs to combat disease and maintain health. He is also not afraid to suggest that dietary supplements can have benefits if people cannot or do not have time or will not consume the requisite foods. This is a pragmatic view the reviewer also supports, despite it being anathema to certain purists in the field of nutrition.
The authors suggestion that a general practitioner should be able to take time out to advise his patients on detailed matters of diet which can cure or ameliorate their particular malady is an interesting one but might prove impractical because of time constraints. Perhaps a future perspective might be that trained clinical nutritionists, either directly or through collaborative links with University Schools of Nutrition, will constitute part of the health-care team in all practices; the cost would be minimal in comparison to the gains.
In the reviewers somewhat subjective opinion slight improvements could be made to the book, particularly in relation to the description of the metabolism of fatty acids, what constitutes an "essential fatty acid" and why such fatty acids are regarded as essential. This is an area that is often misunderstood but also difficult to describe without too much boring chemical detail. Similarly, a mention of the putative health benefits of conjugated linoleic acid, a type of cis, trans fatty acid, and more information regarding polyphenolic flavinoids and health would have been apposite since these are nutritional "hot topics" at present.
This little book has achieved the almost impossible task of condensing the essential aspects of human nutrition pertaining to growth, development, health and recovery from illness and surgery into 18 short, factual and very readable chapters. It is written in a clear and comprehensible style, which makes it a valuable introduction to this very important topic for anyone interested in or working in the health-care professions.
I will certainly keep a copy on my bookshelf.
Klaus W.J. Wahle, Rowett Research Institute, Aberdeen
Essential Surgical Practice 14th Edition
A Cuschieri, RJC Steele, AR Moosa
Butterworth-Heinemann, Oxford
£65, ISBN 0750647809
This is the fourth edition of a popular text for the General Surgeon. The format has been changed for the latest edition to reflect the new structure of surgical training in the UK. The first volume covers the topics appropriate for the basic surgical trainee in the generality of surgery whilst the second volume covers the systematic surgery required by the higher surgical trainee in general surgery. The chapter headings relate to the patient "problems" rather than to specific pathological processes. Examples include "The jaundiced patient," "Patients with head injuries" and "The management of patients with medical problems."
The chapters are well constructed with skilful integration of the relevant information. Each problem is followed through from the pathophysiology to the clinical presentation, investigation and treatment. The chapters are well illustrated and the black and white illustrations are appropriate and generally of good quality.
Two new topics are included in this edition. The first chapter on "Risk assessment in surgery" which is an important part of our clinical practice. This covers the risk of different pathologies and co-morbidity and has useful summaries of different risk scoring systems.
The second new topic is a chapter on "Assessment and professional development." The usual topics of audit, assessment and costing are covered but there is also an excellent section on computing including the use of electronic communication for the beginner and a legal section covering consent, negligence and contracts.
All chapters have short lists of appropriate references for further reading. This volume is specifically designed for the basic surgical trainee but the text is very comprehensive and covers much more than is necessary for the MRCS. For example an entire chapter of twenty-five pages on minimal access therapy is probably more appropriate for the higher trainee.
It is however, a well-written text and provides a comprehensive coverage of the general aspects of surgical management appropriate to both basic and higher trainees. It is a book I would recommend to trainees in general surgery.
Mr R C Smith, Falikirk & District Royal Infirmary, Falkirk
Advanced Surgical Navigation
Eben Alexander III, Robert J Maciunas
Theime, New York 1999
ISBN 865777675
The publication of this book coincides with an explosion in the use of various image guidance systems in clinical neurosurgery. The various sections of the book concisely and comprehensively document advanced neurosurgical practice at the turn of the century. There is, moreover, a good balance between the historical and pioneering aspects of neurosurgical navigation and the more advanced frontiers in technological innovation that are currently being applied in operative practice. The first part of the book contains two chapters that try to place the remainder of the extensive folio into context, in terms of the past and novel challenges. Fourteen chapters then follow this on various brain imaging techniques (CT, MRI, Magnetic Resonance Angiography, Proton Magnetic Resonance Spectroscopy, Positive Emission Tomography, Magnito-encephalopathy and the Utility of Computerisation Techniques for transferring medical data into maps). The practical utility of these techniques is also demonstrated in chapters such as Functional Magnetic Resonance Imaging for planning cortical resections. Section three goes through the various currently available frame based stereotactic systems together with the various modern forms of interactive image guidance framless systems including neuro-endoscopy. Whilst much of the information about the frame based systems is currently available in other texts, and often written by the same authors, the six chapters on image interactive neuro-navigation without frames is a nice compaction of current practice and knowledge. There is then a one hundred and fifty-page section on the various methods of image guidance for epilepsy, radiation and functional neurosurgery. This covers electromagnetic techniques, optical tracking systems, stereotactic radiosurgery, robotic radiosurgery and various lesioning, methodologies for movement disorders. Perhaps the most interesting part of the Section is the last entitled "Frontiers in Neurosurgical Navigation." These chapters cover intraoperative magnetic resonance imaging, robotic guidance in advanced imaging environments and a thoughtful chapter on future advances in neurosurgical navigation and the challenges that are faced. Overall, this is a beautifully presented book with the extensive use of both black and white and colour illustrations and is written by predominantly North American neurosurgeons who are pioneers or recognised experts in their field. While some of the chapters will age rapidly in view of the changing technological developments and their applications in clinical practice, other sections are timely benchmarks and overviews of this rapidly advancing field. This is an extremely comprehensive text and as such would be useful as basic information for most trainees in neurosurgery and indeed many consultants. The book would provide useful background information with which to interpret further modern advances of technology in neurosurgery. It is easy to access because of good referencing and indexing and generally it is very easy to read.
My only concern about it would be the price, which is perhaps a little prohibitive. Nonetheless, it is a useful addition to all neurosurgical libraries.
I R Whittle, Forbes Professor of Surgical Neurology, Western General Hospital, Edinburgh
Multiple Choice Questions on Surgical Diagnosis
R Visvanathan, JSP Lumley
£14.99, ISBN 0750647302
This book is one of a number of current productions relating to multiple choice questions aimed primarily at the MRCS Examination. It is slightly different in that it relates specifically to a surgical textbook, that of Hamilton Bailey's Demonstrations of Physical Signs in Clinical Surgery. This differs to most texts, which are formatted to deal with various core and system modules. The introduction is very helpful in explaining the concept of the multiple-choice question as a means of assessment of knowledge. The authors also highlight the difficulties faced by examiners insetting fair, relevant and unambiguous questions. In particular, the avoidance of "never" and "always" should be avoided although these are still used in one or two of the enclosed questions! The paragraph on advice to candidates in answering MCQ's is also clear and helpful.
The questions in part 1 are clearly laid out and I could only find one or two instances where the text in the options did not directly follow the question in the stem. There are one or two instances where the stem is unnecessarily cumbersome, e.g. in section 7 one if the questions states "In an 8 year old Asian child with massive hepatosplenomegaly the causative disease states are." This would be much more simply stated as "the causes of massive hepatosplenomegaly in an 8 year old Asian child are." Another example of a rather badly worded question is the final question in Section 7. The stem is given simply as "Renal colic is" This term would generally be regarded as inappropriate and would be better changed to "Ureteric colic" The answer given to one of the options that pain is referred to the testis is given by the authors as "False" There are several other answers throughout the text which I would regard at best ambiguous and would, in fact, in many instances disagree with the authors' answers. It would be inappropriate to list every example but one further issue relates to question 9 in Section 8 where the stem is "The urinary bladder is" and one of the options which the authors state to be false is "Readily identifiable on plain radiology when distended" I would have thought this option to be true but if the authors do regard this as false then all the other 4 options in the list are also false. Most of us who are involved in setting and assessing multiple choice questions would insist that at least one of the 5 options is true.
Apart from these criticisms, I do feel that this book would be helpful to candidates preparing for the MRCS Examination. It is nit only useful in giving candidates experience in answering multiple choice questions but the comments following the answers in part 2 are particularly helpful in giving background information relating to the question rather than simply stating the answers themselves. In addition, I think this book would be particularly helpful for final revision before the clinical part of the examination in that it is aimed specifically at clinical signs and symptoms. I would have no hesitation in recommending this book to all trainee surgeons.
Mr W S Hendry, Consultant Surgeon, Stirling Royal Infirmary
Instant Anatomy Second Edition
Robert H Whitaker and Neil R Borley
Blackwell Science, Oxford
£12.95, ISBN 0632054034
This is a concise well-written short text of anatomy that is easy to follow, with clear simple schematic diagrams that illustrate anatomical facts relevant to clinical medicine. The book is designed explicitly as an aid to review and revision, not as a primary source of learning. It contains chapters that deal with aspects of the vasculature, the nervous system, muscles, bones and joints, as well as lists of anatomical data.
Do I like this book? As an aide memoire, it is good as far as it goes but it is short changes you on the functional significance and clinical importance of anatomy. For example, it presents muscles as an alphabetical list. Why not list then in functional groups? For undergraduates, such simple functional correlation would help to link the anatomical knowledge to the clinical skills it underpins, for example, with regard to examination of the nervous system. Similarly, the lymphatics are presented as groups of regional nodes with territories of drainage, but not in terms of the drainage of individual structures or organs which is a way of thinking essential to the staging of malignant disease. The simple structure and clarity of the book might be more appropriate for postgraduates who have already made the functional links of clinical anatomy.
Surface anatomy is not mentioned in this book. For any anatomy book, this has to be a serious omission. The clinical view of the human body relies on our "seeing below the surface" but, usually, with the skin on and so the description of the surface and its relationship with what lies beneath is a fundamental component of anatomical learning. There is nothing on the viscera - the heart, lungs, gastrointestinal tract, urogenital system and associated structures are mentioned in relation to their blood supply and innervation, but not as themselves. Again this is unhelpful.
The authors make it clear that if you are looking for something to promote deep learning and understanding of the subject, this is not the book for you and their honesty is to be commended. I have reservations about books like this because they tend to collude with rote learning but accept that we all find the need for this at times. The approach here tends to be over well tried and is out of step with the thinking that guides most of today's undergraduate curricula and postgraduate learning. In conclusion, this book will serve you well if what you want is a series of lists and quick references to help you remember anatomical facts. Bearing the limitations in mind, it delivers what it promises; and that cannot be bad for £12.95.
Dr Peter Johnston, Department of Biomedical Science, Aberdeen Medical School
Thyroid cancer: a comprehensive guide to clinical
management
Leonard Wartofsky
The Humana Press, New Jersey 2000
$175.00, ISBN 0896034291
This book provides a very good overview of the contemporary management of thyroid cancer in North America. The editor has gathered a group of experts in the different areas of endocrinology, imaging, surgery and oncology to address the problems of diagnosis, management and follow-up of patients with this fascinating or perhaps more accurately these fascinating diseases. The wide variation in the biology and natural history of differentiated thyroid cancers has resulted in a degree of confusion over the optimal management. This book whilst acknowledging it largely ignores controversy and advocates radical treatment for the great majority of patients with differentiated thyroid cancer. The cost-effectiveness of this approach is not questioned although it is alluded to in a couple of brief passages.
There are, perhaps inevitably, several rather repetitive sections as a consequence of the pattern of discussing each cancer type according to a formula but few readers will systematically read the book from cover to cover and this is unlikely to be intrusive. The surgical aspects of management are covered by Orlo Clark and the emphasis is on total or near total thyroidectomy with central neck compartment dissection and selective lateral nodal surgery. It is illustrative of this book that I could find no reference to postoperative hypoparathyroidism, its prevention, management or incidence and the index refers only to the advantages of total thyroidectomy. Perhaps this is not considered an issue or a price worth paying for more radical surgery. The view that a move to more extensive surgery in an attempt to cure cancer is not universally held is not explored. The medical emphasis of the book is such that this is no surgical manual of how to perform a hyroidectomy and this is a defect in a book which aspires to be comprehensive. The advice that surgery is recommended as debulking procedure for anaplastic cancer gives no indication of the practical difficulties. Similarly discussion of the management of surgically unresectable differentiated cancer and the role of very aggressive resection advocated by some head and neck surgeons would have given balance. The various risk stratification schemes for thyroid cancer are mentioned but their relative merits are not considered.
The value of the book however far outweighs these criticisms and as description of the state of the art in the USA it has much to recommend it. The sections on pathology, imaging, epidemiology and future developments are very good and it is a book which I will use as a compact reference for the non-surgical aspects of management of thryoid cancer
Professor Z H Krukowski, Aberdeen Royal Infirmary
Port-site wound recurrences in cancer surgery
MA Redmond, HJ Bonjer, F Kockerling
£61.50, ISBN 3540669299
Early reports of port-site recurrence following resection of cancers from various sites using laparoscopic methods spread alarm through the surgical community. There seems little doubt in retrospect that these anecdotal reports lead to an exaggeration of the importance of this complication, and subsequent work appears to suggest that local recurrence occurs only in 1% of patients undergoing laparoscopic cancer resection.
Nonetheless, as this book emphasises, port site recurrence and wound recurrence have differences in presentation and causation which surgeons should be aware of. The quality of production of this text is excellent. It is amply illustrated with high quality black and white photographs together with excellent figures and very clear tables. Despite over thirty contributors, including the editors, the text is of a remarkably high and uniform standard.
The subject is covered from a clinical, pathological and scientific perspective culminating in simple advice on the prevention and treatment of a port-site recurrence. I can recommend this book without reservation and any surgeon who performs or plans to undertake laparoscopic resection for malignant disease would be well advised to study the text in detail. This is a moving field and no doubt there is still more to learn as the authors fully accept. Large prospective trials are in progress and should answer many of the unresolved questions.
SJ Nixon, The Western General Hospital, Edinburgh
©2000 The Royal College of Surgeons of Edinburgh, J.R.Coll.Surg.Edinb.