- Email: [email protected]
Complications of spinal surgery
160
Surg Neurol 1992;37:159-62
This is a helpful book and will be useful to those who from time to time need it for reference. EBEN ALEXANDER, JR., M.D. Winston-Salem, North Carolina
The N e w Medicine and the Old Ethics. By Albert R. Jonsen. 168 pages. Cambridge, Mass: Harvard University Press, 1990. This book, concerning the ethics of medicine, is written at the behest of the Associate Dean for Students and Alumni of Harvard Medical School, Dr. Dan Federman, to put into print the 1988 George Washington Gay Lectures. These lectures have been in continuous presentation at the medical school since 1922, when they were endowed with the goal of promoting the education of medical students in "medical ethics and business." It follows a great tradition, not the least of which was the 1927 Gay Lectures given by Francis Well Peabody, "The Care of the Patient," which is still receiving very wide circulation. Albert Jonsen, who has a doctorate in history and in theology, has been a "doctor watcher" most of his life. In fact the book is dedicated to his uncle, Charles F. Sweigert, who watched the new medicine meet the old ethics during his medical practice of 47 years and combined a "stern sense of duty with the mental freshness of youth." Many physicians may not be fully aware of Albert Jonsen, one of the outstanding philosopher/ethicists in America, who originally came from San Francisco but more recently has been the chairman of the Department of Medical History and Ethics at the University of Washington in Seattle. This book is a felicitous combination of ancient and modern history of religion and of the present scene of medicine, which itself has become tempestuous and ambiguous. He deals frequently with the term "ambiguous," which he says has the original meaning of observing a subject and walking around it from all directions; he considers the increasing complexities of medicine that derive from the many new developments that have enabled it to do so much for patients and at the same time are so fraught with the potential for harm. Dr. Jonsen considers the history of medicine as a record of scientific discovery, clinical triumph, and personal sacrifice. However, it is also a record of dogmatism and greed in previous generations and even today. He sees the conflict between altruism and self-interest that is built into the structure of medical care and in fact is woven into the very fabric of the lives of physicians. Jonsen feels that medicine has moved from being an institution dominated by the physician--the patient/physician relationships having the most importance and diagnosis and therapy being the dominant script--to an institution in which physicians and many other health providers now share equal billing with the newly empowered patients. He feels that the old ethics is strong but needs to be reconsidered to bring justice, competence, and compassion to bear on all of our contemporary dilemmas in medicine. In chapter after chapter, Dr. Jonsen deals with the very
Book Reviews
important ambiguities of medicine that are in the offing, in particular with many that are undoubtedly soon to be presented as major problems. One particular passage emphasizes his intimate knowledge of medicine: We have long known, for example, that diabetes was an inheritable condition; we now know that a gene on chromosome 6 accounts for 50 percent of genetic susceptibility to insulin-dependent diabetes. We had not clearly known that rheumatoid arthritis was a genetic condition; we are now aware that a collagen gene on chromosome 6 may effect connective-tissue disorders. Can prenatal or presymptomatic interventions for diabetes, arthritis, and a host of other conditions be far behind? He warns that there are times when physicians must not use all the sophisticated knowledge they have if it is not going to benefit the individual patient or group of patients. There is a generous consideration of informed consent, particularly as it has become an increasing challenge to the practice of medicine, and of the increasing protection of the autonomy of the patient. This is a modern book in which the author deals throughout the seven chapters with many contemporary problems. Unlike many books of this sort, it can be read through from cover to cover; all physicians seriously interested in the field of ethics should own it and read it. As more health care institutions become engrossed in medical ethics, as is inevitable, many will be drawn to the thoughtful consideration that Dr. Jonsen has given this subject, since he does not treat medical ethics in terms of philosophical abstractions but maintains that with the onset of the many concrete ethical problems now facing medicine and all health care services, physicians must be an integral part of the decision making. The more highly informed and educated in these subjects the physicians can become, the better the decisions will be. EBEN ALEXANDER, JR., M.D. Winston-Salem, North Carolina
Complications of Spinal Surgery. Edited by Edward C. Tarlov, M.D. 132 pages. $ 8 0 . 0 0 ( m e m b e r s ) , $70.00 ( n o n m e m b e r s ) , $ 7 0 . 0 0 (residents). Park Ridge, Ill. A m e r i c a n Association o f N e u r o l o g i c a l Surgeons, 1991. I S B N : 0 - 9 6 2 4 2 6 - 8 - 4 . This is another one of the excellent series of books being published by the American Association of Neurological Surgeons under the chairmanship of Robert Wilkins of the AANS Publications Committee. The book is well printed and well illustrated, and the editor, Dr. Tarlov, has picked his contributors carefully. The dedication is to Dr. Charles Fager--quite appropriately, since he has made over the years so many contributions to surgery of the spine. One must remember in reading a book of this sort that it is a book about complications; therefore each contributor has been asked to "bare his soul," so to speak, and to emphasize complications, which are set forth to be of benefit to those who read the book.
Book Reviews
One unique feature of this particular volume is the full four pages of introduction, written by Dr. Tarlov, to guide the reader in understanding the various chapters; he has done this instead of putting comments after each paper. Some of the comments are actually fairly adverse, some indicating that he is printing the chapter because he thinks that "dissemination of new views through the printing press is, after all, part of the marvel of Gutenberg's legacy." Dr. Tarlov obviously, was at pains to express his own opinion about the various chapters in this volume; those who refer to this book would do well to read that introduction carefully, which is a considered and conscientious attempt to bring the volume into a single unit. There are chapters on the complications of positioning patients, one even listing the number of complications that can result from putting on the Mayfield headrest. There are complications of spinal surgery that one might very well expect, particularly in respect to the amount of hardware inserted. This is taken up in a short chapter in which some of the illustrations are not numbered in such a way that one can refer easily to them in the text. This is particularly true of Figure 6 on page 18, which shows a three-dimensional computed tomography reconstruction in a patient with back and right lower limb pain; it is difficult to know just exactly what is being illustrated. There are good chapters on vacular injuries secondary to spine surgery that are similar to those that have been published previously, as well as a chapter on vascular injuries due to other causes. The aseptic complications are well covered by George Sypert and E. Joy Arpin-Sypert. There is a particularly good illustration of the proximity of intraabdominal organs to the L-5, S-1 disk space on page 46 in the chapter by Smith and Hanigan. Complications that occur in cancer patients are well covered, as are complications of cranial vertebral junction fusions; also reported are explorations done by a practitioner with a great deal of experience, Dr. Arnold Menezes. Complications of anterior spinal surgery, of corpectomy, and of percutaneous diskectomy are well covered. This will be a book to which many surgeons will want to refer from time to time. It is not a book to read through in an evening. The chapters are well delineated and for those who want to look into a single complication, reference to this book will be helpful. EBEN ALEXANDER, JR., M.D. Winston-Salem, North Carolina
Child and Adolescent Psychiatry. A Comprenhensive Textbook. Edited by M e l v i n Lewis, M.B., B.S., F.R.C.Psych, D . C . H . 1,282 pp. $120.00. Baltimore: Williams & Wilkins, 1991. I S B N : 0 - 6 8 3 - 0 - 4 9 5 4 - 2 .
This large volume (it weighs six pounds and is not the kind of thing you'll carry around with you) is the latest effort to provide a readable and authoritative text in child psychiatry. For the
Surg Neurol 1992;37:159-62
161
most part it succeeds. A lot has happened in the field since the
Basic Handbook of Child Psychiatry, a five-volume attempt to do the same thing, appeared a decade ago. The difference shows. The discipline has changed from a largely clinical pursuit to one that is soundly based in scientific knowledge, largely neurobiological and developmental. The 117 articles that comprise this book reflect that orientation, and neurologists and neurosurgeons will appreciate the emergence in almost every aspect of the profession of a point of view that is much more congruent with their own orientation than perhaps was previously the case. The editor is a professor of pediatrics and psychiatry at Yale University, and fully a fourth of the approximately 150 authors represented here are from Yale as well, so that the tone of the book is reflective of the interests that characterize child psychiatry at that institution. Thus the discussions of developmental neurochemistry, genetic studies, autism, attention deficit disorder, Giles de la Tourette syndrome, the use of clonidine in a variety of disorders, and the study of violence are scholarly and well-written reviews of the kind of scientific inquiry that is ongoing in New Haven these days. This is not to say that the book is parochial, however. It is anything but that. In the nine sections into which the book is organized (Normal Development, Development of Symptoms, Etiology, Nosology and Classification, Diagnostic Assessment, Syndromes, Treatment, Allied Professions, and Training and Research) one can find represented a wide range of distinguished experts from all across the country. In combination, they present a truly comprehensive and representative view of what is occurring in child and adolescent psychiatry as it moves toward the end of this century and the beginning of the next. The section on the development of symptoms is an unusual and rewarding exploration of the metapsychological and developmental nature of psychiatric disorders. This reviewer found the article by Garber and Kashani on the development of the symptom of depression particularly intriguing and informative. It draws heavily on the contributions of emotion theorists to describe the multiple components of affective experience and the influences that shape the expressions of sadness in everyday life and in disordered function. It provides a perspective that is enriching and helpful to the clinical observer. Neurologists and neurosurgeons will probably use this book primarily as a reference, and it will serve them as a source of information on the many disorders of childhood that fall on or near the border between disorders of the nervous system and those of the mind and personality. They may also be tempted, however, to browse, and those who do will find it well worth the time. For instance, there is an article here by Chess and Thomas that summarizes their now 40 years of seminal research into the matter of temperament and is especially engaging to anyone who is interested in people and how they come to behave the way they do. Other readers will find other offerings that capture their attention and reward the investment of their time. This is a first-rate volume that reflects a profession full of new discoveries and fresh perspectives.
RICHARD W. BRUNSTETTER, M.D. Winston-Salem, North Carolina
Surg Neurol 1992;37:159-62
This is a helpful book and will be useful to those who from time to time need it for reference. EBEN ALEXANDER, JR., M.D. Winston-Salem, North Carolina
The N e w Medicine and the Old Ethics. By Albert R. Jonsen. 168 pages. Cambridge, Mass: Harvard University Press, 1990. This book, concerning the ethics of medicine, is written at the behest of the Associate Dean for Students and Alumni of Harvard Medical School, Dr. Dan Federman, to put into print the 1988 George Washington Gay Lectures. These lectures have been in continuous presentation at the medical school since 1922, when they were endowed with the goal of promoting the education of medical students in "medical ethics and business." It follows a great tradition, not the least of which was the 1927 Gay Lectures given by Francis Well Peabody, "The Care of the Patient," which is still receiving very wide circulation. Albert Jonsen, who has a doctorate in history and in theology, has been a "doctor watcher" most of his life. In fact the book is dedicated to his uncle, Charles F. Sweigert, who watched the new medicine meet the old ethics during his medical practice of 47 years and combined a "stern sense of duty with the mental freshness of youth." Many physicians may not be fully aware of Albert Jonsen, one of the outstanding philosopher/ethicists in America, who originally came from San Francisco but more recently has been the chairman of the Department of Medical History and Ethics at the University of Washington in Seattle. This book is a felicitous combination of ancient and modern history of religion and of the present scene of medicine, which itself has become tempestuous and ambiguous. He deals frequently with the term "ambiguous," which he says has the original meaning of observing a subject and walking around it from all directions; he considers the increasing complexities of medicine that derive from the many new developments that have enabled it to do so much for patients and at the same time are so fraught with the potential for harm. Dr. Jonsen considers the history of medicine as a record of scientific discovery, clinical triumph, and personal sacrifice. However, it is also a record of dogmatism and greed in previous generations and even today. He sees the conflict between altruism and self-interest that is built into the structure of medical care and in fact is woven into the very fabric of the lives of physicians. Jonsen feels that medicine has moved from being an institution dominated by the physician--the patient/physician relationships having the most importance and diagnosis and therapy being the dominant script--to an institution in which physicians and many other health providers now share equal billing with the newly empowered patients. He feels that the old ethics is strong but needs to be reconsidered to bring justice, competence, and compassion to bear on all of our contemporary dilemmas in medicine. In chapter after chapter, Dr. Jonsen deals with the very
Book Reviews
important ambiguities of medicine that are in the offing, in particular with many that are undoubtedly soon to be presented as major problems. One particular passage emphasizes his intimate knowledge of medicine: We have long known, for example, that diabetes was an inheritable condition; we now know that a gene on chromosome 6 accounts for 50 percent of genetic susceptibility to insulin-dependent diabetes. We had not clearly known that rheumatoid arthritis was a genetic condition; we are now aware that a collagen gene on chromosome 6 may effect connective-tissue disorders. Can prenatal or presymptomatic interventions for diabetes, arthritis, and a host of other conditions be far behind? He warns that there are times when physicians must not use all the sophisticated knowledge they have if it is not going to benefit the individual patient or group of patients. There is a generous consideration of informed consent, particularly as it has become an increasing challenge to the practice of medicine, and of the increasing protection of the autonomy of the patient. This is a modern book in which the author deals throughout the seven chapters with many contemporary problems. Unlike many books of this sort, it can be read through from cover to cover; all physicians seriously interested in the field of ethics should own it and read it. As more health care institutions become engrossed in medical ethics, as is inevitable, many will be drawn to the thoughtful consideration that Dr. Jonsen has given this subject, since he does not treat medical ethics in terms of philosophical abstractions but maintains that with the onset of the many concrete ethical problems now facing medicine and all health care services, physicians must be an integral part of the decision making. The more highly informed and educated in these subjects the physicians can become, the better the decisions will be. EBEN ALEXANDER, JR., M.D. Winston-Salem, North Carolina
Complications of Spinal Surgery. Edited by Edward C. Tarlov, M.D. 132 pages. $ 8 0 . 0 0 ( m e m b e r s ) , $70.00 ( n o n m e m b e r s ) , $ 7 0 . 0 0 (residents). Park Ridge, Ill. A m e r i c a n Association o f N e u r o l o g i c a l Surgeons, 1991. I S B N : 0 - 9 6 2 4 2 6 - 8 - 4 . This is another one of the excellent series of books being published by the American Association of Neurological Surgeons under the chairmanship of Robert Wilkins of the AANS Publications Committee. The book is well printed and well illustrated, and the editor, Dr. Tarlov, has picked his contributors carefully. The dedication is to Dr. Charles Fager--quite appropriately, since he has made over the years so many contributions to surgery of the spine. One must remember in reading a book of this sort that it is a book about complications; therefore each contributor has been asked to "bare his soul," so to speak, and to emphasize complications, which are set forth to be of benefit to those who read the book.
Book Reviews
One unique feature of this particular volume is the full four pages of introduction, written by Dr. Tarlov, to guide the reader in understanding the various chapters; he has done this instead of putting comments after each paper. Some of the comments are actually fairly adverse, some indicating that he is printing the chapter because he thinks that "dissemination of new views through the printing press is, after all, part of the marvel of Gutenberg's legacy." Dr. Tarlov obviously, was at pains to express his own opinion about the various chapters in this volume; those who refer to this book would do well to read that introduction carefully, which is a considered and conscientious attempt to bring the volume into a single unit. There are chapters on the complications of positioning patients, one even listing the number of complications that can result from putting on the Mayfield headrest. There are complications of spinal surgery that one might very well expect, particularly in respect to the amount of hardware inserted. This is taken up in a short chapter in which some of the illustrations are not numbered in such a way that one can refer easily to them in the text. This is particularly true of Figure 6 on page 18, which shows a three-dimensional computed tomography reconstruction in a patient with back and right lower limb pain; it is difficult to know just exactly what is being illustrated. There are good chapters on vacular injuries secondary to spine surgery that are similar to those that have been published previously, as well as a chapter on vascular injuries due to other causes. The aseptic complications are well covered by George Sypert and E. Joy Arpin-Sypert. There is a particularly good illustration of the proximity of intraabdominal organs to the L-5, S-1 disk space on page 46 in the chapter by Smith and Hanigan. Complications that occur in cancer patients are well covered, as are complications of cranial vertebral junction fusions; also reported are explorations done by a practitioner with a great deal of experience, Dr. Arnold Menezes. Complications of anterior spinal surgery, of corpectomy, and of percutaneous diskectomy are well covered. This will be a book to which many surgeons will want to refer from time to time. It is not a book to read through in an evening. The chapters are well delineated and for those who want to look into a single complication, reference to this book will be helpful. EBEN ALEXANDER, JR., M.D. Winston-Salem, North Carolina
Child and Adolescent Psychiatry. A Comprenhensive Textbook. Edited by M e l v i n Lewis, M.B., B.S., F.R.C.Psych, D . C . H . 1,282 pp. $120.00. Baltimore: Williams & Wilkins, 1991. I S B N : 0 - 6 8 3 - 0 - 4 9 5 4 - 2 .
This large volume (it weighs six pounds and is not the kind of thing you'll carry around with you) is the latest effort to provide a readable and authoritative text in child psychiatry. For the
Surg Neurol 1992;37:159-62
161
most part it succeeds. A lot has happened in the field since the
Basic Handbook of Child Psychiatry, a five-volume attempt to do the same thing, appeared a decade ago. The difference shows. The discipline has changed from a largely clinical pursuit to one that is soundly based in scientific knowledge, largely neurobiological and developmental. The 117 articles that comprise this book reflect that orientation, and neurologists and neurosurgeons will appreciate the emergence in almost every aspect of the profession of a point of view that is much more congruent with their own orientation than perhaps was previously the case. The editor is a professor of pediatrics and psychiatry at Yale University, and fully a fourth of the approximately 150 authors represented here are from Yale as well, so that the tone of the book is reflective of the interests that characterize child psychiatry at that institution. Thus the discussions of developmental neurochemistry, genetic studies, autism, attention deficit disorder, Giles de la Tourette syndrome, the use of clonidine in a variety of disorders, and the study of violence are scholarly and well-written reviews of the kind of scientific inquiry that is ongoing in New Haven these days. This is not to say that the book is parochial, however. It is anything but that. In the nine sections into which the book is organized (Normal Development, Development of Symptoms, Etiology, Nosology and Classification, Diagnostic Assessment, Syndromes, Treatment, Allied Professions, and Training and Research) one can find represented a wide range of distinguished experts from all across the country. In combination, they present a truly comprehensive and representative view of what is occurring in child and adolescent psychiatry as it moves toward the end of this century and the beginning of the next. The section on the development of symptoms is an unusual and rewarding exploration of the metapsychological and developmental nature of psychiatric disorders. This reviewer found the article by Garber and Kashani on the development of the symptom of depression particularly intriguing and informative. It draws heavily on the contributions of emotion theorists to describe the multiple components of affective experience and the influences that shape the expressions of sadness in everyday life and in disordered function. It provides a perspective that is enriching and helpful to the clinical observer. Neurologists and neurosurgeons will probably use this book primarily as a reference, and it will serve them as a source of information on the many disorders of childhood that fall on or near the border between disorders of the nervous system and those of the mind and personality. They may also be tempted, however, to browse, and those who do will find it well worth the time. For instance, there is an article here by Chess and Thomas that summarizes their now 40 years of seminal research into the matter of temperament and is especially engaging to anyone who is interested in people and how they come to behave the way they do. Other readers will find other offerings that capture their attention and reward the investment of their time. This is a first-rate volume that reflects a profession full of new discoveries and fresh perspectives.
RICHARD W. BRUNSTETTER, M.D. Winston-Salem, North Carolina