Reviews and notices of books

Surgical Forum-The Liver Edited Rodney Smith, London. 215 X 135 mm. Pp. 163+x. 1975. London: The Butterworth Group. f2.80. THIS volume brings together an international group of surgeons with an interest in different aspects of hepatic surgery. The book aims to capture the atmosphere of a surgical forum and each author presents a chapter after which the others are asked to comment. In general the Editor, Sir Rodney Smith, has succeeded in his

aim in that the book allows the reader a review of the approach of experts to the four subjects covered, namely cirrhosis of the liver and acute hepatic failure, liver transplantation, hepatic trauma and tumours of the liver. The book should be of value not only to the general surgeon but to specialists with an interest i n liver surgery.

The chapter by Alexander Walt on hepatic trauma reflects the immense experience of the Detroit group and gives a balanced view of the subject. Professor Walt makes a strong case for the avoidance of routine T tube drainage for hepatic injury, but the evidence for the avoidance of T tube drainage in the major blunt injury requiring resection is not clear. The use of antibiotics in patients requiring resection is also somewhat scantily dealt with, but these are minor criticisms of an other- wise excellent contribution.

The chapter by Professor R. Y. Calne puts the case for liver transplantation and carries an authority which few people have the experience to question. Perhaps the case against auxiliary liver transplantation is too strongly made. The controversy relating to the wasting of the transplanted auxiliary liver has not been resolved and there is as yet no firm evidence that specific hepatotrophic factors exist. One may be a little concerned about the use of transplantation for various forms of liver cancer, but the chapter by John Dawson makes it clear that the current therapeutic approach to malignancy within the liver leaves much to be desired. Mr Dawson makes a balanced contribution but perhaps underemphasizes the possible value of chemotherapeutic agents used early after diagnosis in the asymptomatic patient.

The remaining chapter on cirrhosis of the liver and acute hepatic failure is from Professor Terblanche’s group at Cape Town and outlines the approach of this experienced team, particularly in dealing with the problem of bleeding varices as a result of portal hypertension. The chapter is perhaps less valuable to the specialist in that the approach to problem areas is somewhat superficial. For example, it is a little dis- appointing to see the hepatorenal syndrome referred to as a complication of operation on cirrhotic patients without further clarification.

Perhaps the most enjoyable feature of this book is the comments at the end of each chapter. In particular, Professor Walt’s criticisms carry the stamp of authority and wide experience. This is a book of value to generalists and specialists alike and succeeds in its aims of bringing the atmosphere of the forum to the reader.

L . H . BLUMGART

Prostheses and Rehabilitation after Arm Amputation L . F . Bender, Michigan. 228 x 150 min. Pp. 179+xo, with 76 illustrations. 1974. Springfield, IN.: Charles C. Thornas. $12.50. THIS little book deals with some of the problems resulting from either upper limb amputation or congenital arm deficiency, as seen in the United States. The causative factors and incidence are similar to those in the United Kingdom, vir. a high pro- portion being due to trauma (mostly industrial) and about 20 per cent congenital in origin, compared with 30 per cent in Britain.

It is surprising to note that out of400 upper limb amputations seen by the author, only 9 were performed for lesions of the brachial plexus. He rightly advocates arthrodesis of the shoulder and above-elbow amputation for the complete lesion. The reviewer, however, does not agree with the recommended level of bone section given as 24 inches above the end of the humerus. It should be at least 4: inches otherwise the automatic elbow mechanism, used on British prostheses, cannot be incorporated.

Although there is a chapter on ‘Levels of Amputation’, it gives negligible guidance to surgeons concerning optimum levels. The disadvantages of long above-elbow and below-elbow stumps and O F an elbow disarticulation are not stressed. The problems of fitting a wrist disarticulation are mentioned although these have been overcome in the United Kingdom.

Immediate postsurgical fitting is discussed together with the difficulties experienced. These are due mainly to the fact that the majority of the amputations are traumatic and the various receiving hospitals are not conversant with all the techniques involved. Nevertheless, when such fittings have been performed they have been quite successful. It is universally agreed that the sooner a prosthesis can be fitted the greater the chances of an amputee becoming two-handed agiin. Consequently, the author very rightly stresses the need for early fitting for bilateral amputees.

There is an excellent chapter on postoperative therapy and methods of performing numerous daily tasks onc-handed.

The author has nothing new to offer for the relief of phantom pain although he states ‘acupuncture warrants investigation’. More than two-thirds of the book are devoted to prosthetic fabrication, fitting and harnessing. Although the basic principles are similar there are major variations between the American and British techniques.

Mention is made of a variety of hands and other terminal devices including the widely accepted ‘split-hook’. Credit for the myoelectric hand goes to the USSR, while the pioneer work in this field started in Britain is overlooked! There is, however, no indication of the acceptance rate among American amputees.

IAN FLETCHER

Ferguson’s Surgery of the Ambulatory Patient Edited Murk W . Wolcott, Salt Lake City, Utah. Fifth edition. 250 x 180 mm. Pp. 554+xu. Illustrated. 1974. Oxford: Blackwell Scientific Publications. f13.50. DURING the past decade there has been a growing interest in ‘day case’ surgery in this country. The surgery of the ambulatory patient has advanced further in the United States than here not only because of the mutual problem of pressure on hospital beds, but because, as the Editor states in the introductory chapter, the growing cost to the individual patient in the United States ‘has nearly priced the average citizen out of the health care market’.

Our ability to carry out an increasing range of surgical procedures without admitting the patient to hospital is largely due to the considerable advances in modern anaesthesia, which is discussed in the extremely informative chapter by Dr Edwin L. Rushia.

The selection of material for such a book must be extremely difficult and, by and large, the Editor is to be congratulated on the range of topics he has chosen. Not only are the usual procedures for ‘minor surgery’ described in detail, but there is important information dealing with the relatively minor surgical procedures which are often required for the satisfactory care of patients discharged from hospital following major surgery.

In a book with such wide coverage it is inevitable that a number of oddities will appear. To find axillary boils (‘hidradenitis suppurative of axilla’!) in the same chapter separated by only a few pages from fractures of the scapula, including its rarer forms, is perhaps somewhat surprising. Although it is doubtful whether British surgeons would find it acceptable to treat in an outpatients’ department malignant disease of the oral cavity, the chapter on cryosurgery by Dr Andrew Gage does open up important new vistas. The chapter on the breast has a number of surprises: can intra- ductal papillomas be dealt with satisfactorily in an outpatients’ department, and is this the right book in which to describe in detail the technique of an operation for gynaecomastia?

In spite of these occasional excesses, the book contains a vast amount of serious practical information. The illustrations are simple and clear. A young house surgeon, casualty officer or general practitioner wishing to continue the active personal care of his patients following major surgery would do well to peruse this book and keep it on his shelf.

L . KESSFL

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