The management of hand injuries caused by sea urchin spines

Injuries to the hand by sea urchin spines are not commonly seen in the United Kingdom. There are many varieties of sea urchins (Echinoidea) throughout the world. They have a spherical calcium carbonate exoskeleton covered with spines. Certain varieties may be venomous, in particular the flower urchin (Toxopneustes pileolus) found in the Indo-Pacific oceans. Injury may also be caused by the urchin spines or pedicellaria (delicate seizing organs equipped with jaws). A small number of hand injuries associated with sea urchin spines have been reported in the literature.     

An effective alternative management for multiple sea urchin spine injury: Erbium–YAG laser ablation

Complete surgical removal of sea urchin spines can be extremely difficult due to the multiplicity and fragility of the spines. We describe a 49-year-old lady with multiple sea urchin spine injury over her left sole which was successfully treated with Erbium–YAG laser therapy. Laser ablation is very effective in destroying multiple sea urchin spines without causing thermal necrosis of the adjacent tissues, and may be considered as an important non-operative treatment modality.     

Sea urchin spine arthritis of the hand

PURPOSE: Although rare, hand injury caused by puncture with the sea urchin spine can result in serious complications. To emphasize its clinical significance, this article describes a group of patients who sustained chronic granulomatous arthritis induced by puncture with sea urchin spine (designated sea urchin spine arthritis). METHODS: Five patients who developed sea urchin spine arthritis of the hand after puncture with sea urchin spine were treated at our hospitals. All lesions involved the proximal interphalangeal (PIP) joint (4 index fingers and 1 middle finger). Patients experienced pain, swelling, and discomfort around the site of puncture immediately after the injury. These initial symptoms subsided within a few days, and secondary symptoms including fusiform swelling, limited motion, and mild pain of the PIP joint appeared from 1 to 2 months later. Laboratory tests of inflammation and blood cell counts were negative. Plain radiographs showed soft tissue swelling and osteolysis but no visible spine. Thorough synovectomy of the PIP joint was performed, and the granulation tissue around the joint was also removed. RESULTS: No microorganism was identified from tissue culture or polymerase chain reaction in any of the 5 patients. At a mean follow-up of 21 months, 2 patients exhibited essentially normal active motion of the affected PIP joint, whereas the remaining 3 patients had diminished range of motion. CONCLUSIONS: Diagnosis of sea urchin spine arthritis can be made by history of sea urchin spine injury, a symptom-free period before the development of synovitis, and the absence of laboratory test abnormalities. Neither antibiotics nor nonsteroidal anti-inflammatory agents are effective. Undertaken early enough, thorough synovectomy might avoid complications and obtain favorable results. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.     

A comparative analysis of cAMP-dependent protein kinase regulatory subunits in sea urchin and rat spermatozoa

8-Azido cAMP photoaffinity labeling of cAMP-dependent protein kinase regulatory subunits (R1 = 49 K;R2 = 55K) was done on spermatozoa from species lacking, and species containing an epididymis. Spermatozoa from sea urchin and trout contained only R1, while rat caudaepididymal spermatozoa contained both R1 and R2 subunits. This was established by the Mr value of the 8-azido cAMP photolabeled moieties, and a biochemical analysis based on the known differences of protein-nucleotide interactions of Type I and II cAMP-dependent protein kinases. Sea urchin and trout sperm R1 subunits were similar to mammalian sperm R1 subunits in co-migration on SDS-polyacrylamide gels and in both saturation and specificity of nucleotide binding. Calcium enhanced photoprobe binding to rat R1 and R2 subunits and to sea urchin R1 subunit without revealing a sea urchin R2 subunit. Likewise, phosphodiesterase incubation of sea urchin and trout spermatozoa prior to photolabeling did not reveal R2 subunits. These data suggest that the cAMP regulation of sperm physiology may require R1 subunit in species both with and without an epididymis. Further taxonomic study is necessary to determine whether evolutionary acquisition of the epididymis and internal fertilization may have created unique environments favoring the addition of sperm R2 regulatory subunits of cAMP-dependent protein kinase.     

ECHINOIDEA TENOSYNOVITIS

Suppurative tenosynovitis involving the digital fibrous flexor sheaths in the hand can be a devastating problem. A case is reported of tenosynovitis resulting from Echinoidea sp. (sea urchin) spines. The need for awareness of flexor sheath penetration is stressed. Early aggressive operative intervention by a hand surgeon will minimize the subsequent morbidity.     

Management of sea urchin spines in the hand

The left palm of a 43-year-old woman was penetrated by sea urchin spines. Localization of the spines by soft tissue technique x-ray films proved to be the key to their easy removal. A review of the literature shows this to be an uncommon problem and that spine removal may be important to avoid long-term sequelae of pain and loss of function.     

The distribution, metabolism and function of creatine in the male mammalian reproductive tract: a review

Creatine is widely distributed throughout the male reproductive system in several mammalian species, and proteins involved in its metabolism and transport have been reported in a number of cell and tissue types. Creatine is synthesized within some organs, incorporating nitrogen from amino acid metabolism. Although creatine metabolism is obligatory for the motility of sea urchin spermatozoa, this does not appear to be the case for mammals. The possible functions of creatine within the reproductive tract are discussed.     

Composition of Biomineral Organic Matrices with Special Emphasis on Turbot (<Emphasis Type="Italic">Psetta maxima</Emphasis>) Otolith and Endolymph

The soluble organic matrix (OM) of various biominerals (red coral skeleton, oyster shell, sea urchin test, turbot otolith, chicken eggshell) was extracted after demineralization with acetic acid. The protein content of the OM varies strongly from 0.02 to 1.6 µg/mg biomineral whereas proteoglycans present less variations (from 0.7 to 1.4 µg/mg biomineral). Electrophoresis of biominerals OM shows differences in their protein pattern although several bands are present in all matrices. OM of all biominerals shows carbonic anhydrase activity but no activity was detectable in the endolymph. OM of all biominerals also displays an anticalcifying activity. After separation of the OM extracts by chloroform-methanol, 80% of the anticalcifying activity was found in the methanol phase except in the urchin test. After OM precipitation with trichloracetic acid, 70% of the activities was found in the supernatants. Partial biochemical characterization suggests that the anticalcifying factor is a polyanionic and water-soluble molecule, which could be proteoglycans. The endolymph surrounding the otolith also displays an anticalcifying activity although its inhibitous activity was 50 times lower than that of the otolith OM. However, the anticalcifying activity of the endolymph is assumed by a proteic structure (80% activity precipitated with TCA treatment). Our results suggest that both carbonic anhydrase and anticalcifying activities are widespread and play a significant role in the regulation of biomineral formation. Results are discussed in relation to the calcification process that takes place at the fluid-mineral interface.     

Comparative effects of halothane, enflurane, and methoxyflurane on the incidence of abnormal development using sea urchin gametes as an in vitro model system

The incidence of sea urchin embryos developing abnormally after their exposure to equimolar concentrations of halothane, enflurane, and methoxyflurane has been determined. Halothane concentrations in the 0.6-1.25 mM range caused 18-96% of the embryos to undergo abnormal cleavage at the first cell division. This is important because embryos exhibiting atypical cleavage patterns at the first cell division eventually involute and die before reaching gastrulation. Over the same range of concentrations, enflurane and methoxyflurane have minimal effects on development. However, when exposed to 2.5 mM methoxyflurane, nearly 40% of the cells did not fertilize. These results show that volatile anesthetic agents have decidedly different effects on development and suggest that the incidence of abnormal development may not correlate directly with the anesthetic potency of inhalational agents.     

Ultrastructure and growth of the sea urchin tooth

Individual sea urchin teeth consist of many elements, each secreted by a syncytium formed for the purpose. The numerous syncytia of each tooth take up secondary connection with one another in the vicinity of needles and prisms. The elements of the primary tooth skeleton are surrounded by cytoplasm and are therefore intracellular. Following the origin of a syncytium in the plumula, a new tooth element sheath originates in the form of a vesicle, which develops a unified crystallization cavity in the shape of the future tooth element. During the early growth of the sheath, calcium carbonate crystallization begins within the sheath. An inner coating of the sheath functions as a crystallization matrix, and further growth of calcium carbonate takes place centripetally. Collagen does not take part in mineralization. Neither an axial thread nor other organic material inside the hardened mineral was found.     

The specificity of interactions between proteins and sulfated polysaccharides

Sulfated polysaccharides are capable of binding with proteins at several levels of specificity. As highly acidic macromolecules, they can bind non-specifically to any basic patch on a protein surface at low ionic strength, and such interactions are not likely to be physiologically significant. On the other hand, several systems have been identified in which very specific substructures of sulfated polysaccharides confer high affinity for particular proteins; the best-known example of this is the pentasaccharide in heparin with high affinity for antithrombin, but other examples may be taken from the study of marine invertebrates: the importance of the fine structure of dermatan sulfate (DS) to its interaction with heparin cofactor II (HCII), and the involvement of sea urchin egg-jelly fucans in species specific fertilization. A third, intermediate, kind of specific interaction is described for the cell-surface glycosaminoglycan heparan sulfate (HS), in which patterns of sulfate substitution can show differential affinities for cytokines, growth factors, and morphogens at cell surfaces and in the intracellular matrix. This complex interplay of proteins and glycans is capable of influencing the diffusion of such proteins through tissue, as well as modulating cellular responses to them.     

A Serum Factor that Recalcifies Demineralized Bone Is Conserved in Bony Fish and Sharks but Is Not Found in Invertebrates

We investigated the evolutionary origin of a serum activity that induces calcification within a type I collagen matrix, an activity previously described in rat and bovine serum. Serum was obtained from vertebrates with calcified tissues (bony fish and shark), vertebrates without calcified tissues (lamprey and hagfish), and three invertebrates (marine worm, crab, and sea urchin). Serum from the bony fish and shark proved to contain a potent nucleator of collagen calcification; like the previously described calcifying activity in rat serum, the fish and shark activities are both able to recalcify a demineralized rat tibia when tested in Dulbecco’s modified Eagle medium containing as little as 1.5% of the respective serum and have an apparent molecular weight of 50–150 kDa. No calcifying activity could be detected in any of several experimental tests of invertebrate or hagfish serum. Weak calcifying activity could be detected in lamprey serum, but calcification was restricted to the growth plate of the decalcified tibia, with no detectable calcification in the type I collagen of the midshaft. These studies reveal a correlation between the evolutionary timing of the appearance of calcified tissues in vertebrates and the appearance of the serum activity that initiates calcification within collagen and, therefore, support the hypothesis that this serum activity may play a role in normal calcification of bone.     

Synthetic sulfonolipids deduced from sulfonoquinovosyl diacylglycerols of sea urchin reduces hepatic ischemia-reperfusion injury in rats

BACKGROUND: In hepatic surgery and liver transplantation, ischemia-reperfusion (I/R) is an unavoidable process, and protection against hepatic I/R injury is a major unresolved problem. In this study, we investigated whether 3-O-(6-deoxy-6-sulfono-beta-D-glucopyranosyl)-1,2-di-O-acylglycerol bound to saturated C18 fatty acids (beta-SQAG9), which was derived from sea urchin intestines, could reduce this injury. This agent was recently reported to have immunosuppressive effects in allogeneic rat skin grafts. MATERIALS & METHODS: Male Lewis rats were divided into two experimental groups. Group 1 rats were injected with SQAG9 (50 mg/kg) into the penile vein 15 minutes before the induction of ischemia and into the portal vein just reperfusion. The same amounts of normal saline were injected into rats in the control group (group 2). Each experimental groups included six rats. Seventy percent hepatic ischemia (20 minutes) was induced by occluding the blood vessels and bile duct with a vascular clamp. For examination of hepatic function, serum levels of aspartate aminotransferase, (AST) alanine transaminase (ALT), and lactic dehydrogenase (LDH) were measured. In addition, histological examination was also assessed. RESULTS: Three hours after reperfusion, the mean plasma concentration of AST, ALT, LDH in group 1 was suppressed compared with group 2. Six hours after reperfusion, the hepatic damage in group 1 was mild in comparison with that in group 2. CONCLUSIONS: Our data demonstrated that SQAG-9 reduced the warm hepatic I/R injury.     

Synchrotron X-ray Studies of the Keel of the Short-Spined Sea Urchin <Emphasis Type="Italic">Lytechinus variegatus</Emphasis>: Absorption Microtomography (microCT) and Small Beam Diffraction Mapping

In sea urchin teeth, the keel plays an important structural role, and this paper reports results of microstructural characterization of the keel of Lytechinus variegatus using two noninvasive synchrotron x-ray techniques: x-ray absorption microtomography (microCT) and x-ray diffraction mapping. MicroCT with 14 keV x-rays mapped the spatial distribution of mineral at the 1.3 µm level in a millimeter-sized fragment of a mature portion of the keel. Two rows of low absorption channels (i.e., primary channels) slightly less than 10 µm in diameter were found running linearly from the flange to the base of the keel and parallel to its sides. The primary channels paralleled the oral edge of the keel, and the microCT slices revealed a planar secondary channel leading from each primary channel to the side of the keel. The primary and secondary channels were more or less coplanar and may correspond to the soft tissue between plates of the carinar process. Transmission x-ray diffraction with 80.8 keV x-rays and a 0.1 mm beam mapped the distribution of calcite crystal orientations and the composition Ca_1–xMg_xCO₃ of the calcite. Unlike the variable Mg concentration and highly curved prisms found in the keel of Paracentrotus lividus, a constant Mg content (x = 0.13) and relatively little prism curvature was found in the keel of Lytechinus variegatus.     

The pathogenesis of autosomal dominant polycystic kidney disease: an update

The identification of PKD1 and PKD2, the two major genes responsible for autosomal dominant polycystic kidney disease, are the seminal discoveries upon which much of the current investigation into the pathogenesis of this common heritable disease is based. A major mechanistic insight was achieved with the discovery that autosomal dominant polycystic kidney disease occurs by a two-hit mechanism requiring somatic inactivation of the normal allele in individual polarized epithelial cells. Most recent advances are focused on the function of the respective protein products, polycystin-1 and polycystin-2. Indirect evidence supports an interaction between polycystin-1 and -2, albeit it is unlikely that they work in concert in all tissues and at all times. They associate in yeast two hybrid and cotransfection assays and there is a striking similarity in the renal and pancreatic cystic phenotypes of Pkd2-/- and Pkd1del34/del34 mice. Also, the respective homologues of both proteins are expressed in the same sensory neuronal cells in the nematode and the human disease phenotypes remain completely overlapping with the major difference being in relative severity. Mounting evidence supports the hypothesis that polycystin-1 is a cell surface receptor. A close homologue in the sea urchin sperm mediates the acrosome reaction in response to contact with egg-jelly, the nematode homologue functions in mechano- or chemosensation, and the solution structure of the repeated extracellular polycystic kidney disease domains reveals a beta-sandwich fold commonly found in surface receptor molecules. Indirect evidence also supports the initial hypothesis that polycystin-2 is a calcium channel subunit. Several closely related homologues retain the calcium channel signature motif but differ in their predicted interaction domains, and one of these homologues has been shown to be a calcium regulated cation channel. Several important distinctions in polcystin-1 and -2 function have also been discovered. Polycystin-2 has a role in cardiac development that polcystin-1 does not. High level polycystin-2 expression in renal epithelial cells coincides with maturation and elongation of tubules and, unlike polycystin-1, persists into adulthood. In cells in tissue culture, polycystin-2 is expressed exclusively in the endoplasmic reticulum whilst the cellular expression of polycystin-1 remains unknown. Overall, the difficult task of understanding the autosomal dominant polycystic disease process is proceeding apace.     

Mechanisms of fertilization elucidated by gene-manipulated animals

Capacitation and the acrosome reaction are key phenomena in mammalian fertilization. These phenomena were found more than 60 years ago. However, fundamental questions regarding the nature of capacitation and the timing of the acrosome reaction remain unsolved. Factors were postulated over time, but as their roles were not verified by gene-disruption experiments, widely accepted notions concerning the mechanism of fertilization are facing modifications. Today, although in vitro fertilization systems remain our central research tool, the importance of in vivo observations must be revisited. Here, primarily focusing on our own research, I summarize how in vivo observations using gene-manipulated animals have elucidated new concepts in the mechanisms of fertilization.Studies of the mechanisms of fertilization date back to Aristotle (384-322 BCE), who thought that the woman provided fertile ground for the male seed to grow. By the 17^th century, however, it was recognized that females produce eggs. Leeuwenhoek''s microscope provided the next insight, making it possible to visualize the spermatozoa in semen. Using this microscopic observation, Hartsoeker (one of the first spermatologists) claimed that he could observe a small person residing in the head of spermatozoa. Then in 1876, Hertwig found that the nuclei of the sperm and egg fuse during fertilization in sea urchin.1 In the 1950s, mammalian spermatozoa were found to undergo a physiological change called capacitation2,3 and a subsequent morphological change known as the acrosome reaction.4 Thus, when we look back the history, the comprehension of the mechanisms of fertilization sometimes went in the wrong direction, but gradually nearing the true figure by modifying or abandoning old notions. In this process, the evolution of experimental tools such as light microscopy, antibodies, electron microscopy, etc., played important roles. Today, powerful investigative aids such as transgenic animals and/or gene-disrupted KO animals have become available. We can create an animal deficient in a given gene of interest or one with a “designer gene.” For example, the latter includes spermatozoa with a green fluorescent protein (GFP) in their acrosome to report acrosomal integrity. These gene-manipulated animals give us deeper insight into the mechanisms of fertilization. In the present article, I describe the new findings, most of which have depended on the use of gene-manipulated animals.     

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.     

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.     

Book Reviews

Book reviewed in this article: INTESTINAL ANTISEPSIS. By ISIDORE COHN jr, M.D., B.Sc. (Med.), F.A.C.S. PRINCIPLES OF SURGERY: A NEW APPROACH. By D. J. Du PLESSIS, Ch.M., F.R.C.S. SURGERY OF THE ACUTE ABDOMEN. By JOHN A. SHEPHERD, V.R.D., M.D., M.Ch., F.R.C.S. (Edin.), F.R.C.S. (Eng.). VASCULAR DISEASES. By PROFESSOR AG. M. J. TSAPOGAS, M.D., M.Ch., V. V. KAKKAR, F.R.C.S., F.R.C.S. (Edin.) and E. N. GLEAVE, F.R.C.S., F.R.C.S. (Edin.). SOLITARY METASTASES. By PHILIP RUBIN and JEROME GREEN. ADVANCES IN SURGERY. Edited by Claude E. Welch. CLINICAL MANAGEMENT OF SHOCK. By ROBERT M. HARDAWAY, M.D., with a foreword by Francis D. Moore. THE TRAINING OF SURGEONS IN THE FUTURE. Sponsored by the Allen O. Whipple Surgical Society. NERVE AND NERVE INJURIES. By SYDNEY SUNDERLAND, C.M.G., M.D., B.S., D.Sc., F.R.A.C.S. (Hen.), F.R.A.C.P., F.F.A. HISTORICAL ASPECTS OF ABDOMINAL INJURIES. By FRANK L. LORIA, B.S., M.D., F.A.C.S. TRAUMATIC ARTERIAL LESIONS, VOLUME 2. Edited by Tor Hierton, M.D. and Bo Rybeck, M.D. THE SURGEON'S RESPONSIBILITY. By JOHN R. DERRICK, M.D., F.A.C.S. PLANNING OF SURGICAL CENTERS. By ERVIN PüTSEP. PROCEEDINGS OF THE SYMPOSIUM ON COMBINED INJURIES AND SHOCK, UPPSALA, JUNE, 3–6 1967. Edited by BO SCHILDT and LARS THOREIN. MENILRE'S DISEASE: MECHANISM AND MANAGEMENT. By M. SPENCER HARRISON, M.D., F.R.C.P., F.R.C.S., and LIONEL NAFTALIN, B.Sc., F.C.Path. SURGERY OF THE HEAD AND NECK. By ROBERT A. WISE, M.D. and HARVEY W. BAKER, M.D. LOOKING AT MY HEART. By DR PHILIP BLAIBERG. GREAT TEACHERS OF SURGERY IN THE PAST.     

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.