657

are not found, for instance in sterile cysts, another approachis the use of a highly sensitive immunoassay to assess thehydatid origin of the aspirate.15 Concurrent prophylaxiswith praziquantel and a therapeutic dose of albendazolepostaspiration, we feel, would be advisable until reportsfrom other areas where CHD is endemic confirm our

experience.We thank the physicians and surgeons in Kuwait for referring the patients

to us, Ms Bina Joseph for secretarial assistance, and Kuwait University (grantMI 054) and Kuwait Foundation for the Advancement of Sciences (grant84-07-01) for financial support.

Correspondence should be addressed to P. R. H., Department of

Microbiology, Faculty of Medicine, Kuwait University, PO Box 24923,Safat, 13110 Kuwait.

REFERENCES

1 Matossian RM, Rickard MD, Smyth JD. Hydatidosis: a global problem of increasingimportance. Bull WHO 1977; 55: 499-507

2. Kagan IG Serodiagnosis of parasitic diseases In: Rose NR, Friedman H, Fahey JL,eds. Manual of clinical laboratory immunology. Washington, DC. AmericanSociety for Microbiology, 1986· 467-87

3 Jidejian Y. Collective review of hydatid disease. Int Surg 1957, 28: 125-334 Romero-Torres R, Campbell JR. An interpretive review of surgical treatment of

hydatid disease. Surg Gynecol Obstet 1965, 121: 851-64.5 Schantz PM, Gottstein B. Echinococcosis (hydatidosis) In. Walls KF, Schantz PM,

Bocca R, eds. Immunodiagnosis of parasitic diseases, vol 1. Florida. Academic

Press, 1986: 69-1076 Allen AR, Fullmer CD. Primary diagnosis of pulmonary echinococcosis by the

cytologic technique Acta Cytol 1972; 16: 212-16.7 Vercelli-Retta J, Manana G, Reissenweber NJ. The cytologic diagnosis of hydatid

disease Acta Cytol 1982, 26: 159-64

8. McCorkell SJ. Unintended percutaneous aspiration of pulmonary echinococcal cysts.Am J Roentgenol 1984; 143: 123-26

9 Hira PR, Shweiki HM, Siboo R, Behbehani K. Counter-immunoelectrophoresisusing an arc 5 antigen for the rapid diagnosis of hydatidosis and comparison withthe indirect hemagglutination test Am J Trop Med Hyg 1987, 36: 592-97

10. Wheatley WB. A rapid staining procedure for intestinal amoebae and flagellates. Am JClin Pathol 1951; 21: 990-91

11. Gomori G A rapid one-step trichrome method Am J Clin Pathol 1950; 20: 661-64.12. Hammerberg B, Musoke AJ, Williams JF. Activation of complement by hydatid cyst

fluid of Echinococcus granulosus J Parasitol 1977; 63: 327-31.13. Annen JM, Kohler P, Eckert J. Cytotoxicity of Echinococcus granulosus cyst fluid in

vitro. Z Parasitenkd 1981, 65: 79-8814 Schantz PM Echinococcus granulosus: acute systemic allergic reactions to hydatid cyst

fluid in infected sheep. Exp Parasitol 1977; 43: 268-85.15 Schantz PM, Van dan Bossche H, Eckert J. Chemotherapy for larval echinococcosis in

animals and humans Report of a workshop. Z Parasitenkd 1982; 67: 5-26.16. Saimot AG, Meulemans A, Cremieux AC, et al. Albendazole as a potential treatment

for human hydatidosis. Lancet 1983; ii 652-56.17 Morris DL, Dykes PW, Dickson B, Marriner S, Bogan J, Burrows F. Albendazole in

hydatid disease Br Med J 1983; 286: 103-0418. Morris DL, Dykes PW, Marriner S, et al. Albendazole-objective evidence of response

in human hydatid disease. JAMA 1985; 253: 2053-57.19. Okelo GBA Hydatid disease research and control in Turkana. III. Albendazole in the

treatment of inoperable hydatid disease in Kenya-a report on 12 cases. Trans RSoc Trop Med Hyg 1986; 80: 193-95

20. Dennis DT, Kean BH Isolation of microfilariae: report of a new method. J Parasitol1971, 57: 1146-47

21 Peters PA, Warren KS, Mahmoud AAF. Rapid, accurate quantification ofschistosome eggs via Nuclepore filters. J Parasitol 1976, 62: 154-55.

22 Jacobson ES A case of secondary echinococcosis diagnosed by cytological examinationof pleural fluid and needle biopsy of pleura Acta Cytol 1973; 17: 76-79.

23 Brundelet PJ Acid-fast staining of hooklets oftaenia echinococcus. Lancet 1973; i: 678.24. Ishak KG Acid-fast staining of hooklets of taenia echinococcus. Lancet 1973; i:

890-9125. Craig PS, Bailey W, Nelson GS. A specific test for the identification of cyst fluid

samples from suspected human hydatid infections. Trans R Soc Trop Med Hyg1986, 80: 256-57

Reviews of Books

Doctors and Rules: A Sociology of ProfessionalValues

Joseph M. Jacob. London: Routledge. 1988. Pp 250. /;30.ISBN 0-415006880.

I STALKED round this book with caution. Workingdoctors sometimes see a busy army at their elbows, intent oncommentary whilst we are trying to get on with the text.Then the book’s foreword writer warns that this is a highlyoriginal volume which must on no account be read rapidly.And that good reviews must put the work in context,simplify it, suggest all the thrust of its argument, and finallyappraise it. Alas, The Lancet would like 400 words,preferably tomorrow.The clouds lift quite quickly as one moves into the

volume, "directly a study of the regulation of medicine inparticular and indirectly of regulation by groups in general".So appraisal first: this is indeed an interesting book forworking doctors, concerned with how we practise, and howwe arrived there. Jacob’s chapter plan takes in much history,discussions of theories of medicine, of professionalism, ofthe effects of administration; he is an academic lawyerdriving toward the conclusion that we should refurbishrather than rebuild institutions. "The ideas discussed in this

book, from disease and illness via medicine and health toliberty and freedom, present incommensurable values".Jacob questions whether courts, legislature, or indeed

rationality can do the refurbishing job, though "each is verycapable of demolishing the institutions which make ourworld a social world, a human world". The book ends withthe Hippocratic oath.

Jacob is informed and scholarly. His progress is over alarge canvas, full of particular insights--eg, that the

profession requires a separation of service and reward. The

temptation for some medical readers will be to regard thebook as a counterblast, from the inside, to Kennedy’s Reithlectures. That would be wrong, for Jacob’s analysis is toohonest for easy comfort; "it is not part of my argument thatmembers of the profession can do what they like".

This review is being written in the week that the GeneralMedical Council has sent all doctors stern guidance on theirresponsibilities towards AIDS and HIV positive patients,with a mention of serious professional misconduct.

Hippocratic medicine, like noblesse, obleeges inescapably.As I understand Jacob, his work argues for careful, criticalrestoration of civilised institutions, by contrast with the callsof the consumer, enterprise, or science culture. Read it,especially if you worry about patients and clients-anddoctors.

Clinical Dean’s Office,University of Cambridge School of Clinical Medicine,Addenbrooke’s Hospital,Cambridge CB2 2QQTHOMAS SHERWOOD

The Challenge of EpidemiologyIssues and Selected Readings. Discussed and compiled by CarolBuck, Alvaro Llopis, Enrique Najera, and Milton Terris.Washington, DC: Pan-American Health Organisation. 1988.Pp 1013.$30. ISBN 92-75115052.

APPROXIMATELY 250 000 articles from more than 20 000

journals are indexed annually on MEDLARS. Faced withthis volume of material, the most dedicated reader will behard pressed to sort out the wood from the trees and bypublishing this book the Pan-American Health

Organisation has done a big favour to those of us with aninterest in the key events which have contributed to thedevelopment of epidemiology. It is an anthology of 85selected papers previously seen in a wide range of

publications, chosen by experts from throughout the worldand compiled by an editorial team of four prominent

658

members of the public health family. A linking commentarybetween the five sections of the book allows us to trace theevolution of epidemiology through its HistoricalDevelopment, from the Old to the New (which deals withthe transition of epidemiology from infectious disease to itspresent broader application to other health issues),Aetiological Investigations, Health Services and Health

Policy, and a final section on Perspectives and Prospects.Not all of these sections are given equal weighting and Isuspect that some readers will find fault with the choice ofarticles. But those chosen do represent most of the "classic"

writings on epidemiological practice and the linkingdiscussions give some fascinating insights into the

background to major epidemiological investigations.Readers who wish to appreciate the uses to which

epidemiology has been put, or those with an interest in thehistory of medicine, should not only read this book but alsobuy it because it represents remarkable value for money.

Department of Community Medicine,University of Edinburgh MICHAEL GARRAWAY

Recent Advances in Critical Care Medicine, no 3

Edited by I. McA. Ledingham. Edinburgh: Churchill

Livingstone. 1988. Pp 215. 29.50. ISBN 0-443032157.

A BOOK on "recent advances" should survey concisely thelately published work and make a sensible assesment of theplace of new developments in clinical practice. ProfessorLedingham here succeeds admirably in meeting thesecriteria. The topics are all relevant to everyday intensivecare. The book is therefore important reading for all doctorsworking in intensive care units.The first edition, ten years ago, reviewed prognostic

indices in circulatory failure and head injuries. Since then,great advances have been made in predicting the outcomefrom critical illness and these are covered succinctly byKnaus and Zimmerman, who review their own APACHEscoring system. The first edition also had chapters oncoagulation disorders, sepsis, and renal failure. The secondedition five years later included a discussion on sedation and

analgesia. All these topics appear in number three: althoughour understanding of these matters has improved they stillpresent formidable dilemmas in intensive care practice.Sepsis remains the fundamental challenge in critically ill

patients; Miranda and Langrehr’s chapter on the control ofgram-negative bacterial infection is therefore essential

reading.There are two chapters on obstructive pulmonary disease:

one, on chronic obstructive pulmonary disease, summarisesimportant work on respiratory muscle fatigue; the other, onlife-threatening asthma, can leave nobody in any doubt thatpatients with this condition should be looked after inintensive care units. Readers will be familiar with theseminal work of Cuthbertson on the metabolic response totrauma. There is an update on the "ebb and flow" phases ofthis response. Despite much hopeful interest in endogenousopioids in shock, Hinds and Donaldson end their detailedreview with the judgment that there is as yet no indicationfor the routine use of naloxone in circulatory failure. Thosewith long memories will be fascinated by the revival ofnoradrenaline in the management of massive pulmonaryembolus. They will not be surprised that, despite theenormous increase in the sophistication of mechanicalventilators, there have been few if any substantial advancesin weaning.

All three volumes have been edited by one of the UnitedKingdom’s most distinguished intensive care specialists.However, his imminent departure from the United

Kingdom and the fact that only 7 of the 19 contributors workin units in Britain perhaps indicate that all is not well withintensive care medicine and its academic base in this

country.

Intensive Care Unit,Royal Devon and Exeter Hospital,Exeter EX15 2DW J. F. SEARLE

LaparoscopyJean W. Saleh. Philadelphia: W. B. Saunders. 1988. Pp 276.jC43.25. ISBN 0-721621260.

LAPAROSCOPY has gone through several cycles of

popularity. Except in gynaecology it has lately been in adepressed phase, summarily displaced from the diagnosticlimelight by improved radiological imaging and enhancedcytological skills. The author of this book, with patententhusiasm and luminous optimism, predicts an excitingfuture with new therapeutic indications and theintroduction of an ultrasound laparoscope. I am lessconfident. A certain missionary zeal dominates Jean Saleh’shighly personal and comprehensive if somewhat prolixaccount of the subject-"pictures cannot do justice to thewondrous sight that greets the eye".The book was never intended to be a complete atlas,

which is usually a tribute to photographic rather thanclinical skills. It set out to appeal to a broad church ofphysicians, surgeons, gastroenterologists, and

gynaecologists. Inevitably most space has been devoted todiseases of the liver and peritoneum. I read the text withincreasing admiration for Saleh’s vast experience, with cosysatisfaction at his passionate desire to teach proper

techniques to his trainees, but with ever-increasingconviction that he had bitten off more than the laparoscopeshould be asked to chew in any one literary meal. For thereader hunting quick practical tips there are shorter,snappier, and probably better alternatives (eg, PracticalLaparoscopy by Berci and Cuschieri); for the curious,perhaps titillated by the laparoscopic diagnosis of somehepatological obscurity, there are many vast (albeit moreboring) texts of perceived clinicopathological wisdom.A splendid try but strictly for the Saleh fan-club.

City Hospital,Nottingham NG5 1PB TOM BALFOUR

New Editions

A Colour Atlas of AIDS & HIV Disease.-2nd ed. C. F. Farthing, S. E.Brown, R. C. D. Staughton. London: Wolfe Medical. 1988. Pp 115. 16.00A Textbook of Radiological Diagnosis.-5th ed. Edited by K. C. Simpkins.

London: Lewis. 1988. Pp 754. 85.00.Medical Lists for Exammations.-2nd ed. By R. Gabriel, C. M. Gabriel.

Guildford: Butterworth. 1988. Pp 325. /;9.95.DeGowin & DeGoztnn’s Bedside Diagnostic Examinations.-5th ed.Revised

by R. L. DeGowin. Basingstoke: Macmillan. 1987. Pp 1053. 23.95.Endocrine Pathophysiology.-3rd ed. J. M. Hershman. Philadelphia: Lea

and Febiger. London: Quest-Meridien. 1988. Pp 365.$19.50.Operatzve Hand Surgery.-2nd ed. 3 vols. Edited by D. P. Green.

Edinburgh: Churchill Livingstone. 1988. Pp 2458. 175.00.Manual of Climcal Problems in CardlOlogy.-3rd ed. L. D. Hillis, B. G.

Firth, M. D. Winniford, J. T. Willerson. Edinburgh: Churchill LivingstoneBoston: Little Brown. 1988. Pp 477. 9.95.

Tuberous Sclerosis.-2nd ed. Edited by M. R. Gomez. New York: Raven.1988. Pp 287.$86.50.