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Manual of ultrasound in trauma
BOOK REVIEWS Common Sense Emergency Abdominal Surgery Schein M, ed. Berlin: Springer-Verlag, 2000, 382 pp, $52.00. This text represents the author’s no-nonsense approach to the surgical abdomen. He draws on 20 years of clinical and academic experience in the field, but mainly, he emphasizes common sense– based methodology toward the diagnosis and treatment of the acute abdomen. This is not a comprehensive textbook nor is it a cookbooktype handbook to be carried in a laboratory coat. Instead, it is a collection of lessons taught by a seasoned surgeon and his students and written in text form. Some may be offended by the nonformal quality of this handbook. The author makes no apologies for the lack of tables, diagrams, and journal references. The author presents a no-frills approach to abdominal surgical problems and how to determine the “best” way to treat them. Common pitfalls are discussed. The book is divided into 3 main sections—the preoperative phase, the operative phase, and the postoperative phase. The first section helps the reader perform a quick mental triage of surgical priorities and then directs the surgeon through a focused history and physical, the appropriate diagnostic studies, and the formulation of a plan. Schein divides the presentation of the acute abdomen into 5 well-defined patterns: abdominal pain/shock, generalized peritonitis, localized peritonitis, intestinal obstruction, and important medical causes. The ability to categorize the acute abdomen into one of these patterns will guide the reader to the most effective and efficient means of treatment. The second section deals with the operation, from the specific procedure to be performed to the type of suture or type of closure to be used. Antibiotics and more diagnostic tests are also presented. Several nonoperative causes for the acute abdomen are reviewed. The author also discusses when not to operate, when to obtain other studies, and when to observe cautiously. In the third section, Schein presents the topics of nutrition, postoperative antibiotics, complications, and preparing for a second operation. He discusses abscesses, fistulas, ileus versus obstruction, and anastomotic leaks. He has a chapter on wound management and discusses the role of laparoscopy. Finally, the book concludes with a chapter on the Morbidity and Mortality (M&M) conference. The author describes how to prepare a presentation and how to learn from other surgeons’ complications. Again, Schein’s emphasis is on his individual approach, backed by years of personal experience and awareness of established principles. Although he draws on commonly accepted practices and evidence-based medicine, he means to convey his knowledge through common sense and logic. This book is by no means a complete and comprehensive textbook about the surgical abdomen nor is it a thorough preparation for written or
oral board examinations. It is a concise and practical approach toward reaching the ultimate goal—the management and treatment of the acute abdomen. Although Schein directs this book to “residents, thinking surgeons, and even students,” this book is probably most helpful to the junior-level resident or the 4th-year student doing a subinternship in general surgery, in which the initial stages of assessment and treatment plan formulation are learned. TITO L. VASQUEZ, MD Department of Surgery St. Luke’s Hospital Bethlehem, Pennsylvania PII S0149-7944(01)00415-9
Manual of Ultrasound in Trauma Bester L, Johansson K, Kolkman K, Perez A, Sugrue M, eds. Liverpool, New South Wales, Australia: Graphics & Desktop Publishing, 2000, 76 pp, $20.00. The use of ultrasound in trauma is becoming widespread. It provides a rapid, cost-effective, and noninvasive way to assess a patient for possible intra-abdominal trauma. User experience and technique account for most of the limitations of ultrasound. Consequently, surgeons who will be providing care for trauma patients must become proficient in its use. To achieve proficiency, physicians need to understand the basic principals of ultrasound and perfect the technique of the Focused Assessment with Sonography for Trauma (FAST). This pocket-sized book has been developed by the Trauma Department at the Liverpool Hospital in Sydney, Australia. The 6 authors are an international collection of physicians from surgery and radiology who share a common interest in the evaluation and care of trauma patients. The manual is written in a clear and concise manner and is easily readable. The 7 chapters provide the theory and technique needed to evaluate abdominal trauma with ultrasound. The initial chapters provide a history of ultrasound development and the basic principals of ultrasonography. The technical aspects of reverberation, shadowing, gain and reflection, and refraction are explained. Multiple photographs help the reader become familiar with the equipment and visualize how machine adjustment can enhance a study. Of particular importance is the chapter on “Dilemmas in Assessment of Abdominal Trauma.” This chapter describes the patterns of abdominal injury with associated tips and pitfalls. Numerous flow diagrams are provided to assist in the initial assessment and treatment of both blunt and penetrating trauma in stable and unstable patients. The use of modalities other than ultrasound for abdominal traumas, such as serial examinations, computed tomography, laparoscopy, and DPL, are also extensively discussed. The specific technique of the FAST examination is described in great detail in another chapter. The 5 FAST areas are included—
CURRENT SURGERY • © 2001 by the Association of Program Directors in Surgery Published by Elsevier Science Inc.
0149-7944/01/$20.00
551
Morrison’s pouch, pericardium, perisplenic space, paracolic views, and the suprapubic view. Serial photographs show the proper probe angle and placement to assist the reader. Finally, issues of training and accreditation in ultrasound are addressed. Worldwide, a large variation exists in the number of FAST examinations required for accreditation. A 6-month study of using ultrasound in abdominal trauma at the Liverpool Hospital is also included. The authors identified multiple causes of incomplete or unobtainable examinations, including obesity, intra-abdominal scaring, ascites, and bowel interposition. This text is an ideal resource for anyone involved in the evaluation of trauma patients. It will be of most benefit to the junior resident and to surgeons before enrollment in an ultrasound course. DAVID SCAFF, DO Department of Surgery St. Luke’s Hospital Bethlehem, Pennsylvania PII S0149-7944(01)00432-9
Operative Urology: Surgical Skills Krane R, Siroky M, Fitzpatrick J, eds. London: Churchill Livingstone, 2000, 448 pp, $125.00. “I’m a general surgeon. I don’t know anything about urology!” This was my response when asked to review Operative Urology by Robert Krane, Mike Siroky, and John Fitzpatrick. “That’s perfect. You should review the text from the perspective of a general surgery resident,” I was told. I needed it more than I thought; remarkably, within the week, I was doing a renal transplant and dealing with a penetrating renal injury. Operative Urology is a succinct text dealing with the core procedures of modern urology. Sixty chapters cover the indications, preparation, technical steps, and pitfalls involved in the most common urologic procedures. Each chapter is written by a different author; all are known experts in the specific areas of urology. Despite multiple authors, the text reads more like it was written by a single author with a well-followed outline used for each chapter, including indications, operative approach, complications, and postoperative considerations. No text dealing with surgical skills and procedures would be complete without adequate illustrations and diagrams to elucidate the key surgical anatomy and steps. Clear figures, showing the most important technical steps and anatomy, are provided. The drawings are done as line drawings and half-tone and are well labeled. The drawings are unambiguous and are well labeled. They are not detailed enough to comprise a pure atlas of urologic surgery, but they complement the text descriptions satisfactorily. Like any textbook of this type, Operative Urology is limited by what it is not. It does not have the quantity or quality of illustrations to be considered a surgical atlas nor does it have the detail and completeness to be a urology text. The strength of this text is that it combines the best of both an atlas and a 552
comprehensive text to give the reader a concise description of the indications, preparations, technical maneuvers, and postoperative management considerations for the most urologic surgical cases. As a general surgeon, this book is not one I need for my personal library, but it is one that certainly belongs in every residency program library and in the personal library of those involved in the practice of urologic surgery. CARLYLE DUNSHEE, MD Brody School of Medicine East Carolina University Greenville, North Carolina PII S0149-7944(01)00453-6
Surgical Decision Making, 4th ed Norton LW, Van Stiegmann G, Eiseman B, eds. Philadelphia, Pa: W. B. Saunders, 2000, 357 pp, $89.00. For surgical trainees, the American Board of Surgery Certifying Examination represents the final hurdle to board certification. Accordingly, there is considerable anxiety associated with performance on this formidable test. In order to prepare their trainees for this challenge, many residency programs have instituted practice examinations or “mock oral” boards. This technique introduces the residents to the test format at an early stage, and it examines their decision-making abilities. It is the aim of Surgical Decision Making to use algorithms to teach surgical decision making, hence, sharpening the surgeon’s (or resident’s) powers of clinical judgment. Surgical Decision Making is divided into 11 subsections comprising a broad spectrum of topics, from general surgical considerations to subspecialty components, including urology, gynecology, and orthopedics. Within each section, many topics are addressed, each outlining management algorithms, with concise text legends for each step of the process. With few exceptions, each topic (for example, parotid tumor, pulmonary embolus, or renovascular hypertension) is covered in 2 pages. Although basically conservative, the text includes some evolving surgical options, including endovascular grafting of abdominal aortic aneurysms. The text is concise, yet strikingly comprehensive in the number of topics it covers. Despite its brevity (or perhaps because of it), Surgical Decision Making provides a complete step-by-step guide for decision making on a number of diverse clinical situations. This text makes no attempt to delve into the pathophysiology of the diseases it covers. Instead, this book targets management decisions only, clearly geared toward a reader who has mastered basic surgical knowledge. Overall, Surgical Decision Making is an overwhelming success. It is not intended as a comprehensive source of knowledge, but it is an excellent review that provides a systematic approach to many of the most common problems encountered in general surgery. It is a must-read for anyone preparing for the oral board examination. It would clearly make an excellent addition to the
CURRENT SURGERY • Volume 58/Number 6 • November/December 2001
oral board examinations. It is a concise and practical approach toward reaching the ultimate goal—the management and treatment of the acute abdomen. Although Schein directs this book to “residents, thinking surgeons, and even students,” this book is probably most helpful to the junior-level resident or the 4th-year student doing a subinternship in general surgery, in which the initial stages of assessment and treatment plan formulation are learned. TITO L. VASQUEZ, MD Department of Surgery St. Luke’s Hospital Bethlehem, Pennsylvania PII S0149-7944(01)00415-9
Manual of Ultrasound in Trauma Bester L, Johansson K, Kolkman K, Perez A, Sugrue M, eds. Liverpool, New South Wales, Australia: Graphics & Desktop Publishing, 2000, 76 pp, $20.00. The use of ultrasound in trauma is becoming widespread. It provides a rapid, cost-effective, and noninvasive way to assess a patient for possible intra-abdominal trauma. User experience and technique account for most of the limitations of ultrasound. Consequently, surgeons who will be providing care for trauma patients must become proficient in its use. To achieve proficiency, physicians need to understand the basic principals of ultrasound and perfect the technique of the Focused Assessment with Sonography for Trauma (FAST). This pocket-sized book has been developed by the Trauma Department at the Liverpool Hospital in Sydney, Australia. The 6 authors are an international collection of physicians from surgery and radiology who share a common interest in the evaluation and care of trauma patients. The manual is written in a clear and concise manner and is easily readable. The 7 chapters provide the theory and technique needed to evaluate abdominal trauma with ultrasound. The initial chapters provide a history of ultrasound development and the basic principals of ultrasonography. The technical aspects of reverberation, shadowing, gain and reflection, and refraction are explained. Multiple photographs help the reader become familiar with the equipment and visualize how machine adjustment can enhance a study. Of particular importance is the chapter on “Dilemmas in Assessment of Abdominal Trauma.” This chapter describes the patterns of abdominal injury with associated tips and pitfalls. Numerous flow diagrams are provided to assist in the initial assessment and treatment of both blunt and penetrating trauma in stable and unstable patients. The use of modalities other than ultrasound for abdominal traumas, such as serial examinations, computed tomography, laparoscopy, and DPL, are also extensively discussed. The specific technique of the FAST examination is described in great detail in another chapter. The 5 FAST areas are included—
CURRENT SURGERY • © 2001 by the Association of Program Directors in Surgery Published by Elsevier Science Inc.
0149-7944/01/$20.00
551
Morrison’s pouch, pericardium, perisplenic space, paracolic views, and the suprapubic view. Serial photographs show the proper probe angle and placement to assist the reader. Finally, issues of training and accreditation in ultrasound are addressed. Worldwide, a large variation exists in the number of FAST examinations required for accreditation. A 6-month study of using ultrasound in abdominal trauma at the Liverpool Hospital is also included. The authors identified multiple causes of incomplete or unobtainable examinations, including obesity, intra-abdominal scaring, ascites, and bowel interposition. This text is an ideal resource for anyone involved in the evaluation of trauma patients. It will be of most benefit to the junior resident and to surgeons before enrollment in an ultrasound course. DAVID SCAFF, DO Department of Surgery St. Luke’s Hospital Bethlehem, Pennsylvania PII S0149-7944(01)00432-9
Operative Urology: Surgical Skills Krane R, Siroky M, Fitzpatrick J, eds. London: Churchill Livingstone, 2000, 448 pp, $125.00. “I’m a general surgeon. I don’t know anything about urology!” This was my response when asked to review Operative Urology by Robert Krane, Mike Siroky, and John Fitzpatrick. “That’s perfect. You should review the text from the perspective of a general surgery resident,” I was told. I needed it more than I thought; remarkably, within the week, I was doing a renal transplant and dealing with a penetrating renal injury. Operative Urology is a succinct text dealing with the core procedures of modern urology. Sixty chapters cover the indications, preparation, technical steps, and pitfalls involved in the most common urologic procedures. Each chapter is written by a different author; all are known experts in the specific areas of urology. Despite multiple authors, the text reads more like it was written by a single author with a well-followed outline used for each chapter, including indications, operative approach, complications, and postoperative considerations. No text dealing with surgical skills and procedures would be complete without adequate illustrations and diagrams to elucidate the key surgical anatomy and steps. Clear figures, showing the most important technical steps and anatomy, are provided. The drawings are done as line drawings and half-tone and are well labeled. The drawings are unambiguous and are well labeled. They are not detailed enough to comprise a pure atlas of urologic surgery, but they complement the text descriptions satisfactorily. Like any textbook of this type, Operative Urology is limited by what it is not. It does not have the quantity or quality of illustrations to be considered a surgical atlas nor does it have the detail and completeness to be a urology text. The strength of this text is that it combines the best of both an atlas and a 552
comprehensive text to give the reader a concise description of the indications, preparations, technical maneuvers, and postoperative management considerations for the most urologic surgical cases. As a general surgeon, this book is not one I need for my personal library, but it is one that certainly belongs in every residency program library and in the personal library of those involved in the practice of urologic surgery. CARLYLE DUNSHEE, MD Brody School of Medicine East Carolina University Greenville, North Carolina PII S0149-7944(01)00453-6
Surgical Decision Making, 4th ed Norton LW, Van Stiegmann G, Eiseman B, eds. Philadelphia, Pa: W. B. Saunders, 2000, 357 pp, $89.00. For surgical trainees, the American Board of Surgery Certifying Examination represents the final hurdle to board certification. Accordingly, there is considerable anxiety associated with performance on this formidable test. In order to prepare their trainees for this challenge, many residency programs have instituted practice examinations or “mock oral” boards. This technique introduces the residents to the test format at an early stage, and it examines their decision-making abilities. It is the aim of Surgical Decision Making to use algorithms to teach surgical decision making, hence, sharpening the surgeon’s (or resident’s) powers of clinical judgment. Surgical Decision Making is divided into 11 subsections comprising a broad spectrum of topics, from general surgical considerations to subspecialty components, including urology, gynecology, and orthopedics. Within each section, many topics are addressed, each outlining management algorithms, with concise text legends for each step of the process. With few exceptions, each topic (for example, parotid tumor, pulmonary embolus, or renovascular hypertension) is covered in 2 pages. Although basically conservative, the text includes some evolving surgical options, including endovascular grafting of abdominal aortic aneurysms. The text is concise, yet strikingly comprehensive in the number of topics it covers. Despite its brevity (or perhaps because of it), Surgical Decision Making provides a complete step-by-step guide for decision making on a number of diverse clinical situations. This text makes no attempt to delve into the pathophysiology of the diseases it covers. Instead, this book targets management decisions only, clearly geared toward a reader who has mastered basic surgical knowledge. Overall, Surgical Decision Making is an overwhelming success. It is not intended as a comprehensive source of knowledge, but it is an excellent review that provides a systematic approach to many of the most common problems encountered in general surgery. It is a must-read for anyone preparing for the oral board examination. It would clearly make an excellent addition to the
CURRENT SURGERY • Volume 58/Number 6 • November/December 2001