to consider additional areas such as myotomy for achalasia and proce- dures for gastroesophageal reflux. Much of the material presented is clin- ically relevant, whereas other areas, such as hernia repair, remain investi- gational. Although there is little at- tention to the aspects of diagnostic la- paroscopy, the editors were careful to include valuable chapters concerning anesthesia, instrumentation, and the physics of thermal delivery systems. The issues of training and credential- ing are also addressed.

Surgical Laparoscopy reads well as a ready reference atlas that may be used in order to become initially fa- miliar with a technique or for review. The illustrations are well-chosen and clear, and the text print is large, al- lowing for easy reading. This is one of the best books presently available in this field, and well worth the in- vestment.

Jeffrey L. Ponsky, MD Mt. Sinai Medical Center

Cleveland, OH

Pediatric Surgery. By Don K. Nakayama. New York: Gower Medical Publishing, 1992. 145 pages. $125

The discipline of pediatric surgery well lends itself to pictorial represen- tation. Operative photography of con- genital or acquired pediatric surgical disease can illustrate the pathologic lesions involved and provide graphic demonstration of the symptoms they produce. Pediatric Surgery by Don Nakayama takes advantage ‘of this quality. The book arose largely from a series of lectures given to medical students and house officers in which age and symptomatology were pre- sented through radiographs and intra- operative photographs depicting the common problems encountered in pe- diatric surgery. Respiratory distress, vomiting and jaundice, gastrointesti- nal bleeding, and abdominal masses are discussed. Sections on head and neck and abdominal parieties, and an extensive chapter devoted to critical care and pediatric trauma, complete the text. The photographs are gener- ally of excellent quality; about half are in color. This is a definite strength of the volume, and is testimony to the au-

thor’s attention to detail in obtaining these pictures. The accompanying narrative, however, lacks depth and at times seems compromised by the au- thor’s effort to make reference to ev- ery illustration. The text intentionally touches on only the essential points of diagnosis and treatment. Few details of historical perspective or operative treatment are supplied. To offset this limitation, the author has provided an extensive bibliography of pediatric surgical texts and selected articles, should one desire additional informa- tion about a particular subject.

This is an excellent text for the au- dience to whom it is addressed, namely, students and house officers. It provides a problem-oriented ap- proach in an atlas form, giving the reader a visual differential diagnosis indexed by the patient’s age and symptoms. It also provides a starting point for additional inquiries. I think this book is a useful adjunct in the study of pediatric surgery and would be a welcome addition to the library of any hospital involved in the care of infants and children.

Sheldon Bond, MD University of Louisville

Louisville, KY

Multiple System Organ Failure. Edited by Donald E. Fry. St. Louis: Mosby Year Book, 1992.395 pages. $79

This multi-authored monograph edited by Donald Fry brings together an outstanding group of experts who have made substantial contributions to our knowledge of those patients who experience injury, operation, or sep- sis. Each chapter makes use of the ex- perts’ areas of special expertise in elaborating the research being carried out on the mechanisms and mediators involved in the development of mul- tiple systems organ failure (MSOF) and its treatment. The book was de- signed to review present understand- ing of MSOF and available therapy. It fulfills those goals very well. Dr. Fry is eminently qualified to lead this ef- fort, since he, along with Dr. Polk and other University of Louisville sur- geons, was a pioneer in the clinical recognition of sepsis being the major factor involved in MSOF after trauma

and in surgical patients. After Fry’s concise but thorough me-

view of the development of cur knowledge about the s~ntlromc of MSOF and septic respon\e. the sac- tion on MSOF’s mechanisms of de- velopment provides detailed reviews of the work of Drs. Schumer, Saba and colleagues; Border and coworkers; Deitch, Machiedo and Powell; Schirmer and Fry; and Siegel. The au- thors’ descriptions of theories, hy- potheses, and research efforts are complete, and updated, but not totally new to this volume. After all, how many chapters, for how many books on similar subjects can an investiga- tor write? A status report on where these theories and hypotheses fit in or together would have been helpful. Are they all operative? What is cause and what is effect? Do they all contribute to MSOF?

The chapters in the section on me- diators and effecters are also thor- ough, up to date, and worthwhile. The authors offer an overview for the reader of this exciting world of in- flammation, tissue injury, and metabolic changes.

The section on supportive care of pa- tients with potential, incipient, or ac- tual organ failure is timely, factual, and practical. The recommendations are useful, balanced, and substanti- ated-not theoretical.

The final section on issues and con- troversies provides a debate on empiric laparotomy related to the onset of re- mote organ failure, the use of steroids for injury and septic shock, and the im- portance of myocardial depression and translocation of bacteria from the gut. Although many believe that some of these issues have been resolved, the debates are provocative. One could also debate the use of the acronym MSOF, which seems syntactically awkward, rather than multiple organ failure (MOF), which seems clear and neat, but neither acronym can be pro- nounced easily, so why debate?

In the volume’s final chapter, the ed- itor summarizes the current status of knowledge and research related to MSOF. This is an excellent book, rec- ommended to all who care for sick and/or injured patients. It is well ref- erenced and indexed, and reads well.

Arthur E. Baue, MD St. Louis University Hospital

St. Louis, MO

THE AMERICAN JOURNAL OF SURGERY VOLUME 167 MARCH 1994 373