Vol.

2116

No. 5

613

BOOK REVIEWS

should be placed on the salutary effects of enteral feeding. Specific

indications for the use of total parenteral nutrition with case
examples might also be included. A chapter that reviews the
principal factors influencing nutrient utilization by cells (nutrient
delivery, cell membrane transport, and intracellular metabolism)
and how these various steps are modulated by feeding and stress
might also be added. An additional chapter might focus on fat
metabolism and the use of specific fatty acids as immunomodulators in critically ill patients. The use of specific case examples
illustrating the indications for feeding, nutrient requirements,
and the logic behind the decisions would also be valuable.
Residents in all phases of training will find this easy to use
book a valuable reference, which will increase their understanding of surgical nutrition.
WILEY W. SOUBA, M.D.
Gainesville, Florida
Complications in Thoracic Surgery. Walter G. Wolfe. 319
St. Louis: Mosby-Year Book, 1992. $95.00.

pp.

IT IS impossible in a volume of 319 pages to cover thoroughly

all of the complications in thoracic surgery, but Dr. Wolfe has
given it his best. The chapter subjects represent a wide spectrum
of problems including anesthetic complications, cardiac and
renal problems, the hazards of improper positioning of the patient, and complications of radiation therapy, just to name a
few. These provide a nice supplement to the expected chapters
on complications of pulmonary resections, bronchoplastic procedures, and others.
Dr. Wolfe's choice of contributors is a bit unusual and, on
balance, admirable. In addition to well-recognized senior people
such as Drs. Sealy, Moran, Oldham, and Ramming, he has
sought energetic young people in thoracic surgery and related
fields to write appropriate chapters. These young people provide
new perspectives while they gain the discipline and experience
of writing authoritatively and for a wide audience.
As with any multi-authored text, there is variation in narrative
and illustration. Some of the origiiu"l drawings, especially those
in Chapter 27 on tracheal fistulas, are especially clear and pleasing. Some others do not meet those standards. Dr. Wolfe and
his co-author, Dr. Duhaylongsod, have done a particularly fine
job with their chapter entitled "Complications of Pulmonary
Resection." The narrative is comprehensive and readable and
especially well supported by appropriate references. Dr. Ferguson's chapter on "Arrhythmias Associated with Thoracotomy"

the subject admirably.

The editor is to be complimented on choosing new as well as
standard topics for inclusion in this book. Chapters on "Thoracic
Manifestations of HIV-l Infection" and "Complications of

covers

Heart-Lung and Lung Transplantation" bring us worthwhile in-

formation on rapidly evolving fields. The authors have included

up-to-date references in most, if not all, chapters.
We surgeons learn by our own mistakes. It is important that
we also learn from the mistakes made by others. I tell our residents that I hope they never learn to take care of a complication,
knowing full well that they will. I want them to prevent complications instead. Reading this informative book from cover to
cover and then keeping it handy for ready reference when needed
will help thoracic surgeons at any stage of their careers prevent
and treat complications that may occur.
JAMES B. D. MARK, M.D.

Palo Alto, California

Wound Healing: Biochemical and Clinical Aspects. I. Kelman
Cohen, Robert F. Diegelmann, and William J. Lindblad. 656
pp. Philadelphia: W. B. Saunders, 1992. $115.00.

THERE HAS been an explosive growth of wound healing research

in the past decade. The translation of basic science discoveries
into clinical reality reflects the application of new molecular and
cellular biology tools and the impending introduction of effective
vulnerary agents. The editors have had a longstanding interest
in tissue repair research. They have assembled an impressive
array of 69 contributors from diverse areas including molecular

biology, biochemistry, immunology, pharmacology, and surgery,

and the authors share their unique perspectives on tissue repair.
This menagerie permits the editors to fulfill their stated goal of
fostering communication between diverse disciplines, which may
lead to more intellectual fermentation and understanding. The
product is a nicely bound, well-illustrated, 35-chapter and 360page textbook that has a broad scope and gives the reader a
thorough information base for wound repair study.
The text is well organized and divided into five major sections.
The concisely written chapters are easy to read. The book begins
with a historical perspective on wound healing research. The
first major section describes the basic biologic processes involved
in wound healing, such as inflammation, fibroblast proliferation,
angiogenesis, wound contraction, and epithelialization. The next
section is devoted to the structural and regulatory components
of wound healing, which reflects the recent impact of cellular
and molecular biology. These chapters address specific areas of
the extracellular matrix, including collagen and its degradation,
proteoglycans, cell adhesion molecules, and chemoattractants
and growth factors. The most glaring shortcoming of the textbook
is the lack of a comprehensive treatment of the role of growth
factors in wound repair, which is an intense area of investigation.
The chapter devoted to chemoattractants and growth factors
includes only one page on the modulation of healing by addition
of growth factors to wounds, and does not even mention a single
member of the fibroblast growth factor family. A 1992 textbook
should devote at least one chapter to a systematic analysis of
the multiple growth factors known to be present in wounds. The

third section focuses on factors affecting wound repair such as

metabolic aspects, the immune system, and the wound microenvironment. A chapter is devoted to the burgeoning research
area of tissue repair in the mammalian fetus, but it was disappointing to see that there were no references cited beyond 1989.
After this broad overview of the principles of wound healing
with emphasis on basic biology and fundamental principles, the
book then approaches specific wound healing responses by organ
system. These chapters are well-written and address repair of
the skin, bone and cartilaginous tissue, tendon and ligament,
lung,liver, the alimentary canal, and peripheral nerve. A chapter
devoted to repair in the cardiovascular system is conspicuously
absent.

Finally, the last section is devoted to clinical management of

healing tissues. Specific chapters include factitious problems in
wound healing, keloids and excessive dermal scarring, scleroderma, burn scar and skin equivalents, clinical management of
nonhealing wounds, wound dressings, and surgical devices in
wound healing management.
Overall, this comprehensive textbook provides a firm foundation for the study of the basic processes of wound repair and
their clinical implications. As with many textbooks, the chapter
to 2
bibliographies lag the release date of the textbook by up comyears. Nonetheless, Wound Healing is the most current
pilation of basic science and clinical aspects of tissue repair.
Surgeons are all students of wound healing and its sequelae, and
I would recommend this text

as an

addition to

any

surgeon's

library.

N. Scorr ADZICK, M.D.

San Francisco, California