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Diseases of the Lymphatics
Book Review
Diseases of the Lymphatics Norman Browse, Kevin Burnand, Peter Mortimer. London, UK: Arnold Publishers, 2003. ISBN: 0-34076-203-9. Pages: 336. Price: £145. Until now, there have been two textbooks on diseases of the lymphatics. The first, by John Kinmonth, first published in 1972, reappeared in 1982. The second, the Lehrbuch der Lymphologie by Michael Fo¨ldi, illustrated by Stefan Kubik, is unfortunately in German and difficult to access in English-speaking countries. Now there is a third textbook, beautifully brought up to date by Sir Norman Browse and his associates, Kevin Burnand and Peter Mortimar. As a vascular surgeon, I say, this is a book to have. As Sir Norman points out, it is impossible for one, or even two, surgeons to write a comprehensive, authoritative textbook on lymphedema, a complicated set of disorders with many medical connotations. Not only did Peter Mortimar of Saint George’s Hospital join his two colleagues in producing this book, but also the principle authors looked both east and west to bring in nine other contributors to produce an authoritative, up-to-date, and very complete textbook on lymphatic disorders. The organization of the book is well thought out. There are, in general, two parts. The first, devoted to general principles, comprises two-thirds of the volume. The historical chapter, as one would expect from Sir Norman, is beautifully put together, quite readable, and well illustrated. The third chapter, ‘‘Physiology of Lymph Production and Propulsion,’’ challenges our existing knowledge of lymphatic physiology and proposes an entirely new schema. The authors point out that there is considerable evidence against our present concept. They then devote the remainder of their chapter to explaining the four Starling principles which provide the modern explanation for lymph production and propulsion. This volume contains a complete chapter on the genetics of lymphedema. One has an uncomfortable feeling about this text. It seems very preliminary. However, it does serve as an introduction to what must eventually be a full textbook explaining why lymphedema occurs in the very young and develops in the very old. Diagnosis, investigation, and classification of lymphedema is well explained in this textbook, but one would have hoped that the chapter ‘‘Medical and Physical Treatment’’ would have incorporated or dovetailed with the chapter on physiology.
Lymphedema is treated medically much more than surgically, yet surgical treatment occupies a considerable portion of the section ‘‘General Principles.’’ It contains many details of modern lymphedema surgery. Surgeons will be most interested in the descriptions of performance of the modern Charles operation. Students of lymphatic surgery will be pleased to see the very complete explanation of the enteromesenteric bridge operation, advocated by the Saint Thomas group. In a later chapter, we learn that over the years only eight operations have been followed carefully enough to describe that six showed sustained clinical improvement. In the surgical chapter, Peter Gloviczki’s excellent work on lymphaticovenous anastomoses is described and well illustrated. Curiously, Gloviczki remains in the background, giving credit for the many illustrations to the Mayo Foundation! Surgeons are no longer dominant in the care of patients with lymphedema and this is proper since manual lymphatic drainage and other physical medicine techniques have provided excellent palliative care. Nevertheless, we are surprised to find that between 1956 and 1990, only 176 patients have had reducing operations for lower extremity lymphedema at Saint Thomas’ Hospital in London. This amounts to something less than six operations per year. The continuity of the surgical staff has been such that all of this is within the experience of the senior authors of this book. Nowhere else is there so much experience so well documented. There is a chapter showing a relationship between lymphatic insufficiency and chronic venous disease, but since this is such a frequently encountered problem, one is disappointed to find few guidelines for treatment of the combined conditions. Even the common problem of varicose veins in patients with minor lymphedema is omitted in the discussions. There is no better book than this one on diseases of the lymphatics. Every teaching vascular service should have this book, and it would provide a nice graduation gift to vascular trainees who are leaving academic institutions and going into practice in the community. DOI: 10.1007/s10016-003-0051-9 Published online: 10 September 2003
John Bergan, MD
Ó Annals of Vascular Surgery Inc. 587
Diseases of the Lymphatics Norman Browse, Kevin Burnand, Peter Mortimer. London, UK: Arnold Publishers, 2003. ISBN: 0-34076-203-9. Pages: 336. Price: £145. Until now, there have been two textbooks on diseases of the lymphatics. The first, by John Kinmonth, first published in 1972, reappeared in 1982. The second, the Lehrbuch der Lymphologie by Michael Fo¨ldi, illustrated by Stefan Kubik, is unfortunately in German and difficult to access in English-speaking countries. Now there is a third textbook, beautifully brought up to date by Sir Norman Browse and his associates, Kevin Burnand and Peter Mortimar. As a vascular surgeon, I say, this is a book to have. As Sir Norman points out, it is impossible for one, or even two, surgeons to write a comprehensive, authoritative textbook on lymphedema, a complicated set of disorders with many medical connotations. Not only did Peter Mortimar of Saint George’s Hospital join his two colleagues in producing this book, but also the principle authors looked both east and west to bring in nine other contributors to produce an authoritative, up-to-date, and very complete textbook on lymphatic disorders. The organization of the book is well thought out. There are, in general, two parts. The first, devoted to general principles, comprises two-thirds of the volume. The historical chapter, as one would expect from Sir Norman, is beautifully put together, quite readable, and well illustrated. The third chapter, ‘‘Physiology of Lymph Production and Propulsion,’’ challenges our existing knowledge of lymphatic physiology and proposes an entirely new schema. The authors point out that there is considerable evidence against our present concept. They then devote the remainder of their chapter to explaining the four Starling principles which provide the modern explanation for lymph production and propulsion. This volume contains a complete chapter on the genetics of lymphedema. One has an uncomfortable feeling about this text. It seems very preliminary. However, it does serve as an introduction to what must eventually be a full textbook explaining why lymphedema occurs in the very young and develops in the very old. Diagnosis, investigation, and classification of lymphedema is well explained in this textbook, but one would have hoped that the chapter ‘‘Medical and Physical Treatment’’ would have incorporated or dovetailed with the chapter on physiology.
Lymphedema is treated medically much more than surgically, yet surgical treatment occupies a considerable portion of the section ‘‘General Principles.’’ It contains many details of modern lymphedema surgery. Surgeons will be most interested in the descriptions of performance of the modern Charles operation. Students of lymphatic surgery will be pleased to see the very complete explanation of the enteromesenteric bridge operation, advocated by the Saint Thomas group. In a later chapter, we learn that over the years only eight operations have been followed carefully enough to describe that six showed sustained clinical improvement. In the surgical chapter, Peter Gloviczki’s excellent work on lymphaticovenous anastomoses is described and well illustrated. Curiously, Gloviczki remains in the background, giving credit for the many illustrations to the Mayo Foundation! Surgeons are no longer dominant in the care of patients with lymphedema and this is proper since manual lymphatic drainage and other physical medicine techniques have provided excellent palliative care. Nevertheless, we are surprised to find that between 1956 and 1990, only 176 patients have had reducing operations for lower extremity lymphedema at Saint Thomas’ Hospital in London. This amounts to something less than six operations per year. The continuity of the surgical staff has been such that all of this is within the experience of the senior authors of this book. Nowhere else is there so much experience so well documented. There is a chapter showing a relationship between lymphatic insufficiency and chronic venous disease, but since this is such a frequently encountered problem, one is disappointed to find few guidelines for treatment of the combined conditions. Even the common problem of varicose veins in patients with minor lymphedema is omitted in the discussions. There is no better book than this one on diseases of the lymphatics. Every teaching vascular service should have this book, and it would provide a nice graduation gift to vascular trainees who are leaving academic institutions and going into practice in the community. DOI: 10.1007/s10016-003-0051-9 Published online: 10 September 2003
John Bergan, MD
Ó Annals of Vascular Surgery Inc. 587