Book reviews

Amputations and Prostheses. 2nd edition.

M . Vitali. 192 x 260 mm. Pp. 217. Illustrated. 1986. London: Bailliere Tindall. f21 .00.

The second edition of this book has been extensively updated and makes

an excellent contribution to amputation surgery and prosthetics. For too long these subjects have remained isolated from each other and their practitioners are largely ignorant of the problems relating to the other field. If a surgeon routinely carries out amputations without any consultation with those who are responsible for the patients’ subsequent rehabilitation then he is out of touch with reality. This book underlines the necessity of preoperative consultation and stresses the advantages ofsuch a policy. A good example of this is that preoperative consultation may draw attention to the fact that a patient may be unlikely to walk again and therefore would be better off with a through-knee or Gritti-Stokes amputation rather than the usual above-knee operation. The authors emphasize that patients with bilateral above-knee stumps find it difficult to turn over in bed. The quality of the patient’s life can be much improved by a more distal amputation.

The opening historical review is full of interesting detail, including reference to the description by Hippocrates of amputation by disarticulation at the knee. The famous wooden leg of the Marquis of Anglesey is also mentioned, but a recent comment in Anglesey that the design of artificial legs has not improved much since the early 19th century is omitted for obvious reasons! There follows an illuminating chapter on gait analysis, a subject which is bound to develop in the near future as it is relevant not only to amputees but also to those with neurological problems. Prosthetics and individual amputations are exceptionally well described; a good analysis of the advantages and disadvantages of each amputation is given and always with a view to rehabilitation.

There are possibly only two minor criticisms. First, it would have been helpful to have included a fuller description of the skew sagittai flap below-knee amputation with gastrocnemius and soleus muscle myoplasty; second, in the final chapter on future developments, perhaps more could have been made of the importance of having all patients with critically ischaemic limbs seen by vascular surgeons in order to reduce the number of amputations which currently total 5000 each year. These are, however, minor criticisms which in no way detract from an excellent book which should be read by all those involved in this branch of surgery. Such study would surely improve the ultimate outcome for these unfortunate customers.

I. McColl Professor of Surgery Guy’s Hospital London SEl 9RT U K

Perspectives in Colon and Rectal Surgery T. R . Schrock. 70 x 100 mm. Pp. 152. Illustrated. 1988. St. Louis: Quality Medical Publisher Inc. $193.00.

In the Preface, the Editor, Theodore Schrock, states that the originators of the text set out to produce a hybrid of book and journal for colon and rectal surgeons. I am tempted to say that in so doing they have fallen between two ‘stools’, but I realize that this is a cheap jibe and is not entirely correct. The contributors are eminent in their field, and have put together a most readable first edition of a series which hopes to be biannual and topical. The articles are crisp and to the point and well laced with the authors’ pcrsonal experience. The latter is refreshing and in a text of this nature is most fitting. The contents are a mixture of review type articles dealing with current topics and more personal viewpoints of difficult management problems or new techniques. Although the review articles are excellent, I felt at times that the discussion of several controversial topics was ‘thin’ and would have benefited by more in-depth appraisal. While one appreciates the publisher’s desire to reduce the typescript, this could have been achieved by the elimination of the ‘sideline’ contributions. I‘he latter, entitled ‘On being an editor or contributor in medical publishing’, although most informative, seemed out of place in a book of this nature. Hopefully, the next edition will have something a little more relevant in this section.

On balance, this new series of mini-books presents an innovative way of supplying current information about a rapidly expanding

speciality. The question the publishers wish to answer is whether I am prepared to buy it. Whereas the content is certainly worthwhile, I could not justify to my bank manager the purchase of two thin hardback books each year. For a text of this length, supplying a limited amount of information, the publishers would be well advised to produce a cheaper ‘paperback’ version. If they did so, I am sure that it would become a popular addition to the library of most surgeons with an interest in colorectal disease.

Professor ($ Surgery The London Hospital London El IBB U K

N. S. Williams

Diseases of the Veins Pathology, Diagnosis and Treatment N . L . Browse, K . G. Burnand and M . L . Thomas. 192 x 252 mm. Pp. 674. Illustrated. 1988. London: Edward Arnold. f130.00.

The notable advances in phlebology in recent years have not been matched by the availability of major textbooks. This prompts a wider question. How does one obtain effective training in phlebology? Rarely does general surgical training provide a proper experience of laboratory tests, specialist radiology and surgical techniques which have lately become part of the management of complex venous disorders. Even in most vascular units venous disease tends to receive short shrift, as surgeons seek to stem the rising tide of ischaemic legs and aneurysms. Surely if vascular training is to mean anything it should provide a surgeon capable of giving expert care for patients with a range of vascular problems which includes complicated venous and lymphatic diseases. These are more difficult to manage than arterial disease. Of course, primary varicose veins d o not demand specialist care, but even here the scope for improved management is immense.

Consider the trainee surgeon, often unsupervised, coming up for air amid the thronged varicose vein clinic, scratching his brow over chronically ulcerated legs or toiling over the venous remnants of the operating list. What should be his uade mecum? Much has changed since the last edition of that familiar classic from the same stable ‘Dodd and Cockett’.

Having established the need, is this book the answer? The aim was to produce ‘a practical readable book containing something for medical students, residents and consultants’. A modest enough aim, which in the event has been exceeded. It begins very well with a canter past the venous milestones in medical literature, beginning in 1550 BC and tactfully reigning in at 1960. It goes on to deal with virtually every venous disorder except portal hypertension, intracranial diseases and piles.

The anatomy, physiology, radiology and laboratory methods are authoritatively covered and well illustrated. The clinical chapters are rich in practical detail and the referenccs which may number up to 345 per chapter are up-to-date. An excellent chapter on pulmonary embolism is contributed by Dr Graham Miller. The section on chronic leg ulcers is much enhanced by coloured plates.

A reviewer likes to find something to carp about. Why one illustration shows stripping from ankle to groin when the text (rightly in my view) advocates knee to groin was not clear. Perhaps it was part of the authors’ attempt to offer a balanced assessment of the options. Fortunately this is not too balanced, and the reader is seldom left with uncertainty or indecision (unlike many other large textbooks), for the text is liberally spiced with pithy comments and positive opinions highly relevant to patient care.

My main criticism of this book is its ‘utility’ presentation which is not up to modern publishing standards and which does less than justice to the text. The pages appear somewhat crowded and the visibility of figures and print through the poor quality paper undoubtedly detracts from the quality.

Although many textbooks are to be equally admired for their erudition few are such a positive pleasure to read. This book abounds in practical clinical common sense. Both comprehensive and erudite, it escapes the greyness of multiauthorship. It cannot fail to be preeminent in the field for a long time to come.

C. V. Ruckley Consultant Surgeon Royal Infirmary Edinburgh EH3 9YW U K

656 Br. J. Surg., Vol. 76, No. 6, June 1989