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polyps that have any malignant potential. The much more common hyperplastic polyp does not become malignant. Diagnosis of EGC is probably best made by endoscopy and biopsy, but good double contrast radiology also plays an important part, particularly in mass screening programmes. The whole question of mass screening is discussed, and it is clear that its cost effectiveness in Europe would be unacceptably low. However, selective screening is advocated in the well-defined, high risk groups. Surgical management is discussed, but not all surgeons will readily accept the German advocacy of total gastrectomy with wide lymph node clearance for all cases of early gastric cancer.

Many symposium proceedings are dull and repetitive, with much overlap. It is refreshing to report that these proceedings have been admirably edited by Dr Peter Cotton so that they are easily read in an hour or two. There are good references and the whole booklet is most strongly recommended to all abdominal surgeons, endoscopists, physicians and gastroenterologists. If all multi-discipline subjects were handled in such a compact and yet readable way, the clinician’s lot would be a great deal easier. It is usual today to comment on the high price o f a book, but this little book was supplied free, to me at least, by the generosity of Smith. Kline & French!

T. KENNEDY

Recent Advances in Clinical Oncology 1 C. J. Williunis und J . M. A . Whitehouse. 230 x 155 mm. Pp. 405 +xiii. Illuslruted. 1982. Edinburgh: Churchill Livingstone. fI9.50. ‘CLINICAL ONCOLOGY’ is a term which covers a multitude of disciplines. All too often however, the reader of books and articles on this subject finds that he has strayed into pure cancer chemotherapy and that clinical oncology has become synonymous with medical oncology.

This book, expertly edited by Dr C. J. Williams and Professor J. M. A. Whitehouse, is a refreshing surprise. While there is, of course, a good deal of chemotherapy, the title is broadly interpreted, and histopathology, radiotherapy and surgery all receive considerable attention.

For the surgical reader, there is a useful summary article on computed tomography in diagnosis and assessment of cancer by Kreel, and the value of this investigation in many fields, is concisely described. The modern management, and improved outlook in testicular cancer, is covered by chapters on tumour markers, radiotherapy and chemotherapy. An excellent series of contributions deals with ovarian carcinoma. Bladder cancer is considered in all its aspects in a concise chapter by Donohue and Rowland from Indianapolis. The lymphoma section is interesting and deals with very specialized aspects. Isaacson and Wright point out the relationship between coeliac disease and later, developing malignant intestinal histiocystosis. Coleman and Krikorian make interesting observations on ‘second malignancies in patients treated for cancer’. They point out the risks of further cancers in patients treated by both radiation and chemotherapy. The section on breast cancer is both interesting and provocative. Veronesi, while describing his trial of breast conservation with wide excision and axillary dissection, makes the point that this is acceptable only in early cases and that mastectomies of various sorts are essential where there is the larger tumour. When local removal is carried out in his trial, then radiotherapy lo radical dosage automatically follows.

I t will be interesting to see over the years whether further disease in the remaining breast tissue can be shown to be prevented in the patients in his series. There remains the query of delayed appearance of further new primary foci of cancer, years after radiotherapy. It is of course widely known that radiation can be carcinogenic in the breast tissue of young women who would be the most grateful recipients of conservational therapy. The theme is developed further by Martinez, who gives an excellent account of the state of the art in primary radiotherapy for breast cancer, and time will tell whether the radiation oncologist will assume a more major place in the treatment of early breast cancer.

Finally, good chapters on the psychological assessment and consequence of cancer make excellent reading, and close this useful summary of contemporary multi-disciplinary knowledge. The editors and contributors are to be congratulated, and so too are the publishers, who have contrived, by good limp back binding, to keep the price down to f19.50. This book should be in the libraries of all hospitals where cancer is treated.

P. S. BOULTER

Book reviews

It is a strange collection of essays with evidence of poor editing. The first chapter gives a fairly standard description of Raynaud’s phenomenon, with little that can be found outside a n up-to-date vascular textbook. The second chapter deals with the microcirculation in scleroderma and provides a showcase for its author’s studies on the capillary bed of the nailfolds in patients with scleroderma. The third and fourth chapters both deal with the haemorrheology of Raynaud’s disease and come to totally incompatible conclusions. The fifth chapter provides a useful and up-to-date review on the cryoproteins, while the sixth and seventh chapters deal with the difficult and controversial subject of acrocyanosis. In the final chapter the editor has allowed himself the idiosyncratic luxury of two pages for his personal interpretation of ‘Moses Leprosy’, being the earliest record of Raynaud’s phenomenon. I enjoyed reading the chapter on the cryoproteins, but I could hardly recommend buying this book. which costs about f30, for this one contribution.

K. G. BURNAND

Advances in Microcirculation Volume 10. Raynaud Features, Acrocyanosis, Cryoimmunoproteins E. Davis. 245 x I7S mm. Pp. 114 + viii. Illustrated. 1982. Basel; Karger. around U S $60. THIS small book is volume 10 under the umbrella heading of ‘Adimnces in Microcircularion’, it consists of 8 chapters, 6 of which are devoted to Raynaud’s phenomenon and its associated conditions, and 2 to acrocyanosis.

Topical Reviews in Neurosurgery Volume 1 J . M. Rice Edward.y. 220 x 140 mm. Pp. 192 + ix. Illustrated. 1982. Bristol: Wright PSG. f17.S0. N o ONE would quarrel with the idea that advances need to be reviewed. The way in which science (and neurosurgery should aspire to the status of a science) advances, is by piling small facts like grain of sand upon grain of sand, as well as by the flash of blinding light. Most current journals however, d o not create space for review articles, although quite clearly they should. The opportunity has arisen for Mr Rice Edwards to compile a short list of authors who have been willing to write articles on restricted topics, all to do with current neurosurgery. All but two of them are based in London. Two of the London articles are by neurologists rather than neurosurgeons, but are none the worse for that. Interestingly, the reason given for this preference, namely, greater objectivity, applies to all developing and controversial fields, and applies equally to neurological topics. The reason for choosing neurologists for these fields of carotid and vascular bypass surgery is that most British neurosurgeons have done no more than peep into them. The message from these chapters is that a clear picture has not emerged in carotid endarterectomy despite the operation having been practised for a t least 25 years. We are still somewhat uncertain why the operation works. Similarly, the indications for extracranial/intracranial bypass are still developing, and again no clear picture emerges, although the long awaited worldwide trial may shed light on this in the near future. Brian Jennett’s article entitled ‘Efficacy, Efficiency and Adequacy in Neurosurgery’, Fails to come to any conclusions on any of these topics, but reasonably, draws attention to the need for studies in this field. Norman Guthkelch’s article on chronic subdural haematoma illuminates a topic that is nowadays hardly discussed and to d o so in the new context of CT scanning makes a useful contribution. The chemotherapy of gliomas has hardly yet been attended by great success, so that David Thomas’ article is more a report on the battle than a conclusion about who has won. Brian Kendall writes well on the current position in CT, the greatest advance in neurosurgical practice in the last two decades. Lindsay Symon presents his views on surgery in craniopharyngioma, a difficult topic and one which is highly subjective. One applauds his guarded conclusions. The editor contributes a thoughtful article on syringomyelia which serves to show how a simple concept, like the Gardner hypothesis, is insufficient to explain all the features encountered clinically in this fascinating group of conditions which at one time lay entirely within the province of the neurologist.

At a price off17.50 one is bound to provide this kind of book in the library of a unit which trains neurosurgeons. However, most of these contributions will be outdated within two or three years and one wonders whether hardback publishing should concern itself with topical reviews. I enjoyed reading this one and applaud the energy of the authors in making time available from their busy lives. Whether or not there will be further volumes in this series will depend on how this one sells. It would be nice to see it obtain a wide sale throughout the world, and as an example of good sense, written in good English, it has a reasonable chance of doing so.

HUW B. GRlFFlTH

Radiology and Imaging for Medical Students David Sution. 41h edition. 215 x 13S min. Pp. 221 + vii. INustruted. 1982. Edinburgh: Churchill Livingstone. f8.95. THIS little book provides a very comprehensive introduction to radiology and other imaging modalities. All the major medical and surgical conditions, to which radiology may make a contribution, are described. It contains few errors, but many surgeons would take issue with the definition of diverticulitis, the diagnosis of carcinoma of the gallbladder and the use of the barium meal in acute pancreatitis. Unfortunately out-dated investigations, such as pelvic pneumography

Book r e v i e w s

and retroperitoneal air insuftiation, are included. On the other hand, modern imaging methods such as ultrasound and C T scanning have been introduced into this fourth edition. The role of ultrasound, particularly in biliary and liver disease, has been underplayed but the author makes the very valid point that the choice of investigation for any particular patient will be very greatly influenced by the local facilities available. The new interventional techniques in radiology are briefly mentioned, and will provide medical students reading this book with the knowledge that alternatives to standard surgical treatment are now available.

In summary, this is a very useful pocket volume which can be highly recommended to medical students coming on to the wards. Despite the title ’. . ../iw Medicul Students’, most housemen and many final Fellowship candidates would benefit from reading it.

RICHARD MASON

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Operative Ultrasonography Bernusd Sigel. 240 x 155 mtn. Pp. 186 + ix. Illustruted. 1982. Penn.~ylwnitr: Leu & Febiger. $2040. THERE are now available, B-mode real time ultrasound machines and transducer probes which can be used, with suitable sterilization or protection, to obtain high resolution images during an operation. A surgeon wishing to take up intra-operative ultrasound will, however, be faced with a fairly long learning curve. The techniques, initially, seem cumbersome and time-consuming, and the recording and interpretation of the images, can be most difficult. Indeed, it is a salutary lesson. for those apt to criticize their radiological colleagues, to be faced with the humbling and frustrating experience of trying to image the portal vein with a probe held no more than 1 cm away. The slightest pressure of the controlling hand, or probe, or indeed the normal respiratory excursions of the patient, can so easily distort or lose the image.

All of these problems are dealt with in a clear succinct manner in this excellent book by Professor Sigel. The principles and practice of intra- operative ultrasound are laid down, together with advice on instrumentation and sterilization. There are separate chapters devoted to ultrasonography during biliary, pancreatic, renal and vascular surgery; the illustrations of both the techniques and sonograms are clear and numerous. In addition, the author has attempted to make an evaluation of operative ultrasound by comparison with other established diagnostic methods, such as operative cholangiography in the detection of bile duct calculi. High resolution, intra-operative imaging may well change conventional surgical practice, for example, in the demonstration of otherwise undetectable intimal flaps after carotid endarterectomy. However, tiny fragments in the bile duct, and otherwise undetectable small cysts in and around the pancreas, should be noted, but only treated according to accepted principles. With this single proviso, operative ultrasound is safe and there is little doubt that it will be increasingly employed. Any surgeon wishing to embark in this new field should first read this pioneering book.

G . GLAZER

A Practice of Cardiothoracic Surgery M. P. Holden. 240 x 160mtn. Pp. 432i-xvi . Illustrated. 1982. Bri,stol: Wright . PSG. f24.50. THE author has aimed to provide a short textbook for those in training in cardiothoracic surgery. This book spans the whole specialty, including pulmonary and oesophageal surgery, and congenital, ischaemic and valvular heart disease. Minor procedures such as bronchoscopy and chest drains are considered, and there are chapters devoted to intensive care and cardiopulmonary bypass. The recommendations on management are thoughtful, carefully argued and largely unexceptional, but it is difficult, in a subject which is changing relatively rapidly, to avoid controversy. When opinions are expressed as forthrightly and dogmatically as they are here, we can predict that they will meet with considerable argument. The author has usually indicated where a debate exists, but a registrar quoting this book, for example, on the choice of valves. might find himself in disagreement with his seniors. The author lists items for further reading at the end of each chapter but these are cited inconsistently in the text; sometimes obliquely and sometimes not at all. Geographical localization (Stanford, Alabama, Nashville) is insufficient guidance to the appropriate authors. The style is idiomatic--’Only the other day I saw. .’, ‘any well-trained baboon’--and at times discursive with, for example, gratuitous remarks about psychiatry, not appropriate to a concise surgical textbook. But surgeons themselves are not spared. Postoperative bleeding, one of the crosses we still bear, is most commonly due to ‘unutterable carelessness’. This outspokenness, and tendency towards anecdote and hyperbole, does have the favourable result that the reader is continually jolted by the vitality of the language! In summary, this small book is wide-ranging, stimulating and readable, but that is only a personal view.

T. TREASURE

Microscopic and Endoscopic Surgery with the CO, Laser Albert H . Anilrews Jun. und Tiiomus G . Polunyi. 240 x 160 nim. Pp 370+ \ 11. Illu.\trutcd. 1982. Bristol. Wright . PSG. f26.50.

THIS book provides a most excellent summary of the use of the carbon dioxide laser in all its clinical roles.

The history of the medical use of the CO, laser is traced, and the physics of this laser, and its interaction with tissues, is described clearly and in a manner which is comprehensible to the non-physicist.

A number of authors who are, without exception, pioneers in laser surgery within their specialty, describe in detail the clinical uses of this laser. Their opinions are based on a wealth of clinical experiences and, in addition, they indicate clearly where the laser should not be used and where it offers no clear and scientifically-proved advantage over established surgical techniques.

Any book is somewhat out of date by the time it is published and this is particularly true in the field of laser surgery which is developing so rapidly. This book. which is comprehensive in breadth rather than depth, leaves the reader hungry for more information, which may not be easy to find, as few of the references are less than two years old.

Some might prefer a book which covers the use of the CO, laser in a single specialty in greater detail, but insight into the use of this laser in other disciplines is essential to understand the full potential of this most exciting addition to the surgeons armamentarium.

This book must be essential reading for all with an interest in CO, laser surgery as thc introduction to this subject.

J . CARKUTH

Principles of Microsurgical Techniques in Infertility Edited bj, J . Victor Rqviuk tmd N . H . Luuc~ssm. 258 x 168nini. Pp. 294 + sv. I l lustiwed 1982. Nelt. York: Plenum. $35.00. THE scope of this book is broader than might be expected from its title. It includes chapters on the anatomy, physiology and pathology of the fallopian tube, the scientific basis for those interested in tubal surgery. and the treatment of related disease. The instruments, principles and techniques of pelvic microsurgery are well described, and there is a useful chapter on the surgery of the vas deferens by Dubin and Amelar which will be of interest to general and urological surgeons interested in male infertility and sterilization. Conservative techniques for tubal pregnancy are described, and there is a chapter devoted to the medical and surgical treatment of endometriosis which reviews the available experience and controversies well.

The authors are all American, and the individual views of some, are controversial. although the literature and views of surgeons in other parts of the world receive due mention. There is a little repetition, doubtless due to the multi-authorship, and disagreement over some topics such as the use of peritoneal grafts. The routine use of hysterosalpingography and laparoscopy before proceeding to reversal of sterilization. may have some logic, but would not be accepted in the UK. While surgical techniques must be learnt in theatre or laboratory, this book provides essential preparatory reading for those aspiring to contribute to the surgical treatment of infertility. I t will also be helpful to trained surgeons who wish to be informed about the opinions, methods and achievements of their colleagues.

J . STEELE

Munro Kerr’s Operative Obstetrics P. R . Myerscough. 10th diition. 260 x I85nini. Pp. 508+s. Illu.struted. 1982. London: Builli?re Tindull. €25.00. THERE was a time when one read previous editions of Munro Kerr in pieces, i.e. one read about operative obstetric technique from M K but learnt obstetric management and the aims of care from other textbooks. However, this latest edition now contains a great deal of valuable comment on modern obstetric management As well as explaining obstetric procedures in the detail and clarity which has made this book second to none in the past. There are some fascinating sections on induction of labour, modern thought about breech delivery, the management of preterm labour and the fetus of low birthweight. It begins with clear policy statements in discussing the intranatal care of the mother and infant before proceeding to the management of normal and abnormal obstetrics. In addition to the pure description there is much fatherly advice which will enable even inexperienced obstetricians to perform delivery procedures, e.g. breech, with a degree of expertise which has been passed onto them in Munro Kerr. Although the relative ease of performing Caesarean sections in the UK has obviated the need for many of the more obscure procedures, e.g. reductive embryotomy, surgeons and gynaecologists should not forget that in many areas of the world in which they may find themselves, these techniques may be necessary. It is only in this book that familiarization can be obtained. Surgeons and gynaecologists in training will find this volume invaluable and there are many