dents. The Editor and the main contributors are surgeons and paediatricians at the Queen Victoria Children's Hospital,. Monash University, Melbourne, Australia.
Ann R Coll Surg Engl 1994; 76: 71-74
Book reviews An Aid to Paediatric Surgery by R A McMahon. 2nd edition. 267 pages, illustrated. Churchill Livingstone. 1991. £15 .95. ISBN 0 443 04185 7 This is the second edition of a popular book of paediatric surgery intended primarily for medical and paramedical students. The Editor and the main contributors are surgeons and paediatricians at the Queen Victoria Children's Hospital, Monash University, Melbourne, Australia. The book has an international flavour with contributing chapters by authors from the United States, Nigeria, New Zealand and India. The book is available in paperback 24.5 cm x 19 cm with 267 pages. The chapters and the sections within the chapters including the tables, figures and references are clearly laid out and should provide attractive reading for the student at his or her desk. The inherent disadvantage of the size of the book is that it cannot easily be carried around in the pocket of the white coat. The book has been written in a problem-orientated style with chapters such as 'An approach to lumps and swellings', 'Abdominal pain', 'Gastrointestinal bleeding', etc. This approach is particularly attractive for a small group seminar or tutorial teaching. The list of differential diagnoses of common paediatric surgical presentations is clearly presented and the investigations and management of the individual conditions are then discussed individually in following sections. There are some useful and some less useful mnemonics, for example 'Causes That Very Inconveniently Produce Noxious Disease' is supposed to help us remember Congenital, Traumatic, Vascular, Inflammatory, Parasitic, Neoplastic, Degenerative causes. The text is written in simple English, which makes for very easy and pleasant reading. I like the opening chapter which is entitled 'The physiological differences between adults and children', setting the scene for the reader to realise why paediatric surgery is not general surgery in miniature. The second chapter outlines the basic concepts of fluid and electrolyte balance, nutrition and pre- and postoperative care. I find the section on nutrition too brief. Neither enteral feeding nor more particularly parenteral nutrition are covered in any great detail. In modern-day paediatric surgical practice parenteral nutrition plays a very important role in the management of sick surgical infants. There is also, perhaps, a lack of emphasis of several developments which have led to the great improvement in the results of paediatric surgery in general and neonatal surgery in particular. The concentration of experience and expertise of both paediatric surgery and paediatric anaesthesia in regional centres may be well-accepted knowledge in Australia. In this country medical students, the majority of whom will become general practitioners and consultants in district hospitals, may not be familiar with the idea that management of paediatric surgical patients by surgeons and anaesthetists on an occasional basis is inappropriate and is associated with a higher morbidity and mortality (see national CEPOD report). The subsequent clinical problem-orientated chapters are usually comprehensive, up-to-date and well illustrated. With this approach, however, there is necessary overlap as many surgical conditions and their complications can present in different ways, hence some conditions are discussed in several
chapters but not in sufficient detail in any of the chapters. In particular, important conditions such as necrotising enterocolitis and intussusception do not receive sufficient coverage. In the second edition three new chapters on child abuse, sport and ethics have been added and are to be welcomed. In particular, the chapter on ethics is well written and stimulating. This is an affordable textbook for medical students and should be made available in medical libraries, medical schools and departments of paediatric surgery. Trainees in general surgery and paediatric surgery will also find the book easily readable, refreshing their basic knowledge required in the management of paediatric surgical patients. Because of the lack of detail in the embryology, pathophysiology, incidence, clinical presentation and management of individual paediatric surgical conditions, reading will have to be supplemented by the availability of a conventional paediatric surgical textbook. PAUL TAM Clinical Reader in Paediatric Surgery John Radcliffe Hospital Oxford
Surgery: Scientific Principles and Practice edited by L J Greenfield, M W Mulholland, K T Oldham and G B Zelenock. 2208 pages, illustrated. J B Lippincott. 1992. £80.00. ISBN 0 397 51121 3. Do not be put off by the size of this book when you see it on the shelf. Two thousand pages of small typeface are an intimidating prospect for reader and reviewer alike. I do not claim to have assimilated every word, but have dined regularly and, to my surprise, have not suffered mental indigestion. Throughout the book the standard of illustration is excellent with clear two-tone drawings, although some of the plain radiographic reproductions lack definition. The index is excellent. All the contributors are from American medical schools, and about one-third (including the editors) are from the University of Michigan Medical Schools in Ann Arbor. Despite the large number of contributors (155) there is uniformity of a pleasingly direct style. While the names of many of the contributors will be well known, a significant proportion of the authors are younger surgeons and scientists. In the words of the editorchief 'Their fresh and pragmatic approach enhance both the substance and readability of the book.' One can only agree. It would be an understatement to assert that this is a comprehensive modern textbook of surgical practice. For coverage of all aspects of clinical surgery it has few rivals. However, its real strength, and to me its greatest attraction, lies in the initial section dealing with 'Scientific Principles'. Starting with an excellent account of cell structure and function, the integration of basic science and clinical relevance is refreshing throughout. I particularly enjoyed (and learned much from) the sections dealing with Shock and Critical Care. The chapter on Trauma is, as to be expected in a transatlantic text, comprehensive; of particular merit is the integration of trauma management in a way that ignores specialty divisions. Like the opening section on cell biology, the chapter on Tumour Biologyis upto-date (for a major textbook) and well illustrated. Transplantation and Immunology are considered together. Throughout
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this first section the references comprise a sensible mixture of 'classic' papers and contemporary. Part II of the book deals in a systematic way with clinical surgical practice, each section beginning with a brief account of the anatomy and physiology of the relevant organ or system. The operative details are too brief to suffice for a young surgeon seeking practical guidance, but that is not a significant failing in a book of this nature. Despite its size and weight, I enjoyed this book. I actively anticipated reading large parts of the section dealing with Scientific Principles and have learned a good deal from the book. It is a volume that every medical library should have. Its use should not be restricted to those preparing for the FRCS; it is too good an account of modern scientific surgery to be left entirely to those in training. TERENCE J DUFFY Consultant Surgeon The North Staffordshire Hospital Centre Stoke-on-Trent
Paediatric Surgery: A Colour Atlas by Don K Nakayama. 153 pages, illustrated. Gower Medical Publishing. 1992. £59.50. ISBN 1 56375 012 0. This well-presented hardback book is aimed at trainee surgeons and paediatricians, is based on a lecture series given to such trainees, and grew from a chapter written for the larger tome of An Atlas for Pediatric Diagnosis. Initial glances reveal a book set out in orderly fashion with chapters based on a lecture series. The intention was to have a book where the text supplements the illustrations, rather than the more usual opposite, and thus the text is brief and the reader is expected to use a reference text for expansion on the theory of the condition. On closer reflection of the book, one is somewhat disappointed to realise that it is as it says-a book based on slides for a lecture series. It lacks a degree of priority and proportioning of the text and photos, and one feels that the author used all his available lecture material instead of setting out the text and then searching out the best photographic examples to demonstrate his interesting and valid points. Unfortunately, some of the slides do not reproduce well, especially the radiographs, as these lack sufficient black/white differentiation to see clearly the points the author is making. In a lecture, the lecturer points at the slides to identify a particular area, but very few of the figures in his book have arrows or distinct labels to help a trainee identify the specific point in question. Some topics have repetitive photographs, eg oesophageal atresia without fistula, malrotation and volvulus, bilaterial congenital hydroceles, and one feels that the author cannot decide which figure to use, and so uses them all, instead of being more selective and leaving space for other topics. He occasionally has single or multiple photos of an exceptionally rare topic; beautiful figures, but not perhaps useful for trainees when common conditions have not been included. The book does reflect the wide variety of topics on which paediatric surgery is based, and in many aspects does cover those topics. There are some omissions, however, and in a text entitled Paediatric Surgery all the usual conditions ought to be mentioned, and preferably illustrated in an atlas. It is a very pleasant book to have in a library for browsing consultation, but probably not particularly helpful for a trainee to purchase. There is, however, a comprehensive and up-to-
date bibliography, which will certainly be useful for the trainee wanting further information on the topics. JENNY WALKER Consultant Paediatric Surgeon Sheffield Children's Hospital
Practice of Surgery: Urodynamic and Reconstructive Surgery of the Lower Urinary Tract by A R Mundy. 376 pages, illustrated. Churchill Livingstone. 1993. £140.00 ISBN 0 443 03348 X. In each generation of British urologists, one or two will be recognised as masters of reconstructive urology, a field so specialised and technically demanding that very few can accumulate enough experience to be expert. Professor Mundy is one such and this book represents his personal view of the subject. It is written with an assertiveness which will be instantly recognised by those who know the author. The sure-footed vigour makes for a very good read-this is a book both enlightening and entertaining. The elegant illustrations by Philip Wilson match the clarity of the prose so that it is always absolutely certain what both mean. This is not an all-inclusive account of urodynamic and reconstructive surgery and does not claim to be one: remarkably rare and remarkably common procedures are excluded along with operations properly done by paediatric urologists. There are three sections. The first covers general postoperative management, incisions and exposure. The second is devoted to urodynamic problems and the third to reconstructive urology. In both of these latter sections there are some operations, like the surgery of stress incontinence, which are well within the range of the general urologist. Here the value is in the systematic approach to patient selection and the useful practical tips. Others, like cystoplasty, appear infrequently on operating lists outside specialist centres. For the surgeon embarking on an unfamiliar procedure there is enough careful detail to restore flagging confidence. Finally, there are out of the way procedures like urethral reconstruction in women, and probably artificial sphincter implantation, which are best left to the expert. Experienced urologists will value this beautiful book. The trainee who needs to survey the field could hardly find a more enjoyable way to do it. If there is a danger with the style it is that it gives an excessive sense of certainty. In his disarming preface, Tony Mundy acknowledges that his readers might need help "to maintain a healthy degree of scepticism as they read the book". With a guide who knows the way so well, it is sometimes difficult to recognise the real choices and uncertainties which exist. CHRIS FOWLER Consultant Urologist The London Hospital
A Short Practice of Spinal Surgery by H V Crock 2nd, Revised Edition. 338 pages, illustrated. Springer-Verlag. 1992. DM228. ISBN 3 211 82351 4. It is a pleasure to be asked to review the second edition of this important monograph by one of the giants in the field of spinal disorders. This work is not and does not pretend to be a comprehensive description of surgery for spinal disorders, so I do quibble somewhat with the title because conditions such as scoliosis, fractures and tumours are not considered. This volume is
