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Reviews of Books

Surgical Nutrition

Edited by Josef E. Fischer, University of Cincinnati College of Medicine.Boston: Little, Brown. London: Quest. 1983. Pp 811.$71.50.

IT is not unexpected that the increased interest in clinicalnutrition would lead to an important publication on surgicalnutrition under the skilled editorship of Josef Fischer. His welcomeaddition to the growing number of publications on the subject has aslightly misleading title since the book is not limited to surgicalproblems but is really a text on the fundamentals of clinicalnutrition. The volume is characterised by the depth and extent of itscover of the basic principles and the scientific foundations of clinicalnutrition in surgical situations. The large panel of contributors dealcritically with problems such as evaluation, efficacy of parenteralnutritional support, and immunological aspects of nutrition. Thereis a clear introduction on the fundamentals of measuring bodycomposition and intestinal absorption.The book is packed with important information and will clearly be

an essential text for serious students or investigators for years tocome. There is, however, one curious omission. The controversialtopic of home parenteral nutrition, with its difficult decisions as tothe selection of patients and cost containment, receives littleattention although nutritional aspects of single types of organfailure are dealt with effectively and in detail.

Department of Surgery,Royal Victona Infirmary,Newcastle upon Tyne IVAN D. A. JOHNSTON

Clinical Problems, Injuries, and Complications ofGynecologic Surgery

Edited by David H. Nichols, Brown University, Rhode Island. Baltimoreand London: Williams and Wilkins. 1983. Pp 229. 24.50.

THIS is a "Gardeners Question Time" sort of book: a problem isposed in the form of a brief case-history and one of a panel of 38American experts tackles it. Generally the expert defines the

problem more precisely with a few pertinent enquiries, such as,when answering a question on accidental division of the ureter, thelevel at which the ureter was injured; goes on to say how the problemmight have been avoided, for example, by always identifying theureter above the level of the pelvic disease; and finally describes howhe personally would cope with it.The questions cover a frightening number and variety of

operative and postoperative difficulties and complications. In theUnited Kingdom the gynaecologist who injures the urinary orgastrointestinal tract can usually summon, without too much loss offace, the help of a urologist or general surgeon infinitely moreaccustomed to operating on these structures. Nonetheless, I enjoyedreading how I might cope on my own should the necessity arise.Unfortunately, the book is short on technical detail in some of the"How I do its". To take an example from another system dealt with,a small "nick" in the right common ilial artery, sustained at the timeof laparoscopy, is "repaired without difficulty". But precisely howand with what?A patient in my ward was unable to micturate two weeks after

colporrhaphy. "... If successful voiding was not accomplishedwithin a few days there would be no reluctance to send the patienthome with a catheter in place for about 2 weeks". I had neverconsidered doing this before but the patient accepted it, the nursingstaff were delighted with it, and I am grateful to Dr Nichols forsuggesting it.In fact, like the radio programme for gardeners, this small book

abounds with useful and intriguing suggestions on how to avoid andcope with trouble. I should not like to be without it now.

Diriment of Obstetrics and Gynaecology,- sa.ts’ Hospital,ham. Kent D. D. MATHEWS

Diabetes Mellitus and ObesityEdited by B. N. Brodoff, New York Medical College, and S. J. Bleicher,Brooklyn-Cumberland Medical Center, New York. Baltimore and

London: Williams and Wilkins. 1982. Pp 816. 43.50.

ToPics of medical interest tend to follow cycles of fashion, anddiabetes has become increasingly popular in the past decade. Theeditors of this book point to the changing scene as grounds for theirattempt "to provide clinicians and investigators with an up-datedcomprehensive perspective". To this end no less than 137 authors(all except 3 from the USA) have been recruited to write eighty-eightreview articles. The combination of obesity with diabetes mellitusin a book of this kind seems justified because of their genetic,practical, and metabolic associations.

It is presumptious of a reviewer to comment on so many areas ofexpertise but the articles in section 1, on biochemistry andphysiology, seem of high quality. In section 2, on obesity, thechapter on treatment sets out many practical considerations and thesophistication and quality in management aimed at is one that fewclinics can achieve. The theoretical aspects of obesity, particularlycharacterisation, are less interesting. In section 3, on clinical

diabetes, there seems to be uncertainty as to whether boththeoretical and practical aspects are to be covered. The chapter ondiet is well in line with modern thinking and is good on practicaladvice, even though the foodstuffs used are tailored for NorthAmerican tastes. However, a clinician seeking advice on the use ofinsulin and its systems of delivery is likely to be disappointed. I wasparticularly interested to see discussions of exercise and alcohol inrelation to diabetes, which are topics often dealt with poorly in othertexts. There is a bracingly evangelical chapter on the diabetic foot.The last section of the book, on socioeconomic aspects of diabetes, isthe shortest but contains a particularly lucid exposition of sexualproblems in the diabetic.

I am not aware of a comparable book, and with so manycontributors and topics it is not appropriate to attempt to assess anoverall standard. Also, review articles age rapidly, but the editorshave achieved their objective of a "perspective" and produced auseful work of reference. My only comment is that readers turningto this book for practical advice will be rewarded to a variable degreedepending on their needs.

Department of Diabetes and Endocrinology,Dudley Road Hospital,Birmingham R.F.FLETCHER

Psychiatry in Medical Practice

Edited by R. G. Priest, St Mary’s Hospital Medical School, London.Plymouth: Macdonald and Evans. 1982. Pp 499. 19.50.

Psychiatric Disorders

Edited by P. T. Donlon and D. A. Rockwell, University of California atDavis. Bowie, Maryland: Robert J. Brady. 1982. Pp 354. 15.95;$26.95.

THESE two books are intended to inform doctors who are not

psychiatrists, and especially those engaged in primary health care,on how to deal with some of the many psychiatric problems they arelikely to meet in everyday practice. The two books were publishedalmost simultaneously, one in the United Kingdom and the other inthe United States of America. The approach is, however, different:the American book adopts the familiar style of a textbook ofpsychiatry, whereas the British book consists of essays on a range ofpsychiatric topics. To what extent has each book been successful inaddressing its chosen readership on an unfamiliar topic?The American book systematically covers psychiatric assessment,

diagnosis, and treatment of psychiatric disorders, including themanagement of common sexual problems, problems of the elderly,the use of psychotropic drugs, the doctor-patient relationship, crisisintervention, the management of attempted suicide and rape,consultation and referral, and, briefly, child development and theproblems which may be associated with it. The third edition of theDiagnostic and Statistical Manual of the American PsychiatricAssociation (DSM III) has been freely used. The first chapter onassessment is an orthodox account of psychiatric history-taking, andit is followed by a detailed list of psychiatric conditions included inDSM III and an extensive bibliography. This chapter does not fulfil

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the promise of avoidance of jargon made in the preface. The nextchapter is a detailed account of the main psychiatric disorders, againlargely based on DSM III; it contains a good deal of tabulatedinformation. The account on sexual problems is possibly of morepractical help, since its description of methods of management arenot generally available in textbooks of psychiatry. In the chapter ongeriatric psychiatry which covers familiar ground, the discussion ofhypochondriasis is sketchy, the many causes of this importantsyndrome being glossed over in a tendentious psychodynamicexplanation of its origins. The diagnosis of "sundowning" in awoman whose case history is described will cause confusion on thisside of the Atlantic, and the account of "depressive pseudo-dementia" is too tentative for what is now a well-recognisedsyndrome. The chapters on rape and on sex-role stereotyping willserve to keep readers in touch with trends in society with which theymay be unfamiliar, but they scarcely seem to be based on establishedknowledge or practice.That this book has been written by several contributors shows

through clearly. I think most doctors will find the book irritatinglydogmatic, difficult to read, over-inclusive, and not the book to haveat one’s elbow to settle doubts over clinical matters. The book israther less good in serving its intended purpose than many standardundergraduate texts and cannot be recommended.The British book has quite a different character and is more a

literary work than a primarily factual account of the subject. Thebook opens with a lucid account of behavioural approaches intreatment, their theoretical background and practical application.This contribution would serve well in a book on behaviouralsciences for medical undergraduates or in a text for traineepsychiatrists: therein lies its main weakness, it is too detailed forthose coming to the topic for the first time. The other essays are onmiscellaneous topics-that on talking treatments consists ofreminiscences about patients known to the writer; that on usefulpsychotropic drugs gives some information that is of considerableintrinsic interest, but the information is difficult to find among themany quotations; that on the diagnosis and management of sexualproblems is both comprehensive and practical; and that on the morecommon forms of drug dependence is a comprehensive andilluminating piece on a topic perplexing because of its changingform, especially to those who do not meet its problems frequently.The chapter on psychological help for physical illness and oncoping with mental handicap will be of considerable help andrelevance to the general practitioner. Finally, there are chapters onthe extremes of life-that is, on children and the elderly-which arepersonal accounts of practice in these areas. A useful feature of thebook is guidance on the use of compulsory admission to hospital,which general practitioners are likely to find helpful, provided thelegal system discussed is appropriate.Neither of these books fulfils its authors’ stated intentions; of the

two, the British is more interesting and contains several chapterswhich will be both informative and enjoyable to read. I cannot

recommend either book for personal purchase.

Department of Psychiatry,U Olversny of Leeds R. H. S. MIND HAM

Principles of Cosmetics for the DermatologistEdited by Philip Frost and Steven Horwitz, Mount Sinai Medical Center,Miami Beach, Florida. St Louis: C. V. Mosby 1982. Pp 367. 39.

Unwanted Effects of Cosmetics and Drugs used inDermatology

Johan P. Nater, and Anton C DeGroot, State University of Groningen.Amsterdam: Excerpta Medica. 1983. Pp 483.$106.50.

BEAUTY is big business and as much is spent on cosmetics as is ondrugs. Dermatologists are usually not well informed about

cosmetics, which they consider to be an expensive frivolity thatoften irritates the skin and produces other adverse reactions.

Extravagant claims made in advertisements for some products onlyrouse suspicion. However, many cosmetics do have a beneficialeffect. Principles of Cosmetics for the Dermatologist, outcome of aninternational symposium held in Miami in 1980, aims to present

detailed information on the major categories of cosmetic products.to review specific problems caused by them, and to show how theycan be of use to the dermatologist. It contains many useful articles son soaps, shampoos, moisturisers, emollients, perfumes, colouringagents, and sunscreens. Although a few are indifferent most of thepapers, by dermatologists and cosmetic chemists, are excellent.Much worthwhile information on the side-effects of cosmetics can

also be found in Dr Nater’s book, Unwanted Effects of Cosmetics andDrugs Used in Dermatology, which collates published information onthe subject. The book is a useful reference work, beingcomprehensive, up-to-date, and easy to use. The encyclopaedicformat enables easy location of relevant information, and manyreferences are provided.The first section, on local effects of topical drugs, contains

chapters on contact allergy and the techniques and interpretation ofpatch testing. Sensitisers that are found in topical preparations arelisted, as are those that can produce phototoxic and photoallergicreactions. Unusual side-effects are fully covered, including contacturticaria produced by topical preparations of drugs. Other sectionsdiscuss the systemic side-effects of topical and systemic drugs andthe side-effects of photochemotherapy. The new aromatic retinoid’Tigason’ is mentioned, but 13-cis-retinoic acid is not. No doubt itwill be in the next edition.The most valuable section is that on side-effects of cosmetics. The

information given on composition of and adverse reactions fromvarious types of cosmetics is not easily found elsewhere. Nater’s co-author of this section, D. H. Liem, has incorporated much usefulinformation in the tables of ingredients of cosmetics, particularlyrecommended patch test concentrations and vehicle. This volume isan excellent reference book for dermatologists and those in thepharmaceutical and cosmetic industries.

Department of Dermatology,Royal Hallamshire Hospital,Sheffield S. S. BLEEHE:B

A Colour Atlas of Life before Birth

Normal Fetal Development. Marjorie A. England, University of LeicesterLondon: Wolfe 1983. Pp 216.£25.

THIS atlas traces the development of the human embryo and fetusfrom fertilisation onward. The first quarter of the book covers the

pre-embryonic and embryonic periods and the descriptions are

based on Streeter’s series of Horizons, which expresses true age asdays from the date of fertilisation. The rest of the book shows thedevelopment of the anatomical systems and organs. There are alarge number of colour photographs, mostly of external features orviews of dissected specimens. There are also a few photomicro-graphs. Angiograms and pictures of specimens obtained byspecialised techniques such as resin casting, and alizarin-red

staining are included also. The illustrations are of a very highquality. The least informative of them are the photographs of partsof small embryos which are reproduced at magnifications greaterthan 10; even when labelled clearly, much imagination is requiredoverall to visualise what is described in the legend. There seem to betoo many illustrations; some show only minor differences from theirneighbours and add little to the point of the legend or text. The useof true age of the fetus based on date of fertilisation may be desirablein embryology but will be a source of confusion or irritation to thosewith a clinical orientation, to whom menstrual age is the onlvpractical possibility. The text is concise and informative and I amsure that this atlas will be of value to the students of medicine,nursing, and allied fields for whom it is intended.

Department of Pathology,Royal Hospital for Sick Children,Glasgow A. A. M. GlBSOB

New Editions

Jo)’6T/ Problerrzs III iWedzcme.-2nd ed. Edited by Samuel GOroV1fZ. Rue]:Macklin, Andrew L. Jameton, John M. O’Connor, and Susan Sherwm. Her:’Prentice/Hall. 1983 Pp 655. f22.45.Renal Funetzon-Mechanzsrns Preserving Fluzd and Sohite Ball?ict- ,

Heù/rIz.--2nd ed. By Heinz Valtin. Boston: Little, Brown. 1983 Pp 31’$16 95. ’