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Surgery: Scientific principles and practice

1997; Elsevier BV; Volume: 26; Issue: 5 Linguagem: Inglês

10.1016/s0741-5214(97)70112-5

1097-6809

James R. May,

Health and Medical Research Impacts

Surgery: Scientific principles and practice Lazar Greenfield, Michael Mulholland, Keith Oldham, Gerald Zelenock, and Keith Lillemoe; Philadelphia; 1997; Lippincott-Raven; 1784 pages; $110. The editors of this volume set out to develop a new textbook of surgery that would balance scientific principles and clinical practice. Their aim was to present new knowledge in the basic sciences in a readable and well-illustrated format. In this, they have been very successful. To the basic topics of cell biology, metabolism, inflammation, immunology, and wound healing have been added information on gene therapy and cytokines. This portion of the book is extremely well written, easy to understand, and well referenced. The commitment to scientific principles is not limited to the basic topics but extends throughout the book. Each chapter contains the scientific basis for the clinical features and a rationale for treatment of diseases in the various organ groups. One of the features of the book is the standardization and high quality of the illustrations and figures, all of which have been prepared by the one group of medical illustrators. The preface to the first edition states that the editors expected the book to be as useful to experienced practitioners as to students and residents in surgery. There can be no doubt about its use for experienced practitioners and residents. The consistently high standard of contribution from all authors make this volume one of the outstanding references in surgery. As a textbook for students, however, it has some deficiencies. With the exception of acute gastrointestinal hemorrhage, common presenting symptoms such as jaundice and hematuria are not dealt with. In the teaching of medical students, an approach to these presenting symptoms is important and difficult for the student to access in a system-based textbook. There is also a tendency for very basic principles of surgery to be buried from the student's sight in large textbooks. There is much useful information on hernias in the groin for instance, but not a clear-cut statement on how to differentiate inguinal from femoral hernias with relationship to bony landmarks. Similarly, it is important for students to understand how to distinguish between swellings that arise in the scrotum from those that arise in the inguinal region and extend into the scrotum. This information, however, was not included. From the student's perspective, one must also question the balance in a textbook of 1784 pages in which 387 are devoted to vascular surgery and 12 to orthopaedic surgery. Overall, the textbook is current, with recent references included. One exception is the absence of lymphatic mapping in the management of melanoma. Because this is a fundamental change in our knowledge of how melanomas metastasize and has important implications in the treatment of lymph nodes not only in melanoma but in other tumors, it could reasonably be expected that this topic would be covered. Despite these few shortcomings, the textbook represents great value at the listed price and can be highly recommended for residents and experienced practitioners.