- Email: [email protected]
Ophthalmic Plastic Surgery Up-to-Date
950
AMERICAN JOURNAL OF OPHTHALMOLOGY
enees, unfortunately), the facial features involved, associated clinical findings, the diagnostic signs, the basic defects, the genetics, the prognosis, and the treatment, followed by a short list of references. This up-to-date book is stimulating to study or to browse through. It would be a thoughtful gift to any physician. Ophthalmologists will be fascinated because many of the conditions described have associated eye defects. Frank W . Newell
OCULAR PHARMACOLOGY, 2nd
ed. By
Wil-
liam H. Havener. St. Louis, Mosby, 1970. Clothbound, 556 pages, index, illustrations. $29.50 This clearly written and well-organized book reflects the advances in ocular pharmacology made in recent years. The text is divided into two major parts. The first section deals with drugs used in ophthalmic practice and discusses most of the drugs of interest to the ophthalmologist. The second part was not in the earlier edition and is concerned with medications employed in the therapy of cataract, extraocular muscles, glaucoma, infection, intraocular hemorrhage, lacrimal problems, and uveitis. This enables the author to succeed in his goal of outlining treatment from a disease-oriented viewpoint in addition to the drug-classified presentation given in the first part of the book. Some of the material discussed is controversial, but the author acknowledges this and freely admits there is often no "right" therapy. The complete bibliography and detailed index add to the value of this useful and informative book. Seymour B. Goren
A
SYNOPSIS OF PHARMACOLOGY, 2nd
ed.
Edited by V. C. Sutherland. Philadelphia,
APRIL, 1971
W. B. Saunders, 1970. Paperback, 720 page, index. $10.75 The first edition of this synopsis was published in 1959; this second edition has been prepared to meet the need of all students of the health professions requiring an introductory course in pharmacology. The material in this edition has been greatly expanded and includes a review of relevant physiology and pathology. Some detailed material has been omitted to keep the text at less than 700 pages in this paper bound edition. Dr. Sutherland has had the collaboration of Dr. Bertram Katzung in the preparation of the chapters dealing with drugs influencing the autonomic nervous system and the cardiovascular system. Dr. Walter Way helped with the section on anesthetic agents and Dr. Edward Way with the section on analgetic agents. The last chapter, chapter 17, concerns prescription writing—a necessity for the student and refreshing for the practitioner. There is a wealth of fundamental pharmacologic information in this text. The material is presented in outline fashion ; no words are wasted. The text can be used for reference and it has practical value as well in management of dosage schedules, review of side effects, mode of action. Each chapter has an exceedingly well-documented reference list for those who require more detailed information. The individual who digests and remembers much that is written here will be well grounded in pharmacology. Irving H. Leopold
OPHTHALMIC
PLASTIC
SURGERY
UP-TO-
DATE. By John C. Mustardé, Lester T. Jones, and Alston Callahan. Birmingham, Aesculapius, 1970. Clothbound, 201 pages, black-and-white illustrations, subject index. $20.00 This book is by three authors well known in the field of ophthalmic plastic and reconstructive surgery, Mr. John Mustardé, of
VOL. 71. NO. 4
BOOK REVIEWS
Ayr, Scotland; Dr. Lester Jones, of Portland, Oregon; and Dr. Alston Callahan, of Birmingham, Alabama. It is presented as an up-to-date supplement to the authors' previously published separate volumes in this field, and it admirably fulfills their endeavor to modernize their previous concepts in orbital anatomy, ocular adnexal surgery, and surgical complications. The 14 chapters contain Dr. Jones' meticulous revision of a portion of the ocular adnexa and orbital anatomy, and it contains the three authors' combined concepts on certain surgical approaches to these conditions as well as an excellent analysis of applicable surgical complications. Clear step-by-step drawings and selected case presentations are used to exemplify the varieties of surgical techniques and complications. Each author has written in his own literary style, but a uniformity of anatomic nomenclature has been maintained. In each chapter, each of the three authors present their opinions regarding each other's presentation of surgical techniques. This feature is unique and most helpful in broadening the reader's understanding of each author's concepts. Specifically, this book covers the detailed anatomy of the ocular adnexa (Jones), accompanied by well-documented anatomic photographs. In a chapter on congenital anomalies, Alston Calahan presents his latest opinions on the treatment of blepharophimosis, blepharoptosis, and epicanthus inversus. A chapter by Mustardé follows, conveying different concepts on these anomalies, including some modern advances on the treatment of hypertelerism. The chapter on blepharoptosis is excellent. After a presentation of latest concepts of anatomy, the most recent surgical techniques on high levator division and advancement, plication, newer methods of frontalis suspension, and corrugator muscle transplantation are discussed. Traumatic and acquired blepharoptosis, and complications of leavator muscle surgery are very well discussed in the
951
text and are accompanied by applicable case presentations and surgical drawings. The chapters on cicatricial and senile entropion include some of authors Jones and Callahan's most recent work. In another chapter, the etiology and treatment of canalicular obstruction are discussed with emphasis placed on the use and care of the Lester Jones Pyrex lacrimal tubes. The differential section of the facial nerve is proposed by Callahan for the treatment of chronic blepharospasm. There are two well-organized chapters outlining some of the most recent concepts and treatment of the anophthalmic socket. An excellent comparison is made between simple spheres and buried integrated implants in enucleations as well as the newer treatments for migrated or partially extruding muscle-cone implants. The authors' personal preferences as to time and method of treatment of the complications in socket reconstruction are clearly presented. The chapters on reconstruction of the medial canthus and the upper and lower eyelids present one author's opinions on treatment of large defects around the eyelids by the use of mobilized cheek, forehead, and eyelid flaps. Good surgical drawings and photographs are included and well documented. None of the complications of these procedures are discussed. The chapter on orbital fractures presents a most interesting comparison of the opinions of two of the authors (Mustardé and Callahan) on the diagnosis and treatment of the orbital rim and blow-out fractures. Mustardé prefers to rely upon the forced duction test over the radiograph and he warns against early repair. He prefers to wait until the diplopia is proven permanent or the enophthalmus is very marked before reducing the orbital floor. Callahan briefly states the more generally accepted views, including diagnosis by means of radiographs, the transcutaneous reduction of the fracture, and he encourages prompt surgery to avoid the
AMERICAN JOURNAL OF OPHTHALMOLOGY
952
common sequelae of unrepaired orbital fractures, i.e., permanent diplopia and enophthalmus. This book is a most informative, interesting, and useful adjunct to the previous volumes published by these three most capable authors and surgeons. Margaret Obear
HIGHER
EDUCATION
AND THE
NATION'S
HEALTH. Edited by the Carnegie Commission on Higher Education. New York, McGraw-Hill, 1970. Paperback, 130 pages, Appendices A and B, charts, references. The Commission starts with the premise that the most serious shortage of professional personnel in any major occupational group in the United States is in the health services. While recognizing that maldistribution and inefficient use of the physician's time may contribute in part to this shortage, the Commission concludes that immediate steps must be taken to increase the output of physicians, dentists, and their assistants. It states that the number of medical school entrants must be increased by 52% by 1978. It proposes three ways to do this: ( 1 ) decrease the period of training from four to three years, ( 2 ) expand existing and developing schools to an average class size of at least 100 and in some instances to 200 or more, and ( 3 ) establish nine new university health science centers in areas which have sufficient population density, giving thought also to the geographic distribution of such facilities. The Commission also recommends that present two-year medical schools be upgraded to provide the M.D. degree and finally recommends conversion of schools of osteopathy to schools of medicine, wherever feasible. This will require some change in the curriculum, a study of which the Committee strongly recommends. It further proposes
1
APRIL, 1971
that residency programs be restricted to three years and that residency training include experience in community hospitals and other facilities as well as in teaching hospitals. They urge that the university health science centers become more concerned with the problems of delivery of health care to the community. The Commission recognizes a need for area health education centers to serve those areas which do not have the population density to support a university health science center or, as in Los Angeles, where the population density is too great to be serviced by university health science centers. They identify 126 such centers scattered throughout the country. In these area centers, they envision community hospitals conducting educational programs under the supervision of the faculty of the university health science center with which it would be affiliated. The Commission feels that much greater federal participation in the financing of professional education in the health sciences is mandatory. It recommends that establishment of an "educational opportunity bank" for health science students, including residents. It also recommends that a uniform, relatively low tuition be made standard in all schools. For institutional support, the Commission recommends federal financing for cost of instruction supplements, this to be based on the number of students and residents, with bonuses allowed for expansion in enrollment and curriculum reform. They also recommend that construction costs for new and expanding university health science centers and area health education centers be allocated by the federal government to cover up to 75% of the total cost of construction and make available an additional 25% in the form of loans, if needed. For new university health science centers, they recommend an initial grant not to exceed $10 million per year. Finally, the Commission recommends that federal financing for research continue at its
AMERICAN JOURNAL OF OPHTHALMOLOGY
enees, unfortunately), the facial features involved, associated clinical findings, the diagnostic signs, the basic defects, the genetics, the prognosis, and the treatment, followed by a short list of references. This up-to-date book is stimulating to study or to browse through. It would be a thoughtful gift to any physician. Ophthalmologists will be fascinated because many of the conditions described have associated eye defects. Frank W . Newell
OCULAR PHARMACOLOGY, 2nd
ed. By
Wil-
liam H. Havener. St. Louis, Mosby, 1970. Clothbound, 556 pages, index, illustrations. $29.50 This clearly written and well-organized book reflects the advances in ocular pharmacology made in recent years. The text is divided into two major parts. The first section deals with drugs used in ophthalmic practice and discusses most of the drugs of interest to the ophthalmologist. The second part was not in the earlier edition and is concerned with medications employed in the therapy of cataract, extraocular muscles, glaucoma, infection, intraocular hemorrhage, lacrimal problems, and uveitis. This enables the author to succeed in his goal of outlining treatment from a disease-oriented viewpoint in addition to the drug-classified presentation given in the first part of the book. Some of the material discussed is controversial, but the author acknowledges this and freely admits there is often no "right" therapy. The complete bibliography and detailed index add to the value of this useful and informative book. Seymour B. Goren
A
SYNOPSIS OF PHARMACOLOGY, 2nd
ed.
Edited by V. C. Sutherland. Philadelphia,
APRIL, 1971
W. B. Saunders, 1970. Paperback, 720 page, index. $10.75 The first edition of this synopsis was published in 1959; this second edition has been prepared to meet the need of all students of the health professions requiring an introductory course in pharmacology. The material in this edition has been greatly expanded and includes a review of relevant physiology and pathology. Some detailed material has been omitted to keep the text at less than 700 pages in this paper bound edition. Dr. Sutherland has had the collaboration of Dr. Bertram Katzung in the preparation of the chapters dealing with drugs influencing the autonomic nervous system and the cardiovascular system. Dr. Walter Way helped with the section on anesthetic agents and Dr. Edward Way with the section on analgetic agents. The last chapter, chapter 17, concerns prescription writing—a necessity for the student and refreshing for the practitioner. There is a wealth of fundamental pharmacologic information in this text. The material is presented in outline fashion ; no words are wasted. The text can be used for reference and it has practical value as well in management of dosage schedules, review of side effects, mode of action. Each chapter has an exceedingly well-documented reference list for those who require more detailed information. The individual who digests and remembers much that is written here will be well grounded in pharmacology. Irving H. Leopold
OPHTHALMIC
PLASTIC
SURGERY
UP-TO-
DATE. By John C. Mustardé, Lester T. Jones, and Alston Callahan. Birmingham, Aesculapius, 1970. Clothbound, 201 pages, black-and-white illustrations, subject index. $20.00 This book is by three authors well known in the field of ophthalmic plastic and reconstructive surgery, Mr. John Mustardé, of
VOL. 71. NO. 4
BOOK REVIEWS
Ayr, Scotland; Dr. Lester Jones, of Portland, Oregon; and Dr. Alston Callahan, of Birmingham, Alabama. It is presented as an up-to-date supplement to the authors' previously published separate volumes in this field, and it admirably fulfills their endeavor to modernize their previous concepts in orbital anatomy, ocular adnexal surgery, and surgical complications. The 14 chapters contain Dr. Jones' meticulous revision of a portion of the ocular adnexa and orbital anatomy, and it contains the three authors' combined concepts on certain surgical approaches to these conditions as well as an excellent analysis of applicable surgical complications. Clear step-by-step drawings and selected case presentations are used to exemplify the varieties of surgical techniques and complications. Each author has written in his own literary style, but a uniformity of anatomic nomenclature has been maintained. In each chapter, each of the three authors present their opinions regarding each other's presentation of surgical techniques. This feature is unique and most helpful in broadening the reader's understanding of each author's concepts. Specifically, this book covers the detailed anatomy of the ocular adnexa (Jones), accompanied by well-documented anatomic photographs. In a chapter on congenital anomalies, Alston Calahan presents his latest opinions on the treatment of blepharophimosis, blepharoptosis, and epicanthus inversus. A chapter by Mustardé follows, conveying different concepts on these anomalies, including some modern advances on the treatment of hypertelerism. The chapter on blepharoptosis is excellent. After a presentation of latest concepts of anatomy, the most recent surgical techniques on high levator division and advancement, plication, newer methods of frontalis suspension, and corrugator muscle transplantation are discussed. Traumatic and acquired blepharoptosis, and complications of leavator muscle surgery are very well discussed in the
951
text and are accompanied by applicable case presentations and surgical drawings. The chapters on cicatricial and senile entropion include some of authors Jones and Callahan's most recent work. In another chapter, the etiology and treatment of canalicular obstruction are discussed with emphasis placed on the use and care of the Lester Jones Pyrex lacrimal tubes. The differential section of the facial nerve is proposed by Callahan for the treatment of chronic blepharospasm. There are two well-organized chapters outlining some of the most recent concepts and treatment of the anophthalmic socket. An excellent comparison is made between simple spheres and buried integrated implants in enucleations as well as the newer treatments for migrated or partially extruding muscle-cone implants. The authors' personal preferences as to time and method of treatment of the complications in socket reconstruction are clearly presented. The chapters on reconstruction of the medial canthus and the upper and lower eyelids present one author's opinions on treatment of large defects around the eyelids by the use of mobilized cheek, forehead, and eyelid flaps. Good surgical drawings and photographs are included and well documented. None of the complications of these procedures are discussed. The chapter on orbital fractures presents a most interesting comparison of the opinions of two of the authors (Mustardé and Callahan) on the diagnosis and treatment of the orbital rim and blow-out fractures. Mustardé prefers to rely upon the forced duction test over the radiograph and he warns against early repair. He prefers to wait until the diplopia is proven permanent or the enophthalmus is very marked before reducing the orbital floor. Callahan briefly states the more generally accepted views, including diagnosis by means of radiographs, the transcutaneous reduction of the fracture, and he encourages prompt surgery to avoid the
AMERICAN JOURNAL OF OPHTHALMOLOGY
952
common sequelae of unrepaired orbital fractures, i.e., permanent diplopia and enophthalmus. This book is a most informative, interesting, and useful adjunct to the previous volumes published by these three most capable authors and surgeons. Margaret Obear
HIGHER
EDUCATION
AND THE
NATION'S
HEALTH. Edited by the Carnegie Commission on Higher Education. New York, McGraw-Hill, 1970. Paperback, 130 pages, Appendices A and B, charts, references. The Commission starts with the premise that the most serious shortage of professional personnel in any major occupational group in the United States is in the health services. While recognizing that maldistribution and inefficient use of the physician's time may contribute in part to this shortage, the Commission concludes that immediate steps must be taken to increase the output of physicians, dentists, and their assistants. It states that the number of medical school entrants must be increased by 52% by 1978. It proposes three ways to do this: ( 1 ) decrease the period of training from four to three years, ( 2 ) expand existing and developing schools to an average class size of at least 100 and in some instances to 200 or more, and ( 3 ) establish nine new university health science centers in areas which have sufficient population density, giving thought also to the geographic distribution of such facilities. The Commission also recommends that present two-year medical schools be upgraded to provide the M.D. degree and finally recommends conversion of schools of osteopathy to schools of medicine, wherever feasible. This will require some change in the curriculum, a study of which the Committee strongly recommends. It further proposes
1
APRIL, 1971
that residency programs be restricted to three years and that residency training include experience in community hospitals and other facilities as well as in teaching hospitals. They urge that the university health science centers become more concerned with the problems of delivery of health care to the community. The Commission recognizes a need for area health education centers to serve those areas which do not have the population density to support a university health science center or, as in Los Angeles, where the population density is too great to be serviced by university health science centers. They identify 126 such centers scattered throughout the country. In these area centers, they envision community hospitals conducting educational programs under the supervision of the faculty of the university health science center with which it would be affiliated. The Commission feels that much greater federal participation in the financing of professional education in the health sciences is mandatory. It recommends that establishment of an "educational opportunity bank" for health science students, including residents. It also recommends that a uniform, relatively low tuition be made standard in all schools. For institutional support, the Commission recommends federal financing for cost of instruction supplements, this to be based on the number of students and residents, with bonuses allowed for expansion in enrollment and curriculum reform. They also recommend that construction costs for new and expanding university health science centers and area health education centers be allocated by the federal government to cover up to 75% of the total cost of construction and make available an additional 25% in the form of loans, if needed. For new university health science centers, they recommend an initial grant not to exceed $10 million per year. Finally, the Commission recommends that federal financing for research continue at its