Regional Trauma System Design

get a million population in an area where such a number who will get together, agree on what is medically appropri- doesn’t exist, and one can’t extend the borders of the ate, and then try to drive the political and local emergency system if it mandates transport times of an hour and a medical service system in the desired direction. half. We are targeting the design of systems principally to Dr. Berne, everyone wants excellent trauma care, but the urban metropolitan and inner suburban areas. no one wants to pay for the indigent patient. I believe that

As to the turf battles, the basic answer that works most the situation is approaching a crisis in many areas, but the effectively is to have committed surgeons in a community politicians are not yet offering any solutions.

Book Reviews (cont’d)

gut hormones, but to take part in searching for new ones, as well as to study the mode of action and possible clinical applications of many of the established hormones. Many of these investigators have contributed their expertise to the various chapters.

The gut hormones, secretin and gastrin, developed ear- ly in this century were eventually joined by insulin, with a rapid increase in recent years to approximately 36 in in number. This book covers such a wide range of informa- tion that it is an invaluable addition to the library of anyone interested in the areas related to the gastrointesti- nal tract. For example, Section Two includes radioimmu- noassay, immunohistochemistry, pharmacokinetics, and surgical technic. There are seven chapters devoted to the models developed in research projects performed by the various contributing authors. Gastrin and cholecystoki- nin are considered together. Cholecystokinin has had spe- cial significance for me, since my surgical intern partner in 19‘28 was Dr. Eric Oldberg who received his PhD that year for developing with Ivy the concept of cholecystoki- nin. This group has long had a clinical and research inter- est in hypergastrinemia and an active research interest in cholecystokinin, which makes their contributions a hall- mark in the field.

The authors’ stated goal is to provide worthwhile infor- mation to the gastroenterologist, surgeon, endocrinolo- gist, pediatrician, and internist, as well as to all students interested in the function of the gut. Their efforts have certainly succeeded. Those interested in the basic investi- gation of gut hormones, as well as a variety of clinicians, will welcome this book which contains so much basic information. The more than 4,000 references are a nice bonus.

Robert M. Zollinger, MD Senior Consulting Editor

Surgical Infections. By Alan Pollock, with Charles Eas- mon and Mary Evans. London: Edward Arnold, 198’7.246 pages.

This book is attractively produced and is an interesting and succinct look at the ever-important problem of infec- tion in the surgical patient. Alan Pollock has been among

the foremost consistent contributors to new clinical knowledge in this field and has established very high standards for the conduct of prospective trials within the format of the National Health Service in the United King- dom.

The book is very broadly based. Among the chapters I found of great interest were those related to the nature of host defense and the entire section on the evaluation of prophylactic and therapeutic regimens. This latter sec- tion is a special little pearl that is only indirectly related to the subject of the book. Included is the concept of the clinical audit, the appropriate consideration of clinical trials, and finally, a succinct and sensible to-the-point look at clinically applicable statistics. This section is cer- tainly one of the highlights of the book.

Unfortunately, major areas of vast importance have received far too few pages. For example, the entire sub- jects of peritonitis and peptic ulcer perforation are cov- ered in only eight pages. Furthermore, the references are extremely irregular, being as few as 1 or 2 for many chap- ters and exploding to more than 20 for others. On the other hand, as a person interested in the field, I found the selection of references interesting because the references do not represent the same tried and true litany of refer- ences that so often appear after articles and monographs on this subject in North America.

All in all, I enthusiastically recommend the book to senior house officers and fellows who are evolving special interests in problems related to infection in the surgical patient. It provides a superb beginning for this sort of reader and represents a handy and easily read summation of current thought and practice.

Hiram C. Polk, Jr., MD Editor

Pathways in Surgical Management. 2nd Edition. By Michael Hobsley. London: Edward Arnold, 1986. 362 pages. $49.95.

This curious softback book contains some of the most thoughtful analyses of common clinical entities to be found in the surgical literature. The material is presented in an innovative, stimulating, and physiologically sound manner. The algorithms that dot the book are, in some cases, far too complex for easy reading, but in general, are most precisely accurate and represent what ought to be

Continued on page 92.

Volume 154, July 1997 07