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Musculoskeletal Surgery for Cancer: Principles and Techniques
Book Reviews Orthopedic Anesthesia, edited by Denise J. Wedel, 441 pp, with illus, $79, New York, Churchill Livingstone, 1993 In designing a textbook specific to the anesthetic management of patients undergoing orthopedic surgical procedures, one encounters the dilemma that relatively few anesthetic problems are specific to orthopedic practice. Therefore, a decision must be made either to create a text that covers a wide range of issues or to confine the subject matter to the few orthopedic problems that present unique anesthetic challenges. Dr. Wedel chose the former alternative. In light of the short (400-page) format of this subspecialty text, discussions are fairly basic. Thus, some parts of this work will be more valuable to residents in first- and second-year clinical anesthesia than to more advanced trainees in anesthesia or practitioners. The chapter on the preoperative evaluation is basic and will be most useful to beginning trainees or to residents in orthopedics who want a brief overview of the topic. In contrast, the chapters on transfusion medicine and coagulation medicine are fairly comprehensive and current reviews for practicing anesthesiologists. They include helpful discussions on the decision to tranfuse and the risks of regional anesthesia in patients receiving anticoagulant, antiplatelet, and thrombolytic agents. The section on choice of regional or general anesthesia is well done but contains no information on preemptive analgesia, and the description of anesthetic effects on immune function is brief. The discussion of positioning in the chapter on positioning and monitoring is comprehensive and well organized, whereas the section on monitoring is fairly rudimentary. The chapter on regional anesthesia for the pediatric population is a good review for practitioners familiar with anesthesia for such patients. The discussions of specific blocks are concise and useful; the pediatric dose table for local anesthetic agents is a helpful reference. Because of the frequent references to the chapters on adult nerve blocks and neuraxial blockade, this chapter might have been easier to use if it had been combined with the chapters on regional anesthesia for adults or placed just after them. The chapter on geriatrics is an abbreviated review of the influence of advanced age on drug effects and anesthetic risks. In addition, it has a refreshing discussion of some "thorny" ethical issues, such as unnecessary surgical procedures, informed consent, and living wills and financial burden-topics too often ignored by surgical colleagues. The sections specific to orthopedics on microvascular, spine, and tumor operation are well organized and comprehensive. The chapter on tumors contains a nice discussion of the effects of radiation therapy and antitumor drugs. In addition, this portion of the book includes a well-organized chapter on outpatient surgical procedures, which contains a useful chart for preoperative laboratory testing and a good section on dismissal criteria. The chapters on nerve blocks and neuraxial blockade are less comprehensive than those in texts on regional anesthesia; however, they provide references for reviewing specific techniques and are good introductory chapters for beginning residents. The chapter on complications focuses mainly on those associated with regional Mayo Clin Proc 1993; 68:1134-1138
anesthesia but also contains some basic discussion of postoperative complications and embolic phenomena. The chapter on postoperative analgesia is well organized but is too brief to be much more than an introduction to the subject. Likewise, the chapter on chronic pain is too brief, but it has a good discussion of sympathetic dystrophy and some useful diagnostic and therapeutic suggestions for patients with back pain. I would have liked a more comprehensive discussion of epidural corticosteroid injections for sciatica. The topic of anesthesia for orthopedic surgical procedures does not lend itself to a subspecialty text as well as do more complex subspecialties such as anesthesia for cardiac or neurosurgical operations. Nevertheless, this text has a considerable amount of practical information. It is useful for first- and second-year residents and a worthwhile addition to a residency program library. Some chapters provide a helpful review for practicing anesthesiologists. Stephen E. Abram, M.D. Pain Clinic Milwaukee County Medical Complex Milwaukee, Wisconsin
Musculoskeletal Surgery for Cancer: Principles and Techniques, edited by Paul H. Sugarbaker and Martin M. Malawer, 391 pp, with illus, $95, New York, Thieme Medical Publishers, 1992 This text is a complete atlas of the surgical techniques used in musculoskeletal oncology. The authors state that the book is "designed to provide the orthopedic and surgical oncologists with an up-to-date approach to bone and soft tissue sarcomas of the extremities." The text could ideally be divided into two sections. The first seven chapters are an introduction to the problems and an explanation of the principles in musculoskeletal oncology. The first two chapters deal with the principles of treatment of soft tissue sarcomas and osteogenic sarcomas. In the third chapter, the bases of pathology, radiology, and staging of musculoskeletal tumors are discussed. The fourth and fifth chapters address rehabilitation and neurologic aspects. Chapters 6 and 7 provide detailed information on the current and most promising approach in the treatment of soft tissue sarcoma (wide excision in combination with high-dose irradiation) and bone sarcomas (neoadjuvant chemotherapy in conjunction with operation). Both chapters have an excellent review of the results reported in the literature. The second section of the book is an atlas of surgical techniques in musculoskeletal oncology. This section will probably be the most interesting part for both surgical oncologists and orthopedic surgeons who deal with the treatment of sarcomas. The description of the various techniques is up-to-date and clear. For each technique, the relative chapter provides indications and contraindications, information on the postoperative course and management, and a detailed description of the surgical procedure with clear anatomic drawings. A discussion on the surgical difficulties and guidelines in the variants of the procedure follows.
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© 1993 Mayo Foundationfor Medical Education and Research
Mayo Clin Proc, November 1993, Vol 68
BOOK REVIEWS
A complete variety of surgical procedures, both ablative operations and limb salvage, is superbly described by the authors. They emphasize the different indications and techniques of surgical reconstruction. This book will provide both surgeons in training and those who are dedicated to musculoskeletal oncology with a useful and up-todate approach to the treatment of musculoskeletal sarcomas. Franklin H. Sim, M.D. Department of Orthopedics
Skeletal Trauma: Fractures, Dislocations, and Ligamentous Injuries (in 2 vols), edited by Bruce D. Browner, Jesse B. Jupiter, Alan M. Levine, and Peter G. Trafton, 2,208 pp, with illus, $275, Philadelphia, W. B. Saunders Company, 1992 During the past 3 decades, extraordinary changes and advances have occurred in the management of musculoskeletal injuries. These changes have been necessary in response to a continuously increasing pattern of high-velocity injuries combined with patient expectations of quick recovery, less morbidity, and minimal final physical impairment. Physicians specifically interested in the science and practice of traumatology emerged from many medical subspecialties to meet these challenges. The foundation of the AO Group of Switzerland in 1958 profoundly influenced the development of improved implants and the philosophy of operative intervention in fracture care. Although these principles were slowly accepted in North America, the "AO disciples" in the United States rapidly became recognized leaders of skeletal traumatology and were instrumental in the creation of the highly respected Orthopaedic Trauma Association, which provides a forum for the scientific basis of skeletal traumatology. The initiation and completion of this textbook is a product of this group of skeletal traumatologists. Each chapter is a treatise written by highly respected authorities with demonstrated interest and experience in their area of discussion. Although most authors are orthopedic surgeons, many are in other medical subspecialties and are actively involved in traumatology. Globally, this textbook comprehensively organizes all available information and describes the current standard of care for physicians involved in the care of skeletal trauma. The book is divided into four major sections. The first section, General Principles, is an excellent resource for residents in orthopedics and traumatologists who need an update of current concepts. Soft tissue biology, injury, repair, and reconstruction are appropriately emphasized. Sequential chapters on the principles of closedfracture management, external fixation, and internal fixation should be required reading for students of traumatology. The chapter on the Ilizarov method is excellent, and a chapter on physical impairment ratings for fractures is important not only because of the information provided but also because of the perceptive planning to include this topic in the textbook. The second section, Spine and Pelvis, is the most comprehensive and current available description of this anatomic region. The superb illustrations are consistent throughout the rest of the text. The inclusion of treatment algorithms is another unifying textbook
1135
theme. In addition to providing a logical progression of the historical background, mechanism of injury, patient assessment, and treatment alternatives, the chapters in this section describe and illustrate the surgical technique in detail that rivals any of that shown in surgical technique manuals. This section is a comprehensive source for any physician involved in the care of patients with spinal or pelvic injuries. The section on the upper extremity is condensed but comprehensive and reflects the contemporary approach to this anatomic area. The philosophy, breadth of experience, and energy of the section editor are apparent throughout most of this section. The chapter on injuries of the shoulder girdle does not provide the same depth observed in other chapters; the descriptions of treatment alternatives are incomplete, and the lack of illustrations of surgical technique contrasts with the rest of the textbook. The final section, Lower Extremity, is a landmark effort that provides a comprehensive resource for anyone involved in the treatment of skeletal injuries of the lower extremity. The experience of the authors in their area of discussion is readily apparent. The plethora of illustrations, algorithms, and descriptions of the alternative-surgical techniques complements the excellent descriptions of each anatomic area. At first glance, the discussion of foot injuries seems brief, but careful readers will be impressed with the fulfillment of the stated goal of this chapter-to describe the role of internal fixation for foot injuries. The editors have maintained a consistent style and format among the multiple authors and have met their goal of producing a textbook that reflects the current standard of care for the management of patients with skeletal trauma. All chapters are well referenced, and the index is user-friendly. Although most reference lists are alphabetical, some are numerically ordered. The consistency of beautiful illustrations, extensive use of treatment algorithms, and detailed description of alternative surgical techniques are invaluable characteristics of this book. Although physicians in specialties such as neurosurgery, plastic surgery, or general surgery traumatology will find this resource valuable, orthopedic surgeons will be most interested in using this textbook. It could easily become the standard reference textbook for residents in training in orthopedics and practicing orthopedic surgeons involved in the care of patients with skeletal trauma. Arlen D. Hanssen, M.D. Department of Orthopedics
Ophthalmic Histopathology, by W. R. Lee, 337 pp, with illus, $250, New York, Springer-Verlag, 1993 Surgical ophthalmic specimens are encountered rarely by general pathologists. Thus, the handling and processing of this material, which includes the conjunctiva, cornea, and eyeball, often prove a challenge. Although several published articles have discussed this subject, a book addressed solely to the topic and to the histopathologic interpretation has not hitherto been published. W. R. Lee, the titular professor of ophthalmic pathology at the University of Glasgow, has addressed this book to general pathologists as well as to specialists in ophthalmic pathology. The 14
anesthesia but also contains some basic discussion of postoperative complications and embolic phenomena. The chapter on postoperative analgesia is well organized but is too brief to be much more than an introduction to the subject. Likewise, the chapter on chronic pain is too brief, but it has a good discussion of sympathetic dystrophy and some useful diagnostic and therapeutic suggestions for patients with back pain. I would have liked a more comprehensive discussion of epidural corticosteroid injections for sciatica. The topic of anesthesia for orthopedic surgical procedures does not lend itself to a subspecialty text as well as do more complex subspecialties such as anesthesia for cardiac or neurosurgical operations. Nevertheless, this text has a considerable amount of practical information. It is useful for first- and second-year residents and a worthwhile addition to a residency program library. Some chapters provide a helpful review for practicing anesthesiologists. Stephen E. Abram, M.D. Pain Clinic Milwaukee County Medical Complex Milwaukee, Wisconsin
Musculoskeletal Surgery for Cancer: Principles and Techniques, edited by Paul H. Sugarbaker and Martin M. Malawer, 391 pp, with illus, $95, New York, Thieme Medical Publishers, 1992 This text is a complete atlas of the surgical techniques used in musculoskeletal oncology. The authors state that the book is "designed to provide the orthopedic and surgical oncologists with an up-to-date approach to bone and soft tissue sarcomas of the extremities." The text could ideally be divided into two sections. The first seven chapters are an introduction to the problems and an explanation of the principles in musculoskeletal oncology. The first two chapters deal with the principles of treatment of soft tissue sarcomas and osteogenic sarcomas. In the third chapter, the bases of pathology, radiology, and staging of musculoskeletal tumors are discussed. The fourth and fifth chapters address rehabilitation and neurologic aspects. Chapters 6 and 7 provide detailed information on the current and most promising approach in the treatment of soft tissue sarcoma (wide excision in combination with high-dose irradiation) and bone sarcomas (neoadjuvant chemotherapy in conjunction with operation). Both chapters have an excellent review of the results reported in the literature. The second section of the book is an atlas of surgical techniques in musculoskeletal oncology. This section will probably be the most interesting part for both surgical oncologists and orthopedic surgeons who deal with the treatment of sarcomas. The description of the various techniques is up-to-date and clear. For each technique, the relative chapter provides indications and contraindications, information on the postoperative course and management, and a detailed description of the surgical procedure with clear anatomic drawings. A discussion on the surgical difficulties and guidelines in the variants of the procedure follows.
1134
© 1993 Mayo Foundationfor Medical Education and Research
Mayo Clin Proc, November 1993, Vol 68
BOOK REVIEWS
A complete variety of surgical procedures, both ablative operations and limb salvage, is superbly described by the authors. They emphasize the different indications and techniques of surgical reconstruction. This book will provide both surgeons in training and those who are dedicated to musculoskeletal oncology with a useful and up-todate approach to the treatment of musculoskeletal sarcomas. Franklin H. Sim, M.D. Department of Orthopedics
Skeletal Trauma: Fractures, Dislocations, and Ligamentous Injuries (in 2 vols), edited by Bruce D. Browner, Jesse B. Jupiter, Alan M. Levine, and Peter G. Trafton, 2,208 pp, with illus, $275, Philadelphia, W. B. Saunders Company, 1992 During the past 3 decades, extraordinary changes and advances have occurred in the management of musculoskeletal injuries. These changes have been necessary in response to a continuously increasing pattern of high-velocity injuries combined with patient expectations of quick recovery, less morbidity, and minimal final physical impairment. Physicians specifically interested in the science and practice of traumatology emerged from many medical subspecialties to meet these challenges. The foundation of the AO Group of Switzerland in 1958 profoundly influenced the development of improved implants and the philosophy of operative intervention in fracture care. Although these principles were slowly accepted in North America, the "AO disciples" in the United States rapidly became recognized leaders of skeletal traumatology and were instrumental in the creation of the highly respected Orthopaedic Trauma Association, which provides a forum for the scientific basis of skeletal traumatology. The initiation and completion of this textbook is a product of this group of skeletal traumatologists. Each chapter is a treatise written by highly respected authorities with demonstrated interest and experience in their area of discussion. Although most authors are orthopedic surgeons, many are in other medical subspecialties and are actively involved in traumatology. Globally, this textbook comprehensively organizes all available information and describes the current standard of care for physicians involved in the care of skeletal trauma. The book is divided into four major sections. The first section, General Principles, is an excellent resource for residents in orthopedics and traumatologists who need an update of current concepts. Soft tissue biology, injury, repair, and reconstruction are appropriately emphasized. Sequential chapters on the principles of closedfracture management, external fixation, and internal fixation should be required reading for students of traumatology. The chapter on the Ilizarov method is excellent, and a chapter on physical impairment ratings for fractures is important not only because of the information provided but also because of the perceptive planning to include this topic in the textbook. The second section, Spine and Pelvis, is the most comprehensive and current available description of this anatomic region. The superb illustrations are consistent throughout the rest of the text. The inclusion of treatment algorithms is another unifying textbook
1135
theme. In addition to providing a logical progression of the historical background, mechanism of injury, patient assessment, and treatment alternatives, the chapters in this section describe and illustrate the surgical technique in detail that rivals any of that shown in surgical technique manuals. This section is a comprehensive source for any physician involved in the care of patients with spinal or pelvic injuries. The section on the upper extremity is condensed but comprehensive and reflects the contemporary approach to this anatomic area. The philosophy, breadth of experience, and energy of the section editor are apparent throughout most of this section. The chapter on injuries of the shoulder girdle does not provide the same depth observed in other chapters; the descriptions of treatment alternatives are incomplete, and the lack of illustrations of surgical technique contrasts with the rest of the textbook. The final section, Lower Extremity, is a landmark effort that provides a comprehensive resource for anyone involved in the treatment of skeletal injuries of the lower extremity. The experience of the authors in their area of discussion is readily apparent. The plethora of illustrations, algorithms, and descriptions of the alternative-surgical techniques complements the excellent descriptions of each anatomic area. At first glance, the discussion of foot injuries seems brief, but careful readers will be impressed with the fulfillment of the stated goal of this chapter-to describe the role of internal fixation for foot injuries. The editors have maintained a consistent style and format among the multiple authors and have met their goal of producing a textbook that reflects the current standard of care for the management of patients with skeletal trauma. All chapters are well referenced, and the index is user-friendly. Although most reference lists are alphabetical, some are numerically ordered. The consistency of beautiful illustrations, extensive use of treatment algorithms, and detailed description of alternative surgical techniques are invaluable characteristics of this book. Although physicians in specialties such as neurosurgery, plastic surgery, or general surgery traumatology will find this resource valuable, orthopedic surgeons will be most interested in using this textbook. It could easily become the standard reference textbook for residents in training in orthopedics and practicing orthopedic surgeons involved in the care of patients with skeletal trauma. Arlen D. Hanssen, M.D. Department of Orthopedics
Ophthalmic Histopathology, by W. R. Lee, 337 pp, with illus, $250, New York, Springer-Verlag, 1993 Surgical ophthalmic specimens are encountered rarely by general pathologists. Thus, the handling and processing of this material, which includes the conjunctiva, cornea, and eyeball, often prove a challenge. Although several published articles have discussed this subject, a book addressed solely to the topic and to the histopathologic interpretation has not hitherto been published. W. R. Lee, the titular professor of ophthalmic pathology at the University of Glasgow, has addressed this book to general pathologists as well as to specialists in ophthalmic pathology. The 14