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Noninvasive diagnostic techniques in vascular disease
BOOK REVIEWS
Noninvasive Diagnostic Techniques in Vascular Disease. 3rd Edition. Edited by Eugene F. Bernstein. St. Louis, Missouri: CV Mosby, 1985.919 pages. This edition of what has become one of the standard references in the field of vascular diagnosis has been quite significantly revised and updated from earlier editions published in 1978 and 1982. Included among the 75 editors and contributing authors are eminent authorities in every aspect of vascular diagnostic modalities. Given the rapid proliferation of noninvasive vascular laboratories over the past decade, a comprehensive resource of this type is badly needed to establish a level of excellence in this specialty and to focus attention on the important issues of test selection, technical pitfalls, clinical relevance, and cost-effectiveness. The book is well organized, presenting in the first section a number of chapters devoted to in-depth consideration of the basic fundamentals and instrumentation peculiar to each diagnostic technique. The next major section consists of chapters on practical application and interpretation of the same tests, including up-to-date references to each method as reported in the literature. State-of-the-art methodology is covered in detail, and techniques on the threshold of wider application are also adequately described. Some duplication of material is inevitable in a multiauthored text of this type, but the areas of repetition serve to add emphasis to important concepts and allow presentation of conflicting viewpoints. Few surgeons will find reason to read this encyclopedic text from cover to cover. Rather, it will serve best as a practical resource for physicians and vascular laboratory technicians faced with a particular problem in clinical diagnosis or research investigation related to the vascular system. Although the title suggests that the book is devoted entirely to noninvasive techniques, invasive diagnostic methods are also presented in sufficient detail to permit the reader to maintain a balanced perspective. In addition, there is ample discussion of therapeutic applications of the information derived from the vascular laboratory to keep the material clinically relevant. Where contradictory points of view have been expressed by different contributors, the editors have inserted a brief chapter expressing their own recommendation for the test, or sequence of tests, preferred in a given situation. One might wish to see at least one chapter on diagnostic techniques in disorders of the lymphatic system, particularly as those conditions must be differentiated from venous disease. The place of descending venography also deserves additional emphasis in appropriate sections. Technically the book is almost without flaw. The numerous illustrations are pertinent and of excellent quality; the references, extensive; and the index, exhaustive.
Altogether, it is a noteworthy contribution to the field, not only as a guide to diagnosis, but also as a method of approach to the vascular patient. Robert B. Smith, III, MD Atlanta, Georgia
Management of Vascular Surgical Problems. By W. Andrew Dale, MD. New York: McGraw Hill, 1985. 601 pages. $55.00. This very unusual book represents the singular experience of one of the recognized experts in the field of vascular surgery over his long and productive career. It is, thus, an anthology of one person’s thoughts and opinions based upon his own life’s work. It is very readable, spanning interesting synopses of historical features to the latest developments in the field of vascular surgery. However, the basic format is a brief but remarkably in-depth coverage of all of the aspects of a given area in the field. These are divided into 34 chapters which quite completely cover the field of vascular surgery. Common problems, such as abdominal aortic aneurysm and chronic leg ulcers, are given as much consideration as rare disorders, such as carotid body tumors and ergotism. Complications, such as lymph fistula and infection, are covered. New procedures like venous valve reconstruction are presented, as well as old ones, such as primary lumbar sympathectomy. Each of the chapters is replete with tidbits of information in the diagnosis and treatment of those disorders, including many useful technical details. The book also has a highly personal style which often borders on a folksy conversational character. This is not meant to be critical; on the contrary, it adds to its appeal. Dr. Dale has recognized that not everyone would agree with his opinions and experiences and so has provided a balance. Each chapter concludes with an individual commentary by a recognized “expert” in the area covered. Most, but not all, of the commentaries are complimentary, but each gives a very nice opposing or amplifing view of the important areas addressed by Dr. Dale previously in the chapter. This is a very unique and interesting approach. Although I did not agree personally with all of Dr. Dale’s views, learning what they are was a treat. I think this book can be highly recommended to anyone seriously interested in vascular surgery-from expert to beginner-since it is an opportunity for all to learn from a master surgeon. It also makes for a very good read. William M. Abbott, MD Boston, Massachusetts
Continued on page 247
Volume 153, February 1997
197
Noninvasive Diagnostic Techniques in Vascular Disease. 3rd Edition. Edited by Eugene F. Bernstein. St. Louis, Missouri: CV Mosby, 1985.919 pages. This edition of what has become one of the standard references in the field of vascular diagnosis has been quite significantly revised and updated from earlier editions published in 1978 and 1982. Included among the 75 editors and contributing authors are eminent authorities in every aspect of vascular diagnostic modalities. Given the rapid proliferation of noninvasive vascular laboratories over the past decade, a comprehensive resource of this type is badly needed to establish a level of excellence in this specialty and to focus attention on the important issues of test selection, technical pitfalls, clinical relevance, and cost-effectiveness. The book is well organized, presenting in the first section a number of chapters devoted to in-depth consideration of the basic fundamentals and instrumentation peculiar to each diagnostic technique. The next major section consists of chapters on practical application and interpretation of the same tests, including up-to-date references to each method as reported in the literature. State-of-the-art methodology is covered in detail, and techniques on the threshold of wider application are also adequately described. Some duplication of material is inevitable in a multiauthored text of this type, but the areas of repetition serve to add emphasis to important concepts and allow presentation of conflicting viewpoints. Few surgeons will find reason to read this encyclopedic text from cover to cover. Rather, it will serve best as a practical resource for physicians and vascular laboratory technicians faced with a particular problem in clinical diagnosis or research investigation related to the vascular system. Although the title suggests that the book is devoted entirely to noninvasive techniques, invasive diagnostic methods are also presented in sufficient detail to permit the reader to maintain a balanced perspective. In addition, there is ample discussion of therapeutic applications of the information derived from the vascular laboratory to keep the material clinically relevant. Where contradictory points of view have been expressed by different contributors, the editors have inserted a brief chapter expressing their own recommendation for the test, or sequence of tests, preferred in a given situation. One might wish to see at least one chapter on diagnostic techniques in disorders of the lymphatic system, particularly as those conditions must be differentiated from venous disease. The place of descending venography also deserves additional emphasis in appropriate sections. Technically the book is almost without flaw. The numerous illustrations are pertinent and of excellent quality; the references, extensive; and the index, exhaustive.
Altogether, it is a noteworthy contribution to the field, not only as a guide to diagnosis, but also as a method of approach to the vascular patient. Robert B. Smith, III, MD Atlanta, Georgia
Management of Vascular Surgical Problems. By W. Andrew Dale, MD. New York: McGraw Hill, 1985. 601 pages. $55.00. This very unusual book represents the singular experience of one of the recognized experts in the field of vascular surgery over his long and productive career. It is, thus, an anthology of one person’s thoughts and opinions based upon his own life’s work. It is very readable, spanning interesting synopses of historical features to the latest developments in the field of vascular surgery. However, the basic format is a brief but remarkably in-depth coverage of all of the aspects of a given area in the field. These are divided into 34 chapters which quite completely cover the field of vascular surgery. Common problems, such as abdominal aortic aneurysm and chronic leg ulcers, are given as much consideration as rare disorders, such as carotid body tumors and ergotism. Complications, such as lymph fistula and infection, are covered. New procedures like venous valve reconstruction are presented, as well as old ones, such as primary lumbar sympathectomy. Each of the chapters is replete with tidbits of information in the diagnosis and treatment of those disorders, including many useful technical details. The book also has a highly personal style which often borders on a folksy conversational character. This is not meant to be critical; on the contrary, it adds to its appeal. Dr. Dale has recognized that not everyone would agree with his opinions and experiences and so has provided a balance. Each chapter concludes with an individual commentary by a recognized “expert” in the area covered. Most, but not all, of the commentaries are complimentary, but each gives a very nice opposing or amplifing view of the important areas addressed by Dr. Dale previously in the chapter. This is a very unique and interesting approach. Although I did not agree personally with all of Dr. Dale’s views, learning what they are was a treat. I think this book can be highly recommended to anyone seriously interested in vascular surgery-from expert to beginner-since it is an opportunity for all to learn from a master surgeon. It also makes for a very good read. William M. Abbott, MD Boston, Massachusetts
Continued on page 247
Volume 153, February 1997
197