Reviews and notices of books 75

Atlas of Applied Vascular Surgery Kiyoshi lnokuchi and Akira Kusaba. 295 x 210 mm. Pp. 198, with 301 illustrations. 1976. Tokyo: Igaku Shoin. $42.

kidney conditions including calculous disease. The final sec- tion deals with urinary diversion above the level of the brim of the pelvis.

PROFESSOR Inokuchi is one of the pioneers of the design of vascular stapling devices and much of this beautifully produced monograph presents technical applications of a relined stapler of his own design, but this is more than an atlas of vascular techniques. Inokuchi is an established authority on the surgery of portal hypertension and those interested in this subject will find details of ingenious procedures little known outside Japan. Inokuchi and Kusaba published their results of left gastric venous-caval shunt in 1968. The method that they now describe uses an interposed saphenous vein graft, joined to the divided left gastric vein by a stapled anastomosis and to the side of the inferior vena cava by suture. The intention is to decompress gastro-oesophageal varices with minimal lowering of the portal venous pressure, and analyses of the results in 100 patients seem remarkably good. Experience with a modified splenorenal and with selective splenorenal anastomosis is also described.

Another technical innovation is anastomosis (stapled) of the left suprarenal vein to the inferior mesenteric vein in advanced breast cancer. When combined with right adrenalectomy, the rationale is to allow inactivation of adrenal oestrogen by the liver, whilst preserving endogenous corticosteroid production and avoiding the need for steroid replacement. This procedure (with bilateral oophorectomy) is reported in 90 patients, with results that compare well with conventional series after bilateral adrenalectomy.

Among the variety of other techniques described and illustrated are rejoining severed arms, free jejunal transplant for replacement of the cervical oesophagus, gastric tube pedicles with and without anastomosis to the neck vessels, carotid reconstruction for Takayasu’s arteritis and the use of arterio- venous anastomoses in preserving patency of vascular re- constructions in the presence of a poor distal run-off.

Progress in surgery might perhaps be seen as a rather unpredictable game of leap-frog, in which surgical technique and surgical physiology alternately appear a jump ahead. This is a stimulating and exciting book, the delights of which are enhanced by the knowledge, characteristically unrevealed in the text, that the numerous accomplished and elegant drawings are the work of Dr Kusaba himself.

MARTIN BIRNSTINCL

Operative Urology. The Kidneys, Adrenal Glands and Retroperitoneum EditedBruce H. Stewart. 280 x 215 mm. Pp. 361 +xii.lllustrared. 1975. Baltimore: Williams & Wilkins. $39.50. THIS book, which is a cooperative effort of the Departments of Urology and Colon and Rectal Surgery at the Cleveland Clinic, Ohio, is a curious work and not an easy one to review. The subject matter has been chosen as the surgery of the kidneys, adrenal glands and retroperitoneum and it is unusual to have a book on operative surgery which confines itself on an anatomical rather than on a pathological basis. Having said this, one can go on immediately to state that it is beauti- fully produced with a profusion of excellent illustrations which are clearly drawn and will be a help to a surgeon who wishes to know the details of any of the operations which are described.

There is an opening section on general information which is concerned mainly with basic anatomy and the preparation of patients. The X-rays which accompany this section are remarkably clear and well chosen.

The next section deals with operations on the adrenal gland; the indications for these lie mainly in the province of the surgeon interested in endocrine or cancer surgery. The following section on operations on the kidney is very much the province of the urologist, while the section which deals with procedures in the peritoneum would be most valuable to the cancer surgeon or the surgeon interested in hyper- tension and certain vascular procedures. The main bulk of the work concerns itself with a variety of operations for

One presumes that another volume is intended which will deal with operative procedures below the brim of the pelvis, though this is not specifically stated in the preface or any- where that the reviewer has been able to find.

Turning to the actual operations and methods which are described, one finds a curious mixture of standard procedures and some very modern and up-to-date methods and here and there references to methods which have been relegated to the category of historical by most surgeons. For example, in describing a procedure for staghorn calculi it is surprising to find a recommendation to use the old so-called ‘bloodless plane’ for doing an extensive nephrotomy. This is dealt with at some length while the more modern and much more helpful method of local renal hypothermia is dismissed in one short paragraph. In fact, renal hypothermia does not find a place in the index at all.

In the part dealing with intestinal conduits there are some beautiful illustrations of the use of auto-suturing instruments, which clearly appeal greatly to the authors but which would be available in very few British hospitals.

As is so commonly the case in American textbooks, the references at the end of each chapter are almost exclusively American, there being very few references to British or conti- nental sources.

This book, in the reviewer’s opinion, would be useful in a hospital or medical school with a library designed for the use of registrars and those in training, but it is doubtful whether any established surgeon would be eager to buy it at the price of almost $40.

ROBERT COX

Standard Orthopaedic Operations John Crawford Adams. 250iox 195 mm. Pp. 384, with 267 illustrations. 1976. Edinburgh: Churchill Livingstone. f10. THE author of this book has an established and well-earned reputation for his ability to instruct and educate the young surgeon. His previous works on clinical orthopaedics have become required reading, and rightly so. This volume covers all the standard orthopaedic operations which a surgeon in training is likely to face independently. It is rare, nowadays, for one author to undertake the writing of an entire book of this type; such manuals are usually a compendium by multiple authors. It is an ambitious task and one in which he has succeeded well.

The range of standard orthopaedic procedures is described with the author’s characteristic clarity. The text is brief and unencumbered, and the line drawings with which he has chosen to illustrate the main details are a model of simplicity. It is difficult, if not impossible, to fault this publication. If the reader does not get beyond the first two paragraphs of the introduction-and this is highly unlikely-he will already have learned lessons of lasting importance to his surgical career. The opening sentence sets the style: ‘It is well to remember that the operation that the surgeon approaches as a matter of routin-ften even casually-may, for the patient, be a major event of his life’, and further: ‘Thus it behoves a surgeon, each time that he operates, to put himself for a moment in the position of the patient’.

This book will enjoy a long and lasting reputation and one may expect reprints and further editions within a comparatively short time. One small suggestion only for future editions: since each standard orthopaedic operation usually carries with it a particular hazard, would it not be helpful to define the hazard as a comment to each operation? For example, the operation for de Quervain’s disorder risks damage to the terminal branches of the radial nerve; excision of the head of the radius risks damage to the posterior interosseous nerve, etc. In view of the readership for whom the book is intended, such a precautionary note at the end of each operation might be very helpful.

L. KESSEL