808

DISCUSSION

The mi-mark helix produced no more discomfort than didinsertion of an I.U.C.D. or its removal when the threads arevisible. The risk of uterine perforation is very low on accountof the flexibility of the soft plastic and is certainly less thanthat associated with the use of metal hooks or biopsy curettes.We see no reason why this instrument should not be used bydoctors other than trained gynaecologists.We suggest that the mi-mark helix may be used as a first

resort in the management of missing l.U.C.D. threads, providedpregnancy can be excluded. If patients are seen within ten daysof the onset of their last menstrual period there is no need forultrasound examination to detect the i.u.c.D. or exclude preg-nancy. If the thread(s) cannot be retrieved ultrasound becomesnecessary to determine whether the i.u.c.D. is in the uterine

cavity, and if so it should be removed by some other means.

In this way the majority of patients with missing l.U.C.D.S willbe spared weeks of needless anxiety and the risks of generalanaesthesia for what is in most cases a relatively trivial prob-lem.

We thank Henleys Medical Supplies Ltd., London N8 ODL, for sup-plying the mi-mark helix and the family-planning doctors of Brent andHarrow Area Health Authority who referred the patients describedhere.

Requests for reprints should be addressed to R. P. H., Division ofPerinatal Medicine, Clinical Research Centre, Watford Road, Harrow,MiddlesexHA13UJ.

REFERENCES

1. McArdle, C. R. Obstet. Gynec. 1977, 51, 330.2. Basu, H. K. Br. med. J. 1977, i, 713.3. Milan, A. R., Markley, R. L. Obstet. Gynec. 1973, 42, 469.

Reviews of Books

Ulcerative Colitis

Clinical Gastroenterology Monograph Series. M. ]. GOODMAN,Bury General Hospital, Greater Manchester, and M. SPAR-BERG, Northwestern University, Chicago, Illinois. Chichesterand New York: Wiley. 1978. Pp. 205. 13.50.

JosBHH KiRSNER notes in his foreword to this book thatulcerative colitis is a disease which "can be as incapacitatingas chronic renal insufficiency, as relentless as leukaemia and asmalignant as any neoplasm." The main purpose of this book-is to provide the general physician with clear practical guide-lines on the pathophysiology, diagnosis, and treatment of thisdisease. Crohn’s disease is considered only in the differentialdiagnosis and will doubtless be the subject of a future volumein this series. Because this book is not aimed at the gastroen-terologist, certain sections, and in particular that on aetiology,are short, and the reference list is limited. In general, however,the authors succeed in their task. The pathological and clinicalfeatures and the management of the disease are well describedand illustrated, and there is a wealth of practical advice. Thedangers of precipitating toxic dilatation with drugs such as’Lomotil’, codeine phosphate, and opiates is stressed as are thehazards of any but the most gentle barium enema. Broad-spec-trum antibiotics often seem to be responsible for precipitatingrelapses; if an antimicrobial is indicated co-trimoxazole is sug-gested as being not so liable to cause this complication. Discussionon the differential diagnosis is repeated in several chapters anddoes not include the recent exciting work on pseudomem-branous colitis. There are good chapters on ulcerative colitisin childhood and pregnancy. The authors favour an annualdouble-contrast barium enema when following-up patientswith extensive disease of more than 7 years’ duration, whereasmany centres in Britain prefer colonoscopy, which has theadvantage of allowing multiple mucosal biopsies to be taken.This book can be recommended to the general physician orsurgeon wanting a summary of the current state of play.

Principles of Drug Information Services

ARTHUR S. WATANABE and CHRISTOPHER S. CONNER, Universityof Colorado Medical Center. Denver, Hamilton, Illinois: Drug In-telligence Publications Inc. 1978. Pp. 256.$16.25.

THIS practical self-instruction manual, which covers all

aspects of providing a drug-information service, concentrateson how to answer requests for specific patient-oriented infor-mation. Each chapter ends with exercises for self-assessmentand the last chapter consists of examples of clinical problemsillustrating the topics dealt with in the rest of the book. Thebibliography is extensive and useful. That this refers pre-

dominantly to the American literature reflects both the origin ofthe book and the fact that little has been published in Britainon drug-information services; however, there are some usefulBritish publications, such as the Drug and Therapeutics Bull-etin, which are not listed. The two best chapters are those de-scribing how to do a systematic literature search and how toassess sources of drug information. The latter covers, amongother things, the evaluation of results of clinical trials and ofreports of adverse reactions to drugs; and it warns about thedangers of relying on secondary sources of information. Thebook is written mainly for North American clinical pharmacystudents who are perhaps more closely involved with drug pre-scribing and patient-care than is usual for pharmacists in Bri-tain, and this is reflected particularly in the illustrative exam-ples used. However, it would be a valuable manual for anypharmacist providing a drug-information service, and es-

pecially for those responsible for training pharmacy students.

The Edinburgh School of Surgery After Lister

JAMES A. Ross, President, Royal College of Surgeons of Edin-burgh, 1973-76. Edinburgh: Churchill Livingstone. 1978. Pp.220. [,7.00.

THIS delightful book consists of a collection of biographicalsketches of the surgeons of the Edinburgh School after Listerup to World War II. The author has collected his informationfrom many sources-sometimes from the accounts of his moresenior colleagues, sometimes from personal knowledge of thesurgeon described. The text will interest both the medical per-son and the layman. The pen-sketches reveal personal detailsthat give a clearer picture of those now dead than do simpleobituary notices. If there is any criticism it can only be thatthe good nature of the author has perhaps blunted the sharp-ness of his dissection of the individual personalities concer-ned-"de mortuis nil nisi bonum". Readers will be intriguedto see set out the progress from surgery as a whole to its pres-ent fragmentation into many specialties. In each specialty awell-known figure is described and to those trained in Edin-

burgh the names are well known; many are outstandingfigures. Only the future will show which names will live onwith Lister’s-Fraser, Argyll Robertson, perhaps Dott? Theauthor writes in an intimate and personal fashion and hisknowledge of and love for the Edinburgh School makes thisvolume well worth reading.

New Editions

Human Physiology.-7th ed. By O. C. J. Lippold and F. R. NB’inton.Edinburgh: Churchill Livingstone. 1979. Pp. 514. DO.50.

Rheumatologic Interviewing and Physical Examinanon of rhe

yo:?:M.—2nd ed. By Howard F. Polley and Gene G. Hunder. Londonand Philadelphia: Saunders. 1978. Pp. 286. 13.25 (hardback’.