Book reviews

Surgery of Liver Disease in Children E . R. Howard (ed.) . 195 x 252 mm. Pp. 242. Illustrated. 1991. Oxford: Butterworth-Heinemann. €75.

This is a most welcome and valuable book. The past two decades have seen significant advances in many aspects of paediatric liver surgery including an understanding of the segmental anatomy of the liver, the development of portoenterostomy for biliary atresia, the use of sclerotherapy to control variceal bleeding, and the role of liver transplantation. Whereas there have been numerous texts dealing with progress in adult surgical conditions, these have paid limited attention to paediatric aspects. This book redresses the balance by providing a comprehensive review of current management on the whole range of childhood surgical liver disorders.

As well as anticipated chapters on biliary atresia, portal hypertension, surgery for hepatic tumours and liver replacement, other useful contributions include physiology and anaesthesia, liver trauma, and chemotherapy for tumours. The editor should take credit not only for writing the majority of the chapters himself but for producing a free-flowing text that includes contributions from France and Japan. The book is well illustrated with high quality black-and-white photographs, although there is no uniformity of style in the line diagrams; these would benefit from revision when the next edition is produoed. This baak will be bought and treasured by surgeons who treat children with liver disease.

J. A. C. Buckels

The Liver Unit Queen Elizabeth Hospital Birmingham B15 2TH UK

General Thoracic Surgery. 3rd ed. T. W . Shields (ed.) . 225 x 285 mm. Pp. 1251. Illustrated. 1989. Philadelphia: Lea and Febiger. €105.

This is the third edition of what has become a standard general thoracic surgery text. It has been thoroughly updated and achieves its stated aim of being an extensive coverage of the specialty.

Twenty-five new chapters have been incorporated since the second edition, with important topics such as computed tomography, magnetic resonance imaging and jet ventilation now being covered. A full section is devoted to thoracic trauma, with separate chapters on: trauma to the chest wall, pleura and thoracic viscera; adult respiratory distress syndrome; management of foreign bodies of the upper aerodigestive tract; trauma to the oesophagus; and diaphragmatic injuries. I found this section of the book contained particularly worthwhile additions to previous editions. While all topics in thoracic surgery are to a greater or lesser extent covered, emphasis is perhaps on occasion not totally suited to contemporary issues. For instance, although the volume contains over 1250 pages, only 12 are devoted to lung transplantation. I would have liked a full section on this important topic, particularly as it is of interest to the younger surgeon and those in training. The final three sections of the book have, by the strictest of criteria, a non-surgical content. They are devoted to radiation therapy, chemotherapy and immunotherapy, and much of the information in them is essential knowledge for the thoracic surgeon. However, illustrations in these sections are relatively scanty and the writing style often somewhat disparate compared with the rest of the volume.

While the editing is extremely skilful, this book suffers the problems seen generally with multiauthor volumes, particularly as regards continuity and, in a few cases, repetition. The illustrations are generally excellent throughout, although all are in black and white. The volume is well referenced, although many of these are somewhat historical with very few from the past 5 years. This no doubt reflects the time necessary to prepare such a large volume.

I would unhestitatingly recommend this volume to any thoracic or indeed aspiring thoracic surgeon. It is a reference work and not an easy read as a volume, but for reference to a particular topic it is most useful. Librarians of all postgraduate medical libraries with a surgical readership should consider this a suitable purchase for their shelves.

P. L. C. Smith Department of Surgery Hammersmith Hospital London W12 ONN U K

On Narcotism by the Inhalation of Vapours J. Snow with an introductory essay by R. H. Ellis. 184 x 288mm. Pp. 142. Illustrated. 1991. London: Royal Society of Medicine. f20.

John Snow was many decades ahead of his time as a medical scientist. His epidemiological studies during the 1849 and 1854 outbreaks of cholera in London, culminating in the proof that cholera is a water-borne infectious disease, are known to every medical student. His work on inhalational anaesthesia is less well known, but no less impressive.

Between 1848 and 1852 Snow published, in the London Medical Gazette, a series of articles that described his experimental, clinical and philosophical observations on the use ofinhalational anaesthetic agents. The articles were later republished as pamphlets, and this lovely book brings together the collected pamphlets in facsimile form. In his introduction, Richard Ellis speculates that Snow was searching through the London Medical Gazette of 18 December 1846 for his own case report ofileal strangulation by a mesenteric defect, when he came across the first UK account of the invention of anaesthesia in Boston, Massachusetts. Within days, he had witnessed ether anaesthesia for himself. Eighteen months later Snow began to publish his own work, which included detailed animal experiments on both qualitative and quantitative aspects of inhalational anaesthesia. He quickly realized that it was vital to control the rate of administration of ether and chloroform, and he designed a vaporizer. When accounts of anaesthesia-related deaths came from Newcastle, Cincinnati, Boulogne and Hyderabad, he was able to analyse them critically and explain their causes. Snow included fascinating case reports on anaesthesia for lithotomy, breast cancer, maxillary and orthopaedic surgery, and to facilitate clinical examination. He offered advice on preoperative fasting, and made an early contribution to audit by publishing mortality rates for major amputation under anaesthesia. This he did to allow comparison with data from surgery without anaesthesia, at the same time acknowledging the inadequacy of historical controls. Snow expressed disdain for social drinking, but took wine himself as part of an extraordinary series of experiments to compare the effects of alcohol with those of ether and chloroform. In the course of these experiments he proved, using his own design of ‘breathalyser’, that alcohol is excreted in the breath.

I found this book enormously enjoyable, not only for its historical insights but also for the intellectual clarity and scientific rigour exhibited by John Snow. A second copy would make an excellent gift for your favourite anaesthetist.

A. Mitchell Milton Keynes General Hospital Milton Keynes MK6 5LD UK

Comprehensive Atlas of Lumbar Spine Surgery H. Tsuji. 219 x 285 mm. Pp. 327. Illustrated. 1991. St Louis: Mosby- Year Book. US $129.

Professor Tsuji is one of the leading spinal surgeons in Japan and his Atlas is based on personal experience over the past 30 years. The book sets out to illustrate aspects of spinal surgical technique with comprehensive line drawings, prepared by the author himself. The result can be highly recommended for the young surgeon. Orthopaedic surgeons in the UK may find it surprising that techniques relating to the treatment of spinal tumours are included; traditionally, Japanese orthopaedic surgeons have always managed tumours and spinal vascular malformations.

I have only two minor criticisms. First, there is an undue emphasis on the use of fat grafts following exploration of the spinal canal. Second, in relation to anterior interbody fusion techniques, the surgical approaches that the author depicts, involving section of the abdominal muscles, have been largely replaced either by approaches through the rectus sheath itself or by lateral muscle-splitting incisions of the type described by Fraper from Adelaide.

Overall, this is an excellent monograph that has been very ably translated into English by Professor Edgar Dawson of the UCLA School of Medicine.

H. V. Crock

Royal Postgraduate Medical School Hammersmith Hospital London WI2 ONN U K

720 Or. J. Surg., Vol. 79, No. 7, July 1992