Effort-Related Axillosubclavian Vein Thrombosis

Dr. Mehigan, we have been concerned about the dan- ly, excise it, and restore the normal venous anatomy as gers of long-term coumadin treatment, particularly in closely as possible. young and active patients. This concern is amply docu- The morbidity of resection of the medial clavicle is mented in the literature. With regard to balloon angio- minimal. The cosmetic effect is not unsightly at all: in plasty, I do not favor its use in these patients because I heavily-muscled men, it is almost completely inapparent. think that early restenosis is virtually sure to occur. I suspect that in a young, slim woman, there would be

I believe that one should address the lesion itself direct- some deformity from the removal of the clavicle.

Continued on page 86.

Book Reviews (cont’d)

patients hospitalized on a surgical service are malnour- ished, higher than noted in Chapter 9. The omission of a balanced presentation detracts from the impact of the author’s argument. In the elderly population, parotitis and decubitus ulcer are not the complications generally seen, rather a combination of aging, drugs, and altered physiology are what usually increase the risk and lead to septic or cardiopulmonary complications superimposed on a less resilient, adaptable, and responsive organism.

These deficiences aside, there is a message of preven- tion of operative complications through proper prepara- tion that is evident throughout the text. This is an impor- tant message and one that all surgical trainees should be aware of. The specifics given are, however, regional, which limits their universal applicability.

A. Get-son Greenberg, MD San Diego, California

Current Emergency Diagnosis and Treatment. 2nd Edition. By John Mills, Marty T. Ho, Patricia R. Salver, and Donald D. Tnmkey. Los Altos, CA: Lange Medical Publishers, 1985. 864 pages.

Although the majority of the editors and contributors to this book represent specialties other than emergency medicine, they have succeeded in presenting a useful vol- ume that is especially worthwhile to students and house staff facing their first experiences in the emergency de- partment.

Of particular interest is the organization of the first I4 chapters, wherein the simultaneous evaluation and treat- ment of seriously ill patients who have signs and symp- toms of disease but whose diagnosis is as yet unknown is presented. These discussions of common presentations, such as coma, chest pain, syncope, dyspnea, and so on, give the reader an organized approach to diagnosis and management which often must occur almost simulta- neously in the emergency setting. This section contains many useful tables summarizing the differential diagno- sis of common signs and symptoms of disease. Similar information is also presented in the form of algorithms, which although popular in recent textbooks, leave little room for the nuances of presentation common in the majority of patients.

The remainder of the work is organized along more traditional lines, with individual chapters covering each category of emergency problem. Although most of these chapters are rather brief, essential material is covered, and they are generally well referenced. Discussions of treatment are appropriately limited to treatment usually performed in the emergency department, and guidance is given for the disposition of patients. There is an extensive chapter on emergency procedures, with adequate illustra- tions. Specific sections cover prehospital care, emergency department administration, and the handling of mass casualties.

While not a reference text for emergency medicine resi- dents, it is nevertheless a valuable book for students and house staff rotating through the emergency department.

Donald M. ikomas, MD Louisville, Kentucky

Cutaneous Melanoma. Edited by Charles M. Balch and Gerald W. Milton. Philadelphia: J. B. Lippincott, 1985. 538 pages. $69.00

This is an encyclopedic review of the current status of knowledge regarding cutaneous melanoma that is edited and primarily authored by two superb surgeons who have contributed significantly’to our understanding of melano- ma. The book is a typical quality Lippincott publication with illustrations, typeface, and style of presentation that make it extremely clear and easy to read.

Although is suffers considerably from its large size, it would make a most appropriate addition to any medical school library. It tells virtually everyone more than they want or need to know about melanoma. Furthermore, a detraction to a number of the chapters by the catalogue format employed, which includes a wide listing and de- tailing of options and opinions without any effort made, in many cases, to bring them to a coherent conclusion with a recommendation that can be grasped by someone not so similarly close to the illness and its current treatment as the authors. The inclusion of more than 100 pages devoted to manifestations of the disease in various parts of the world is not very helpful, since melanoma is quite clearly a single disease with modest variations in promptness of diagnosis.

There is an attempt throughout the book to compare several of the persisting controversies regarding melano-

Volume 152, July 1886 61

Stevenson and Reid

Book Reviews (cont’d)

ma in an objective fashion. On the other hand, the points presented are largely supported by references to the au- thors’ previous works and therefore, a uniformly balanced view of contrary opinion may be lacking. Notwithstand- ing this, there is a description of the useful integration of multimodality therapy which is occasionally appropriate for the patient with clinical stage III and IV disease.

Even in view of the foregoing criticisms, this is the sort of book that will become an appropriate reference source, as it is up-to-date and thoroughly encyclopedic. The com- bination of quality photomicrographs and surgical draw- ings also add to its usefulness as a reference text.

Hiram C. Polk, Jr., MD Louisville, Kentucky

international Trends in General Thoracic Surgery. Voluh~e I. Lung Cancer. Edited by N.C. Delarue and H. Eschapasse. W.B. Saunders, 1985.315 pages.

It seems as if we have the beginning of another series of books from W. B., Saunders similar in make-up to the familiar “Clinics” of various kinds. Although the title of the series may be a bit unwieldy, the concept is a good one. As noted in the foreword, we unilingual and provincial North Americans frequently lack a critical appreciation of the important progress being made in other parts of the world, and this series is designed to correct that deficien- CY.

The editors and publishers wisely chose a convenient size for the volume, 7 by 10 inches, and the text is easy on the eyes and clearly up to the quality we have come to expect from them, which makes the erroneous illustra- tions (Figures lo-l, lO-2, and 10-3) even more mysterious.

This first volume on lung cancer has 27 chapters under four major headings, and 14 of these chapters include discussions. These discussions are a planned feature of the entire series and are written by representatives of the surgical fraternity from other parts of the world in order to add depth and perspective to selected topics.

As would be expected in a multiauthored text, there is a certain unevenness both in writing style and content; however, all of the chapters are valuable and some are outstanding. When Peters writes about perioperative management or Paulson about superior sulcus tumors or the Mayo Clinic group about radiographically occult lung cancer, one is wise to pay close attention because these investigators are apt to be relating the gold standards of knowledge and treatment in the field. Although the infor- mation is not new, it is up-to-date and convenient for reference. One improvement would be the inclusion of chapters on some of the newer diagnostic and therapeutic modalities such as laser therapy and the use of photopor- phyrin derivatives.

The chapters by foreign authors lend valuable perspec- tive to the issues at hand and demonstrate to us in North America, who are often chauvinistic in our thoughts about medical progress these days, that important contribu- tions are also being made from other countries.

I plan to keep this volume handy for reference and look forward to subsequent volumes. I hope the subject area of general thoracic surgery has enough staying power and wide enough reader interest to sustain a series such as this. Volume I is certainly a good start.

James B. D. Mark, MD Stanford, California

Management of Vascular Trauma. Edited by Morris D. Derstein. Baltimore: University Park Press, 1985.195 pages.

This small book specifically deals with noniatrogenic trauma to the vascular tree. The book is reasonably well- organized and begins with a basic discussion of some aspects of the biomechanics of blunt and penetrating trauma. Unfortunately, much of the discussion on biome- chanics deal with ballistics, which although important, bears no special relationship to vascular injury. The intro- ductory section concludes with a discussion of the triage and initial management of patients with presumed or suspected vascular injury.

Four chapters deal specifically with vascular injuries of the neck, thorax, abdomen, andperipheral arteries. These chapters are written by various authors and the approach to each of the problem areas varies greatly: For example, the chapter on vascular injuries to the abdomen contains several sample cases of management of difficulteroblems, such as suprarenal aortic injuries, which are detailed in the initial part of the chapter. In the latter section of the chapter, a variety of injuries are catalogued, including lesions of the portal vein, major visceral arteries, renal artery and veins, and so on. These sections are presented as a review of the literature, in which various series deal- ing with the specific injuries are outlined. Although this approach is very useful and the chapter is well referenced, there is often no mention of operative techniques. The addition of illustrative material would be useful. The section on vascular injuries of the thorax is written by Dr. DeBakey and the group from Houston and outlines many of the principles that they have learned from their vast experience with vascular trauma. Again, the use of illus- trative material to describe approaches would have been helpful in this chapter. The section dealing with traumat- ic arterial venous fistulas has a brief but excellent discus- sion of the pathophysiology of arteriovenous fistulas with several good drawings and tables. There is an excellent short discussion of the treatment of these injuries as well. Perhaps the best-written chapter describes the use of

Continued on page 92.

06 IWI American Journal ol Surgwy