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The omentum: Research and clinical applications
BOOK REVIEWS John M. Porter, MD, Book Review Section Editor
Current critical problems in vascular surgery, vol. 2 Frank Veith, ed. St. Louis, 1990, Quality Medical Publishing, 475 pages, $79.95. The sixteenth annual symposium on critical problems in vascular surgery has been published in volume 2 by Quality Medical Publishing, Inc. It is the assembled and edited talks presented in November of 1989 at the Montefiore Einstein Symposium. Dr. Veith not only hosted an excellent symposium but has now undertaken the herculean task of editing and assembling the program in published form for all. The book is attractively bound and divided into 11 sections. Each section has a brief introduction by the editor, and then the speakers' talks given at the symposium are included. Section I, for example, covers the topic of important issues and general advances in vascular surgery. Included are discussions of why patients bleed and clot, intimal hyperplasia, and the prospects for successful drug prophylaxis. Will endothelial cells ever be successfully "seeded" in vascular grafts? The impact of magnetic resonance imaging and genetic engineering are discussed. The second section deals with the practical problems of lower extremity ischemia and gangrene. The controversy regarding synthetic grafts versus autologous tissue for the conduit is presented by authors who have clinical experience in the use of the graft of their choice. Considerable space is devoted to endovascular surgery with discussions of balloon angioplasty, laser, fibrinolytic therapy, and alternating devices. The editor again has assembled vascular surgeons from the United States and abroad who have a wealth of knowledge in their fields. Cerebrovascular disease, aortic aneurysms, and occlusive disease have sections that update and present the latest facts and figures where applicable. In addition, a section is devoted to perioperative management and medical treatments for the vascular patient. Newer concepts and some updates also are discussed. This book contains approximately 350 pages devoted to the vascular issues with a very complete index. Each author's presentation has a listed bibliography making it a good reference. I would recommend this book for surgeons who want the current approach to a variety of common vascular conditions encountered in a daily clinical practice of vascular surgery. William H. Edwards, ME) Edwards-Eve Clinic Nashville, Tenn.
The omentum: Research and clinical applications Harry S. Goldsmith, ed., New York, 1990, SpringerVerlag, 252 pages, $59.00. The major part of this monograph is devoted to the use of the omentum in cerebral ischemia, spinal cord injury, 126
hydrocephalus, Buerger's disease, and cerebral malignancy. It begins with a historic overview, presents some basic biologic and anatomic characteristics, and suggests future applications of the omentum. A number of authors present clinical applications of using the omentum for revascularization. Vascular surgeons are seldom interested in the omenrum, but they might consider its use in situations such as the lack of a distal artery acceptable for bypass in severe lower limb ischemia, graft infection, or unresponsive lymphedema. The recent development of distal revascularization in lower limb ischemia has made it possible to restore the blood supply of the foot by femoral-to-foot artery bypass technique. Nonetheless, some patients with Buerger's disease cannot receive the benefit of revascularization because the leg veins, essential for distal bypass grafts, are diseased (phlebitis migrans), or the patients have no appropriate distal arteries. Some of these patients might avoid amputation by biologic bypass revascularization, which is described in the chapter, "Omental transplantation for Buerger's disease." Even though this is not a direct vascular reconstruction procedure, the author shows favorable follow-up results in patients with rest pain and toe ulceration, in terms of healing of the ulcers and relief o f symptoms. Thus a concern might be early wound complications at the distal skin incision. It must take some time to develop new circulation through the omentum to the skin, which has suffered from poor nutrition. A useful aspect o f the omentum is described in the chapter, "Lumbo-omental shunt for treatment of communicating hydrocephalus." It features the absorptive capacity of the omentum, which might be beneficial to treatment of lymphedema and perigraft seroma. In aortic graft infection, removal of the aortic graft with extraanatomic bypass or in situ aortic graft replacement are options. Many vascular surgeons cover the aortic stump or graft with the omentum. There is no description in the monograph of clinical application of the omentum in aortic graft infection. The chapter, "Anatomy of the greater and lesser omentum in the mouse with some physiological implications" clearly gives us the rationale to use the omentum in these situations. The chapter, "Summation: Ideas and lessons learned" is a comprehensive overview of the omentum and should be read before the rest of this book. This book will be of very little interest to the vascular surgeon unless one is interested in a new, unproven method of treating Buerger's disease or lymphedema. Naomichi Nishikimi, M D University of North Carolina at Chapel Hill
Current critical problems in vascular surgery, vol. 2 Frank Veith, ed. St. Louis, 1990, Quality Medical Publishing, 475 pages, $79.95. The sixteenth annual symposium on critical problems in vascular surgery has been published in volume 2 by Quality Medical Publishing, Inc. It is the assembled and edited talks presented in November of 1989 at the Montefiore Einstein Symposium. Dr. Veith not only hosted an excellent symposium but has now undertaken the herculean task of editing and assembling the program in published form for all. The book is attractively bound and divided into 11 sections. Each section has a brief introduction by the editor, and then the speakers' talks given at the symposium are included. Section I, for example, covers the topic of important issues and general advances in vascular surgery. Included are discussions of why patients bleed and clot, intimal hyperplasia, and the prospects for successful drug prophylaxis. Will endothelial cells ever be successfully "seeded" in vascular grafts? The impact of magnetic resonance imaging and genetic engineering are discussed. The second section deals with the practical problems of lower extremity ischemia and gangrene. The controversy regarding synthetic grafts versus autologous tissue for the conduit is presented by authors who have clinical experience in the use of the graft of their choice. Considerable space is devoted to endovascular surgery with discussions of balloon angioplasty, laser, fibrinolytic therapy, and alternating devices. The editor again has assembled vascular surgeons from the United States and abroad who have a wealth of knowledge in their fields. Cerebrovascular disease, aortic aneurysms, and occlusive disease have sections that update and present the latest facts and figures where applicable. In addition, a section is devoted to perioperative management and medical treatments for the vascular patient. Newer concepts and some updates also are discussed. This book contains approximately 350 pages devoted to the vascular issues with a very complete index. Each author's presentation has a listed bibliography making it a good reference. I would recommend this book for surgeons who want the current approach to a variety of common vascular conditions encountered in a daily clinical practice of vascular surgery. William H. Edwards, ME) Edwards-Eve Clinic Nashville, Tenn.
The omentum: Research and clinical applications Harry S. Goldsmith, ed., New York, 1990, SpringerVerlag, 252 pages, $59.00. The major part of this monograph is devoted to the use of the omentum in cerebral ischemia, spinal cord injury, 126
hydrocephalus, Buerger's disease, and cerebral malignancy. It begins with a historic overview, presents some basic biologic and anatomic characteristics, and suggests future applications of the omentum. A number of authors present clinical applications of using the omentum for revascularization. Vascular surgeons are seldom interested in the omenrum, but they might consider its use in situations such as the lack of a distal artery acceptable for bypass in severe lower limb ischemia, graft infection, or unresponsive lymphedema. The recent development of distal revascularization in lower limb ischemia has made it possible to restore the blood supply of the foot by femoral-to-foot artery bypass technique. Nonetheless, some patients with Buerger's disease cannot receive the benefit of revascularization because the leg veins, essential for distal bypass grafts, are diseased (phlebitis migrans), or the patients have no appropriate distal arteries. Some of these patients might avoid amputation by biologic bypass revascularization, which is described in the chapter, "Omental transplantation for Buerger's disease." Even though this is not a direct vascular reconstruction procedure, the author shows favorable follow-up results in patients with rest pain and toe ulceration, in terms of healing of the ulcers and relief o f symptoms. Thus a concern might be early wound complications at the distal skin incision. It must take some time to develop new circulation through the omentum to the skin, which has suffered from poor nutrition. A useful aspect o f the omentum is described in the chapter, "Lumbo-omental shunt for treatment of communicating hydrocephalus." It features the absorptive capacity of the omentum, which might be beneficial to treatment of lymphedema and perigraft seroma. In aortic graft infection, removal of the aortic graft with extraanatomic bypass or in situ aortic graft replacement are options. Many vascular surgeons cover the aortic stump or graft with the omentum. There is no description in the monograph of clinical application of the omentum in aortic graft infection. The chapter, "Anatomy of the greater and lesser omentum in the mouse with some physiological implications" clearly gives us the rationale to use the omentum in these situations. The chapter, "Summation: Ideas and lessons learned" is a comprehensive overview of the omentum and should be read before the rest of this book. This book will be of very little interest to the vascular surgeon unless one is interested in a new, unproven method of treating Buerger's disease or lymphedema. Naomichi Nishikimi, M D University of North Carolina at Chapel Hill