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Intestinal fistulas
BOOK REVIEWS
Intestinal Fistulas. By John Alexander-Williams, MD and Miles Irving, MD. Bristol, London, Boston: Wright PSG, 1982.229 pages. For the physician who occasionally treats a patient with an intestinal fistula, this monograph offers an excellent historical analysis of changing patterns in the management of this complex problem. The basic principle of aggressive metabolic and nutritional resuscitation while the precise anatomy of the fistula is being defined is readily apparent throughout the book. The roles of both urgent and delayed surgical intervention in the overall management plan are thoughtfully explained. Following this overview, the authors discuss management of fistulas that arise from each of the alimentary organs. Although the text is redundant at times, the aforementioned principles are reviewed in relation to each type of fistula to establish what the authors suggest will afford the optimal chance of cure. Yet data regarding success rates are often absent, perhaps because their inclusion would detract from the overall excellent readability of this book. The same reasoning may account for the superficial descriptions of surgical procedures undertaken for various types of fistulas. The reader cannot help but come away with basic guidelines for the management of the surgical patient who has any one of a variety of intestinal fistulas, and the author deserves to be commended for it. A more detailed analysis of the individual types of fistulas will, of course, require consultation of other sources. John J. Ferrera, MD Surgical Infections. By Lewis M. Flint, MD and Donald E. Fry, MD. Garden City, New York: Medical Examination Publishing Co., Inc., 1982. 180 pages. $23.00. Infections and infectious disease have entered a major arena in the surgical battleground. Drs. Flint and Fry have produced a handbook which attempts to summarize the current state-of-the-art in diagnosis and treatment of surgical infection. The intent is to gather pathology, microbiology, pharmacology, and surgical technique into one simple compendium for the management of difficult problems. The book is concise and has as it’s major attributes an interesting historic account of surgical infection and a sophisticated description of the immunobiology of sepsis, including a detailed account of secreted factors that govern immunologic response as well as prostaglandin, complement, and properdin systems. This volume is a true handbook that presents one method of treatment for each of a variety of infectious complications. In general, these m.ethods are acceptable and well documented. (Each chapter contains appropriate references to document the presented point of view.) The book suffers somewhat because it presents only a single approach to each particular area of infectious disease, which in some cases (for example, chloramphenicol
Volume 144,
October 1982
as a prophylactic antibiotic for vascular surgery), runs contrary to the accepted opinion of most surgical SPecialists. Although the book hardly focuses on the state-ofthe-art or the comprehensive treatment of infectious disease, it does serve the purpose of being a concise manual of the infectious complications of surgical diseases and their management. It can serve as a handy reference and, for those inclined t.o more serious deliberation, is an excellent introduction to the field of infectious disease in surgery. Peter J. Fabri, MD Infection in the Perioperative Patient. By Alix Mathieu, MD and John Burke, MD. New York: Grune & Stratton, 1982.456 pages. $44.50. The field of critical care is rapidly erupting and now encompasses surgery, medicine, pediatrics, and anesthesiology. An anesthesiologist and a renowned surgeon have entered this treatise into the arena of infectious disease. The book is intended primarily for anesthesiologists but has a certain appeal to the surgical specialist as well. It is subdivided into sections devoted to preoperative, intraoperative, and postoperative problems and attempts to deal, in depth, with a variety of areas ranging from the basic biochemistry and pathophysiology of infection to the abnormalities of, among other things, burns, transplants, and cardiac patients. Many of the chapters are devoted to an analysis of the syndrome of multiple organ system failure, both as an entity and as separate diseases. Each chapter is endowed with an abundant bibliography and presents an unbiased state-of-the-art account. As is the case with most volumes by more than one author, the material is, in many instances, dated at the time of publication. Discussions of antibiotics must be considered with tongue-incheek because of the recent introduction of more effective agents. Specifically, the entire section on nutrition, although comprehensive, authoritative, and extremely well referenced, ignores entirely the recent recognition of the effect of nutritional support on carbon dioxide production and possibly respiratory failure in the patient who is critically ill. In a volume dedicated to anesthesiologists, the effect of nutrition on the respiratory system should hardly be overlooked. The large number of typographic errors detract from the readability of the work but, overall, this volume is both comprehensive and timely. It presents, in one locus, a discussion of the vast majority of areas of interest to a surgeon or anesthesiologist who encounters a problematic infection. Material in every chapter is supported by adequate bibliographic documentation to satisfy even the purists among us. This work would have been “on the cutting edge” a year or two ago and is an adequate and stimulating addition to the literature on surgical infections. Peter J. Fabri, MD
495
Intestinal Fistulas. By John Alexander-Williams, MD and Miles Irving, MD. Bristol, London, Boston: Wright PSG, 1982.229 pages. For the physician who occasionally treats a patient with an intestinal fistula, this monograph offers an excellent historical analysis of changing patterns in the management of this complex problem. The basic principle of aggressive metabolic and nutritional resuscitation while the precise anatomy of the fistula is being defined is readily apparent throughout the book. The roles of both urgent and delayed surgical intervention in the overall management plan are thoughtfully explained. Following this overview, the authors discuss management of fistulas that arise from each of the alimentary organs. Although the text is redundant at times, the aforementioned principles are reviewed in relation to each type of fistula to establish what the authors suggest will afford the optimal chance of cure. Yet data regarding success rates are often absent, perhaps because their inclusion would detract from the overall excellent readability of this book. The same reasoning may account for the superficial descriptions of surgical procedures undertaken for various types of fistulas. The reader cannot help but come away with basic guidelines for the management of the surgical patient who has any one of a variety of intestinal fistulas, and the author deserves to be commended for it. A more detailed analysis of the individual types of fistulas will, of course, require consultation of other sources. John J. Ferrera, MD Surgical Infections. By Lewis M. Flint, MD and Donald E. Fry, MD. Garden City, New York: Medical Examination Publishing Co., Inc., 1982. 180 pages. $23.00. Infections and infectious disease have entered a major arena in the surgical battleground. Drs. Flint and Fry have produced a handbook which attempts to summarize the current state-of-the-art in diagnosis and treatment of surgical infection. The intent is to gather pathology, microbiology, pharmacology, and surgical technique into one simple compendium for the management of difficult problems. The book is concise and has as it’s major attributes an interesting historic account of surgical infection and a sophisticated description of the immunobiology of sepsis, including a detailed account of secreted factors that govern immunologic response as well as prostaglandin, complement, and properdin systems. This volume is a true handbook that presents one method of treatment for each of a variety of infectious complications. In general, these m.ethods are acceptable and well documented. (Each chapter contains appropriate references to document the presented point of view.) The book suffers somewhat because it presents only a single approach to each particular area of infectious disease, which in some cases (for example, chloramphenicol
Volume 144,
October 1982
as a prophylactic antibiotic for vascular surgery), runs contrary to the accepted opinion of most surgical SPecialists. Although the book hardly focuses on the state-ofthe-art or the comprehensive treatment of infectious disease, it does serve the purpose of being a concise manual of the infectious complications of surgical diseases and their management. It can serve as a handy reference and, for those inclined t.o more serious deliberation, is an excellent introduction to the field of infectious disease in surgery. Peter J. Fabri, MD Infection in the Perioperative Patient. By Alix Mathieu, MD and John Burke, MD. New York: Grune & Stratton, 1982.456 pages. $44.50. The field of critical care is rapidly erupting and now encompasses surgery, medicine, pediatrics, and anesthesiology. An anesthesiologist and a renowned surgeon have entered this treatise into the arena of infectious disease. The book is intended primarily for anesthesiologists but has a certain appeal to the surgical specialist as well. It is subdivided into sections devoted to preoperative, intraoperative, and postoperative problems and attempts to deal, in depth, with a variety of areas ranging from the basic biochemistry and pathophysiology of infection to the abnormalities of, among other things, burns, transplants, and cardiac patients. Many of the chapters are devoted to an analysis of the syndrome of multiple organ system failure, both as an entity and as separate diseases. Each chapter is endowed with an abundant bibliography and presents an unbiased state-of-the-art account. As is the case with most volumes by more than one author, the material is, in many instances, dated at the time of publication. Discussions of antibiotics must be considered with tongue-incheek because of the recent introduction of more effective agents. Specifically, the entire section on nutrition, although comprehensive, authoritative, and extremely well referenced, ignores entirely the recent recognition of the effect of nutritional support on carbon dioxide production and possibly respiratory failure in the patient who is critically ill. In a volume dedicated to anesthesiologists, the effect of nutrition on the respiratory system should hardly be overlooked. The large number of typographic errors detract from the readability of the work but, overall, this volume is both comprehensive and timely. It presents, in one locus, a discussion of the vast majority of areas of interest to a surgeon or anesthesiologist who encounters a problematic infection. Material in every chapter is supported by adequate bibliographic documentation to satisfy even the purists among us. This work would have been “on the cutting edge” a year or two ago and is an adequate and stimulating addition to the literature on surgical infections. Peter J. Fabri, MD
495