Reviews and notices of books

Atlas of Vascular Surgery Robert R . Linton, Boston. 310 X 240 mm. Pp. 504fxoi i i . I l lus- trated. 1973. London: W. B. Saunders Company. f27.65. THIS expensive and lavishly produced work based on the personal experience of an internationally acknowledged master vascular surgeon disappointingly fails to measure up to expectation.

Both the introduction and part 1, dealing with diseases of veins, are strikingly devoid of modern methods of assessment. The section on thrombo-embolic disease is especially poor in this respect, for the radiofibrinogen uptake test, Doppler scanning and the prophylactic effect of subcutaneous heparin, to mention but a few, are not even mentioned. The views expressed regarding management and the vigorous advocacy of venous interruption will certainly not find general accept- ance among surgeons in this country.

By comparison, the sections in part 2, dealing with arterial disease, are of high standard, containing an abundance of prac- tical points, invaluable to the tyro and inducing a sense of dPjir-ou in the experienced. The portions on aortic aneurysmal disease are easily the best in the entire work though even here minor points of contention exist; for example, few surgeons now advocate complete removal of the aneurysm. The management of aorto-iliac occlusive disease is very adequately dealt with, but many would not share the author’s opinion that aortography is seldom indicated, or his strong condemnation of the bypass principle without division of the aorta because of the risk of graft thrombosis.

The saphenous vein bypass for femoropopliteal disease is well described, though some aspects of technique are at variance with those generally accepted. Few British surgeons would agree that total removal of a popliteal aneurysm and its accompanying vein is either wise or necessary, or that superficial femoral vein ligation at the groin should be per- formed as a preliminary to low thigh amputation to prevent subsequent pulmonary embolism.

In the section on cerebrovascular insufficiency, disease of the brachiocephalic trunks is dismissed on one page and the value of bypass procedures for multiple lesions and in poor risk patients is not discussed. Carotid endarterectomy is well described but techniques for vertebral artery insufficiency are not mentioned.

It is regrettable that some portions of this atlas are dis- appointing because the remainder contains much worthwhile practical advice, especially for young surgeons in training. The standard of the colour illustrations is high but their number could be reduced without detriment. The corres- ponding reduction in cost might be an important considera- tion in a book currently priced at f27.65.

G. SLANEY

Roentgen Examinations in Acute Abdominal Diseases J . Friemann-Dahl, Oslo. Third edition. 230 X 150 mm. Pp. 617+ xiu, with 432 illustrations. 1974. Springfield, Ill.: Charles C . Thomas. $29.50. THE third edition of this book which now appears 14 years after the previous one carries the same stamp of authority that characterized the original work. So much of our know- ledge of the radiological interpretation of the acute abdomen has stemmed from this author that it is perhaps hard to realize that much of the information that is now accepted as commonplace was included as original observations in the first edition.

The hospital where the author practised was orginally responsible for much of our knowledge of plain radiography and. more recently, of abdominal aortography, and it is gratifying to see in this new edition the appropriate attention being given to this newer method of examination. Perhaps in the United Kingdom the value and potentiality of arterio- graphy in acute abdominal vascular conditions and in closed abdominal trauma are not yet fully realized.

Throughout this book the superb quality of the radiographs stands out and there is no doubt that many of the errors of interpretation that occur are the direct results of attempts to interpret films of inadequate quality. Perhaps some of the illustrations where the original blocks have been retained show some loss of their original crispness.

In acute abdominal emergencies it is unfortunate that expert radiological assistance which always should be avail- able is often not consulted, as although the dramatic signs of perforation and obstruction are usually easily recognized the finer and less obvious features which may be vital are not appreciated. This book presents an authoritative and detailed study of these features which would well repay serious study.

A few statements that have been carried on from earlier editions such as ‘the importance of fluoroscopy in chest conditions’ could well be edited from future editions, and the too frequently occurring spelling errors unreasonably detract from this excellent book.

Besides the value of this authoritative book to radiologists, it should be readily available for reference in any emergency department where radiological investigations of the acute abdomen are made.

The publishers of the book maintain an excellence and quality in keeping with their other productions for which they have gained universal acclaim.

ERIC SAMUEL

Surgical Technology. Basis for Clinical Practice Mary Louise Hoeller, St Louis, Missouri. Third edition. 245 X 170 mm. Pp. 386+xii, with 295 illustrations. 1974. London: Henry Kimpton. f5 ,20. BRITISH readers may be puzzled by the title. The previous two editions were entitled The Operating Room Technician, which is more explicit to us. The book describes modern American views on the organization, training and practice in the opera- ting theatre. The changed title is intended to reflect the response of theatre staff to technical advances in surgical procedures.

To the surgeon the book presents a hotch-potch of anatomy, operative detail, theatre equipment, anaesthetic and radio- logical techniques, sterile trolley layouts, legal requirements, patient handling and theatre organization. However, a t a time of readjustment within the Health Service, when operat- ing theatre resources are overstretched, progressive American views on the total running of theatres is of great interest to those involved in planning and administration. This book offers a stimulating view of the theatre to those working full- time as nurses and technicians. To the surgeon it displays the careful organization and training behind the efficient scrub- nurse handing him instruments.

R. M. KIRK

Cardiovascular Applications of Ultrasound Edited Robert S . Reneman. 2 4 0 ~ 165 mm. Pp. 462+x0. Illustrated. 1974. New York: American Elsevier Publishing Company. $28.90. THIS book contains the proceedings of an international sym- posium held in Belgium in May 1973. As the editor points out, the importance of ultrasound in cardiology, cardiovas- cular physiology and pharmacology is growing fast, and the contributors to this book include a number of the most active investigators in the field.

In part 1 ultrasonic Doppler flowmeters are dealt with from the point of view of instrumentation and theory. This sect ion includes a discussion on possible harmful biological effects, the problem of noise and the functional limitations of the Doppler flowmeter, methods of display and computa- tion and the problems of quantification. In the next sections the uses of transit time instruments to measure organ dimen- sions and small volume displacements are described, and there follow two sections on the experimental and clinical applications of catheter tip velocity probes and the effects of vascular curvatures and stenoses on the velocity profile. The clinical applications of Doppler instruments in cerebral vas- cular disease, for coronary artery blood flow measurements, in peripheral arterial disease, in venous disease and for the non- invasive recognition of heart disease are fully discussed.

In contrast to the 389 pages devoted to Doppler ultra- sound, flow measurement and experimental applications, the use of pulsed echo for cardiac diagnosis occupies less than 50 pages. Since many would consider this to be the most important and exciting development of ultrasound, the un- even weighting is disappointing to say the least. The section

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