Surgical pathophysiology

Surgical pathophysiology

942 Book Reviews The high risk foot in diabetes meUitus Robert G. Fryberg, ed. New York, 1990, Churchill Livingstone, 569 pages, $89.95. This book i...

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The high risk foot in diabetes meUitus Robert G. Fryberg, ed. New York, 1990, Churchill Livingstone, 569 pages, $89.95. This book is a comprehensive, up-to-date analysis of diabetic foot problems. The list of authors represents a wealth ofmultidisciplinary experience that is appropriate to this difficult clinical problem. The chapters on vascular disease, noninvasive studies, angiography, and vascular reconstruction ~ be appreciated by vascular surgeons. The authors provide a fairly detailed basis for modern clinical management of vascular disease in the diabetic. Other chapters on the neuropathic foot, biomechanics, orthotics, and footgear are well written and provide much practical knowledge. Chapters on total contact casting, oxygen therapy, and the use of antibiotic-loaded bone cement did not represent the same level of scientific rationale or legitimacy. Numerous photographs throughout will help the uninitiated reader understand that successful outcome with the diabetic foot can be achieved through many approaches and the final product comes in many shapes. Vascular surgeons caring for significant numbers of diabetics with foot problems will find this book a valuable resource in daily clinical practice. Frank LoGerfo, A4D New England DeaconessMedical Center

Surgical pathophysiology Ansgar O. Aasen, Bo Risberg, eds. New York, 1990, Harwood Academic Pub., 452 pages, $65.00. This multiauthor text is organized into two principle sections: "General Pathophysiological Aspects of Surgical Disease" and "Organ Specific Mechanisms." All authors are prominent surgeons or anesthesiologists from Scandinavia with substantial research and clinical experience. The book can be best appreciated as a collection of independent reviews by experts in the field. Although 24 topics are covered, the book does not present a unified or comprehensive approach to surgical pathophysiology. Some chapters focus on extremely narrow areas such as radiation injury to the small intestine, complement activation during open heart surgery, ~aad prophylactic use of antibiotics in gastrointestinal surgery. Three chapters concern the role of proteases in critically ill patients and pancreatitis. Several sections are of specific interest for vascular surgeons. These include a review of hemodilution and tissue oxygenation, which is somewhat cursory and emphasizes effects of hemodilution during cardiopulmonary bypass. The role of oxygen radicals in posthypoxic reoxygenation tissue injury is better elucidated, providing a strong introduction to the topic and complete references. Hemostasis and vascular endothelium is presented in a concise fashion with reference to recent studies on endothelial seeding of prosthetic vascular grafts. The chapter on thrombolytic problems in surgical patients is also readable and complete.


In sum, this text represents an interesting if uneven collection of essays on surgically relevant topics. Because of multiple authors, it does not provide a consistent approach to underlying mechanisms and clinical manifestations. The references in some of the chapters are outdated. Such a text could stimulate the research interests of a young resident or trainee and, in selected areas, may provide useful information for a practicing surgeon. Unfortunately, the portion of the book related to vascular surgical topics restricts its usefulness to the practicing vascular surgeon and more current reviews are available in the peer reviewed literature. Bruce L. Gewertz,M_D Department of Surgery University of Chicago

Recent advances in noninvasive diagnostic techniques in vascular disease Eugene F. Bernstein, ed. St. Louis, 1990, Mosby-Year Book, 373 pages, $67.00. Dr. Bernstein organized an international meeting in 1977 to bring together many of the recognized experts in noninvasive vascular diagnosis and to document how these new, rapidly evolving techniques were being applied clinically. The proceedings of that meeting were published the following year as the first edition of Noninvasive Diagnostic Techniques in Vascular Disease, which has become one of the standard texts in this field. The most recent edition of that comprehensive text was published in 1985. The present monograph is a shorter (3,73 pages), somewhat eclectic, summary of recent advances in the noninvasive diagnosis of vascular occlusive disease that have occurred during the 5 years since the publication of the most recent edition of the parent volume. The book is divided into 12 sections of two to five chapters each. Most of the authors are recognized authorities and have written extensively on their assigned topics. After some initial background information, there is a section that focuses on the qualifications and training of the vascular technologist as well as the laboratory's director. The new technique of color-flow Doppler imaging and its current clinical indications are clearly discussed in the subsequent section that contains numerous wellreproduced color plates. Section IV on Transcranial Doppler (TCD) Sonography is particularly notable and reflects Dr. Bernstein's personal interest and leadership in this area. The principles and clinical application of conventional TCD sonography are followed by an authoritative discussion of the more sophisticated, three-dimensional technique. Since TCD sonography is not widely offered in most vascular laboratories, this section might be of particular importance to vascular surgeons unfamiliar with its applications. Two additional sections on carotid artery plaque and asymptomatic carotid stenosis are followed by a section devoted to the intraabdominal applications of duplex scanning. The technical details of each type of testing are