- Email: [email protected]
Nonsurgical biliary drainage
Fletcher et al
23. Veranesi U, Adamus J, Bandiera CC, et al. Inefficacy of immediate node dissection in stage I melanoma of the limbs. N Engl J Med 1977;297:627-30. 24. Cohen MH, Ketcham AS, Felix EL, et al. Prognostic factors in patients undergoing lymphadenectomy for malignant melanoma. Ann Surg 1977;186:635-42. 25. Breslow A. Tumor thickness, level of invasion and node dissection in stage I cutaneous melanoma. Ann Surg 1975; 182:572-5. 26. Fortner JG, Woodruff J, Schottenfield D, Maclean 6. Biostatistical basis of elective node dissection for malignant melanoma. Ann Surg 1977;186:101-3. 27. Goldsmith HS. The debate over immediate lymph node dissection in melanoma. Surg Gynecol Obstet 1979; 148:403-5. 28. Creech 0 Jr, Krementz ET, Ryan RF, Winblad JN. Chemotherapy of cancer. Ann Surg 1958;148:616-32. 29. Janoff KA, Moreson D, Nohlgren J, Davenport C, Richards C, Fletcher WS. The treatment of stage I melanoma of the extremities with regional hyperthermic isolation perfusion. Ann Surg 1982;196:316-23. 30. Krementz ET, Ryan RF. Chemotherapy of melanoma of the extremities by perfusion: fourteen years clinical experi-
ence. Ann Surg 1972;175:900-17. 31. Stehlin JS Jr, Clark RL. Melanoma of the extremities: experience with conventional treatment and perfusion in 339 cases. Am J Surg 1965; 110:366-88. 32. Wagner DE. A retrospective study of regional perfusion for melanoma. Arch Surg 1978;111:410-2. 33. McBride CM. Sugarbaker EV, Hickey RC. Prophylactic isolation perfusion as the primary therapy for invasive malignant melanoma of the limbs. Ann Surg 1975;182:316-24. 34. Das Gupta TK. Results of treatment of 269 patients with primary cutaneous melanoma: a five year prospective study. Ann Surg 1977;186:201-9. 35. Wanebo HJ, Fortner JG, Woodruff J, et al. Selection of the optimum surgical treatment of stage I melanoma by depth of microinvasion: use of the combined microstage technique (Clark-Breslow). Ann Surg 1975;182:302-15. 36. Southwick HW. Malignant melanoma. Cancer 1976;37: 202-5. 37. Balch CM, Murad TM, Soong S. et al. A multifactorial analysis of melanoma: prognostic histopathological features comparing Clark’s and Breslow’s staging methods. Ann Surg 1978;188:732-42.
Book Reviews (cont’d) elude scar revision, collagen injection, and treatment of major burns, pressure sores, vascular insufficiency, and diabetic foot infections. If these must be included, they should be mentioned only to emphasize the need for a definitive care plan by a specialized practitioner. The authors give much treatment advice with which I do not agree. For example, they recommend debridement of purulent, necrotic pressure sores in the emergency department on an outpatient basis. Although the concept of this book has much to recommend it, the content does not. The few good sections enumerated do not offset the detracting portions, and much of the advice is not based on current theory. Martin C. Robson, MD
rica. The two articles from the United States include one by Joe Geenen on balloon dilatation of bile duct strictures and one by Alan Hofmann on the bile loss syndrome. As might be expected, several papers overlap considerably, and the quality of the papers varies. On the whole, this book provides a good update of information in this relatively new area. However, several articles documenting the risks of percutaneous transhepatic drainage report complication rates considerably lower than are now being published, fail to mention such complications as liver abscess and empyema of the gallbladder, and do not mention the high rate of renal problems that I have observed at UCLA. Moreover, since the publication of this book in 1984, two additional trials of preoperative percutaneous transhepatic drainage have failed to demonstrate any benefit for this procedure. One article reports a 95 percent success rate in 97 patients who underwent endoscopic placement of an endoprosthesis for benign obstruction at 13 centers. However, only nine incidences of catheter obstruction are reported, and no information is provided on the length of follow-up. Similarly, endoscopic balloon dilatation is reported in another paper to be successful in 18 of 27 biliary strictures (67 percent), in 6 of 8 pancreatic duct strictures (75 percent), and in 29 of 30 strictures of the sphincter of Oddi (97 percent). Although the author states that there was only a short follow-up period in most patients, one must be concerned that reports of this type are misleading and would not be acceptable to most peer-reviewed journals because of inadequate follow-up. I entirely agree with the view expressed by Peter Cotton in one review article, that prospective, randomized studies are needed and that “the patients’ interests were not necessarily best served by technical gymnastics, particularly if they had to be repeated frequently.”
Nonsurgical Biliary Drainage. Edited by M. Classen, J. Geenen, and K. Kawaii. Berlin: Springer-Verlag, 1984. 126 pages.
This 126 page book contains 20 short articles covering four general areas: pathology and surgery of biliary obstruction, percutaneous transhepatic drainage, transampullary drainage, and disturbances after biliary drainage. Although never clearly stated in the text or preface that these papers were presented at a particular symposium, one review article states that “this summary attempts to outline the areas of agreement and disagreement among the participants of the round table.” Sixteen of the 20 papers are authored by European radiologists or gastroenterologists who have been leaders in nonsurgical biliary drainage. One article on external transhepatic drainage comes from Japan, and one report of a controlled trial of preoperative transhepatic drainage comes from South Af-
Continued
598
Henry A. Pitt, MD
on page 602.
The American Journal of Surgery
23. Veranesi U, Adamus J, Bandiera CC, et al. Inefficacy of immediate node dissection in stage I melanoma of the limbs. N Engl J Med 1977;297:627-30. 24. Cohen MH, Ketcham AS, Felix EL, et al. Prognostic factors in patients undergoing lymphadenectomy for malignant melanoma. Ann Surg 1977;186:635-42. 25. Breslow A. Tumor thickness, level of invasion and node dissection in stage I cutaneous melanoma. Ann Surg 1975; 182:572-5. 26. Fortner JG, Woodruff J, Schottenfield D, Maclean 6. Biostatistical basis of elective node dissection for malignant melanoma. Ann Surg 1977;186:101-3. 27. Goldsmith HS. The debate over immediate lymph node dissection in melanoma. Surg Gynecol Obstet 1979; 148:403-5. 28. Creech 0 Jr, Krementz ET, Ryan RF, Winblad JN. Chemotherapy of cancer. Ann Surg 1958;148:616-32. 29. Janoff KA, Moreson D, Nohlgren J, Davenport C, Richards C, Fletcher WS. The treatment of stage I melanoma of the extremities with regional hyperthermic isolation perfusion. Ann Surg 1982;196:316-23. 30. Krementz ET, Ryan RF. Chemotherapy of melanoma of the extremities by perfusion: fourteen years clinical experi-
ence. Ann Surg 1972;175:900-17. 31. Stehlin JS Jr, Clark RL. Melanoma of the extremities: experience with conventional treatment and perfusion in 339 cases. Am J Surg 1965; 110:366-88. 32. Wagner DE. A retrospective study of regional perfusion for melanoma. Arch Surg 1978;111:410-2. 33. McBride CM. Sugarbaker EV, Hickey RC. Prophylactic isolation perfusion as the primary therapy for invasive malignant melanoma of the limbs. Ann Surg 1975;182:316-24. 34. Das Gupta TK. Results of treatment of 269 patients with primary cutaneous melanoma: a five year prospective study. Ann Surg 1977;186:201-9. 35. Wanebo HJ, Fortner JG, Woodruff J, et al. Selection of the optimum surgical treatment of stage I melanoma by depth of microinvasion: use of the combined microstage technique (Clark-Breslow). Ann Surg 1975;182:302-15. 36. Southwick HW. Malignant melanoma. Cancer 1976;37: 202-5. 37. Balch CM, Murad TM, Soong S. et al. A multifactorial analysis of melanoma: prognostic histopathological features comparing Clark’s and Breslow’s staging methods. Ann Surg 1978;188:732-42.
Book Reviews (cont’d) elude scar revision, collagen injection, and treatment of major burns, pressure sores, vascular insufficiency, and diabetic foot infections. If these must be included, they should be mentioned only to emphasize the need for a definitive care plan by a specialized practitioner. The authors give much treatment advice with which I do not agree. For example, they recommend debridement of purulent, necrotic pressure sores in the emergency department on an outpatient basis. Although the concept of this book has much to recommend it, the content does not. The few good sections enumerated do not offset the detracting portions, and much of the advice is not based on current theory. Martin C. Robson, MD
rica. The two articles from the United States include one by Joe Geenen on balloon dilatation of bile duct strictures and one by Alan Hofmann on the bile loss syndrome. As might be expected, several papers overlap considerably, and the quality of the papers varies. On the whole, this book provides a good update of information in this relatively new area. However, several articles documenting the risks of percutaneous transhepatic drainage report complication rates considerably lower than are now being published, fail to mention such complications as liver abscess and empyema of the gallbladder, and do not mention the high rate of renal problems that I have observed at UCLA. Moreover, since the publication of this book in 1984, two additional trials of preoperative percutaneous transhepatic drainage have failed to demonstrate any benefit for this procedure. One article reports a 95 percent success rate in 97 patients who underwent endoscopic placement of an endoprosthesis for benign obstruction at 13 centers. However, only nine incidences of catheter obstruction are reported, and no information is provided on the length of follow-up. Similarly, endoscopic balloon dilatation is reported in another paper to be successful in 18 of 27 biliary strictures (67 percent), in 6 of 8 pancreatic duct strictures (75 percent), and in 29 of 30 strictures of the sphincter of Oddi (97 percent). Although the author states that there was only a short follow-up period in most patients, one must be concerned that reports of this type are misleading and would not be acceptable to most peer-reviewed journals because of inadequate follow-up. I entirely agree with the view expressed by Peter Cotton in one review article, that prospective, randomized studies are needed and that “the patients’ interests were not necessarily best served by technical gymnastics, particularly if they had to be repeated frequently.”
Nonsurgical Biliary Drainage. Edited by M. Classen, J. Geenen, and K. Kawaii. Berlin: Springer-Verlag, 1984. 126 pages.
This 126 page book contains 20 short articles covering four general areas: pathology and surgery of biliary obstruction, percutaneous transhepatic drainage, transampullary drainage, and disturbances after biliary drainage. Although never clearly stated in the text or preface that these papers were presented at a particular symposium, one review article states that “this summary attempts to outline the areas of agreement and disagreement among the participants of the round table.” Sixteen of the 20 papers are authored by European radiologists or gastroenterologists who have been leaders in nonsurgical biliary drainage. One article on external transhepatic drainage comes from Japan, and one report of a controlled trial of preoperative transhepatic drainage comes from South Af-
Continued
598
Henry A. Pitt, MD
on page 602.
The American Journal of Surgery