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Book Reviews
Anaesthesia Science. N. R. Webster and H. F. Galley
(editors). Published by Blackwell Publishing/BMJ Books,
London, UK. Pp. 466; indexed; illustrated. Price £69.50.
ISBN 9780-7279-1773-7.
Anaesthesia Science is a new book that aims to cover in
detail areas of science related to the practice of
Anaesthesia, Critical Care and Pain Management. The
editors state, in their Preface, that they wish to comp-
lement rather than replace more comprehensive texts, and
concentrate on areas covered less well elsewhere. It is
aimed at trainee anaesthetists preparing for their pro-
fessional examinations. The 30 chapters have been written
by 46 authors, mostly European, the vast majority of
whom are well-known experts in their respective field.
The book contains 466 pages and is very well produced
in a medium sized hardback edition, which is more than
pocket-sized but small enough to be used in the theatre or
clinic environment. It is comprehensively referenced and
the text clearly set out, with good use of tables, line dia-
grams, and clinical images where appropriate. It is to the
editors’ credit that the chapters generally conform to a
lucid style, and most provide a historical perspective to the
subject matter, which is both interesting and informative.
Most chapters are referenced through the text with a range
of 20180 current references, though a small minority
refer simply to ‘further reading’.
The reasons for failure in professional examinations
often reflect poor knowledge of the fundamental principles
of basic physiology, pharmacology, and statistics. The
outside cover states that Anaesthesia Science is based on
the syllabus for the primary FRCA examination and,
although it does not profess to be comprehensive, the
mixture of topics included is slightly eclectic. The book is
broadly divided into Pharmacology, Physiology, and
Measurement, but these are rather artificial distinctions.
For example, there is a very good chapter on heart failure,
which is mostly concerned with advances in pharmaco-
logical and other management, but is included under
‘Physiology’, whereas the chapter on cardiovascular
assessment contains mostly physiology, but is listed under
‘Measurement’. There is more emphasis on certain topics
at the expense of others. Specific, brief chapters on ana-
phylaxis and antibiotics are included, but no mention of
renal or haematological pathophysiology, topics that are
changing rapidly and often cause confusion among trai-
nees. However, the first two sections of the book are
largely very good, and the chapter on pharmacogenomics
is the best resume of this topic I have read. Conversely,
the ‘Measurement’ section was a little thin, with a fairly
basic chapter on assessment of respiratory function; chap-
ters on nanotechnology and study design seemed incongru-
ous within the whole book, but there was an excellent
chapter on magnetic resonance imaging.
So should you buy it? It really depends on what you are
looking for. Anaesthesia Science would not replace
Scientific Foundations, were it still in print, yet is much
more than a collection of vignettes, is very well produced,
and reasonably priced. In many respects, this book will
enable practitioners to fill gaps in their knowledge and fill
a gap in the market. Therefore, it should achieve its stated
aims. As the editors recognize, examination candidates
will still need to read both more specialized and also more
inclusive texts. However, I suspect that examiners will
also find it useful, because it provides up-to-date details in
several selected areas and so potential candidates may
follow suit.
J. P. Thompson
Leicester, UK
Oxford Handbook of Clinical Medicine, 7th Edn.
M. Longmore, I. Wilkinson, T. Turmezei and
C. K. Cheung (editors). Published by Oxford University
Press, Oxford, UK. Pp. 840; indexed; illustrated. Price
£22.95. ISBN 0-19-856837-1.
The Oxford Handbook of Clinical Medicine enters its
seventh edition, 21 yr after the first edition entered junior
doctors’ white-coat pockets. In itself, such ongoing
demand is an indication of this book’s appeal. The Oxford
Handbook series was originally ground-breaking in its
format; bullet-points, a matter-of-fact approach married
with a white-coat-pocket size, and splash-proof covers
made them a big hit. Their compact dimensions belied
their detailed contents. Many readers will be familiar with
the enormous amount crammed into the current Oxford
Handbook of Anaesthesia. The Oxford Handbook of
Clinical Medicine does not disappoint in this regard—its
840 pages of tightly spaced text waste no words on flowery
prose or descriptive style, and information is delivered in a
direct and unambiguous style, with minimal preamble.
Photographs, radiographs, and line illustrations are used
generously, and this edition is the first to use colour
#The Board of Management and Trustees of the British Journal of Anaesthesia 2007. All rights reserved. For Permissions, please e-mail:
British Journal of Anaesthesia,98 (6): 849–51 (2007)
by guest on April 12, 2012 from
photographs and illustrations. Images are used to illustrate
important points where necessary, and occasionally to
provide clinical examples. While radiographs or clinical
photographs may measure only 1 2 cm in width, they are
remarkably clear and comprehensible. A small selection of
radiographs is presented in larger format in an appendix
towards the end of the book.
The text is split intelligently into digestible chunks that
are headed clearly and follow in logical progression.
Knowledge is presented very much in the style of a guide-
book, with advice being offered didactically and with
minimal discussion of the alternatives. Clearly, this has
strong and weak points; for examination preparation, the
reader may be insufficiently informed of the broader per-
spective around a clinical problem, but for practical, ward-
based medicine, the reader will be efficiently prepared.
The range and depth of content are breath-taking. The
book begins, as it has in previous editions, with a generic
and philosophical section regarding the role of the doctor,
communication skills, diagnostics, and empathy. Clinical
skills follow and, system by system, a large variety of
signs and symptoms are described. This rather general, but
interesting, section occupies around 80 pages. The largest
section of the book follows: ‘internal’ medicine,
comprising cardiovascular, chest, gastroenterology, renal,
haematology, infectious diseases, neurology, oncology,
palliative care, and rheumatology. This section occupies
almost 500 pages and is impressively detailed. The next
section, which occupies around 190 pages, covers surgery,
epidemiology, clinical chemistry, eponymous syndromes,
and radiology. This seventh edition is the first to contain a
radiology section. This new section is well written, and is
comprehensive enough to inform doctors requesting radio-
logical investigations. The next 30-page section contains
reference intervals and descriptions of a number of ward-
based, physician-orientated practical procedures. These
will not be very useful to most surgeons or anaesthetists,
but will be greatly appreciated by junior medical trainees.
Finally, the book finishes with a nicely written and well-
illustrated section on medical emergencies. These are
indexed for rapid availability on the inside front cover of
the book. Many of these emergencies have pertinence for
anaesthetists (e.g. status epilepticus, dysrhythmias, pul-
monary oedema, and acute asthma), and most will be of
use in intensive care.
The style of the book is generally pleasing and invites
occasional browsing. As a pocket book, it would certainly
be very useful to medical trainees, and its direct, clear,
and didactic style suits this purpose well. I doubt its use-
fulness as a revision text because of its lack of discursive-
ness, but I am sure that this was not the authors’ aim. The
text is well proofed, on the whole, although the occasional
error has made it into print (e.g. ‘loosing weight’).
With a modest price, this compact book seems to me a
sensible investment for many trainees and consultants in
anaesthesia. Our occasional brush with other medical
specialties and our tendency to be first at the scene may
well make this book a life-saver. For trainees in intensive
care, this book will also be useful and worth carrying to
work daily. On the whole, I congratulate the authors and
the publishers on improving a book that already holds a
prominent place in British medical practice, and commend
it to all medical practitioners.
J. G. Hardman
Nottingham, UK
Anaesthesia and the Practice of Medicine: Historical
Perspectives. M. K. Sykes and and J. P. Bunker (editors).
Published by The Royal Society of Medicine Press Ltd,
London, UK. Pp. 303; Price £15.95. ISBN 978-1-85315-
This concise book of 23 chapters tells the story of
advances in anaesthetic knowledge and practice over 150
years since its demonstration in the Ether Dome in
Massachusetts in 1846. It is the story of the development
of anaesthesia as a speciality in its own right. The book
also shows how these developments in anaesthesia have
allowed advances to be made in other specialities such
as cardiac surgery, intensive care, resuscitation, the treat-
ment of chronic pain, and the provision of pain relief in
Of the 23 chapters, 15 are written by M. K. Sykes, for-
merly Professor of Anaesthesia at Hammersmith and
Oxford, and 8 are by J. P. Bunker, formerly Chair of
Anaesthesia at Stanford and Visiting Professor at Harvard.
The book is written from their European and American
perspectives. They took 6 years to write this book, which
is based on their professional experience and on their
extensive research. They have similar styles of writing
and, as in any good book with a tale to tell, one chapter
leads easily on to another. The breadth and depth of this
book are impressive, and you can read it cover to cover.
Four of the chapters (curare, the Copenhagen polio epi-
demic, anaesthesia for cardiac surgery, and halothane
hepatitis) are especially interesting.
The book demonstrates that ideas can be born before
their time. Humphry Davy had described the narcotic
effects of nitrous oxide in 1799, but it was another 47 yr
until Morton demonstrated surgical anaesthesia with ether.
However, although anaesthesia now permitted patients to
undergo surgery painlessly, further developments in major
surgery had to wait until Lister demonstrated how to
prevent sepsis, in 1867.
In cardiac surgery, Souttar had performed a mitral
valvotomy in 1925, in a patient who survived, and in
Book Reviews
by guest on April 12, 2012 from
... Chronic kidney disease (CKD) refers to the progressive and irreversible decline in renal function and is defined as kidney damage for ≥3 months based on findings of abnormal structure or function or glomerular filtration rate (GFR) <60 mL/min/1.73 m 2 for ≥3 months with or without evidence of kidney damage [1]. There are five different stages of CKD, determined by measuring a patient's estimated GFR (eGFR). ...
... Management of predialysis patients aims to reduce the rate of decline in renal function and the likelihood of reaching ESRD, avoid and treat complications and comorbidities of CKD, and provide symptomatic relief. Patients with ESRD require renal replacement therapy (RRT), a treatment which is advised to start once eGFR <15 mL/min and the patient is symptomatic [1]. RRT options include transplantation or dialysis: haemodialysis (HD), haemofiltration, and peritoneal dialysis (PD). ...
... The numerous aetiologies of CKD can be grouped as genetic, glomerular, vascular, and tubulointerstitial diseases or due to urinary tract obstruction [4]. The most common causes are related to diabetes and hypertension [1]. Despite the vast number of causes, classification of renal function into the five stages and long-term management are usually ...
Full-text available
Patients with chronic kidney disease frequently present with chronic elevations in markers of inflammation, a condition that appears to be exacerbated by disease progression and onset of haemodialysis. Systemic inflammation is interlinked with malnutrition and muscle protein wasting and is implicated in a number of morbidities including cardiovascular disease: the most common cause of mortality in this population. Research in the general population and other chronic disease cohorts suggests that an increase in habitual activity levels over a prolonged period may help redress basal increases in systemic inflammation. Furthermore, those populations with the highest baseline levels of systemic inflammation appear to have the greatest improvements from training. On the whole, the activity levels of the chronic kidney disease population reflect a sedentary lifestyle, indicating the potential for increasing physical activity and observing health benefits. This review explores the current literature investigating exercise and inflammatory factors in the chronic kidney disease population and then attempts to explain the contradictory findings and suggests where future research is required.
... The deleterious effect of hypoxemia in TBI patients is well known [3]. Acknowledge guidelines advocate PaO2 values between 8.0 and 13.3 kPa (60-100 mmHg) [5,6,20]. ...
... Patients were divided according to the collected PaO2 (highest alveolar-arterial O2 gradient or lowest PaO2 value). Arterial oxygen tension levels were defined a priori to analysis: hypoxemia was defined as <10.0 kPa, normoxemia as 10.0 to 13.3 kPa and hyperoxemia as >13.3 kPa [20]. The primary outcome was 6-month mortality and the secondary outcome was in-hospital mortality. ...
Full-text available
The relationship between hyperoxemia and outcome in patients with traumatic brain injury (TBI) is controversial. We sought to investigate the independent relationship between hyperoxemia and long-term mortality in patients with moderate-to-severe traumatic brain injury. The Finnish Intensive Care Consortium database was screened for mechanically ventilated patients with a moderate-to-severe TBI. Patients were categorized, according to the highest measured alveolar-arterial O2 gradient or the lowest measured PaO2 value during the first 24 hours of ICU admission, to hypoxemia (< 10.0 kPa), normoxemia (10.0-13.3 kPa) and hyperoxemia (> 13.3 kPa). We adjusted for markers of illness severity to evaluate the independent relationship between hyperoxemia and 6-month mortality. A total of 1116 patients were included in the study, of which 16% (N= 174) were hypoxemic, 51% (N= 567) normoxemic and 33% (N= 375) hyperoxemic. The total 6-month mortality was 39% (N= 435). A significant association between hyperoxemia and a decreased risk of mortality was found in univariate analysis (P= 0.012). However, after adjusting for markers of illness severity in a multivariate logistic regression model hyperoxemia showed no independent relationship with 6-month mortality (hyperoxemia vs. normoxemia OR 0.88, 95% CI 0. 63--1.22, P= 0.43; hyperoxemia vs. hypoxemia OR 0.97, 95% CI 0.63-1.50, P= 0.90). Hyperoxemia in the first 24 hours of ICU admission after a moderate-to-severe TBI is not predictive of 6-month mortality.
... Currently, approximately 750,000 laparoscopic cholecystectomies are performed annually in the United States (accounting for roughly 90% of all cholecystectomies) with an overall serious complication rate that remains higher than that seen in open cholecystectomy, including bleeding, bile duct injury and bile leak, despite increasing familiarity with the proce- dure [2][3][4]. Pneumoperitoneum is used with laparoscopic surgery rise of the intra-abdominal pressure (IAP) and can lead to ischemic reperfusion kidney injury due to alterations in renal blood flow and reduction of the urinary output and creatinine clearance [5, 6]. Following desufflation of the abdomen, IAP and splanchnic blood flow normalize, signifying reperfusion. ...
... Split-thickness skin grafts were utilised as they are more easily available and have a better graft take due to their low metabolic needs when compared to full thickness skin grafts. 22 Learning points ▸ Necrotising fasciitis is a clinical diagnosis, hence requiring a high index of clinical suspicion. ▸ Necrotising fasciitis cannot be managed by intravenous antibiotics alone. ...
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A 35-year-old woman with a 3-day history of chickenpox, presented to the hospital in septic shock and with multifocal, non-adjacent lesions of necrotising fasciitis. Necrotising fasciitis is a rare yet life-threatening complication of chickenpox. Blood cultures and wound swabs confirmed the presence of Streptococcus pyogenes. The initial emergency management included oxygen, aggressive fluid resuscitation and antimicrobial therapy. Once the patient was stabilised, surgical management ensued. This included debridement and eventual grafting of the necrotic skin lesions. Intensive management and follow-up for 8 weeks were required before the patient was deemed fit for discharge.
... 5 6 Other common complications include wound or systemic infection, and ileus-which can result in prolonged inpatient stay. 6 ...
A 67-year-old man underwent a laparoscopic cholecystectomy, which was complicated by an empyematous gallbladder. Postoperatively, he was found to have acute renal failure (evidenced by abdominal distension and pain, anuria and vomiting). This was thought to be secondary to pneumoperitoneum, an essential part of the laparoscopic procedure.
Full-text available
Urinary schistosomiasis is caused by the parasite Schistosoma haematobium and is endemic in the African and Asian countries, usually in areas with no proper sanitation. We present a case of a 12 year old boy seen in Ireland where these parasites are not endemic. An uncommon modality was used to confirm the condition and after being treated with Praziquantel the child made an excellent recovery.
Full-text available
This article provides an overview of the diagnosis and treatment of Fournier’s gangrene, a necrotizing fasciitis of the perineal, genital, or perianal areas, which commonly affects men. The article will highlight the symptoms of the condition and the pertinent anatomy.
All dental practitioners must be proficient at taking a medical history, examining a clothed patient and recognising relevant clinical signs. The general examination of a patient should take into account findings from the history. This paper does not attempt to address the detailed oral and dental examination carried out by dental practitioners but focuses on the holistic patient assessment - essential for safe patient management.
ABSTRACT Background: Short-term memory (STM) decline in breast cancer patients resulting from chemotherapy was evaluated by means of blood biomarkers, a questionnaire, and a computerized STM test. Methods: This study was conducted from January 2013 to June 2013, recruiting 90 subjects: 30 breast cancer patients beginning the 3rd of 4th cycles of docetaxel and cyclophosphamide chemotherapy, 30 recovered patients (who completed 4 cycles of docetaxel for a minimum of 6 months), and 30 healthy subjects (disease-free females). The levels of hemoglobin, red and white blood cells, and cortisol in serum, and a computerized STM test were analyzed to estimate the effects of chemotherapy on STM. A questionnaire was given to all subjects to assess quality of life. Results: Statistically significant differences were observed for the blood parameters (hemoglobin, red and white blood cells, and cortisol levels) between healthy and on-treatment subjects (respectively 13.47±0.96 g/dL vs 5.37±0.38 g/dL, 4.58±0.41 10<sup>12</sup>/L vs 2.07±0.13 10<sup>12</sup>/L, and 6.15±1.03 10<sup>9</sup>/L vs 0.86±0.41 10<sup>9</sup>/L). Scores of the STM test were significantly lower for patients compared to healthy subjects. As indicated by the results of the questionnaire, breast cancer patients had a higher tendency to forget than healthy controls (X<sup>2</sup>=3.15; p<0.0001) and recovered subjects (X<sup>2</sup>=3.15; p<0.0001). Conclusion: We found depleted levels of hemoglobin, red and white blood cells as a result of chemotherapy, and elevated levels of stress correlated with poor performances in the computerized STM test. A higher cortisol level might be an important precursor of STM deterioration. Monitoring cortisol would be beneficial for evaluating the quality of life of breast cancer patients on chemotherapy.
The first aim of the present study was to determine the cause of dyspepsia after negative conventional diagnostic work-up. In such patients, an extended diagnostic work-up was performed including esophageal pH monitoring and manometry, gastric and hepatobiliary scintigraphy, and lactose tolerance test. In 88 of 220 dyspeptic patients (mean age 49 years, range 17–87; 114 women) presenting to our gastroenterological outpatient department, a cause for dyspepsia was found by conventional work-up. Thirty-one of the remaining patients did not enter extended work-up, because of minor symptoms. In 47 of 101 patients entering extended work-up, a diagnosis was established (21 endoscopynegative gastroesophageal reflux disease, 11 gastric stasis, 6 biliary dyskinesia, and 5 lactase deficiency among them). A second aim of the study was to determine whether clusters of symptoms such as gastroesophageal reflux-like, dysmotility-like, and dyspepsia of unknown origin reliably predict the groups of diseases suggested by these terms. This was not the case. In conclusion, in 40% of dyspeptic patients, a conventional diagnostic work-up led to a diagnosis that explained a patient's symptoms. After a negative conventional diagnostic work-up, an extended diagnostic work-up with functional tests yielded a possible explanation for their symptoms in 47% of patients. In such patients symptomatology was of little help for predicting the diagnosis.
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