Principles of surgery — 5th edition companion handbook

Principles of surgery — 5th edition companion handbook

-_--that some authors, although often world-renowned for their work and knowledge in the field, have imposed their personal views on techniques and i...

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-_--that some

authors, although often world-renowned for their work and knowledge in the field, have imposed their personal views on techniques and indications. Although this does not detract from their experience or their message, the discussion and the overall elucidation of subjects is not always objective. Aside from these criticisms, this text is a very broad and comprehensive review of the wide variety of surgical procedures that should be understood by the general surgeon. It is easy to read, and the figures and illustrations are generally in sufficient number. The quality of the illustrations, however, is irregular, and is marked by the occasional dark diagram and unclear roentgenogram. I recommend this book to anyone wanting a single comprehensive text of most currently performed operations. It will continue to be popular with general surgeons in practice, as well as with trainees. Abe Fingerhut, MD Centre Hospitalier Intercommunal Poissy, France

Atlas of Organ Transplantation. Edited by Thomas E. Star-A, Ron Shapiro, and Richard L. Simnwns. New York: Gower Medical Publishing, 1992.384 pages. $175

This is a hard-cover, well-made book, printed on high-quality paper of folio size. It attempts to provide a text book compilation of the technical aspects of transplantation. There is substantial need for this collection of information in the rapidly changing discipline of transplantation. The book contains 452 illustrations. It is appropriately titled an “Atlas,” and its strongest component is the superb group of line-drawing illustrations, reinforced with color photographs of actual operative specimens, along with a large number of tables listing such parameters as requirements for preoperative evaluation, preoperative orders, postoperative orders, etc., all in color. The atlas is divided into eleven chapters and addresses all aspects of organ and tissue transplantation. Although most of the authors are from the University of Pittsburgh, each chapter is written by


recognized experts in the field. The narrative component of the book is set in 8-point type and is easily read. Each chapter provides a narrative description of the various illustrations and provides some background information about the various technical procedures. There is considerable variation from chapter to chapter concerning the depth of theory provided to support the opinion of the authors. Some chapters have as few as 15 or 20 references, whereas others have more than 100. The book is not intended as a reference book but as an atlas expressing the opinion of a selected group of recognized experts. The narrative is well written and easily comprehensible. It is perhaps the best publication of its type in the field and will be of particular interest to medical students, residents, and fellows. In summary, this book provides a needed addition to the available library concerning transplantation; the editors have achieved their stated goal of providing a comprehensive compendium of the technical aspects of transplantation at this time. John C. McDonald, MD Louisiana State University Medical Center Shreveport, LA

Principles of Surgery - 5th Edition Companion Handbook. Edited by Seymour 1. Schwartz, G. Tom Shires, Frank C. Spencer, and Wendy Cowles Husser. New York: McGraw-Hi& Inc., 1991. 650 pages. $25 Oxford Handbook of Clinical Surgery. By G. R. McLatchie and S. Parameswaran. New York: Oxford University Press, 1990. 862 pages. $29.95

Several major surgical texts offer an abbreviated handbook for quick reference. The following is a comparative review of two such books: Principles of Surgery - 5th Edition Companion Handbook by Drs. Schwartz, Shires, and Spencer, and Oxford Handbook of Clinical Surgery by Drs. McLatchie

and Pararneswaran. This reviewer’s perspective is that of a senior medical



student determining whlcn r’tt;m:r~zt: would be better for other ‘senior.-lel-el students. The senior medical student has lirnited responsibility for patiem care and is still in a fact-finding process. He or she is asked by residents and :;taff not only about the patient’s history and physical examination but also related facts about the patient‘s disease and its treatment. The student needs a pocket reference to read and quickly learn the key historical facts, anatomy, epidemiology, signs, symptoms, and methods of diagnosis and treatment of the disease in question. The intern or resident has had more exposure to these facts and may prefer a brief outline of policy and procedure. In general, the Principles qfSurgery Companion Handbook contains a more complete consideration of most topics. It contains more historical facts and epidemiologic data. It often includes a synopsis of significant research, interpretations of physical findings, descriptions of pathophysiologic processes, ways to differentiate the possible diagnoses, and methods of diagnosis and treatment. The Oxford Handbook of Clinical Surgery

inconsistently presents that same information, but more often provides a concise step-by-step guide to the diagnosis and treatment of a given disease. Classic findings are often listed but not explained. The busy house officer may benefit from its clear listings of facts, findings, and protocol. The Oxford Handbook of Clinical Surgery is more procedure-oriented than is the Principles oj’ Surgery Companion Handbook. The Oxford Handbook contains a chapter entitled “Practical Hints for Housemen,” which explains how to intubate a patient, excise cutaneous lesions, do a sigmoidoscopy, and perform other common, minor invasive procedures. This is followed by “Anatomy for Surgeons,” in which each organ’s blood and nerve supplies, lymphatic drainage, and important anatomic relationships are listed and/or illustrated. Next is a chapter on “Operative Surgery,” which takes the reader through each operation, starting with its goal and including special consent, required anesthesia, the position of the patient, necessary equipment, type of incision, operative procedure, closure,









and complications. This could serve as an excellent briefing for medical students in their post graduate year 1 or postgraduate year 2 who are asked to first-assist in a procedure with which they are not familiar. The fourth-year medical students have much of the aforementioned explained to them during the procedure and are asked more about indications rather than technical aspects of an operation. The Oxford Handbook also concerns itself with etiquette and ethics in a surgical practice. It addresses, for example, the surgeon’s interaction with the elderly patient, the difficult patient, and the patient with a “label.” Negligence, treatment risks, informed consent, death, suicide, and euthanasia are also discussed. It lists special precautions to take while operating on patients with acquired immunodeficiency syndrome. Communication with colleagues is also covered. The chapters on the appendix and acute appendicitis well demonstrate the differences between the two handbooks. In the Principles of Surgery, Drs. Schwartz, Shires, and Spencer open with an in-depth discussion of the function and anatomy of the appendix. This is followed by the statistical incidence, male-to-female ratio, age distribution, and so forth. The etiology and pathophysiology are then considered in great detail. Classic signs are described as are the ways to elicit each one. Laboratory and radiographic findings pertinent to the diagnosis are discussed. Complications are explained, as are their incidence and diagnosis. The differential diagnosis contains information that may help distinguish various disorders. It is then explained how those who are elderly, very young, or pregnant may differ in presentation, treatment, and prognosis. The entire discussion covers five pages. Those familiar with this information may believe that it is, superfluous. However, the medical student may benefit from such a complete source of information. The.Oxford Handbook is quite different. It tells the reader that appendicitis is the most common cause of acute abdomenal pain in the United Kingdom and that it has a variable presentation. It then describes those at greatest risk for a positive diagnosis.


Symptoms, signs, and differential diagnosis are listed as key words. There are no lengthy discussions of the disease process and related findings, and the treatment and complications anz concisely described. Anatomic facts and operative procedures are found in their respective chapters. It should be noted that a few chapters, for example those dealing with transplant surgery and colon cancer, were similar in structure and content. Occasionally, as in diverticular disease of the colon, the Oxford Handbook had a more thorough discussion. Understanding that senior medical students have different roles in patient care, depending on the person and the institution, one book cannot be recommended for all. Principles of Surgery is a rich source of information that would well serve most students preparing for question-and-answer sessions, and the Oxford Handbook, with its emphasis on procedure and protocol, may best benefit students in an “acting-internship” role. Caroline W. Thompson, MD University of Louisville Louisville, KY

The Work of Human Hands Hardy Hendren and Surgical Wonder at Children’s Hospital. By G. Wayne Miller. New York: Random House, 1993.350 Pages. $23

Books describing the everyday heroism that is part of the practice of medicine have become trite, falling somewhere between the public’s total disaffection for physicians in general and the bought-and-paid-for instant deification books about a few doctors who have periodically come to the public’s attention in recent years. This book focuses on the remarkable career commitment of a senior surgeon at the Children’s Hospital in Boston, Hardy He&en, and perhaps is all the more appreciated because of the times in which it appears. By tracing the key events in the care of a child with severe congenital anomalies involving multiple organs, but especially the urinary tract, the story is both well presented and hu-



MARCH 1994

manely done. The references to Her&en’s lifelong commitment to congenital defects in this area is done well and thoughtfully. The personal role of this surgeon, both in his interface with his little patients and their families and in his own life, is compassionately but accurately described. Unlike some other medically oriented books in recent years, this one makes one realize what everyday acts of bravery, imagination, and compassion occur in the work of many people in medicine, and especially so in individuals who have chosen to expand the frontiers of medical and surgical progress. This book could well become a warm but frank handbook for the families of children who must face the formidable stages of surgical correction of major anomalies. This book is largely pitched at the lay public, but I can assure you that physicians who know and even those who do not know Hendren will find this a refreshing look at the good surgeons do, and the warmth and kindness they confer upon patients, despite events in their personal lives that are, at best, sobering. In terms of the social environment in which we live today, would only that this might become a bestseller! Hiram C. Polk, Jr., MD University of Louisville Louisville, Kentucky

Surgical Laparoscopy. Edited by Karl A. Zucker, Robert W. Baily, and Eo?dieJoe Reddick. St. Louis: Quality Medical Publishing, Inc., 1991. 350 pages. $100 The availability of educational texts

has not kept pace with the rapid proliferation of new laparoscopic procedures. This book provides an up-todate and comprehensive review of the evolving discipline of laparoscopic surgery. The chapter authors are renowned surgeons and are themselves pioneers in this field. The chapters are concise and quite readable. References to the international literature and the authors’ own clinical experience are frequently made. The book discusses almost all the areas of development in laparoscopic surgery current at its writing, although a second edition will certainly be necessary