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The Nobel Chronicles
brain”, and “the right lesion”. The points made are very simple but most of us have had or will have some difficulties putting them into practice during our operative career. The author then moves onto specifics, with some interesting points of view about “tethered cervical cord syndrome” and certain types of cervical spondylotic myelopathy. It is obvious that Adams has had great difficulties restricting his writing to only those spinal topics, considering his extensive experience. This chapter is a valuable supplement to the textbook discussions about the basic problems of spinal spondylosis and its relation to spinal movements. One thing that I was a little puzzled with was the so-called “painfree” laminectomy. At the operation, patients receive an epidural catheter through which diamorphine is administered for 3 days postoperatively. The infusion system has potential complications, and must be monitored. In my experience, this type of intensive pain treatment is seldom needed. Laminectomy patients are usually fairly free of pain and are mobile the day after surgery. Adams’ tip is good to remember as an alternative choice of management, but I would not put it to routine use. The text concludes with descriptions
The Nobel Chronicles hree scientists shared the 1965 Nobel Prize in Physiology or Medicine for their discoveries on the genetic control of enzyme and virus synthesis. André Lwoff (figure, left) was born in Ainay-le-Château, France. After obtaining his MD in 1927, he joined the faculty of the Pasteur Institute, where in 1938 he became the head of the Microbic Physiology department. François Jacob (figure, middle) was born in Nancy, France, and studied medicine at the University of Paris. In 1950, he also joined the Pasteur Institute in Lwoff’s department where Jacques Monod (figure, right), another Parisian and biologist, had been the laboratory director.
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of various procedures and personal hints for obtaining good operative results. A nice touch is the tips for control of different types of intraoperative bleeding, a problem that no one wants to encounter during surgery. I can imagine how helpful this section will be for young neurosurgeons with little operative experience. Tips for temporal lobe surgery were also interesting and helpful. However, I felt a little uncomfortable with some of Adams’ ideas on subarachnoid haemorrhage and vasospasm. Adams is very strict with time limits for operating and with patient selection in the acute phase. In our department, which has 100–130 patients with subarachnoid haemorrhage annually, we have not encountered any major problems in surgical outcome when operating on patients between 4 and 8 days after the acute subarachnoid haemorrhage. We are less strict about age limits for patients. Also, we recommend postoperative angiography to confirm proper ligation of ruptured aneurysms and think that it is important for educational reasons for surgeons to make control angiographies. However, I agree with Adams’ preference for concentrating aneurysm surgery in specialist vascular units or, at least, in sufficiently experienced units. Adams’ operative comments on
aneurysm surgery are good and his instructions are sound. Posterior fossa aneurysms are extremely difficult; luckily they seem well-suited to endovascular treatment, reducing the need for operations. When I finished the book for the first time, I had mixed feelings. Maybe the inconsistency of the content was bothering me: some parts were so advanced and difficult that I had a hard time understanding them, yet a few pages later I encountered basic and trivial rules for surgery. On a second reading, however, I was actually happy to find many practical tips and hints to improve my own surgical technique. This book is the autobiography of a talented and experienced neurosurgeon, who is also a first-class teacher. Adams concludes wisely that by writing this book he has exposed his personality— and yes, we readers are able to catch a glimpse of the pains and joys of being a neurosurgeon. I recommend this book to all those who are interested in neurosurgery, and to colleagues who want to avoid getting into trouble; remember to KISS. Antti Ronkainen Department of Neurosurgery, University Hospital of Kuopio, PL 1777, FIN70210 Kuopio, Finland
After a decade of work proteins (J Mol Biol, 1961; on the morphogenesis and 3: 318-56), they explained the nutritional needs of how DNA transcribed its ciliated parasites, Lwoff “message” into an RNA began, in 1930, study of molecule (they called the nature of the symbiotic it “messenger RNA”), association between bactedirecting protein synthesis. 1965: André Lwoff riophages and the lysoDuring the Nazi occugenic (host) bacteria. He (1902-94),François pation of France, Jacob Jacob (b 1920), and and his colleagues showed fled to England, joined the Jacques Monod that the trait of “peaceful Free French Army, and (1910-76) coexistence” between the fought in North Africa virus and the host and Normandy. He was (lysogeny) can be transmitted to the wounded in action and was later next generation through chromosomal awarded the Croix de Guerre and the alterations. They also discovered that Companion of the Liberation, two of mutation induced by ultraviolet light France’s highest military honours. For transformed the non-infectious forms their roles during the Resistance, of bacteriophage into infectious forms. Lwoff won the Medal of Resistance Pursuing the concept that each and Monod the Croix de Guerre. A enzyme had its own regulating gene, friend of Albert Camus, Monod was Monod, Jacob, and also a philosopher of science; in colleagues studied bioChance and Necessity (Knopf, 1971), chemical genetics; they his international bestseller, he postulated the existence discussed the role of biology in the real of the “operon”—a segworld, and how random mutation ment of the chromosome supported Darwinian concepts of containing the regulatory evolution. gene. In their essay, Tonse N K Raju Genetic regulatory mecha University of Illinois, C h i c a g o ,I L ,U S A nisms in the synthesis of
THE LANCET • Vol 354 • July 31, 1999
The Nobel Chronicles hree scientists shared the 1965 Nobel Prize in Physiology or Medicine for their discoveries on the genetic control of enzyme and virus synthesis. André Lwoff (figure, left) was born in Ainay-le-Château, France. After obtaining his MD in 1927, he joined the faculty of the Pasteur Institute, where in 1938 he became the head of the Microbic Physiology department. François Jacob (figure, middle) was born in Nancy, France, and studied medicine at the University of Paris. In 1950, he also joined the Pasteur Institute in Lwoff’s department where Jacques Monod (figure, right), another Parisian and biologist, had been the laboratory director.
T
434
of various procedures and personal hints for obtaining good operative results. A nice touch is the tips for control of different types of intraoperative bleeding, a problem that no one wants to encounter during surgery. I can imagine how helpful this section will be for young neurosurgeons with little operative experience. Tips for temporal lobe surgery were also interesting and helpful. However, I felt a little uncomfortable with some of Adams’ ideas on subarachnoid haemorrhage and vasospasm. Adams is very strict with time limits for operating and with patient selection in the acute phase. In our department, which has 100–130 patients with subarachnoid haemorrhage annually, we have not encountered any major problems in surgical outcome when operating on patients between 4 and 8 days after the acute subarachnoid haemorrhage. We are less strict about age limits for patients. Also, we recommend postoperative angiography to confirm proper ligation of ruptured aneurysms and think that it is important for educational reasons for surgeons to make control angiographies. However, I agree with Adams’ preference for concentrating aneurysm surgery in specialist vascular units or, at least, in sufficiently experienced units. Adams’ operative comments on
aneurysm surgery are good and his instructions are sound. Posterior fossa aneurysms are extremely difficult; luckily they seem well-suited to endovascular treatment, reducing the need for operations. When I finished the book for the first time, I had mixed feelings. Maybe the inconsistency of the content was bothering me: some parts were so advanced and difficult that I had a hard time understanding them, yet a few pages later I encountered basic and trivial rules for surgery. On a second reading, however, I was actually happy to find many practical tips and hints to improve my own surgical technique. This book is the autobiography of a talented and experienced neurosurgeon, who is also a first-class teacher. Adams concludes wisely that by writing this book he has exposed his personality— and yes, we readers are able to catch a glimpse of the pains and joys of being a neurosurgeon. I recommend this book to all those who are interested in neurosurgery, and to colleagues who want to avoid getting into trouble; remember to KISS. Antti Ronkainen Department of Neurosurgery, University Hospital of Kuopio, PL 1777, FIN70210 Kuopio, Finland
After a decade of work proteins (J Mol Biol, 1961; on the morphogenesis and 3: 318-56), they explained the nutritional needs of how DNA transcribed its ciliated parasites, Lwoff “message” into an RNA began, in 1930, study of molecule (they called the nature of the symbiotic it “messenger RNA”), association between bactedirecting protein synthesis. 1965: André Lwoff riophages and the lysoDuring the Nazi occugenic (host) bacteria. He (1902-94),François pation of France, Jacob Jacob (b 1920), and and his colleagues showed fled to England, joined the Jacques Monod that the trait of “peaceful Free French Army, and (1910-76) coexistence” between the fought in North Africa virus and the host and Normandy. He was (lysogeny) can be transmitted to the wounded in action and was later next generation through chromosomal awarded the Croix de Guerre and the alterations. They also discovered that Companion of the Liberation, two of mutation induced by ultraviolet light France’s highest military honours. For transformed the non-infectious forms their roles during the Resistance, of bacteriophage into infectious forms. Lwoff won the Medal of Resistance Pursuing the concept that each and Monod the Croix de Guerre. A enzyme had its own regulating gene, friend of Albert Camus, Monod was Monod, Jacob, and also a philosopher of science; in colleagues studied bioChance and Necessity (Knopf, 1971), chemical genetics; they his international bestseller, he postulated the existence discussed the role of biology in the real of the “operon”—a segworld, and how random mutation ment of the chromosome supported Darwinian concepts of containing the regulatory evolution. gene. In their essay, Tonse N K Raju Genetic regulatory mecha University of Illinois, C h i c a g o ,I L ,U S A nisms in the synthesis of
THE LANCET • Vol 354 • July 31, 1999