Annals of the Royal College of Surgeons of England (1990) vol. 72, 340-343
Clinical and pathological effects on the rabbit's eye of some plant-derived ophthalmic swabs Erasmus 0 Oji PhD(Lond) FRCS Professor in Ophthalmology Jos University Medical School, Plateau State, Nigeria
Key words: Plant materials; Intraocular implantation; Clinical and pathological effects
The stems of corn, millet, sugar cane and the banana leaf frond excite some clinical and pathological effects in the rabbit's eye when implanted either into the anterior chamber (AC) or subconjunctivaliy. These effects have not been sight threatening. The materials can either be left to be cleared by the body's phagocytes when they produce mild inflammatory reaction or removed surgicaily if the inflammatory response is moderate when fragments have been left intraocularly.
The stems of corn, millet, and sugar cane, and the banana leaf frond, have been shown to be suitable alternative surgical swabs for use in ophthalmology (1). In some developing countries such as Nigeria, the supply of the conventional compressed hydrocellulose German Spontex® swabs is scarce and, where available, they are very expensive to buy. In these situations the plantderived swabs are a cheap and safe alternative for ophthalmic use. Any foreign material introduced into the eye induces a degree of inflammatory foreign body reaction. Some highly refined materials such as the polymethylmethacrylate (PMMA) which is used in the manufacture of intraocular lenses induce almost no reaction in most eyes and can be tolerated indefinitely. Materials such as these plant-derived swabs, made of raw plant cellulose, are not refined and would be expected to induce a degree of inflammatory response which could be sight threatening. The current study was undertaken in order to assess the degree of harm these swabs would do if accidentally left inside the human eye during surgical operations. Present appointment and correspondence to: Mr E 0 Oji FRCS, Locum Consultant Ophthalmologist, Western Ophthalmic Hospital, St Mary's Hospital Medical School, London NW1
5YE
Materials and methods The following plant materials: corn stem, banana leaf frond, the millet stem and the cane sugar stem were studied for their clinical and pathological effects when implanted either subconjunctivally or into the anterior chamber (AC) of the rabbit's eye. The plant materials were obtained from the town of Jos in Nigeria where they grow abundantly in the rainy season. The barks of the plant stems were peeled off and their spongy interior was cut into small wedges which were transported to London for the current experiments. New Zealand White (NZW) adult male rabbits were used in these experiments. Their weight range was 2.0 to 3.4 kg. Twenty-five rabbits were divided into five groups of five rabbits each (A-E). Group A rabbits were implanted with the corn stem, group B the millet stem and group C the banana leaf frond. Group D rabbits received the cane sugar stem swabs while group E rabbits were implanted with the German Spontex swabs which were used as control. Both the test swabs and the control Spontex swabs were wrapped in tinfoil and autoclaved with a wet heat autoclave at 140°C for 20 min. After autoclaving, small fragments, 0.5 x 0.5 x 1.0 mm in size were cut out from each of the swabs and implanted into the AC of the randomly selected rabbit's eyes, using a sterile microsurgical technique. Implants were also placed subconjunctivally in randomly selected eyes. In each group, two eyes were left without implants for clinical comparison. Implantation of the swabs was done under general anaesthesia using sodium pentobarbitone for induction and maintenance of anaesthesia. After implantation, the rabbits were observed daily with the slit lamp biomicroscope for up to 6 weeks. The eyes which developed moderate uveitis were treated with 1% atropine drops twice daily and drops of
Effects of some plant-derived ophthalmic swabs
341
was reoperated on and the fragment removed with microforceps after 2 weeks. The three eyes with the subconjunctival implants showed only mild local conjunctival hyperaemia as those in group A.
Group C rabbits (banana leaf frond swabs) Five eyes in this group had AC implants of the sterile banana leaf frond swab. As in group A, all eyes in this group showed only minimal uveitis. There was no hypopyon or posterior synechiae. The three eyes with subconjunctival implants showed minimal local hyperaemia. Figure 1. Macrophotograph of a rabbit's eye 2 weeks after the implantation of a small fragment of sterile corn stem swab in the AC. There is mild uveitis only. There is no hypopyon or
posterior synechiae.
betamethazone-neomycin four times daily until the resolution of their eveitis. Four eyes which reacted with moderate uveitis were reoperated on and the swabs removed from the AC with microforceps. Photographs of the clinical reactions of the eyes were taken with a special hand-held camera designed for fieldwork on trachoma by Professor B R Jones and F Sheen of Moorfield's Eye Hospital, London (unpublished). Twenty eyes, four from each group, were enucleated and processed histologically for the study of the pathological effects of these foreign bodies in the eye.
Results Clinical effects Group A rabbits (corn stem swabs) All five eyes which received AC implants with the sterile corn stem fragments showed only very mild uveitis which resolved without treatment in 2-4 weeks. Figure 1 is a macrophotograph of an eye in this group 2 weeks after surgical implantation. No hypopyon or posterior synechiae occurred in these eyes. Pupillary reaction to bright light was not impaired. The three eyes in this group which received subconjunctival corn stem implantation showed minimal localised conjunctival hyperaemia which lasted only for a few weeks. Figure 2 shows a macrophotograph of an eye in this group with subconjunctival implant 2 weeks after implantation. Apart from the small swelling caused by the residual foreign body, there were no excessive granulomas at the site of the implant and no associated keratouveitis was observed.
Group B rabbits (millet stem swabs) Five eyes in this group received AC implants of the millet stem sterile swab. Four of the eyes had only mild anterior uveitis while one had a moderate uveitis; Fig. 3. This eye
Group D rabbits (cane sugar stem swabs) Cane sugar stem swab fragments were implanted in the AC of five eyes of this group. Three of these eyes showed only mild uveitis. Two of the eyes exhibited moderate uveitis. One of the two was treated with 1% atropine drops twice daily and Betnesol-NO drops four times daily for 6 weeks, when the uveitis was completely resolved. The other moderately uveitic eye in this group had the fragment removed surgically. In this group the subconjunctival implantation showed only localised hyperaemia.
Group E rabbits (German Spontex swabs) This group had the control German Spontex swabs inserted in their AC; four eyes. Of these four eyes, two showed mild uveitis while two showed moderate uveitis. Because of the brisk uveitis of the latter two, the implants were removed surgically after 1 week in the AC. Subconjunctival implants in one eye of this group showed minimal local reaction as in the test swabs. One rabbit was lost in this group from anaesthetic death. All the unoperated control eyes in each group (two eyes of groups A-D and one eye of group E) remained normal throughout the experiment.
Figure 2. Macrophotograph of a rabbit's eye with a subconjunctival implantation of a small fragment of the corn stem swab. There is a localised small swelling and localised hyperaemia.
342
E Q Oji
Figure 3. Macrophotograph of a rabbit's eye with a small sized fragment of millet stem swab in the AC. There is a residual millet stem foreign body in the AC (centre), with moderate
uveitis.
Figure 5. Microphotograph of a subconjunctivally implanted corn stem swab fragment. Note the foreign body granuloma. (Haematoxylin and eosin preparation.)
vitreous body, and the posterior poles of all the eyes examined.
Pathological effects Figure 4 is a microphotograph of a corn stem swab fragment in the AC of the rabbit. There is a foreign body inflammatory reaction only around the fragment. There are no other intraocular pathological changes. The posterior chamber, the lens, the vitreous and the posterior pole of the eye were all normal in high-field microscopy. Similar mild pathological effects were observed in enucleated eyes from rabbit groups B, C, and D. Figure 5 is the microphotograph of a subconjunctivally placed corn stem fragment. There is a local foreign body granuloma and no intraocular pathology was seen. This type of localised reaction was obtained in all the test swabs and the control German Spontex swab studied in this experiment. Figure 6 is the microphotograph of an AC implanted German Spontex control swab. There is a local foreign body reaction around the swab fragment with marked giant cell production. The anterior chamber angles were not obliterated with inflammatory debris and there were no intraocular pathologies in the posterior chamber, lens,
This study shows that the four plant-derived surgical swabs can cause mild uveitis when they gain access into the AC of the rabbit's eye. However, this uveitis is soon halted by the rabbit's eye defence mechanism without threat to the sight. Some fragments produced moderate uveitis, and this necessitated surgical removal in order to avoid vision deprivation. It is of interest to note that the same size of small fragment of the German Spontex control swab induces more local inflammation around it than those of the test swabs. This result is difficult to explain. The German Spontex swab is a compressed hydrocellulose sponge, much more refined than the four natural plant-derived test swabs and so could be expected to incite less inflammatory response in the eye than the test swabs which are unrefined natural products. However, it could
Figure 4. Haematoxylin and eosin processed microphotograph of a corn stem fragment in the AC of a rabbit's eye. Note localised reaction around the foreign body.
Figure 6. Microphotograph of an AC implanted German Spontex swab. Note the marked giant cell reaction around the control swab. (Haematoxylin and eosin preparation.)
Discussion
Effects of some plant-derived ophthalmic swabs
be that the high density of the compressed hydrocellulose Spontex swab is more inflammogenic than the naturally loosely spaced cellulose fibres of these test swabs. The rabbit's eye reacts vigorously to any intraocular foreign body, much more so than the eye of humans. It is therefore legitimate to extrapolate that if fragments of these swabs are left in the human eye by accident, that the intraocular inflammation would also be mild or even milder than in the rabbit's eye. From these studies I would recommend the use of these swabs in areas where they are a cheaper alternative, in the knowledge that they are efficient blood absorbers and have some risk of causing only mild intraocular inflammation when left inside the eye. If this accident should happen, the eyes could be treated conservatively when the fragments left are small in size and surgically when the size and the consequent uveitis is moderate. From a practical viewpoint, the corn stem swab would
343
appear to be the material of first choice while the millet stem swab is easily the second choice. I am grateful to Professor L P Le Quesne and the British Council for the scholarship during the tenure of which I was able to carry out this study. I thank Professor G J Johnson of The Institute of Ophthalmology, London, for the laboratory space and his kind support in these experiments and Professor Garner of the same Institute for the processing of the pathological specimens.
Reference I Oji EO. Locally available plant materials for use as ophthalmic surgical swabs. Ann R Coll Surg Engl 1986;68:307-9.
Received 8 March 1990
Notes on books A Clinical and Pathological Atlas: The Records of a Surgeon in St Vincent, The West Indies by A Cecil Cyrus. 263 pages, illustrated. Published privately. £85, $150. Dr Cyrus was born on the small island of St Vincent in the Caribbean. He studied medicine in Belfast, obtained the FRCS and a subsequent Commonwealth Fellowship to study ophthalmology at Moorfields Hospital. He has spent his working life back home. During his career he has, with considerable skill, taken more than 3000 colour photographs, accumulated over 1000 pathological specimens and many hundreds of X-ray pictures. From these he has selected the best to produce this atlas. Because of inbreeding there is a high incidence of congenital malformations on the island. Trauma, both accidental and deliberate, has produced some shocking pictures. Chronic tropical infections result in many disabling conditions as do tumours, which often present late. Dr Cyrus had very limited access to investigations and his collection of clinical abdominal conditions is chastening. In his last section he displays some of the bizarre miscellaneous conditions he has encountered. The photographs have clear and sometimes entertaining annotations and in these the author reveals himself as a modest, caring and likeable man. Because he realised that such a personal collection as this would not be a commercial proposition he has published the atlas privately. It may be obtained from: or from: Miss Jacqueline Sykes Dr A Cecil Cyrus North Wold Printers Ltd The Botanic Clinic Unit A, Estate Road Montrose Pocklington Light Industrial Estate St Vincent Pocklington The West Indies York Y04 20P R M KIRK
Pediatric Anesthesia edited by George A Gregory. 2nd edition, 2 volumes. 1388 pages, illustrated. Churchill Livingstone, New York. 1989. £90.00. ISBN 0 443 08544 7 This second edition of a successful textbook includes new chapters on malignant hyperthermia, pain management, fluids and electrolyte therapy, recovery from anaesthesia and the history of paediatric anaesthesia. There are ten new authors and the volumes have been updated throughout. Clear layout makes for easy reading and this new edition should prove as popular as the first.
Abdominal Wall Hernias: An Atlas of Anatomy and Repair by John L Madden. 344 pages, illustrated. W B Saunders Company, Philadelphia. 1989. £68.00. ISBN 0 7216 1288 1
A large number of clear half-tone illustrations together with some colour photographs complement a lucid text in this new volume on groin hernias. A novel addition is an appendix giving extracts from famous eighteenth- and nineteenth-century works on hernia by such great names as Gimbernat, Cooper, Scarpa, Cloquet and Bassini. This book can be unequivocally recommended to all SHOs and Registrars in general surgery.
Laser Angioplasty edited by Timothy A Sanborn. 121 pages, illustrated. Alan R Liss Inc., New York. 1989. $49.50. ISBN 0 471 50992 2 In the past few years the concept of minimally-invasive surgery has developed and lasers have captured the imagination, the media and the public. This volume provides an introduction to the clinical use of lasers in cardiovascular disease and is useful in giving the present state-of-the-art. It will no doubt soon become out of date but nevertheless it now serves a useful purpose.
Clinical and pathological effects on the rabbit's eye of some plant-derived ophthalmic swabs Erasmus 0 Oji PhD(Lond) FRCS Professor in Ophthalmology Jos University Medical School, Plateau State, Nigeria
Key words: Plant materials; Intraocular implantation; Clinical and pathological effects
The stems of corn, millet, sugar cane and the banana leaf frond excite some clinical and pathological effects in the rabbit's eye when implanted either into the anterior chamber (AC) or subconjunctivaliy. These effects have not been sight threatening. The materials can either be left to be cleared by the body's phagocytes when they produce mild inflammatory reaction or removed surgicaily if the inflammatory response is moderate when fragments have been left intraocularly.
The stems of corn, millet, and sugar cane, and the banana leaf frond, have been shown to be suitable alternative surgical swabs for use in ophthalmology (1). In some developing countries such as Nigeria, the supply of the conventional compressed hydrocellulose German Spontex® swabs is scarce and, where available, they are very expensive to buy. In these situations the plantderived swabs are a cheap and safe alternative for ophthalmic use. Any foreign material introduced into the eye induces a degree of inflammatory foreign body reaction. Some highly refined materials such as the polymethylmethacrylate (PMMA) which is used in the manufacture of intraocular lenses induce almost no reaction in most eyes and can be tolerated indefinitely. Materials such as these plant-derived swabs, made of raw plant cellulose, are not refined and would be expected to induce a degree of inflammatory response which could be sight threatening. The current study was undertaken in order to assess the degree of harm these swabs would do if accidentally left inside the human eye during surgical operations. Present appointment and correspondence to: Mr E 0 Oji FRCS, Locum Consultant Ophthalmologist, Western Ophthalmic Hospital, St Mary's Hospital Medical School, London NW1
5YE
Materials and methods The following plant materials: corn stem, banana leaf frond, the millet stem and the cane sugar stem were studied for their clinical and pathological effects when implanted either subconjunctivally or into the anterior chamber (AC) of the rabbit's eye. The plant materials were obtained from the town of Jos in Nigeria where they grow abundantly in the rainy season. The barks of the plant stems were peeled off and their spongy interior was cut into small wedges which were transported to London for the current experiments. New Zealand White (NZW) adult male rabbits were used in these experiments. Their weight range was 2.0 to 3.4 kg. Twenty-five rabbits were divided into five groups of five rabbits each (A-E). Group A rabbits were implanted with the corn stem, group B the millet stem and group C the banana leaf frond. Group D rabbits received the cane sugar stem swabs while group E rabbits were implanted with the German Spontex swabs which were used as control. Both the test swabs and the control Spontex swabs were wrapped in tinfoil and autoclaved with a wet heat autoclave at 140°C for 20 min. After autoclaving, small fragments, 0.5 x 0.5 x 1.0 mm in size were cut out from each of the swabs and implanted into the AC of the randomly selected rabbit's eyes, using a sterile microsurgical technique. Implants were also placed subconjunctivally in randomly selected eyes. In each group, two eyes were left without implants for clinical comparison. Implantation of the swabs was done under general anaesthesia using sodium pentobarbitone for induction and maintenance of anaesthesia. After implantation, the rabbits were observed daily with the slit lamp biomicroscope for up to 6 weeks. The eyes which developed moderate uveitis were treated with 1% atropine drops twice daily and drops of
Effects of some plant-derived ophthalmic swabs
341
was reoperated on and the fragment removed with microforceps after 2 weeks. The three eyes with the subconjunctival implants showed only mild local conjunctival hyperaemia as those in group A.
Group C rabbits (banana leaf frond swabs) Five eyes in this group had AC implants of the sterile banana leaf frond swab. As in group A, all eyes in this group showed only minimal uveitis. There was no hypopyon or posterior synechiae. The three eyes with subconjunctival implants showed minimal local hyperaemia. Figure 1. Macrophotograph of a rabbit's eye 2 weeks after the implantation of a small fragment of sterile corn stem swab in the AC. There is mild uveitis only. There is no hypopyon or
posterior synechiae.
betamethazone-neomycin four times daily until the resolution of their eveitis. Four eyes which reacted with moderate uveitis were reoperated on and the swabs removed from the AC with microforceps. Photographs of the clinical reactions of the eyes were taken with a special hand-held camera designed for fieldwork on trachoma by Professor B R Jones and F Sheen of Moorfield's Eye Hospital, London (unpublished). Twenty eyes, four from each group, were enucleated and processed histologically for the study of the pathological effects of these foreign bodies in the eye.
Results Clinical effects Group A rabbits (corn stem swabs) All five eyes which received AC implants with the sterile corn stem fragments showed only very mild uveitis which resolved without treatment in 2-4 weeks. Figure 1 is a macrophotograph of an eye in this group 2 weeks after surgical implantation. No hypopyon or posterior synechiae occurred in these eyes. Pupillary reaction to bright light was not impaired. The three eyes in this group which received subconjunctival corn stem implantation showed minimal localised conjunctival hyperaemia which lasted only for a few weeks. Figure 2 shows a macrophotograph of an eye in this group with subconjunctival implant 2 weeks after implantation. Apart from the small swelling caused by the residual foreign body, there were no excessive granulomas at the site of the implant and no associated keratouveitis was observed.
Group B rabbits (millet stem swabs) Five eyes in this group received AC implants of the millet stem sterile swab. Four of the eyes had only mild anterior uveitis while one had a moderate uveitis; Fig. 3. This eye
Group D rabbits (cane sugar stem swabs) Cane sugar stem swab fragments were implanted in the AC of five eyes of this group. Three of these eyes showed only mild uveitis. Two of the eyes exhibited moderate uveitis. One of the two was treated with 1% atropine drops twice daily and Betnesol-NO drops four times daily for 6 weeks, when the uveitis was completely resolved. The other moderately uveitic eye in this group had the fragment removed surgically. In this group the subconjunctival implantation showed only localised hyperaemia.
Group E rabbits (German Spontex swabs) This group had the control German Spontex swabs inserted in their AC; four eyes. Of these four eyes, two showed mild uveitis while two showed moderate uveitis. Because of the brisk uveitis of the latter two, the implants were removed surgically after 1 week in the AC. Subconjunctival implants in one eye of this group showed minimal local reaction as in the test swabs. One rabbit was lost in this group from anaesthetic death. All the unoperated control eyes in each group (two eyes of groups A-D and one eye of group E) remained normal throughout the experiment.
Figure 2. Macrophotograph of a rabbit's eye with a subconjunctival implantation of a small fragment of the corn stem swab. There is a localised small swelling and localised hyperaemia.
342
E Q Oji
Figure 3. Macrophotograph of a rabbit's eye with a small sized fragment of millet stem swab in the AC. There is a residual millet stem foreign body in the AC (centre), with moderate
uveitis.
Figure 5. Microphotograph of a subconjunctivally implanted corn stem swab fragment. Note the foreign body granuloma. (Haematoxylin and eosin preparation.)
vitreous body, and the posterior poles of all the eyes examined.
Pathological effects Figure 4 is a microphotograph of a corn stem swab fragment in the AC of the rabbit. There is a foreign body inflammatory reaction only around the fragment. There are no other intraocular pathological changes. The posterior chamber, the lens, the vitreous and the posterior pole of the eye were all normal in high-field microscopy. Similar mild pathological effects were observed in enucleated eyes from rabbit groups B, C, and D. Figure 5 is the microphotograph of a subconjunctivally placed corn stem fragment. There is a local foreign body granuloma and no intraocular pathology was seen. This type of localised reaction was obtained in all the test swabs and the control German Spontex swab studied in this experiment. Figure 6 is the microphotograph of an AC implanted German Spontex control swab. There is a local foreign body reaction around the swab fragment with marked giant cell production. The anterior chamber angles were not obliterated with inflammatory debris and there were no intraocular pathologies in the posterior chamber, lens,
This study shows that the four plant-derived surgical swabs can cause mild uveitis when they gain access into the AC of the rabbit's eye. However, this uveitis is soon halted by the rabbit's eye defence mechanism without threat to the sight. Some fragments produced moderate uveitis, and this necessitated surgical removal in order to avoid vision deprivation. It is of interest to note that the same size of small fragment of the German Spontex control swab induces more local inflammation around it than those of the test swabs. This result is difficult to explain. The German Spontex swab is a compressed hydrocellulose sponge, much more refined than the four natural plant-derived test swabs and so could be expected to incite less inflammatory response in the eye than the test swabs which are unrefined natural products. However, it could
Figure 4. Haematoxylin and eosin processed microphotograph of a corn stem fragment in the AC of a rabbit's eye. Note localised reaction around the foreign body.
Figure 6. Microphotograph of an AC implanted German Spontex swab. Note the marked giant cell reaction around the control swab. (Haematoxylin and eosin preparation.)
Discussion
Effects of some plant-derived ophthalmic swabs
be that the high density of the compressed hydrocellulose Spontex swab is more inflammogenic than the naturally loosely spaced cellulose fibres of these test swabs. The rabbit's eye reacts vigorously to any intraocular foreign body, much more so than the eye of humans. It is therefore legitimate to extrapolate that if fragments of these swabs are left in the human eye by accident, that the intraocular inflammation would also be mild or even milder than in the rabbit's eye. From these studies I would recommend the use of these swabs in areas where they are a cheaper alternative, in the knowledge that they are efficient blood absorbers and have some risk of causing only mild intraocular inflammation when left inside the eye. If this accident should happen, the eyes could be treated conservatively when the fragments left are small in size and surgically when the size and the consequent uveitis is moderate. From a practical viewpoint, the corn stem swab would
343
appear to be the material of first choice while the millet stem swab is easily the second choice. I am grateful to Professor L P Le Quesne and the British Council for the scholarship during the tenure of which I was able to carry out this study. I thank Professor G J Johnson of The Institute of Ophthalmology, London, for the laboratory space and his kind support in these experiments and Professor Garner of the same Institute for the processing of the pathological specimens.
Reference I Oji EO. Locally available plant materials for use as ophthalmic surgical swabs. Ann R Coll Surg Engl 1986;68:307-9.
Received 8 March 1990
Notes on books A Clinical and Pathological Atlas: The Records of a Surgeon in St Vincent, The West Indies by A Cecil Cyrus. 263 pages, illustrated. Published privately. £85, $150. Dr Cyrus was born on the small island of St Vincent in the Caribbean. He studied medicine in Belfast, obtained the FRCS and a subsequent Commonwealth Fellowship to study ophthalmology at Moorfields Hospital. He has spent his working life back home. During his career he has, with considerable skill, taken more than 3000 colour photographs, accumulated over 1000 pathological specimens and many hundreds of X-ray pictures. From these he has selected the best to produce this atlas. Because of inbreeding there is a high incidence of congenital malformations on the island. Trauma, both accidental and deliberate, has produced some shocking pictures. Chronic tropical infections result in many disabling conditions as do tumours, which often present late. Dr Cyrus had very limited access to investigations and his collection of clinical abdominal conditions is chastening. In his last section he displays some of the bizarre miscellaneous conditions he has encountered. The photographs have clear and sometimes entertaining annotations and in these the author reveals himself as a modest, caring and likeable man. Because he realised that such a personal collection as this would not be a commercial proposition he has published the atlas privately. It may be obtained from: or from: Miss Jacqueline Sykes Dr A Cecil Cyrus North Wold Printers Ltd The Botanic Clinic Unit A, Estate Road Montrose Pocklington Light Industrial Estate St Vincent Pocklington The West Indies York Y04 20P R M KIRK
Pediatric Anesthesia edited by George A Gregory. 2nd edition, 2 volumes. 1388 pages, illustrated. Churchill Livingstone, New York. 1989. £90.00. ISBN 0 443 08544 7 This second edition of a successful textbook includes new chapters on malignant hyperthermia, pain management, fluids and electrolyte therapy, recovery from anaesthesia and the history of paediatric anaesthesia. There are ten new authors and the volumes have been updated throughout. Clear layout makes for easy reading and this new edition should prove as popular as the first.
Abdominal Wall Hernias: An Atlas of Anatomy and Repair by John L Madden. 344 pages, illustrated. W B Saunders Company, Philadelphia. 1989. £68.00. ISBN 0 7216 1288 1
A large number of clear half-tone illustrations together with some colour photographs complement a lucid text in this new volume on groin hernias. A novel addition is an appendix giving extracts from famous eighteenth- and nineteenth-century works on hernia by such great names as Gimbernat, Cooper, Scarpa, Cloquet and Bassini. This book can be unequivocally recommended to all SHOs and Registrars in general surgery.
Laser Angioplasty edited by Timothy A Sanborn. 121 pages, illustrated. Alan R Liss Inc., New York. 1989. $49.50. ISBN 0 471 50992 2 In the past few years the concept of minimally-invasive surgery has developed and lasers have captured the imagination, the media and the public. This volume provides an introduction to the clinical use of lasers in cardiovascular disease and is useful in giving the present state-of-the-art. It will no doubt soon become out of date but nevertheless it now serves a useful purpose.
