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Sémiologie et traitement des algies discalés et ligamentaires du rachis
191
Book reviews
reading Dr. Lap&s monograph the following critical remarks may be noted. In the marketing-analytical approach, the costs of a thousand cases of preventable perinatal deaths can be calculated; but several investigations have shown that the proposed new forms of organization of obstetrical care can dramatically reduce not only perinatal mortality but perinatal morbidity too. In testing the wishes of consumers, one should consider whether the answer is without immediate importance or leads to immediate consequences. For example, when asking women whether they prefer domicilary delivery, in a situation where the answer has no immediate consequences, or has no need to be in accordance with reality, emotional factors can be predominant. The fact that the high-income group is admitted more frequently to hospital on medical indication than the low-income, with social insurance facilities, points to the fact that the high-income group frequently get this so called medical indication because of the personal interest of the obstetricians. It can also be an argument for better selection in the high-income group, and of a wrong policy of the general practioner and the midwife in not referring high-risk cases of the low-income group. Everyone, who wishes to get useful information about the costs of the obstetrical care service in the Netherlands, should read this book - preferably critically. J. Janssens, Amsterdam
Skmiologie et Traitement mentaires du Rachis
des Algies Discale
et Liga-
0. Troisier Masson et Cie, Paris, 1973 (xv+579 pp., 288 Figs) Ffr. 185. When viewed in terms of practical use, the most important part of this book outlines various therapeutic methods for the treatment of lesions of the spinal ligaments and discs. Besides specific indications, the following subjects are considered successively: vertebral manipulations and tractions, immobilization, infiltrations, massage and mobilization, chemical nucleolysis, administration of corticoids and finally surgical
intervention. The advantages and disadvantages of each method are explored, together with the indications, inherent in each therapeutic measure. Abundant practical suggestions and didactic examples are supplied, all generously illustrated with excellent photographs and diagrams. It is however striking that Troisier didn’t provide a place for physiotherapy in this wide range of therapeutic methods. The preceding and more theoretical chapters are discussed from a markedly clinical viewpoint. It would be wrong to show less interest in these, for they contain functionally important remarks for practical use. Anatomical and physiological concepts are dynamically represented, designed to make the future study of the lesions easily understandable. The heavy stresses (forces) on the spine, vertebral statics and dynamics, the functions of spinal marrow and the segmentary study of the roots are all discussed. Symptomatology includes pain and dynamic and neurological disorders. Two types of lesions correspond to these. Disc degeneration is mentioned first, viewed from an anatomical, chemical and histological angle. Then, slipped discs are taken into account; their nature, localization and relationship to adjacent structures. The clinical symptoms are divided into 5 groups: spinal, neurological, dura mater, ligamental syndromes and psychogenic features. Among the evolutionary aspects, onset and progressiveness of pathology are discussed, considering in turn: initial trauma, annular and nuclear protrusion, mixed types, inflammatory lesions and posterolateral herniations. As to progressiveness, either a resolution can be found or a status quo or aggravation of the disorders may occur. The different intervening mechanisms are discussed extensively. Most striking is the descriptive tone of the book: making it an excellent reference work of great interest to physicians who are already somewhat familiar with the pathology of spinal ligaments and discs. The book is, however, less appropriate as an introduction to the making of diagnoses and the providing of an outline for treatment, because wellanalysed concepts, usually followed by a coordinated synthesis. are often too purely descriptive. M, D’Hooghe,
Ghent
Book reviews
reading Dr. Lap&s monograph the following critical remarks may be noted. In the marketing-analytical approach, the costs of a thousand cases of preventable perinatal deaths can be calculated; but several investigations have shown that the proposed new forms of organization of obstetrical care can dramatically reduce not only perinatal mortality but perinatal morbidity too. In testing the wishes of consumers, one should consider whether the answer is without immediate importance or leads to immediate consequences. For example, when asking women whether they prefer domicilary delivery, in a situation where the answer has no immediate consequences, or has no need to be in accordance with reality, emotional factors can be predominant. The fact that the high-income group is admitted more frequently to hospital on medical indication than the low-income, with social insurance facilities, points to the fact that the high-income group frequently get this so called medical indication because of the personal interest of the obstetricians. It can also be an argument for better selection in the high-income group, and of a wrong policy of the general practioner and the midwife in not referring high-risk cases of the low-income group. Everyone, who wishes to get useful information about the costs of the obstetrical care service in the Netherlands, should read this book - preferably critically. J. Janssens, Amsterdam
Skmiologie et Traitement mentaires du Rachis
des Algies Discale
et Liga-
0. Troisier Masson et Cie, Paris, 1973 (xv+579 pp., 288 Figs) Ffr. 185. When viewed in terms of practical use, the most important part of this book outlines various therapeutic methods for the treatment of lesions of the spinal ligaments and discs. Besides specific indications, the following subjects are considered successively: vertebral manipulations and tractions, immobilization, infiltrations, massage and mobilization, chemical nucleolysis, administration of corticoids and finally surgical
intervention. The advantages and disadvantages of each method are explored, together with the indications, inherent in each therapeutic measure. Abundant practical suggestions and didactic examples are supplied, all generously illustrated with excellent photographs and diagrams. It is however striking that Troisier didn’t provide a place for physiotherapy in this wide range of therapeutic methods. The preceding and more theoretical chapters are discussed from a markedly clinical viewpoint. It would be wrong to show less interest in these, for they contain functionally important remarks for practical use. Anatomical and physiological concepts are dynamically represented, designed to make the future study of the lesions easily understandable. The heavy stresses (forces) on the spine, vertebral statics and dynamics, the functions of spinal marrow and the segmentary study of the roots are all discussed. Symptomatology includes pain and dynamic and neurological disorders. Two types of lesions correspond to these. Disc degeneration is mentioned first, viewed from an anatomical, chemical and histological angle. Then, slipped discs are taken into account; their nature, localization and relationship to adjacent structures. The clinical symptoms are divided into 5 groups: spinal, neurological, dura mater, ligamental syndromes and psychogenic features. Among the evolutionary aspects, onset and progressiveness of pathology are discussed, considering in turn: initial trauma, annular and nuclear protrusion, mixed types, inflammatory lesions and posterolateral herniations. As to progressiveness, either a resolution can be found or a status quo or aggravation of the disorders may occur. The different intervening mechanisms are discussed extensively. Most striking is the descriptive tone of the book: making it an excellent reference work of great interest to physicians who are already somewhat familiar with the pathology of spinal ligaments and discs. The book is, however, less appropriate as an introduction to the making of diagnoses and the providing of an outline for treatment, because wellanalysed concepts, usually followed by a coordinated synthesis. are often too purely descriptive. M, D’Hooghe,
Ghent