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Editors: Michael M Henry, Jeremy N Thompson
736 pp Price £34.95 ISBN 0-7020-1588-1 (h/b)
London: WB Saunders, 2001 .
Clinical Surgery has been modelled on the same publisher's Clinical Medicine, which has a strong following among students. As well as offering a beginner's guide to surgical principles, it aims to serve graduates studying for the MRCS or AFRCS.
The first section, on general surgical principles, explains the structure of a surgical firm and how to set about training for a surgical career. Advice on obtaining patients' consent and on dealing with death and bereavement is well geared to the needs of students and trainees. A brief description of important conditions and procedures in the accident and emergency department is followed by some helpful aphorisms. I was surprised to find no advice here on avoidance of nasopharyngeal intubation in patients with suspected basal skull fracture; and there is no mention of the danger of using adrenaline in a digital ring block. A comprehensive chapter on surgical investigations is accompanied by detailed explanations of imaging principles, and the chapters on anaesthetic and analgesic principles, perioperative management and postoperative complications will be useful to the uninitiated. Unusually for a basic surgical textbook, Clinical Surgery also offers detailed coverage of critical care, multiorgan failure and the principles of oncology and transplantation. The contentious use of the ‘no-touch’ technique to avoid spillage of tumour cells during colectomy for cancer is advocated without qualification. A very good chapter on practical procedures is illustrated by clear diagrams.
The second section deals systematically with individual body regions. A sound algorithm for investigating neck swellings typifies the practical approach. Good chapters on otolaryngology, cardiothoracic and hepatic/pancreatic/biliary conditions follow. I did spot some weaknesses in the chapter on acute abdominal conditions. For example, it misses the opportunity to educate students on important non-surgical emergencies presenting as ‘an acute abdomen’ (e.g. acute myocardial infarction with ill-defined epigastric pain). Furthermore, the discourse on management of bleeding oesophageal varices due to portal hypertension should include at least a mention of the increasingly used transjugular intrahepatic portosystemic shunt. The classification of mechanical bowel obstruction into luminal, mural and extramural is logical although extramural (predominantly due to adhesions and hernias) accounts for over 95% of cases; it might be better for the student to learn about extramural causes first rather than putting gallstone ileus at the top of the list. The chapters on breast diseases and arterial and venous conditions are comprehensive and easy to understand. The ‘icing on the cake’, seldom offered in basic works of this sort, is section three with its chapters on the surgical subspecialties. Each chapter serves as a good introduction to that specialty up to the level required for the MRCS/AFRCS.
The book is attractively laid out in colour with many line drawings, clinical pictures, X-rays and scans. Clear, concise tables detailing important information are particularly welcoming. I wholeheartedly recommend it to students looking for a surgical textbook.