The Soft Tissues: Trauma andSports Injuries

Ed G R McLatchie, CM E LennoxButterworth-Heinemann, £45, pp 485ISBN 0-7506-0170-1

Soft tissue trauma is often neglected,yet many of us spend our time in out-patient clinics dealing with conditions

affecting these tissues. As long ago as

1940 Reginald Watson-Jones was quoted as

saying, "It is worse to sprain an ankle than tobreak it," because soft tissue injuries are

often ignored, with consequent morbidity.Damage to soft tissue may be the same

whether incurred during sporting activitiesor from non-sporting trauma, and The SoftTissues usefully groups the pathology andmanagement together. The first few chaptersare heavy going, and it is not until the sixthchapter that excellence appears, with a

precise and concise chapter on tendon injury.From then on the uphill struggle eases andthe regional accounts of injuries in the middlesection are in general excellent. The finalchapter in this middle section, on rehabili-tation, is particularly good and to some

extent removes the need to mention thegeneral management of soft tissue trauma inother chapters.An excellent chapter on pains in growing

children is unfortunately spoilt by use of theAmerican classification for juvenile chronicarthritis; this differs from that used in Britain

and the rest of the world, which follows thework of the world authority on the disease,who happens to be British (Barbara Ansell). Ithink it would have been enough to saythat one should always remember juvenilechronic arthritis as a cause of pain in childrenand leave it at that.The third section covers specific groups of

sporting injuries. Where the text relates theinjuries to particular aspects of the sport,such as in the chapter on dance and gym-nastics, this is very helpful. I leamt that the"efficiency" (whatever that means in the shoeworld) of running shoes is reduced by 23%after 150 miles and by 45% after 500 miles.This perhaps adds further support to a recentsuggestion that there may not be a lot tobe gained by buying the more expensiverunning shoes. I am surprised that in aBritish text soccer is not covered as thissport probably results in more attendances atcasualty departments and general practicesurgeries than all other sports put togetherbecause of the large numbers playing eachweekend.The book's strength is that it is compre-

hensive, bringing together material from awide variety of sources into a single volume.Weaknesses are that there is much repetitionwith respect to certain injuries, particularlyof the ankle and the knee, which could beavoided by suitable cross referencing. Thereare varying styles of references and manyprinting errors, which should be eradicatedin future editions.-wENDY N DODDS, consultantrheumatologist, St Luke's Hospital, Bradford

Oxford Textbook ofRheumatologyEd P J Maddison, David A Isenberg, PatriciaWoo, DavidN GlassOxford University Press, £120, pp 1 42ISBN 0-19-262026-6

ompetition among large rheumatologytextbooks is becoming increasinglyfierce. Previously the leaders have

been broadly based on national lines, withBritish (Copeman's Textbook of the Rheu-matic Diseases, £100) and American (Kelley'sTextbook of Rheumatology, £172) the maincontenders. The Oxford Textbook of Rheu-matology is a two volume text taking an

intemational form, with authors from bothsides of the Atlantic offering a more globalview of this specialty.The format is a tried and tested one,

dividing basic science, pathological features,and relevant investigations into one volumeand descriptions of disease into the second.However, it succeeds in filling two niches notcovered elsewhere. In the clinical volume, inaddition to a chapter specifically devoted tochildhood arthropathies, there are portionsin most sections emphasising manifestationsof each disease as they present in childhood,which will encourage trainees and more

experienced rheumatologists to leani more

about childhood arthritides. More impor-tantly, the book includes segmentsy oftenwritten jointly with relevant specialists,providing a perspective on manifestationsof rheumatological problems as faced bynon-rheumatologists. This increases otherspecialists' awareness of the subject but alsoencourages the placing of rheumatology in itstrue context as a specialty within generalmedicine.

The multiauthor format used for this bookprovides readers with an up to date reviewwritten by clinicians and scientists withexperience of research in a topic that changesrapidly from year to year. There are, how-ever, features that emphasise the need forcareful editing of such complete textbooks inorder to avoid some of the unnecessary

idiosyncrasies that individual authors haveincluded in their text, which add little to thecontent and may even confuse. In addition,the style allows more than one author to giveviews on the same subject. An increase incross referencing between chapters not onlywould be to readers' benefit but could alsoiron out the, albeit minor, variations betweenauthors.

Notwithstanding these minor irritations,the Oxford Textbook is thorough and compre-hensive and generally provides a good biblio-graphy (even if some seminal references are

repeated in different chapters with differingdates). It is generally easy to read and assimi-late and is a worthy addition to the textsalready available. Whether it can replace the

Stapling of a mesh patch during laparoscopic hemiorrhaphy illustrated in Laparoscopic Urologic Surgery(Raven, $151.50, ISBN 0 7817 0044 2). There seems no limit to the advances taking place in all aspects ofminimal surgery.

gold standard, widely regarded as Kelley'stextbook, remains to be seen.-AAXFIELD,senior lecturer in rheumatology, University of Glasgow

BMJ VOLUME 308 5 FEBRUARY 1994422

Best books on anaesthesia: a personal choice

I naesthesia is applied physiology,pharmacology, and physics; theirpplication depends on knowledge of

medicine and surgery. General textbooks ofanaesthesia should move from the scientificprinciples to clinical practice and will neverinclude enough detail for someone especiallyinterested in particular topics.

I guess that the large textbooks are boughtmostly by libraries and by candidates for theFRCA examinations who want somethingmore than spoon feeding, though my adviceto them is to use the contents pages of a largetextbook as a list of topics to be covered andto write their own textbook of notes fromreviews and editorials. These are written bythe same people who write the chapters in thetextbooks but are more up to date.

Contributors to textbooks must givereaders perspective, not merely regurgitatedfact. The editors must have done more thancollect the manuscripts and send them tothe publisher. No textbook is going to beglaringly incorrect for even a chapter or two,so probably the most important considerationis whether it is easy to read. Is the text asensible size and laid out well? Are thediagrams clear, and are they to a uniformstyle? Will the pages dissolve or stick togetherwhen the inevitable coffee or propofol getsspilled on them? Textbooks must be a goodsource of references, and references to recentreviews are as important as references tooriginal work. Unfortunately, most textbooksnow use the Vancouver style for references.This is good in short lists but infuriatingwhen you want to find whether a particularreference is quoted in a list of 200. Whattextbooks need (but which none has) aresubsidiary lists in alphabetical order, comingafter the numerical list, cross referenced to itand to occurrence in the text.

Books for the specialist* Textbook of Anaesthesia. 2nd edn. Ed A RAitkenhead, G Smith. (C49.) Churchill Livingstone,1990. ISBN 0-443-03957-7.

Anaesthesia. 2nd edn. Ed W S Nimmo, D JRowbotham, G Smith. (L149.50.) Blackwell Scien-tific, 1994. ISBN 0-632-03244-8.

** Clinical Anesthesia. 2nd edn. Ed P G Barash,B F Cullen, R K Stoelting. (,C1 13.) Lippincott, 1992.ISBN 0-397-51160-4.** Anaesthesia. 3rd edn. Ed R D Miller. (,c165.)Churchill Livingstone, 1990. ISBN 0443-08594-3.

** General Anaesthesia. 5th edn. Ed J F Nunn, J EUtting, B R Brown Jr. (,C110.) Butterworth, 1989.ISBN 0-407-00693-1.

*** Lee's Synopsis of Anaesthesia. 11th edn. R SAtkinson, G B Rushman, N J H Davies. (,C39.50.)Butterworth/Heinemann, 1993. ISBN 0-7506-1449-8.

* Handbook of Clinical Anesthesia. 2nd edn.Ed P G Barash, B F Cullen, R K Stoelting. (,L24.)Lippincott, 1992. ISBN 0-397-51297-X.

Ifyou want "a textbook for the exam" thenAitkenhead and Smith will do for part 1FRCA and Nimmo and Smith for

part 3. I cannot star Nimmo and Smith, notbecause it is not as good as Aitkenhead andSmith-both books are well written andpresented-but because candidates for part 3should have a broader outlook.There are three all inclusive general texts

worth considering. It is hard to distinguishbetween them. The two American books,Barash and Miller, all but ignore writersoutside North America. Nunn is more cos-mopolitan but is now the oldest of the three,though a new edition is in preparation.Textbooks are like grant applications: by thetime you've completed one it's time for thenext. Barash is a single volume and I preferthe typeface. The current edition suffersa bit from the Portakabin approach: newinformation is too often tacked on, not inte-grated. Miller's two volumes are on heavierpaper. Some ofthe diagrams are poor. Expertsare sometimes so convincing in their opinionsthat one wonders when they were last in anoperating theatre; Miller includes a refreshingchapter by Roizen, in which he gives a list ofbooks for readers to consult and humblyadmits that there is little good controlledevidence about technique and outcome.

Synopsis is in its eleventh edition. I keepmy old editions lovingly on the shelf, as aninvestment for the future when NHS pensionfunds have been privatised. It can be an

infuriating book, but, although the text maybe fairly cryptic, references are truncated,and there are few diagrams, Synopsis isusually a helpful source of rapidly requiredinformation."Baby Barash" gets a flower not because it

is the best of these books but because it isunique: an epitome of the larger text, forcarrying around and reading at odd moments.I suspect that new editions of the other largetextbooks will come similarly accompanied,provided they survive more than an editionor two. Of all medical printed matter, largetextbooks may be the first to move to elec-tronic publication.

Books for the generalist and forundergraduates* Lecture Notes on Anaesthetics. 4th edn. J NLunn. (;12.95.) Blackwell Scientific, 1991. ISBN0632-03192-1.

*** Anaesthesia, Analgesia and Intensive Care. EdA P Adams, JN Cashman. (LI14.99.) Edward Arnold,1991. ISBN 0-340-54927-0.

* Ostlere and Bryce-Smith's Anaesthetics forMedical Students. 10th edn. T B Boulton, C EBlogg. (p9.50.) Churchill Livingstone, 1989. ISBN0-443-02821-4.* Norris and Campbell's Anaesthetics, Resuscita-tion and Intensive Care. 7th edn. D Campbell, A ASpence. (,13.95.) Churchill Iivingstone, 1989. ISBN0-443-04067-2.

cc 5 aby Barash" has been recommendedfor students but it is far too com-prehensive. Non-specialists and

students need to appreciate anaesthetists'problems, not know how to solve them.Authors writing books for students havea tendency to irrelevant detail, which thestudents then inevitably remember, butauthors must not forget that students "know"that too much oxygen is harmful and that toomuch fluid causes heart failure. The result ishypoxic, poorly resuscitated patients. Lunnhas the balance right, in a well written,clearly presented book that everyone whoneeds the services of an anaesthetist shouldhave to reread at regular intervals. For themore interested, or for the senior houseofficer in anaesthesia, Adams and Cashman(unusually for a student text a multiauthorbook) is excellent. It includes intensive care,whereas Lunn does not.

Ostlere and Bryce-Smith is the book I usedas a student. It has the merit of being smalland, in common with Norris and Campbell,is a good easy read, giving a realistic flavourof the specialty. Neither book has gooddiagrams, and both seem a little tired. Isit worth keeping original authors' namesattached to books that inevitably will bemuch changed since their first editions?-NEVILLE GOODMAN, consultant senior lecturer inanaesthesia, University ofBristol

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