- Email: [email protected]
LONG-NECKED DISC AND BONE RONGEURS
1033
remarkably little damage, which was not at all what we had expected in view of previous experience with sensitised dogs." 12 Surprised by the lack of damage in the first two anuric kidneys, we took all possible precautions with the others to make certain that they were truly anuric.
Reviews of Books Intra-abdominal Crises KENNETH D. KEELE, M.D., F.R.C.P., consultant physician ; NORMAN M. MATHESON, F.R.C.S., M.R.C.P., F.A.C.S., consultant surgeon, Ashford Hospital, Middlesex. London: Butterworths. 1961. Pp. 397. 50s.
DISCUSSION
experiments indicate that some transplantation-sensitising factor is present in urine, and various workers have failed to find any sign of it in plasma, it must be contributed either by the kidney or by the mucosal surface of the lower urinary tract. It may arise in the mucosal cells of the bladder; experiments are in progress to establish this point. In view of the lability of the urine-sensitising factorfor example, its destruction by freezing to -20°Cit is unlikely to be mucopolysaccharide since such complexes are usually stable when subjected to freezing and thawing. Experiments are in hand to try to isolate and characterise the sensitising factor. Although the arrest of renal function came within the expected period after transplantation, the histological appearances of the anuric kidneys in group 1 indicate surprisingly mild parenchymal damage. We have no satisfactory explanation of this unexpected result. One should remember that kidneys in non-sensitised animals can also be rendered oliguric with surprisingly little glomerulotubular damage. Possibly only mild sensitisation is evoked by urine infusions. Since
our
The expenses involved in these experiments were defrayed grant to W. J. D. from the Medical Research Council.
by
Surgery
ABDOMINAL
a
F.R.C.S.E.
M. WILLIAMS Lond.
New Inventions LONG-NECKED DISC AND BONE RONGEURS ANTERIOR spinal surgery, whether for tuberculosis of the spine, removing neoplasms, or removing discs, requires bone rongeurs with particularly long necks.
The
forceps (see figure), specially made for me by Allen & Hanburys, Ltd., Bethnal Green, London, E.2, have been under trial now for three years and have proved successful. A. R. HODGSON Orthopædic and Traumatic Unit, Department of Surgery, University of Hong Kong
F.R.C.S.E.
Senior Lecturer
in Orthopædic Surgery
the
concern
of
general practi-
dangerous occasion for someone to have an abdominal emergency is when he is already a patient in hospital. This is because hospital staffs have usually been alerted to the possibility by the time an abdominal emergency reaches hospital; only the symptoms of postoperative emergencies have to be recognised by them as an alert, and the very fact of previous surgery itself calls complications to mind. In comparison with the general practitioner, the surgeon and physician are therefore trained by experience less to notice the red light than to confirm it. A further problem for the surgeon, since he may have to explore, is to make a diagnosis precise pathologically, functionally, and anatomically-a goal not always possible to reach in
M.R.C.V.S.
M.SC.
are
most
L. BLACK Department of Surgery, Postgraduate Medical School of London, W.12
emergencies
tioner, physician, and surgeon, and it is in approach to the subject that the interest of each must vary. The general practitioner needs to recognise the dangers lurking in a symptom or group of symptoms, so that, without necessarily making the exact diagnosis every time, he can at least heed the alarm when it sounds. It is sometimes said, and not without truth, that the
W. J. DEMPSTER F.R.C.S.,
of the Acute Abdomen
JOHN A. SHEPHERD, V.R.D., M.D., CH.M., F.R.C.S., Q.H.S., consultant general surgeon, Liverpool Region. Edinburgh: E. & S. Livingstone. 1960. Pp. 1228. 100s.
,
full. The two attitudes are well reflected in these books. Intraabdominal Crises is written by physician and surgeon hand-inhand, with an eye to the practitioner’s problems; it seeks to resolve the schism of mind inculcated by years of orthodox teaching (and even by the topography of many casualty departments)-that there are on the one hand " medical " emergencies, on the other " surgical ". In the outcome, their work is an essay developing the topic from the initial moment of crisis, gradually unfolding the development and management of the case from that moment. So chapter 1 starts with the background of patient, of the first observer, then general practitioner, to the administrative mechanism of hospital admission in this country-emergency bed service, ambulance and casualty service. Thence to a discourse on presenting symptoms and predominant signs, followed by an intelligent review in chapter 5 of those conditions which may delude by simulating the intra-abdominal crisis. This is the first and most valuable part of the book. From the general in part 1 to the particular in part 2; and in this lies the closer affinity to Surgery of the Acute Abdomen, a considerable work written by one surgeon alone. This has the orthodox approach of the surgically trained; for, after two opening chapters on principles of diagnosis and management, each subject is taken in anatomical order from the top downwards and within outwards. A final chapter on " medical conditions simulating the acute surgical abdomen " reveals the old schism. The merits of this work lie in its completeness, rarities being intentionally included; in an appendix on the incidence of the various disorders leading to emergency operation; and in a full and well-classified bibliography. It is too long to be read as a whole and must be regarded as a work of reference for surgeons in training and already trained. Intraabdominal Crises may be read straight through by student, practitioner, and postgraduate, for though it contains no references it is a concise exposition.
Blood Diseases of Infancy and Childhood CARL H. SMITH, M.D., professor of clinical pediatrics, Cornell University Medical College, New York. St. Louis: C. V.
Mosby. London: Henry Kimpton.
1960.
Pp. 551. 127s. 6d.
NO-ONE is better qualified to write on this subject than Professor Smith. The writer must not only know about diseases of the blood, but also be able to fit this knowledge into
remarkably little damage, which was not at all what we had expected in view of previous experience with sensitised dogs." 12 Surprised by the lack of damage in the first two anuric kidneys, we took all possible precautions with the others to make certain that they were truly anuric.
Reviews of Books Intra-abdominal Crises KENNETH D. KEELE, M.D., F.R.C.P., consultant physician ; NORMAN M. MATHESON, F.R.C.S., M.R.C.P., F.A.C.S., consultant surgeon, Ashford Hospital, Middlesex. London: Butterworths. 1961. Pp. 397. 50s.
DISCUSSION
experiments indicate that some transplantation-sensitising factor is present in urine, and various workers have failed to find any sign of it in plasma, it must be contributed either by the kidney or by the mucosal surface of the lower urinary tract. It may arise in the mucosal cells of the bladder; experiments are in progress to establish this point. In view of the lability of the urine-sensitising factorfor example, its destruction by freezing to -20°Cit is unlikely to be mucopolysaccharide since such complexes are usually stable when subjected to freezing and thawing. Experiments are in hand to try to isolate and characterise the sensitising factor. Although the arrest of renal function came within the expected period after transplantation, the histological appearances of the anuric kidneys in group 1 indicate surprisingly mild parenchymal damage. We have no satisfactory explanation of this unexpected result. One should remember that kidneys in non-sensitised animals can also be rendered oliguric with surprisingly little glomerulotubular damage. Possibly only mild sensitisation is evoked by urine infusions. Since
our
The expenses involved in these experiments were defrayed grant to W. J. D. from the Medical Research Council.
by
Surgery
ABDOMINAL
a
F.R.C.S.E.
M. WILLIAMS Lond.
New Inventions LONG-NECKED DISC AND BONE RONGEURS ANTERIOR spinal surgery, whether for tuberculosis of the spine, removing neoplasms, or removing discs, requires bone rongeurs with particularly long necks.
The
forceps (see figure), specially made for me by Allen & Hanburys, Ltd., Bethnal Green, London, E.2, have been under trial now for three years and have proved successful. A. R. HODGSON Orthopædic and Traumatic Unit, Department of Surgery, University of Hong Kong
F.R.C.S.E.
Senior Lecturer
in Orthopædic Surgery
the
concern
of
general practi-
dangerous occasion for someone to have an abdominal emergency is when he is already a patient in hospital. This is because hospital staffs have usually been alerted to the possibility by the time an abdominal emergency reaches hospital; only the symptoms of postoperative emergencies have to be recognised by them as an alert, and the very fact of previous surgery itself calls complications to mind. In comparison with the general practitioner, the surgeon and physician are therefore trained by experience less to notice the red light than to confirm it. A further problem for the surgeon, since he may have to explore, is to make a diagnosis precise pathologically, functionally, and anatomically-a goal not always possible to reach in
M.R.C.V.S.
M.SC.
are
most
L. BLACK Department of Surgery, Postgraduate Medical School of London, W.12
emergencies
tioner, physician, and surgeon, and it is in approach to the subject that the interest of each must vary. The general practitioner needs to recognise the dangers lurking in a symptom or group of symptoms, so that, without necessarily making the exact diagnosis every time, he can at least heed the alarm when it sounds. It is sometimes said, and not without truth, that the
W. J. DEMPSTER F.R.C.S.,
of the Acute Abdomen
JOHN A. SHEPHERD, V.R.D., M.D., CH.M., F.R.C.S., Q.H.S., consultant general surgeon, Liverpool Region. Edinburgh: E. & S. Livingstone. 1960. Pp. 1228. 100s.
,
full. The two attitudes are well reflected in these books. Intraabdominal Crises is written by physician and surgeon hand-inhand, with an eye to the practitioner’s problems; it seeks to resolve the schism of mind inculcated by years of orthodox teaching (and even by the topography of many casualty departments)-that there are on the one hand " medical " emergencies, on the other " surgical ". In the outcome, their work is an essay developing the topic from the initial moment of crisis, gradually unfolding the development and management of the case from that moment. So chapter 1 starts with the background of patient, of the first observer, then general practitioner, to the administrative mechanism of hospital admission in this country-emergency bed service, ambulance and casualty service. Thence to a discourse on presenting symptoms and predominant signs, followed by an intelligent review in chapter 5 of those conditions which may delude by simulating the intra-abdominal crisis. This is the first and most valuable part of the book. From the general in part 1 to the particular in part 2; and in this lies the closer affinity to Surgery of the Acute Abdomen, a considerable work written by one surgeon alone. This has the orthodox approach of the surgically trained; for, after two opening chapters on principles of diagnosis and management, each subject is taken in anatomical order from the top downwards and within outwards. A final chapter on " medical conditions simulating the acute surgical abdomen " reveals the old schism. The merits of this work lie in its completeness, rarities being intentionally included; in an appendix on the incidence of the various disorders leading to emergency operation; and in a full and well-classified bibliography. It is too long to be read as a whole and must be regarded as a work of reference for surgeons in training and already trained. Intraabdominal Crises may be read straight through by student, practitioner, and postgraduate, for though it contains no references it is a concise exposition.
Blood Diseases of Infancy and Childhood CARL H. SMITH, M.D., professor of clinical pediatrics, Cornell University Medical College, New York. St. Louis: C. V.
Mosby. London: Henry Kimpton.
1960.
Pp. 551. 127s. 6d.
NO-ONE is better qualified to write on this subject than Professor Smith. The writer must not only know about diseases of the blood, but also be able to fit this knowledge into