Prevalence of hypovitaminosis D in elderly women in Italy: clinical consequences and risk factors

In order to evaluate the prevalence, risk factors, and clinical consequences of hypovitaminosis D in elderly Italian women a multicenter study of 43 osteoporosis centers from all regions of Italy was carried out. Study population included 700 women aged 60–80 years in whom blood was taken for 25-hydroxyvitamin D (25OHD) and parathyroid hormone (PTH) measurements. All subjects were also questioned to assess the prevalence of several risk factors for hypovitaminosis D, osteoporotic fractures and activities of daily living (ADL). Values of 25OHD lower than 5 ng/ml were found in 27% of the women and lower than 12 ng/ml in 76%. 25OHD and PTH levels were negatively correlated (r=–0.38, after logarithmic transformation of both variables). 25OHD levels significantly declined with advancing age and number of pregnancies and were positively correlated with educational level (years spent at school), dairy calcium intake, and days spent on holiday by the sea. In a multivariate model including all these variables, the only one that remained significant was the level of education. The lowest age-adjusted 25OH D levels were found in smokers or in women living in central Italy as compared with those living in northern or southern Italy. The mean (±SD) age-adjusted 25OH D values were significantly lower in women who sustained a hip fracture (7.1±2.2 versus 11.0±9.9). Women with low 25OHD levels (<12 ng/ml) had worse scores for ADL and mobility ADL (move outdoors, use stairs, walk at least 400 m, carry a heavy object). Vitamin D deficiency is extremely common among elderly Italian women. Women with lower educational level, living in central Italy, smokers or with lower intake of dairy products are at greater risk. Hypovitaminosis D is associated with worsening of the ability to perform activities of daily living and higher hip fracture prevalence. This finding should lead to an urgent population-based strategy to remedy this condition.Local participants in the study (name and Italian town of study site): S. Adami, Verona; M. Bevilacqua, Milano; E.M. Bibolotti, Piombino; F. Cantini, Prato; S. Coaccioli, Terni; R. Conca, Milano; D. Costi, Parma; G. D'Avola, Catania; O. Di Munno, Pisa; M. Ferraris, Vercelli; P. Filipponi, Perugia; C.M. Francucci, Ancona; G. Gandolini, Milano; S. Gatto, Napoli; P. Gigliotti, Cosenza; T. Gismondi, Bari; S. Gnudi, Bologna; E. Grimaldi, Trieste; G. Isaia, Torino; G. La Montagna, Napoli; G. Lojacono, Bari; R.V. Lovato; F. Luparelli, Taranto; U. Martorana, Palermo; A. Mathieu, Cagliari; D. Maugeri, Catania; S. Minisola, Roma; S. Miozzi, Roma; G. Occhipinti, Livorno; R. Pellerito, Torino; D. Policicchio, Avellino; M. Portigliatti Barbos, Torino; G.B. Rini, Palermo; G. Rosa, Napoli; D. Schinella, Pordenone; M. Sfrappini, Tronto; P. Simonetta, Reggio Calabria; L. Sinigaglia, Milano; S. Stisi, Benevento; A. Tarroni, Rimini; F. Trotta, Ferrara; F. Versace, Savona     

A multicenter experience on patient and technique survival in children on chronic dialysis

In this study we compared patient and technique survival of 163 new hemodialysis (HD) patients (age 11.4±3.1 years) and 295 peritoneal dialysis patients (7.7±4.8 years. P< 0.001), treated in 23 dialysis centers participating in the Italian Registry of Pediatric Chronic Peritoneal Dialysis (CPD) during the years 1989–2000. Three HD (1.8%) and 17 CPD (5.8%) patients died; the overall average death rate was 9.8/1,000 patient-years in HD and 29.8/1,000 patient-years in CPD patients. No statistically significant difference in patient survival between CPD and HD was found, while the survival of 102 CPD children younger than 5 years at the start of dialysis was lower (P=0.0001) than that of 193 CPD and 160 HD patients aged 5–15 years. We registered 12 modality failures among HD (7.4%) patients and 44 among CPD (14.9%) patients. The main causes were vascular access failure and patient choice in HD, and infection in CPD patients. Technique survival was lower (P=0.007) in CPD than in HD patients; a statistically significant difference (P=0.01) was also observed between both the 0- to 5- and the 5- to 15-year-old CPD patients and the HD patients aged 5–15 years. Logistic regression analysis confirmed age at initiation of dialysis to be a predictor of patient death (P=0.0001) in the whole patient population, and of technique failure in HD (P=0.006) but not in CPD patients (P=0.16).Dialysis centers and investigators participating in the Italian Registry of Pediatric Chronic Peritoneal Dialysis: Unità Operativa (U.O.) di Nefrologia, Ospedale San Lazzaro, Alba (G. Viglino); Servizio di Nefrologia, Ospedale Policlinico, Anzio (F. Della Grotta); Servizio Nefrologia Pediatrica, Clinica Pediatria, Ancona (I. Rätsch); Servizio di Nefrologia, Ospedale Mazzoni, Ascoli Piceno (M. Ragaiolo); U.O. di Nefrologia e Dialisi, Ospedale Giovanni XXIII, Bari (A.D. Caringella, P. Sorino); Istituto di Pediatrica Clinica, Bari (R. Penza); U.O. di Nefrologia e Dialisi, Ospedale Malpighi, Bologna (L. Catizone); U.O. di Nefrologia, Ospedale Umberto I, Brescia (S. Bassi); U.O. di Nefrologia, Ospedale Civile, Brescia (G. Cancarini); Servizio Nefrologia e Dialisi, Clinica Pediatrica, Ospedale Meyer, Firenze (G. Lavoratti); U.O. di Nefrologia Dialisi e Trapianto, Istituto G. Gaslini, Genova (F. Perfumo, E. Verrina); Clinica Pediatrica, Messina (C. Fede); U.O. di Nefrologia Dialisi e Trapianto, Clinica Pediatrica De Marchi, Milano (A. Edefonti, G. Ardissino); Nefrologia Adulto e Bambino, Università di Napoli (G. Capasso); U.O. di Nefrologia e Dialisi, Ospedale Santobono, Napoli (C. Pecoraro); U.O. di Nefrologia, Dialisi e Trapianto, Clinica Pediatrica, Università di Padova (G. Zacchello, B. Andreetta); U.O. di Nefrologia e Dialisi, Ospedale Di Cristina, Palermo (S. Maringhini); U.O. di Nefrologia, Ospedale Civico, Palermo (F. Caputo); U.O. di Nefrologia e Dialisi, Ospedale Silvestrini, Perugia (U. Buoncristiani); U.O. di Nefrologia, Ospedale Santo Spirito, Pescara (A. Ciofani); Dipartimento di Nefrologia e Urologia, Ospedale Bambino Gesù, Roma (G. Rizzoni, S. Rinaldi); Clinica Pediatrica, Policlinico Gemelli, Roma (E. Salvaggio); U.O. di Nefrologia Dialisi e Trapianto, Ospedale Regina Margherita, Torino (R. Coppo, B. Gianoglio)     

Bile duct injuries during laparoscopic cholecystectomy: a 1994–2001 audit on 13,718 operations in the area of Rome

Background Bile duct injuries (BDIs) during laparoscopic cholecystectomy (LC) still are reported with greater frequency than during open cholecystectomy (OC).Methods In 1999, a retrospective study evaluating the incidence of BDIs during LC in the area of Rome from 1994 to 1998 (group A) was performed. In addition, a prospective audit was started, ending in December 2001 (group B).Results In group A, 6,419 LCs were performed (222 were converted to OC; 3.4%). In group B, 7,299 LCs were performed (225 were converted to OC; 3.1%). Seventeen BDIs (0.26%) occurred in group A and 16 (0.22%) in group B. Overall, mortality and major morbidity rates were 12.1% and 30.3%, respectively, without significant differences between the two groups.Conclusions The incidence and clinical relevance of BDIs during LC in the area of Rome appeared to be stable over the past 8 years and were not influenced by the use of a prospective audit, as compared with a retrospective survey.(T. Zanarini) Other members that actively participated in this multicenter study are: C. Allegri, Ospedale Cristo Re, Roma; D. Antonellis, Ospedale S. Giuseppe, Marino; N. Basso, Università La Sapienza, Roma; F. Cancrini, Ospedale S. Carlo di Nancy, Roma; G. Cucchiara, Ospedale Fatebenefratelli, Roma; A. Garofalo, Ospedale S. Camillo Forlanini, Roma; A.L. Gaspari, Università Tor Vergata, Roma; M. Lombardi, Ospedale CTO, Roma; G. Massi, Ospedale S. Camillo Forlanini, Roma; R. Marrese, G.B. Grassi, Ospedale S. Filippo Neri, Roma; V. Mazzucato, M. Mulieri, Ospedale Nuovo Regina Margherita, Roma; A. Montori, Università La Sapienza, Roma; A. Moraldi, Ospedale S. Giacomo, Roma; G. Pasquini, Ospedale Civile, Velletri; E. Santoro, Istituto Regina Elena, Roma; F. Scutari, Ospedale S. Spirito, Roma; R. Tersigni, Ospedale S. Camillo Forlanini, Roma; C.E. Vitelli, Ospedale Madre G. Vannini, Roma; F. Zaraca, M. Carboni, Università La Sapienza, Roma     

Haemolytic-uraemic syndrome in childhood: surveillance and case-control studies in Italy

Seventy-six cases of haemolytic-uraemic syndrome (HUS) were collected over a 4-year period during a surveillance and case-control study. The annual incidence of 0.2 per 100,000 children aged 0–14 years is lower than in other countries; 34% had no prodromal diarrhoea. Evidence for verocytotoxin-producingEscherichia coli (VTEC) infection was found in 72% of patients and 3% of controls; 88% of patients with bloody diarrhoea, 67% with non-bloody diarrhoea and 55% without diarrhoea were VTEC positive. Seventy-three percent of patients had creatinine clearance 80 ml/min per 1.73 m², normal blood pressure, no proteinuria and haematuria <2+ after 1 year of follow-up. One patient died and none had non-renal sequelae. VTEC positivity was significantly correlated with a good outcome, while the absence of diarrhoea and a high total white blood cell count at onset were not predictors of a bad outcome. Household contacts of HUS patients had diarrhoea more frequently than those of the control group, supporting the hypothesis of person-to-person transmission of VTEC infection.Italian HUS Study Group: P. Pasquini, Epidemiology and Biostatistic Laboratory, Istituto Superiore di Sanità, Rome: A. Edefonti, A. Bettinelli-Paediatric Clinic of the University of Milan; A. Caringella, T. De Palo Division of Nephrology and Dialysis, Giovanni XXIII Children's Hospital, Bari; G. Capasso, N. De Santo, Chair of Nephrology of the 1st Faculty of Medicine of the University of Naples: S. Bassi, Division of Nephrology and Dialysis, Umberto I^o Hospital, Brescia; G. Montini, G. Zacchello, Paediatric Department of the University of Padua; M. Gaido, R. Coppo, Division of Nephrology and Dialysis, Regina Margherita Children's Hospital, Turin; F. Perfumo, R. Gusmano, Division of Nephrology and Dialysis, G. Gaslini Children's Hospital, Genoa; E. Salvaggio, Paediatric Clinic of the A. Gemelli University of Rome; L. Peratoner, Paediatric Clinic of the University of Trieste; C. Setzu, Paediatric Division, G. Brotzu Hospital, Cagliari; A. Bosco, Division of Nephrology and Dialysis, G. Di Cristina Children's Hospital, Palermo; R. Penza, Paediatric Clinic of the University of Bari; M. Cecconi, Paediatric Clinic of the University of Ancona; I. Pela, Paediatric Clinic of the University of Florence     

Book reviews

(Wylie Churchill-Davidson) A Practice of Anaesthesia Edited by H.C. C hurchill -D avidson.
Introduction to the Practice of Anaesthesia. Edited by M onte L ichtiger & F rank M oya
Advances in Cardiopulmonary Resuscitation Edited by P. S afar (Associate Editor J.O. Elam)
Pulmonary Pathophysiology. The Essentials By J ohn B. W est
Medical Acid-Base Balance. The Basic Principles By M ichael L.G. G ardner.
The Regulation of Respiration during Sleep and Anaesthesia. Advances in Experimental Medicine and Biology. Volume 99 Edited by R obert S. F itzgerald , H enry G autier & S ukhamay L ahiri.
Pain Relief in Labour. A handbook for midwives By D onald D. M oir
Regional Blocks for Nurse Anaesthetists. A Technical Manual By P hyllis A dams R oberts.     

Pharmacokinetic aspects of fluid therapy

Volume kinetics could be a useful tool to better understand fluid distribution and its implications for fluid therapy. By using non-linear regression, it is possible to fit dilution data to an equation that describes fluid distribution in one- and two-volume models reasonably well. These models could be adapted to fit different clinical situations. In the future, it would be useful to design models similar to target control infusion models in pharmacokinetics. Such models should probably use dilution of Hb or other endogenous tracers in combination with blood pressure as endpoints.

• peri-operative fluid therapy continues to be an exercise in empiricism, with nagging questions about efficacy and complications

• in 1997, several authors introduced kinetic modeling (volume kinetics) describing the peak effects and clearance of intravenously infused fluids in terms similar to those used in pharmacokinetics

• this chapter briefly summarizes currently accepted principles of fluid therapy, discusses the general approach to kinetic analysis of fluid therapy, reviews currently available data defining kinetic responses to fluid therapy, and speculates about future applications of this approach

• further research is warranted where anaesthetic drugs in combination with haemorrhage are studied kinetically in humans

• it is important to implement a non-invasive analysis of an endogenous tracer such as Hb to facilitate future use of kinetic models for fluids

• an outcome study comparing fluid administration according to kinetic principles vs standard of care is warranted

Influence of hormonal and reproductive factors on the risk of vertebral deformity in European women

The aim of this study was to determine whether variation in the level of selected hormonal and reproductive variables might explain variation in the occurrence of vertebral deformity across Europe. A population-based cross-sectional survey method was used. A total of 7530 women aged 50–79 years and over were recruited from 30 European centres. Subjects were invited to attend for an interviewer-administered questionnaire and lateral spinal radiographs which were taken according to a standard protocol. After adjusting for age, centre, body mass index and smoking, those in the highest quintile of menarche (age 2=16 years) had an increased risk of vertebral deformity (odds ratio [OR]=1.48; 95% confidence interval [CI] 1.16, 1.88). Increased menopausal age (>52.5 years) was associated with a reduced risk of deformity (OR=0.78; 95% CI 0.60, 1.00), while use of the oral contraceptive pill was also protective (OR=0.76; 95% CI 0.58, 0.99). There was a smaller protective effect associated with one or more years use of hormone replacement therapy, though the confidence limits clearly embraced unity. There was no apparent effect of parity or breast-feeding on the risk of deformity. We conclude that oestrogen status is an important determinant of vertebral deformity. Ever use of the oral contraceptive pill was associated with a 25% reduction in risk of deformity though the effect may be a result of the higher-dosage oestrogen pills used in the past. Parity and breast-feeding do not appear to be important and would appear to have little potential for identification of women at high risk of vertebral deformity.The European Vertebral Osteoporosis Study Group. &Project Management Group: D. Agnusdei (Siena, Italy), K. Bergmann (Berlin, Germany), C. Cooper (Southampton, UK), J. Dequeker (Leuven, Belgium), D. Felsenberg (Berlin, Germany), J. A. Kanis (Sheffield, UK), G. Kruskemper (Bochum, Germany), H. Raspe (Lubeck, Germany), A. J. Silman (Project leader; Manchester, UK).Data Co-ordinating Centre (Manchester): T. W. O'Neill, J. Varlow, D. Marsden, M. Naves Diaz, A. J. Silman.Radiology Co-ordinating Centre (Berlin): D. Felsenberg, E. Wieland, L. Kalidis, J. Mews. PARTICIPANTS:Austria: Graz. T. Lauermann, K. Weber;Belgium: Leuven, J. Dequeker, P. Geusens;Croatia: Zagreb. I. Jajic;Czech Republic: Prague, S. Havelka, P. Vavrincova;France: Montceau-Les-Mines. P.D. Delmas, F. Marchand;Germany: Berlin Steglitz, D. Felsenberg; Berlin Potsdam, D. Banzer; Berlin Charite. S. Kirschner, W. Reisinger; Bochum, J. Janott, H. Schatz; Erfurt, J. Franke; Heidelberg, C. Scheidt-Nave, R. Ziegler; Jena, K. Aben-droth, B. Felsch; Lubeck, C. Matthis, H. Raspe;Greece: Athens, A. Antoniou, G. Lyritis;Hungary: Budapest, C. Kiss, G. Poor;Italy: Siena, D. Agnusdei, C. Gennari; Milan, S. Ortolani;Netherlands: Rotterdam, A. Hofman, H. A. P. Pols;Norway: Oslo, J. A. Falch, H. E. Meyer;Poland: Szczecin, S. Czekalski, T. Miazgowski; Warsaw, K. Hoszowski, R. S. Lorenc;Portugal: Oporto, A. Aroso, A. Lopez Vaz;Russia: Moscow, L. I. Benevolenskaya, E. E. Mikhailov;Slovakia: Piestany, A. Letkovska, P. Masaryk;Spain: Barcelona, D. Roig Escofet, M. Ruiz Martin; Canary Islands, M. Sosa; Madrid, M. Diaz Curiel, A. Rapado; Oviedo, J. B. Cannata Andia, J. B. Diaz Lopez;Sweden: Malmö, O. Johnell, B. Nilsson;Turkey: Istanbul, G. Dilsen;United Kingdom: Aberdeen, D. M. Reid; Bath, A. K. Bhalla, F. Ring; Cambridge, C. Todd, R. Williams; Harrow. J. Reeve; Sheffield, R. Eastell; Truro, A. D. Woolf.     

Book Reviews

Book reviewed in this article: CHOICES AND CHARACTERISTICS IN COMPUTERIZED TOMOGRAPHY : Edited by A. WACKENHEIM and G. H. Du BOULAY. NITRATES. III. CARDIOVASCULAR EFFECTS : Edited by P. R. LICHTLEN, H. -J. ENGEL, A. SCHREY and H. J. C. SWAN. RHEUMATIC VALVULAR DISEASE IN CHILDREN : Edited by JOSEPH B. BORMAN, M.B., B.Ch. (Wits.)., F.R.C.S. (Eng.)., F.A.C.S., F.A.C.C, and MERVYN S. GOTSMAN, M.D., F.R.C.P., F.R.C.P.(G), F.A.C.S. CLINICAL DISORDERS OF THE SHOULDER : By LIPMANN KESSEL, M.B.E. (Mlty)., M.C., F.R.C.S. THROMBOSIS AND ATHEROSCLEROSIS : Edited by NILS U BANG, M.D., JOHN L. GLOVER, M.D., ROBERT W. HOLDEN, M.D., and DOUGLAS A. TRIPLETT, M.D. TOPICS IN ACUTE AND CHRONIC PANCREATITIS : Edited by L. A. SCURO and A. DAGRADI. ESSENTIALS OF ANORECTAL SURGERY : By STANLEY M. GOLDBERG, M.D., F.A.C.S., PHILIP H. GORDON, M.D., F.R.C.S. (C)., F.A.C.S., and SANTHAT NIVATVONGS, M.D., F.A.C.S. ADVANCES IN EXTERNAL FIXATION : Edited by RENNER M. JOHNSTON, M.D. HAND SPLINTING. PRINCIPLES AND METHODS : By ELAINE EWING FESS M.S., O.T.R. KAREN S. GETTLE O.T.R., and JAMES W. STRICKLAND, M.D. THE NAIL : Edited by MAURICE PIERRE.     

Influence of CYP3A5 and ABCB1 gene polymorphisms on calcineurin inhibitor‐related neurotoxicity after hematopoietic stem cell transplantation

Yanagimachi M, Naruto T, Tanoshima R, Kato H, Yokosuka T, Kajiwara R, Fujii H, Tanaka F, Goto H, Yagihashi T, Kosaki K, Yokota S. Influence of CYP3A5 and ABCB1 gene polymorphisms on calcineurin inhibitor‐related neurotoxicity after hematopoietic stem cell transplantation.
Clin Transplant 2010: 24: 855–861. © 2009 John Wiley & Sons A/S. Abstract: Background: One severe side effect of calcineurin inhibitors (CNIs: such as cyclosporine [CsA] and tacrolimus [FK506]) is neurotoxicity. CNIs are substrates for CYP3A5 and P‐glycoprotein (P‐gp), encoded by ABCB1 gene. In the present study, we hypothesized that genetic variability in CYP3A5 and ABCB1 genes may be associated with CNI‐related neurotoxicity. Methods: The effects of the polymorphisms, such as CYP3A5 A6986G, ABCB1 C1236T, G2677T/A, and C3435T, associated with CNI‐related neurotoxicity were evaluated in 63 patients with hematopoietic stem cell transplantation. Results: Of the 63 cases, 15 cases developed CNI‐related neurotoxicity. In the CsA patient group (n = 30), age (p = 0.008), hypertension (p = 0.017), renal dysfunction (p < 0.001), ABCB1 C1236T (p < 0.001), and G2677T/A (p = 0.014) were associated with neurotoxicities. The CC genotype at ABCB1 C1236T was associated with it, but not significantly so (p = 0.07), adjusted for age, hypertension, and renal dysfunction. In the FK506 patient group (n = 33), CYP3A5 A6986G (p < 0.001), and ABCB1 C1236T (p = 0.002) were associated with neurotoxicity. At least one A allele at CYP3A5 A6986G (expressor genotype) was strongly associated with it according to logistic regression analysis (p = 0.01; OR, 8.5; 95% CI, 1.4–51.4). Conclusion: The polymorphisms in CYP3A5 and ABCB1 genes were associated with CNI‐related neurotoxicity. This outcome is probably because of CYP3A5 or P‐gp functions or metabolites of CNIs.     

Audiovisual reviews

Measurement of pH and PCO₂ By E.O. P arbrook , R.L. H ughes & G.D. P arbrook
Measurement of CO₂ in Gas Mixtures By E.O. P arbrook , R.L. H ughes , P.D. D avis & G.D. P arbrook
Oxygen Measurement 1 and 2 By E.O. P arbrook , W.G. A nderson , P.D. D avis & G.D. P arbrook
Films on epidural analgesia
Lumbar Epidural Analgesia in Obstetrics By L.E.S. C arrie & A.H. M ac L ennan
Thoracic Epidural Analgesia By P. G riffiths
Epidural Injections By G.M.J. W hite
Obstetric Analgesia by the Caudal Approach By F.P. M eehan     

BOOK REVIEWS

Book reviewed in this article: GUIDE TO ORTHOPAEDICS 1. TRAUMA By K. L. G. MILLS, M.A., M.B., B.Chir. (Camb.), B.Sc. (Lond.), F.R.C.S. (Eng.), F.R.C.S. (Edin.), F.R.C.S. (Canada), L.R.C.P. (Lond.). FUNDAMENTAL TECHNIQUES OF PLASTIC SURGERY AND THEIR SURGICAL APPLICATIONS By IAN A. MCGREGOR, M.B., Ch.M., F.R.C.S. (Eng.), F.R.C.S. (Glasg.), Hon. F.R.A.C.S. INFECTION IN SURGERY - BASIC AND CLINICAL ASPECTS Edited by J. McK. WATTS, P. J. MCDONALD, P. E. O'BRIEN, V. R. MARSHALL, and J. J. FINLAY-JONES. BUT WESTWARD LOOK NURSING IN WESTERN AUSTRALIA 1829–1979 By VICTORIA HOBBS. CURRENT ORTHOPAEDIC MANAGEMENT Edited by WILLIAM J. KANE, M.D., Ph.D. SYNOPSIS OF SURGERY By RICHARD D. LIECHTY, M.D. and ROBERT T. SOPER, M.D.     

Autologous blood predeposit for elective surgery: An Italian experience

A program of predeposit autotransfusion in elective surgery was implemented with the main purpose of decreasing the incidence of posttransfusion hepatitis and of conserving homologous blood. Specific procedures and computer programs were designed to monitor the transfusion practice by key indicators, and the incidence of posttransfusion hepatitis and HTLV-III infections. Arrangements were devised to ensure the proper management of autologous and homologous units. In 1985, autologous units accounted for 13.5% of all units transfused in elective surgery. While encouraging, our results indicate that efforts have to be made to improve organization and increase awareness of the benefits of autotransfusion in the medical and lay communities.

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Resumen Un programa de autotransfusión predepositada en cirugía electiva ha sido organizado con el propósito de rebajar la incidencia de hepatitis postransfusional y de conservar sangre homôloga. Se diseñaron procedimientos especiales y programas de computación para la monitoría de las prácticas de transfusión por medio de indicadores claves, y la incidencia de hepatitis postransfusional y de infección por HTLV-III. Se establecieron arreglos especiales para asegurar el debido manejo de las unidades autólogas y homologas. En 1985, las unidades autólogas representaron el 13.5% de la totalidad de las unidades transfundidas en cirugía electiva. Aunque promisorios, los resultados indican que deben emprenderse esfuerzos orientados a mejorar la organización y a incrementar el conocimiento de los beneficios de la autotransfusión tanto entre los médicos como en la comunidad general.

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Résumé Un programme de transfusion reposant sur l'emploi du propre sang du malade (sang autologue) prélevé avant l'intervention a été mis en oeuvre au cours de la chirurgie élective. Son but principal est de réduire la fréquence de l'hépatite posttransfusionnelle et l'utilisation de sang homologue. Des méthodes spécifiques et programmées sur ordinateur ont été mises au point de manière à contrôler la pratique de la transfusion en fonction d'éléments clefs et aussi de contrôler la fréquence de l'hépatite post-transfusionnelle et des infections HTLV-III. Des dispositions ont été établies pour assurer l'emploi adéquat d'unités de sang du malade ou de sang homologue. En 1985, la méthode a été employée dans 13.5% des cas au cours de la chirurgie élective. Bien qu'encourageants, les résultats obtenus indiquent que les efforts doivent être poursuivis pour améliorer l'organisation de ce mode d'auto-transfusion et aussi pour améliorer ses résultats.

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Members of the Autotransfusion Team, 1985 B. Andreoni, F. Annoni, A. Anselmi, C. Arienta, C. Bagni, M. Baiguini, L. Baldini, L. Beretta, S. Berra, G. Bevilacqua, R. Biffi, L. Bigatello, V. Buzzetti, G. Cantaluppi, G. Cantoni, L. Ceretti, D. Chiurazzi, M. Citterio, C. Confalonieri, E. Consonni, E. Contessini Avesani, A. Cortelezzi, C. Crosta, Jr., M. Cugnasca, G. Damia, C. De Luca, P. De Rai, A. De Sanctis, S. Doldi, M. Erba, C. Ferrari, O. Ferri, N. Fraschini, S.M. Gaini, P.L. Giorgetti, G. Giuffrida, G. Gonnella, G. Granata, A. Inzaghi, G.L. Legnani, T. Longo, A. Mandressi, A. Mantovani, R. Marconato, M. Marinoni, R. Massei, A. Mattioli, M. Marzotto, M. Meriggi, M. Mezzetti, S. Miani, G. Miserocchi, W. Montorsi, A. Morbidelli, L. Morelli, R. Mozzana, E. Mozzi, A. Nespoli, M. Nosotti, A. Odero, N. Olivari, G.F. Pellegrini, G. Petrini, G. Pezzuoli, E. Pisani, M.N. Pizzi, S. Poma, P. Rampini, R. Ravagnan, E. Ronchetti, R. Rosati, R. Rossi, U. Ruberti, R. Russo, P. Salvini, M.G. Sandri, L. Santambrogio, V. Scortecci, R. Scorza, P. Settembrini, P. Setti Carraro, E. Sibilla, G. Signoroni, V.A. Sironi, A. Tajana, L. Tarenzi, A.M. Taschieri, P. Tombolini, G. Tomei, M. Tos, R. Trazzi, A. Trimboli Cataldo, A. Trinchieri, L. Vicentini, R. Villani, G. Vincre, A. Vinci, C.P. Voci, and M. Zavannone.

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See Acknowledgment for members of the Autotranfusion Team.

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Supported in part by a grant from Ministero della Sanità, Rome, Italy.     

BOOK REVIEWS

Book reviewed in this article: THE CANCER REFERENCE BOOK: DIRECT AND CLEAR ANSWERS TO EVERYONE'S QUESTIONS By PAUL M. LEVITT and ALISA S. GURALNICK, with Dr A. ROBERT KAGAN and Dr HARVEY GILBERT. REVIEW OF MEDICAL PHYSIOLOGY By WILLIAM F. GANONG M.D. TECHNIQUES OF VAGOTOMY By Alan G. Johnson, M.Chir., F.R.C.S. and Keith W. Reynolds, M.S., F.R.C.S. APLASTIC ANAEMIA by C. G. GEARY, F.R.C.P. A TEXTBOOK OF SURGICAL PATHOLOGY By Sir CHARLES ILLINGWORTH, C.B.E., M.D., Ch.M., Hon. LL.D. (Glas., Leeds), Hon. D.Sc. (Sheffield, Belfast), F.R.C.S., Hon. F.R.C.S., Hon. F.A.C.S., Hon. F.R.C.P.S., Hon. F.C.S.G., and the late BRUCE M. DICK M.B., F.R.C.S. GASTROINTESTINAL SURGERY by JOHN S. NAJARIAN, M.D. and JOHN P. DELANEY, M.D. RECENT RESULTS IN CANCER RESEARCH ADJUVANT THERAPIES AND) MARKERS OF POST-SURGICAL MINIMAL RESIDUAL DISEASE: Markers and General Problems of Cancer Adjuvant Theraples G. BONNADONNA, G. MATTAY and S. E. SALMON. OPERATIVE SURGERY: FUNDAMENTAL INTERNATIONAL TECHNIQUES. ABDOMEN by HUGH DUDLEY, Ch.M, F.R.C.S, F.R.C.S. (Ed), F.R.A.C.S., CHARLES ROB, M.C., M.D, M.Chir, F.R.C.S, and RODNEY SMITH, K.B.E, MS, F.R.C.S.     

The influence of alcohol consumption on the risk of vertebral deformity

The influence of alcohol consumption on the risk of osteoporosis is not well established. The aim of this study was to determine the relationship between frequency of alcohol consumption and the risk of vertebral deformity across different European populations. A population survey method was used. Men and women aged 50 years and over were recruited from population-based sampling frames in 36 centres from 19 European countries. Subjects were invited to attend by letter of invitation for an interviewer-administered questionnaire and lateral spinal radiographs. Vertebral deformity was defined morphometrically using the McCloskey-Kanis method. Data from 14 237 individuals were available for this analysis. Alcohol consumption was compared between the 809 men and 884 women with vertebral deformity and the 5905 men and 6639 women without vertebral deformity. The frequency of alcohol intake was greater in men than women. Overall, there was no detectable association between frequency of alcohol intake and vertebral deformity in either men or women. Stratification by age showed that women 65 years and over who took alcohol on more than 5 days per week had a reduced risk of vertebral deformity compared with those taking alcohol less than once per week. This protection was most obvious after adjusting for age, centre, body mass index, smoking, current level of physical activity and previous fractures (odds ratio [OR]=0.65; 95% confidence intervals [CI]=0.43, 0.99). There was a smaller and non-significant protective effect amongst men aged 65 years and over and this was most apparent amongst moderately frequent drinkers (1–4 days per week) (OR=0.81; 95% CI=0.62, 1.08). There was no association between the occurrence of vertebral deformity and frequency of alcohol consumption in younger men and women. Overall, the effects of the frequency of alcohol consumption on vertebral deformity were modest. In older women, regular consumption on more than 5 days per week is associated with a reduced risk. Further, prospective data are required to confirm these findings. It is also necessary to investigate, in terms of amount of alcohol consumed, at what level the benefits of regular intake are obviated by the increased risks from alcohol excess.The European Vertebral Osteoporosis Study Group. &Project Management Group: D. Agnusdei (Siena, Italy), K. Bergmann (Berlin, Germany), C. Cooper (Southampton, UK), J. Dequeker (Leuven, Belgium), D. Felsenberg (Berlin, Germany), J. A. Kanis (Sheffield, UK), G. Kruskemper (Bochum, Germany), H. Raspe (Lubeck, Germany), A. J. Silman (Project leader; Manchester, UK).Data Co-ordinating Centre (Manchester): T. W. O'Neill, J. Varlow, D. Marsden, M. Naves Diaz, A. J. Silman.Radiology Co-ordinating Centre (Berlin): D. Felsenberg, E. Wieland, L. Kalidis, J. Mews. PARTICIPANTS:Austria: Graz. T. Lauermann, K. Weber;Belgium: Leuven, J. Dequeker, P. Geusens;Croatia: Zagreb, I. Jajic;Czech Republic: Prague, S. Havelka, P. Vavrincova;France: Montceau-Les-Mines. P.D. Delmas, F. Marchand;Germany: Berlin Steglitz, D. Felsenberg; Berlin Potsdam, D. Banzer; Berlin Charite. S. Kirschner, W. Reisinger; Bochum, J. Janott, H. Schatz; Erfurt, J. Franke; Heidelberg, C. Scheidt-Nave, R. Ziegler; Jena, K. Aben-droth, B. Felsch; Lubeck, C. Matthis, H. Raspe;Greece: Athens, A. Antoniou, G. Lyritis;Hungary: Budapest, C. Kiss, G. Poor;Italy: Siena, D. Agnusdei, C. Gennari; Milan, S. Ortolani;Netherlands: Rotterdam, A. Hofman, H. A. P. Pols;Norway: Oslo, J. A. Falch, H. E. Meyer;Poland: Szczecin, S. Czekalski, T. Miazgowski; Warsaw, K. Hoszowski, R. S. Lorenc;Portugal: Oporto, A. Aroso, A. Lopez Vaz;Russia: Moscow, L. I. Benevolenskaya, E. E. Mikhailov;Slovakia: Piestany, A. Letkovska, P. Masaryk;Spain: Barcelona, D. Roig Escofet, M. Ruiz Martin; Canary Islands, M. Sosa; Madrid, M. Diaz Curiel, A. Rapado; Oviedo, J. B. Cannata Andia, J. B. Diaz Lopez;Sweden: Malmö, O. Johnell, B. Nilsson;Turkey: Istanbul, G. Dilsen;United Kingdom: Aberdeen, D. M. Reid; Bath, A. K. Bhalla, F. Ring; Cambridge, C. Todd, R. Williams; Harrow. J. Reeve; Sheffield, R. Eastell; Truro, A. D. Woolf.     

Book Reviews

Book review in this Article:
Intravenous Anaesthtic Agents By J ohn W. D undee , No. 1 of Current Topics of Anaesthesia. General Editors F eldman , S tanley A. & S curr , C yril F.
Lectures Notes on Anaesthetics By J ohn , L unn
intravenous Anaesthetic Agents By J ohn W. D unim . No. 1 of Current Topics of Anaesthesia. General Editors F eldman , S tanley A. & S curr , C yril F.
Lectures Notes on Anaesthetics By J ohn N. L unn .
Topics in Anaesthesia and Intensive Care. For undergraduates By J. A ndrew T hornton & C yril J. L evy .
A Handbook of Anaesthetics for medical students and general medical practitioners S.A. O duntan & K.A. O duro .
Year Book of Anaesthesia 1978 Edited by J.E. E ckenhoff , A.J. B art , E.A. B runner , H. S teele H olley & H.W. L inde .
Relief of Intractable Pain Monographs in Anaesthesiology. Volume 1. Edited by M ark S werdlow .
Pain. Its nature, analysis and treatment By M ichael R. B ond .
Monitoring Cerebral Function. Long term Recordings of Cerebral Electrical Activity By P amela P ryor .
Seminars in Neurological Surgery. Neural Trauma Edited by A. J ohn P opp , R obert S. B ourke , L ouis R. N elson & H arold K. K imelberg .
Interpreting the Electrocardiogram By J ames S. F leming
Physiological Aspects of Anaesthetic and Inert Gases By A.G. M ac D onald & K.T. W ann .
Transcutaneous Oxygen Measurement Professor K. S tosseck . Anaesthesiology and Resuscitation, vol. 108.
Respiratory Physiology—the essentials By J ohn B. W est , 2nd edn.
Atlas of Emergency Medicine By P eter R osen & G eorge S tehnrach .
Editing Scientific Books and Journals By M aeve O'C onnor .
Stress-free Anaesthesia. Analgesia and the suppression of stress responses International Congress and Symposium Series No. 3. Edited by C. W ood .     

Book Reviews

Book reviewed in this article: TRAUMA CARE : Edited by WILLIAM ODLING-SMEE, M.B., F.R.C.S., and ALAN CROCKARD, M.B., F.R.C.S. THORACIC AND CARDIOVASCULAR SURGERY. CONTINUING EDUCATION REVIEW. 713 ESSAY QUESTIONS AND REFERENCED ANSWERS : By EDWIN C. JAMES, M.D., D. PAUL HOAN, M.D., DAVID A. BROWDIE, M.D., GEORGE W. IWEN, M.D., and WILLIAM H. HEYDORN, M.D. OPERATIVE ARTERIAL SURGERY : By P, R. F. BELL, M.D., F.R.C.S., and W. BARRIE, M.D., F.R.C.S. Bristol FUNDAMENTALS OF HAEMATOLOGY : By RICHARD A RIFKIND, M.D., ARTHUR BANK, M.D., PAUL A. MARKS, M.D., HYMIE L. NOSSEL, M.D., ROSE RUTH ELLISON, M.D. and JOHN LINDENBAUM, M.D. Chicago OPERATIVE SURGERY. FUNDAMENTAL INTERNATIONAL TECHNIQUES : Edited by CHARLES ROB, M.C., M.D., M.Chir., F.R.C.S., RODNEY SMITH, K.B.E., Hon. D.Sc, M.S., F.R.C.S., Hon. F.R.A.C.S., Hon. F.R.C.S.(Ed.)., Hon. F.A.C.S., Hon. F.R.C.S.(Can.)., Hon. F.R.C.S.(L)., Hon. F.D.S., and HUGH DUDLEY Ch.M., F.R.C.S., F.R.C.S(Ed.)., F.R.A.C.S. HEAD AND NECK. PART I AND PART II : Edited by J. S. P. WILSON, F.R.C.S.(Ed.)., Hon. F.R.C.S. ATHEROSCLEROSIS V PROCEEDINGS OF THE FIFTH INTERNATIONAL SYMPOSIUM : Edited by ANTONIO M, GROTTO JR, LOUIS C. SMITH and BARBARA ALLAN. SURGICAL PROBLEMS IN CHILDREN RECOGNITION AND REFERRAL : By HOWARD C. FILSTON, M.D., F.A.C.S., F.A.A.P. DISASTER MEDICINE VOLUME 3 : Edited by R. FREY and P. SAFAR COLD AND FROST INJURIES -REWARMING DAMAGES BIOLOGICAL, ANGIOLOGICAL AND CLINICAL ASPECTS : By HANS KILLIAN. Berlin, Heidelberg MEDICAL EXAMINATION REVIEW. VOLUME 5. SURGERY. 1000 MULTIPLE CHOICE QUESTIONS WITH REFERENCED EXPLANATORY ANSWERS : By M. D. RAM, B.SC, M.D., M.S.(SURG.)., Ph.D., F.R.C.S.(Eng.), F.R.C.S.(Ed.), F.R.C.S.(Can.), F.A.C.S. ORGAN PRESERVATION FROM TRANSPLANTATION : Edited by ARMANDM. KAROW, JR. Ph.D., and DAVID E. PEGG, M.D., M.R.C. Path. SURGERY OF FEMALE INCONTINENCE : Edited by STUART L. STANTON, F.R.C.S., M.R.C.O.G.; and EMIL A. TANAGHO, M.D. SURGICAL MANAGEMENT OF OBESITY : Edited by J. D. MAXWELL, M.D., F.R.C.P., J-C GAZET, M.S., F.R.C.S., and T. R. E. PILKINGTON, M.D., F.R.C.P. A COLOUR ATLAS OF PAEDIATRIC SURGICAL DIAGNOSIS : By LEWIS SPITZ, M.B., Ch.B., Ph.D., F.R.C.S. (Edin)., F.R.C.S. (Eng.)., G. M. STEINER, M.B.B.S., D.C.H., D'Obs., R.C.O.G., F.R.C.R., F.R.C.P., and R. B. ZACHARY, M.B., Ch.B., F.R.C.S.I., F.R.C.S. (Eng.). DISORDERS OF THE NERVOUS SYSTEM -A PRIMER : By ALEXANDER G. REEVES, M.D. MICROSURGERY OF THE BRAIN ANATOMICAL AND TECHNICAL PRINCIPLES 1 AND 2 : By WOLFGANG SEEGER. ARTHRITIS OF THE KNEE - CLINICAL FEATURES AND SURGICAL MANAGEMENT : Edited by M. A. R. FREEMAN, M.D., F.R.C.S. SPINA BIFIDA OCCULTA ORTHOPAEDIC, RADIOLOGICAL AND NEUROSURGICAL ASPECTS : By C. C. MICHAEL JAMES, Ph.D. (Edin.)., F.R.C.S. (Edin)., and L. P. LASSMAN, M.B., B.S. (Lond.)., F.R.C.S. RECONSTRUCTION OF THE HEAD AND NECK : Edited by MALCOLM A. LESAVOY, M.D., F.A.C.S. THE PRACTICE OF HAND SURGERY : Edited by D. W. LAMB, M.B., C.H.B., F.R.C.S.E., and K. KUCZYNSKI, M.B., C.H.B., F.R.C.S.E. EYE SURGERY AN INTRODUCTION TO OPERATIVE TECHNIQUE : By GEORG EISNER, M.D. CHEIROLUMBAR DYSOSTOSIS DEVELOPMENTAL BRACHYCHEIRY AND STENOSIS OF THE BONY VERTEBRAL LUMBAR CANAL : By A. WACKENHEIM.     

No evidence for genotype/phenotype correlation in<Emphasis Type="Italic"> NPHS1</Emphasis> and<Emphasis Type="Italic"> NPHS2</Emphasis> mutations

Primary steroid-resistant nephrotic syndrome (SRNS) is characterized by childhood onset of proteinuria and progression to end-stage renal disease. In 26% of cases it is caused by recessive mutations in NPHS2 (podocin). Congenital nephrotic syndrome (CNS) is caused by mutations in NPHS1 (nephrin) or NPHS2. In three families mutations in NPHS1 and NPHS2 had been reported to occur together, and these tri-allelic mutations were implicated in genotype/phenotype correlations. To further test the hypothesis of tri-allelism, we examined a group of 62 unrelated patients for NPHS1 mutations, who were previously shown to have NPHS2 mutations; 15 of 62 patients had CNS. In addition, 12 CNS patients without NPHS2 mutation were examined for NPHS1 mutations. Mutational analysis yielded three different groups. (1) In 48 patients with two recessive NPHS2 mutations (11 with CNS), no NPHS1 mutation was detected, except for 1 patient, who had one NPHS1 mutation only. This patient was indistinguishable clinically and did not have CNS. (2) In 14 patients with one NPHS2 mutation only (4 with CNS), we detected two additional recessive NPHS1 mutations in the 4 patients with CNS. They all carried the R229Q variant of NPHS2. The CNS phenotype may be sufficiently explained by the presence of two NPHS1 mutations. (3) In 12 patients without NPHS2 mutation (all with CNS), we detected two recessive NPHS1 mutations in 11 patients, explaining their CNS phenotype. We report ten novel mutations in the nephrin gene. Our data do not suggest any genotype/phenotype correlation in the 5 patients with mutations in both the NPHS1 and the NPHS2 genes.Members of the Study Group of the Arbeitsgemeinschaft für Pädiatrische Nephrologie (APN) participating in this study: J. Thaarup (Aalborg, Denmark); P. Henning (Adelaide, Australia); I. Attrach (Aleppo, Syria); A. Bakkaloglu (Ankara, Turkey); C. Rudin (Basel, Switzerland); R. Bogdanovic (Belgrade, Yugoslavia); S. Briese, J. Gellermann, T. Lennert, U. Querfeld, Sacherer, M. Schürmann, and M. Zimmering (Berlin, Germany); C. Roth, C. Schröter, and B. Utsch (Bonn, Germany); Matthes (Bremen, Germany); A. Heilmann and G. Kalvoda (Dresden, Germany); F. Wegner (Düren, Germany); V. Schumacher (Düsseldorf, Germany); Bär, B. Bosch, M. Kamm, S.M. Karle, K. Nüsken, C. Plank, W. Rascher, and B. Zimmermann (Erlangen, Germany); K. E. Bonzel, M. Bald, P. Hoyer, and U. Vester (Essen, Germany); U. Neyer (Feldkirch, Austria); Rippel (Frankfurt, Germany); M. Brandis, A. Fuchshuber, K. Häffner, A. Kirchhoff, and M. Pohl (Freiburg, Germany); J. Steiss (Giessen, Germany); J.P. Haas (Greifswald, Germany); L. Patzer (Halle, Germany); M. Kemper, H. Altrogge, D.E. Müller-Wiefel, U. Peters, and K. Timmermann (Hamburg, Germany); J.H.H. Ehrich, H. Haller, and C. Strehlau (Hannover, Germany); M. Daschner, S. Hessing, Janssen, D. Kiepe, S. Köpf, O. Mehls, and B. Tönshoff (Heidelberg, Germany); F. Prüfer and L.B. Zimmerhackl (Innsbruck, Austria); U. John, J. Misselwitz, G. Rönnefarth, and J. Seidel (Jena, Germany); D. Blowey and J. Scheinman (Kansas City, Mo., USA); B. Beck, K. Frankenbusch, B. Hoppe, C. Licht, D. Michalk, T. Ronda, and L. Stapenhorst (Cologne, Germany); D. Drozdz and A. Pogan (Krakau, Poland); Froster, E. Vogel and S. Wygoda (Leipzig, Germany); R. Hettenger (Los Angeles, Calif., USA); H. Schriewer and H.-P. Weber (Lüdenscheid, Germany); R. Beetz (Mainz, Germany); M. Konrad (Marburg, Germany); H. Fehrenbach (Memmingen, Germany); M. Griebel and B. Klare (München, Germany); M. Bulla, S. Fründ, E. Kuwertz-Bröking, A. Schulze-Everding and Yelbuz (Münster, Germany); L. Monnens (Nijmegen, The Netherlands); J. Janda and T. Seemann (Prag, Czech Republic); G. Adomssent, G. Krüger, Lorenzen, J. Muscheites, H.-J. Stolpe and M. Wigger (Rostock, Germany); W. Sperl (Salzburg, Austria); R. Egger (Schaffhausen, Switzerland); V. Tasic (Skopje, Macedonia); M. Bald and H.-E. Leichter (Stuttgart); O. Amon (Tübingen, Germany); T. Arbeiter, C. Aufricht and K. Müller (Vienna, Austria); D. Bockenhauer and N. Siegel (New Haven, Conn., USA); and T. Neuhaus and A. Staub (Zürich, Switzerland)     

Book Reviews

Book reviewed in this article: REOPERATIVE GASTROINTESTINAL SURGERY. By THOMAS TAYLOR WHITE, M.D., F.A.C.S. and R. CAMERON HARRISON, M.D., F.A.C.S., F.R.C.S. Boston: Little, Brown & Company, 1973 PRACTICAL OPHTHALMOLOGIST. By ARTHUR LIM SIEW MING and KHOO CHONG YEW. Singapore: P. G. Medical Books, 1974. FUNDAMENTALS OF COLONIC SURGERY. By LESIE W. OTTINGER, M.D. Boston: Little Brown & Company, 1974 SURGICAL ANATOMY FOR CLINICAL EXAMINATION. By ANDREW M. MUNSTER, M.D., F.R.C.S. and G. J. Thomas, M.M.A., B.A. Springfield, Illinois: Charles C. Thomas, 1973 ADVANCES IN SURGERY. Edited by JAMES D. HARDY and R. M. ZOL LINGER. Chicago THE SPLEEN. By A. I. S. MacPHERSON, Ch.M., M.B., R.R.C.S.Ed., F.R.S.E., JOHN RICHMOND, M.D., F.R.C.P.Ed., F.R.C.P.Lond. and A. E. STUART, M.B., Ch.B., PhD., F.R.C.P.Ed., F.R.S.E. Springfield     

Book Reviews

Book reviewed in this article: ETIOLOGY OF URINARY CALCULI By L. B. JOSHI A SURVEY OF SHOCK WITH SPECIAL REFERENCE TO FLUIDS, ELECTROLYTES AND METABOLITES By J. H. Pollock , B. S., M. D., F.I.C.S. MODERN TRENDS IN ANÆSTHESIA By F. I. EVANS, M.B., B.S., F.R.C.S., F.F.A.R.A.C.S., and T. C. GRAY, M.D., F.F.A.R.C.S., F.F.A.R.A.C.S. (Hon.), F.F.A.R.C.S.I. (Hon.) REGIONAL BLOCK By DANIEL C. MOORE, M.D. THE CHRISTIAN PHYSICIAN IN THE ADVANCE OF THE SCIENCE AND PRACTICE OF MEDICINE by A. M. CONNELL and G. A. LINDEBOOM PERIDURAL ANALGESIA AND ANESTHESIA By P. C. LUND, M.D., F.A.C.A. COMPREHENSIVE BACKGROUND FOR ANESTHESIOLOGY By W. F. POWELL, M.D. DEATH IN THE OPERATING THEATRE By ANTONIO BOBA, M.D. FUNDAMENTAL CONSIDERATIONS IN ANESTHESIA By C. L. BURNSTEIN, M.D. RADIOLOGY IN WORLD WAR II by K. D. A. ALLED, M.D. THE ROYAL COLLEGE OF SURGEONS IN IRELAND AND ITS MEDICAL SCHOOL 1784–1966 By J. D. H. WIDDESS PROGRESS IN NEUROLOGICAL SURGERY, VOLUME 1 By H. KRAYENBUHL, P. E. MASPES and W. H. SWEET COLOSTOMY CARE By BETTY HUGHES and E. WILSON, M.D., M.S., M.Sc. (Melb.), M.R.A.C.P., F.R.C.S. (Eng.), F.R.C.S. (Edin.), F.R.A.C.S., F.A.C.S. PATHOLOGICAL PHYSIOLOGY FOR THE ANÆSTHESIOLOGIST By R. H. SMITH, M.D., edited by JOHN ADRIANI, M.D. HAMILTON BAILEY'S EMERGENCY SURGERY by T. J. McNAIR, M.D., F.R.C.S. (Edin.), F.R.C.S. (Eng.) RENAL TRANSPLANTATION By R. Y. CALNE, M.A., M.S., F.R.C.S.     

Books Reviewed

Book reviewed in this article: ANESTHESIA FOR OPEN HEART SURGERY. L. E. FREDERICK, M.D., and D. P. MORSE, M.D. CARDIOVASCULAR SURGERY, 1965. Edited by F. A. SIMONE, M.D. CONTRIBUTIONS TO MEDICINE and SURGERY BY ST. VINCENT'S HOSPITAL STAFF, SYDNEY. Edited by T. NASH, F.R.C.S., F.R.A.C.S., F.A.C.S. A HANDBOOK OF SURGICAL DIATHERMY. J. P. MITCHELL, T.D., M.S., F.R.C.S. (Edin.), F.R.C.S., and G. N. LUMB, M.B.B.S.(Lond.), F.R.C.S. SURGERY OF THE DIGESTIVE SYSTEM IN THE RAT. By RENE LAMBERT, M.D., translated by BRIAN JULIEN. THE ARCHITECTURE OF BONE. By MICHAEL C. HALL, Ph.D., F.R.C.S.(C), F.A.C.S., with the assistance of DOROTHY S. KINOSHITA, B.Sc. THE OTAGO MEDICAL SCHOOL UNDER THE FIRST THREE DEANS. By Sir CHARLES HERCUS and Sir GORDON BELL.